197 Final

The knee is classified as a ___________ joint. a. Saddle b. Gliding c. Hinge d. Ellipsoidal

c.Hinge

Which of the following findings would differentiate an allergic reaction from an anaphylactic reaction? a. Urticaria b. Wheezing c. Hypotension d. Abdominal cramps

c.Hypotension

Your patient has a history of pernicious anemia. If not treated, your primary concern for this patient should be: a. Hypovolemia b. Prolonged blood clotting time c. Hypoxia d. Infection

c.Hypoxia

Your patient is a 45-year-old type I diabetic complaining of a five-day history of abdominal pain, nausea and vomiting, and increased urination and thirst. His skin and mucous membranes are warm and dry. HR = 112 bpm and regular, BP = 94/60, RR = 12 and regular. Your treatment for this patient would most likely include: a. IV of NS KVO, nitroglycerin 0.4 mg SL, every 3 to 5 minutes b. IV of NS KVO, 50 percent dextrose IVP c. IV of NS 1-2 L d. IV of D5W KVO, 50 percent dextrose IVP

c.IV of NS 1-2 L

Complications associated with endometritis include all of the following, EXCEPT: a. sepsis b. infertility c. fibroid tumors d. death

c.fibroid tumors

Signs of an ectopic pregnancy include all of the following, EXCEPT: a. missed, late, or unusually light menstrual period. b. syncope. c. fundal height at the level of the umbilicus. d. unilateral lower abdominal pain.

c.fundal height at the level of the umbilicus.

The external ear ends at the ________. a. Auricle b. External auditory canal c. Tympanic membrane d. Tragus

c.Tympanic membrane

Gangrene, so called because the infected area oozes foul-smelling liquid, occurs as a result of: a. Group A hemolytic streptococci b. Pressure ischemia c. Stevens-Johnson syndrome d. An untreated infection

d.An untreated infection

Which of the following techniques destroys some, but not all, microorganisms? a. Cleaning b. Disinfection c. Decontamination d. Sterilization

b.Disinfection

Your patient has taken an excessive amount of Prozac. Which of the following findings would indicate serotonin syndrome? a. Spasm of the neck muscles or vocal cords b. Elevated temperature c. Tics or bizarre behavior d. Diarrhea

b.Elevated temperature

Which of the following is a prerenal cause of acute renal failure? a. Pyelonephritis b. Embolism of the renal vein c. Ureteral obstruction due to renal calculi d. Massive overdose of ibuprofen

b.Embolism of the renal vein

Which medication is best for improving hypotension secondary to anaphylactic shock? a. Diphenhydramine b. Epinephrine c. Hydrocortisone d. Oxygen

b.Epinephrine

Which of the following treatment regimens for anaphylaxis lists the medications in the correct order of administration following oxygen? a. Dexamethasone, diphenhydramine, epinephrine b. Epinephrine, diphenhydramine, dexamethasone c. Epinephrine, dexamethasone, diphenhydramine d. Diphenhydramine, epinephrine, dexamethasone

b.Epinephrine, diphenhydramine, dexamethasone

Which of the following is NOT likely to negatively impact the emotional or behavioral status of a patient with a psychiatric disorder? a. Medical illness b. Following the same routine daily c. Stressful situations d. Taking recreational drugs and using alcohol

b.Following the same routine daily

LSD, STP, and PCP are examples of: a. Amphetamines b. Hallucinogens c. Sedatives d. Narcotics

b.Hallucinogens

Your patient is a 27-year-old male complaining of difficulty breathing. He states that he has just returned from a month-long backpacking trip across Arizona. He describes a two-week history of fatigue, fever, nausea, vomiting, diarrhea, and abdominal pain. He started experiencing difficulty breathing yesterday. He has no significant medical history and takes no medications. Physical examination reveals hot, moist skin; bilateral lower-lobe rales on auscultation of the lungs; and the abdomen is soft and nontender. Which of the following is most likely? a. Legionnaire's disease b. Hantavirus infection c. Anthrax d. Scorpion bite

b.Hantavirus infection

A smoker who also takes supplemental vitamin K would be expected to: a. Have a higher incidence of polycythemia b. Have enhanced clotting ability c. Have a lower risk of developing pulmonary embolism d. Be unable to generate active forms of clotting factors II, VII, IX, and X

b.Have enhanced clotting ability

Which of the following situations would result in erythropoietin secretion? a. CVA b. Hypoxia c. Alkalemia d. Hemophilia

b.Hypoxia

Your patient is a 28-year-old male with a history of panic attacks. He states that symptoms began about 20 minutes ago and that he has been unable to get them under control. He complains of shortness of breath, chest pain, dizziness, and a feeling that he is going to die. His skin is warm and moist. HR = 132, BP = 138/98, RR = 26 and shallow. You spend 15 minutes on-scene with him attempting to "talk him down" without success. Which of the following is MOST appropriate? a. Oxygen, IV, nitroglycerin, aspirin, morphine b. IV, diazepam c. Oxygen d. IV, haloperidol

b.IV, diazepam

Your patient is a 24-year-old, 176-pound male who is alert and oriented 12 hours after ingesting thirty 500 mg tablets of Tylenol. Which of the following are the most likely complaints or findings? a. Confusion, lethargy, and hyperthermia b. Nausea, vomiting, weakness, and fatigue c. Abdominal pain and oliguria d. Signs and symptoms of liver failure

b.Nausea, vomiting, weakness, and fatigue

Which of the following is the BEST method of communicating with an emotionally disturbed patient? a. Ignore statements that are irrelevant to the situation. b. Tell the patient you understand how he feels. c. Explain that you are concerned with the patient's welfare. d. Agree with everything the patient says.

c.Explain that you are concerned with the patient's welfare.

Dehydration is most likely to result in: a. Thrombocytopenia b. Leukocytosis c. Increased hematocrit d. Increased prothrombin time

c.Increased hematocrit

Which of the following situations would NOT result in anemia? a. Blood loss b. Destruction of red blood cells c. Increased production of erythropoetin d. Iron deficiency

c.Increased production of erythropoetin

An allergen's most common route of entry in an anaphylactic reaction is: a. Absorption b. Ingestion c. Injection d. Inhalation

c.Injection

A type I diabetic presents with deep, rapid respirations and a fruity odor on her breath. Which of the following would best help correct the underlying physiologic disturbance? a. Oxygen b. Dextrose c. Insulin d. Glucagon

c.Insulin

Which of the following best describes the mechanism of action of activated charcoal? a. It absorbs toxins in the stomach. b. It neutralizes both acidic and alkaline substances in the stomach. c. It adsorbs toxins in the stomach. d. It prevents substances from ionizing in the small intestine.

c.It adsorbs toxins in the stomach.

Which of the following is TRUE of mittelschmerz? a. It is typically located unilaterally in one of the upper abdominal quadrants. b. It is usually accompanied by heavy vaginal bleeding. c. It is associated with ovulation. d. It is a sign of ectopic pregnancy.

c.It is associated with ovulation.

You encounter a patient complaining of polyuria, polyphagia, polydipsia, and abdominal pain. Based on these complaints, which of the following would you also expect to find? a. Complaint of chest pain and shortness of breath b. Blood glucose of less than 70 mg/dL c. Kussmaul's respirations and a fruity breath odor d. Blood glucose between 80 and 120 mg/dL

c.Kussmaul's respirations and a fruity breath odor

A patient with no prior history of renal disease is experiencing restlessness, agitation, dysuria, and flank pain radiating into the groin. Appropriate treatment for this patient would consist of all of the following EXCEPT: a. IV fluid therapy b. Phenergan c. Lasix IV d. Morphine

c.Lasix IV

Which of the following would be most typical of a patient suffering from diverticulitis? a. Dark, tarry stools b. Diffuse abdominal pain c. Left lower quadrant pain d. Inability to have a bowel movement

c.Left lower quadrant pain

Naproxen, ibuprofen, and ketorolac are all examples of: a. MAOIs b. SSRIs c. NSAIDs d. TCAs

c.NSAIDs

Your patient is a 33-year-old female who is alert and in significant distress. She describes a one-week history of diffuse lower left quadrant abdominal pain that became acutely worse and specific 1/2 hour ago. She has not had her menstrual period in four months. HR = 120, BP = 72/48, RR = 20. Which of the following would be LEAST likely to have contributed to her current condition? a. Previous ectopic pregnancy b. Tubal ligation c. Oral contraceptive use d. Previous pelvic inflammatory disease

c.Oral contraceptive use

A cat scratches a patient on the arm. Twenty-four hours later, the area is swollen and red. What additional signs or symptoms is the patient most likely to exhibit? a. Fever and hypotension b. Loss of appetite c. Pain and warmth at the injury site d. Urticaria

c.Pain and warmth at the injury site

Which of the following is NOT considered an appropriate method of controlling a combative patient in the prehospital setting? a. Droperidol b. Leather restraints c. Pepper spray d. Verbal de-escalation

c.Pepper spray

You have administered glucagon to a diabetic patient. Which of the following should occur? a. Stimulation of the pancreatic alpha cells, resulting in lipolysis b. Stimulation of the pancreatic beta cells, resulting in a decreased blood glucose level c. Glycogenesis, resulting in a decreased blood glucose level d. Glycogenolysis, resulting in an increased blood glucose level

d.Glycogenolysis, resulting in an increased blood glucose level

When assessing a fistula used for hemodialysis, which of the following should concern you? a. Pulsation with each heartbeat b. A bruit on auscultation c. Bruising around the fistula d. Lack of a palpable vibration

d.Lack of a palpable vibration

A three-year-old male patient has a history of an underdeveloped cell-mediated immune system. Which of the following MOST likely contribute to this deficiency? a. Hypoadrenalism b. HIV infection c. Type I diabetes mellitus d. Thymus gland insufficiency and a lack of thymosin secretion

d.Thymus gland insufficiency and a lack of thymosin secretion

Your patient is an alcoholic who stopped drinking three days ago. Which of the following should concern you the most in the care of this patient? a. Abdominal cramps b. Command hallucinations c. Hypothermia d. Potential for seizures

d.Potential for seizures

1. What structures may be affected in a urinary tract infection in a female patient? a. Vagina, bladder, urethra b. Bladder, ureters, vagina c. Urethra, bladder, kidney d. Kidney, bladder, fallopian tubes 2. Which of the following statements best explains why urinary tract infections are more common in females than in males? a. The presence of estrogen in the lining of the female reproductive tract makes the mucous membranes more prone to infection. b. Bacteria from the vagina commonly enter the female urethra. c. The female urethra is shorter than those in males, more easily allowing bacteria to enter the rest of the urinary tract. d. Males have more acidic urine, which is effective in eliminating bacteria from the urinary tract. 3. Your patient is a 34-year-old male who had just finished dialysis at an outpatient dialysis center when he became unresponsive. The patient has a very weak radial pulse; cool, diaphoretic skin; and clear and equal lung sounds. HR = 112, BP = 78/44, RR = 8 and shallow, SaO2 = 90%, blood glucose = 60 mg/dL. In addition to cardiac monitoring, managing the airway, and starting an IV of normal saline, which of the following is indicated? a. 250 mL fluid challenge b. 50 percent dextrose c. 250 mL fluid challenge, 50 percent dextrose d. 2 g magnesium sulfate 4. Of the following, which is TRUE of the changes in blood chemistry and composition in a patient with chronic renal failure? a. Blood glucose decreases. b. H+ excretion leads to alkalosis. c. Polycythemia occurs. d. Uremia and creatinine levels increase. 5. Which of the following would most increase the likelihood of a urinary tract infection? a. Prior history of renal calculi b. Lack of sexual activity c. Urinary retention d. Male gender 6. Tenderness associated with pyelonephritis is best evaluated by percussing: a. In the midline, just superior to the symphysis pubis b. Just lateral to the spine slightly superior to the sacroiliac joint c. Laterally, just superior to the superior iliac crest d. Just lateral to the spine slightly inferior to the 12th rib 7. Your patient states she thinks she has a UTI. Which of the following questions will provide you with useful information about the patient's problem? a. "Do you have a history of kidney stones?" b. "Are you sexually active?" c. "Is it painful when you urinate?" d. "Are you having any vaginal discharge?" 8. A patient undergoes neurological changes during hemodialysis. Of the following, which is the most likely cause of these neurologic abnormalities? a. Acute myocardial infarction b. Hyperglycemia c. Hypotension d. Accumulated blood urea 9. Your patient is a 30-year-old male complaining of pain radiating from the left flank into the groin. He states that it began as a vague pain in his flank, then became very sharp and radiating. Based on his description of his pain, you would also expect him to complain of: a. Inability to urinate b. Purulent urethral discharge c. Fever d. Painful urination 10. Treatment of a patient in acute renal failure may include all of the following EXCEPT: a. IV normal saline b. Dialysis c. Furosemide d. Potassium 11. Your patient is a 22-year-old male who is alert and in mild discomfort, complaining of left flank pain. The patient describes the pain as diffuse, located at the left flank, and he states that it has been getting increasingly more "crampy" over the past 30 minutes. He describes the pain as a 3 on a scale of 0 to 10. He denies dysuria and hematuria. HR = 88, BP = 116/70, RR = 10. Based on your clinical findings, which of the following is indicated? a. Oxygen b. Morphine c. IV with fluid administration d. Lasix 12. Fifty percent dextrose solution is placed on side A of a membrane, and 25 percent dextrose is placed on side B of a membrane. Assuming the membrane is permeable to water, but not solutes, what will happen? a. Water may move freely in both directions, but there will be no net movement of water. b. Net movement of water from side B to side A will occur. c. Net movement of water from side A to side B will occur. d. Water will not move in either direction. 13. A 76-year-old patient with acute interstitial nephritis presents with oliguria, altered mental status, and edema to his face, hands, and feet. Of the following, which best describes the pathophysiology behind these clinical findings? a. Increased GFR results in retention of water, electrolytes, and metabolic waste. b. Na+ and K+ excretion results in diuresis and dehydration. c. Decreased GFR results in retention of water, electrolytes, and metabolic waste. d. H+ excretion results in diuresis and alkalosis. 14. Your patient is a 32-year-old female who is alert and complaining of dysuria. She describes a three-day history of pain with urination and urinary urgency and difficulty. She describes the pain as a 5 on a scale of 0 to 10. Physical examination reveals tenderness on palpation of the lower abdomen bilaterally and warm, dry skin. HR = 88, BP = 126/78, RR = 12. The most appropriate action is: a. Oxygen, IV fluids, morphine b. BLS transport in position of comfort c. Oxygen, IV fluids d. IV fluids, morphine 15. Which of the following statements about hemodialysis is TRUE? a. Blood is removed from the body, wastes are collected in a filter, and blood is then returned to the body. b. Dialysate is placed in the abdominal cavity, the peritoneum acts as a dialysis membrane, and dialysate is then removed from the abdominal cavity. c. Dialysate enters the circulation through the venous site of a fistula and leaves through the arterial side of the fistula. d. Dialysis approximates the physiology of the nephron by placing blood on one side of a semipermeable membrane and dialysate on the other side. 16. In healthy individuals, which of the following is NOT a function of the kidney? a. Excretion of glucose b. Secretion of erythropoietin c. Excretion of wastes d. Regulation of water and electrolyte balance and pH 17. All of the following are common complications of renal dialysis EXCEPT: a. Bleeding from the needle puncture site b. Dysfunction of the fistula c. Air embolism d. Localized infection at the needle puncture site 18. Which of the following findings is most suggestive of cystitis? a. Abdominal distension b. Suprapubic tenderness to palpation c. Flank pain radiating to the groin d. Diffuse, periumbilical abdominal pain 19. A patient with no prior history of renal disease is experiencing restlessness, agitation, dysuria, and flank pain radiating into the groin. Appropriate treatment for this patient would consist of all of the following EXCEPT: a. IV fluid therapy b. Phenergan c. Lasix IV d. Morphine 20. All of the following may be associated with urinary tract infection EXCEPT: a. Cystitis b. Cholecystitis c. Prostatitis d. Pyelonephritis

21. Your patient is an 83-year-old male with a fever of 103°F. In addition, the patient is confused and combative. Heart rate = 132, respirations = 20, blood pressure = 100/70, Sp O2 95% on room air, and blood glucose level = 90 mg/dL. During your examination you note that the patient has a Foley catheter and that the collection bag appears not to have been emptied for quite some time. The bag is full of dark, cloudy urine with sediment at the bottom of the bag. Which of the following is most appropriate? a. Acetaminophen suppository b. BLS transport without intervention c. Furosemide d. Intravenous fluid therapy with normal saline 22. Which of the following is LEAST likely to lead to acute renal failure? a. Pneumonia b. Urethral obstruction c. Interstitial nephritis d. Heart failure with hypotension 23. Your patient is a 68-year-old male who is conscious but confused and lying on his kitchen floor. The patient offers no complaint other than wishing to be helped up from the floor. The patient can tell you that he "slipped a few days ago" and has been on the floor since. Physical examination reveals dry, cool skin; dry mucous membranes; clear lung sounds bilaterally; and no indications of trauma. HR = 112, BP = 98/70, RR = 14, SaO2 = 96%. Your partner finds an appointment card indicating the patient missed a hemodialysis appointment two days ago. Which of the following is the best course for managing this patient? a. 1,000 mL fluid bolus b. 250 mL fluid bolus c. IV of NS at a keep-open rate d. Dopamine infusion 24. All of the following symptoms are consistent with urinary tract infection EXCEPT: a. Passing hard, granular material in the urine b. Difficulty beginning and continuing to void c. Tenderness over one or both flanks d. Frequent urge to urinate 25. Which of the following would interfere with urine production? a. Benign prostatic hypertrophy b. Renal calculi c. Tumor in the renal pelvis d. Toxic damage to the nephrons 26. Which of the following best describes the mechanism of action of ACE inhibitors? a. They inhibit sodium reabsorption, causing increased excretion of sodium. b. They increase the GFR directly. c. They inhibit the conversion of angiotensin I to angiotensin II. d. They inhibit the formation of renin in the renin-angiotensin system. 27. Your patient is complaining of pain secondary to epididymitis. Where should you expect the pain to be located? a. Flank b. Testes c. Suprapubic region d. Lower left or right quadrant, depending on which side is affected 28. Your patient is a 68-year-old female who is conscious but confused and lying supine in bed without complaint. Her daughter states that the patient was recently diagnosed with a bladder infection and has been taking antibiotics. She also states that her mother has not produced urine for two days, during which she has become increasingly confused. Physical examination reveals swelling to the face, hands, and feet; cool and moist skin; and lung sounds that are clear and equal bilaterally. HR = 104 , BP = 142/88, RR = 14, SaO2 = 96%. In addition to administering oxygen and monitoring the cardiac rhythm, which of the following courses of action is most appropriate? a. IV of NS with 250 cc fluid challenge b. 12-lead ECG, IV of NS KVO c. IV of NS KVO, furosemide, 40 mg d. IV of NS KVO 29. Your patient has a history of benign prostatic hypertrophy. Which of the following complaints is most consistent with this history? a. "It seems like I urinate a gallon at a time." b. "My urine is cloudy and has a strong odor." c. "I can't seem to urinate." d. "I have blood in my urine first thing in the morning." 30. Your patient is a 35-year-old male whom you suspect of having a kidney stone. All of the following would be consistent with this impression EXCEPT: a. Hematuria b. A description of "knifelike" pain c. Restlessness d. Fever 31. You are called to a local physician's office where you find a 52-year-old male patient with a history of chronic renal failure. He is conscious but disoriented. The physician reports that the patient's wife brought him in because he has had a "chest cold," missed dialysis yesterday, and is now "acting strangely." Physical examination reveals cool, diaphoretic skin; edema to dependent areas, and lung sounds with rhonchi in the right upper lobe. HR = 118, BP = 142/100, RR = 20 and deep, SaO2 = 97%, blood glucose = 79 mg/dL. Bloodwork performed by the physician in his office indicates a pH of 7.2. In addition to 15 liters per minute of oxygen by nonrebreathing mask and an IV of normal saline at a keep-open rate, which of the following is most appropriate for this patient in the prehospital setting? a. IV sodium bicarbonate, 1 mEq/kg b. IV magnesium sulfate, 10 gm c. IV dextrose, 25 gm d. IV furosemide, 120 mg 32. The leading cause(s) of end-stage renal failure is (are): a. Renal calculi and kidney infection b. Acute renal failure c. Uncontrolled diabetes mellitus and hypertension d. Kidney infection 33. Which of the following statements about chronic renal failure (CRF) is accurate? a. CRF is diagnosed when 70 percent of the nephrons are lost and the patient is clinically unstable. b. The only treatment for CRF is a kidney transplant. c. CRF is reversible if the cause is found and treated. d. Hemodialysis can reverse CRF, but CAPD cannot.

The order Hymenoptera includes: a. Wasps b. Jellyfish c. Spiders d. Scorpions

a.Wasps

Your female patient states that it is painful when she has intercourse. This complaint could be documented as: a. dyspareunia b. dysmenorrheal c. vaginismus. d. endometriosis.

a.dyspareunia

The purpose of determining the mechanism of injury and the index of suspicion for the trauma patient at the same time is to allow you to: A) Decide whether to transport the patient B) Identify comorbid factors C) Document a complete scene size-up D) Anticipate your patient's injuries Anticipate your patient's injuries Which of the following accounts for the highest number of trauma deaths in the United States of America? A) Motor vehicle crashes B) Falls C) Assaults D) Firearms injuries Motor vehicle crashes Which of the following acts resulted in the development of modern EMS systems? A) Ryan White Act B) Highway Safety Act of 1966 C) Good Samaritan Act D) The Trauma Care Systems Planning and Development Act of 1990 Highway Safety Act of 1966 In addition to handling all types of specialty trauma, which level of trauma center provides continuing medical and public education programs? A) IV B) III C) I D) II I Upon arriving on a scene where the mechanism of injury indicates a potentially life-threatening injury, you should employ which of the following interventions to BEST help deliver the care that is needed? A) Reevaluate the scene size-up. B) Initiate transport immediately, delaying more extensive care until you are en route. C) Ask a surgeon to respond to the scene. D) Call immediately for air medical transport to reduce the "Golden Period." Initiate transport immediately, delaying more extensive care until you are en route. Which of the following physical findings indicates the need for immediate transport? A) Vital signs: systolic blood pressure 80, respiratory rate 8 B) Glasgow Coma Scale Score of 15 C) Second-degree burns involving 9 percent of total body surface area in an adult patient D) Fractured right femur Vital signs: systolic blood pressure 80, respiratory rate 8 Which of the following requires immediate transport to a trauma center? A) A 40-year-old who fell 12 feet from a garage roof with a radius fracture B) A 36-year-old female in a motor vehicle crash who has a blood pressure of 100/60 C) A 22-year-old motorcyclist with a tibia fracture D) A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger As a paramedic your role in trauma care consists of all of the following EXCEPT: A) Providing rapid transport to appropriate facilities B) Promoting injury prevention C) Providing care to seriously injured trauma patients D) Providing surgical interventions to stop hemorrhage Providing surgical interventions to stop hemorrhage Which of the following is NOT true of trauma triage criteria? A) For patients who meet trauma triage criteria, the appropriate facility is the largest trauma center in your region. B) Assessment of vital signs/level of consciousness, anatomy of injury, mechanism of injury, and age of the patient are key elements of trauma triage criteria. C) Trauma triage criteria are geared to help you formulate an index of suspicion when making decisions about your trauma patient. D) Trauma triage criteria are guidelines to help you determine whether your patient needs transport to a trauma center. For patients who meet trauma triage criteria, the appropriate facility is the largest trauma center in your region. Which of the following is NOT considered a significant mechanism of injury in pediatric patients? A) Vehicle collision with intrusion into compartment where child is a passenger B) Fall of 5 feet C) Bicycle-vehicle collision at 30 mph D) Any collision in which a child is ejected from the vehicle Fall of 5 feet Which of the following is NOT an example of trauma? A) An abrasion to the knee B) Chest pain C) Cerebral contusion D) A stab wound to the abdomen Chest pain Which of the following is NOT a consideration when assessing a trauma patient? A) SAMPLE history B) MedicAlert bracelets C) Underlying medical conditions D) Medical insurance coverage Medical insurance coverage Which level of trauma facility has minimal surgical support but can stabilize before transferring to a higher-level trauma facility? A) III B) II C) IV D) I III Which of the following statements about trauma is TRUE? A) Life-threatening injuries may exist with little external evidence. B) Dramatic-appearing extremity injuries may draw the paramedic's focus from life-threatening injuries. C) Life-threatening injury occurs in less than 10 percent of trauma patients. D) All of the above are true. All of the above are true. The leading cause of death in people under age 44 is: A) Heart attack. B) Trauma. C) Cancer. D) Cardiovascular disease. Trauma. Which of the following patients is NOT a candidate for air medical transport? A) Combative trauma patient B) Seriously injured patient with cardiac tamponade C) Patient with prolonged extrication time D) Burn patient with over 50 percent second-degree burns Combative trauma patient Which of the following is more relevant to the assessment and history of the medical patient than to the trauma patient? A) AVPU B) SAMPLE C) OPQRST D) DCAP-BTLS OPQRST Modern medicine treats trauma as a ________. A) Crisis B) Disease C) Life threat D) Medical problem Disease A trauma center that has surgical care capability available at all times and can handle all but the most seriously injured specialty and multisystem trauma patients is a Level ________ trauma center. A) III B) I C) IV D) II II Which of the following is the best, most cost-effective way for EMS personnel to help reduce trauma-related morbidity and mortality? A) Participate in injury-prevention programs B) Keep up-to-date on trauma management knowledge and skills C) Transport all trauma patients to a trauma center D) Provide complete patient care reports so that accurate data can be entered into the trauma registry Participate in injury-prevention programs Which level of trauma facility stabilizes and prepares to transport trauma patients to a higher-level facility but does NOT necessarily have surgical capabilities? A) I B) II C) IV D) III IV Which of the following mechanisms would yield the greatest index of suspicion for serious injury? A) Helmeted bicyclist losing control and falling off his bike onto a gravel surface at 15 miles per hour B) Adult falling 12 feet from a ladder landing in the mud C) Fifty-mile-per-hour motor vehicle crash with partial ejection D) Roll-over motor vehicle collision with a restrained driver Fifty-mile-per-hour motor vehicle crash with partial ejection Which level of trauma facility can provide neurosurgery, microsurgery, and care for multisystem trauma? A) III B) II C) I D) IV I Which of the following patients does NOT require specialty-center capabilities beyond that offered by a trauma center? A) A 67-year-old with second- and third-degree burns over 50 percent of the body B) A 25-year-old with amputation of three fingers C) A 4-year-old with a closed-head injury D) A 22-year-old with bilateral open femur fractures A 22-year-old with bilateral open femur fractures Which of the following best differentiates medical and trauma patient assessment? A) There is no concept for "medical load and go" patients. B) Palpation is frequently not as crucial when assessing the medical patient. C) Scene safety is not an issue with the medical patient. D) Assessing breath sounds is not crucial to trauma assessment. Palpation is frequently not as crucial when assessing the medical patient. Which of the following mechanisms of injury does NOT call for immediate transport to a trauma center? A) Motor vehicle crash with a 20-mile-per-hour impact B) Pedestrian struck by a vehicle at 25 miles per hour C) Thirty-foot fall from a tree D) Motor vehicle crash requiring 1 hour for patient extrication Motor vehicle crash with a 20-mile-per-hour impact Which of the following is an acceptable way of reducing prehospital time to maximize the use of the "Golden Period" for trauma patients? A) Skip spinal immobilization in the blunt trauma patient B) Start all IVs on the scene to allow for more rapid transport C) Load the patients and begin transport before doing a primary assessment D) Call for air medical transport, if indicated Call for air medical transport, if indicated Which of the following means "the anticipation of injury to a body region or organ"? A) Index of injury B) Index of suspicion C) Newton's First Law of Motion D) Mechanism of injury Index of suspicion Which of the following is generally considered to be important reassessment of both medical and trauma patients (the others being generally reserved for a trauma patient)? A) The detailed exam B) The reassessment C) The identification of mechanism of injury D) The rapid trauma assessment The reassessment According to the Haddon Matrix, which of the following would be a pre-event host factor impacting the risk for injury in a vehicle collision? A) Level of EMS providers responding B) The type of vehicle C) Using a cellular phone while driving D) Road design Using a cellular phone while driving Vehicle supplemental restraint systems (air bags) are meant to: A) Prevent unrestrained occupants from taking the down-and-under pathway in frontal impacts B) Protect infants and children who ride in the front seat of the vehicle C) Prevent injury from secondary impacts D) Absorb the energy exchange of rapid deceleration Absorb the energy exchange of rapid deceleration When assessing a patient with a crush injury, which of the following findings would indicate that toxins have entered the central circulation? A) Hot, red skin B) Increased urine output C) Cardiac arrhythmia D) Central hyperventilation syndrome Cardiac arrhythmia People in which of the following age groups are prone to significant trauma due to falls? A) College-aged adults B) Geriatric population C) Pediatric population Geriatric population Which of the following is NOT a complication of crush syndrome? A) Renal failure B) Difficult-to-control hemorrhage C) Cardiac arrhythmias D) Systemic alkalosis Systemic alkalosis The two factors that refer to the rate of change of speed are: A) Deceleration and velocity B) Mass and weight C) Acceleration and deceleration D) Acceleration and inertia Acceleration and deceleration Which of the following injuries is most likely in a rear-end collision? A) Thoracic and abdominal injuries B) Head and neck injuries C) Pelvic fractures D) Lumbar spine injuries Head and neck injuries You are called to the scene of a vehicle crash in which a car was rear-ended while stopped at a stop sign. Which of the following laws of physics serves as the basis for analyzing the mechanism of injury and the associated index of suspicion for injuries? A) The amount of energy transmitted to an object is inversely proportional to its rate of deceleration. B) Energy can neither be created nor destroyed. C) A body at rest will remain at rest unless acted on by an outside force. D) A body in motion will remain in motion unless acted on by an outside force. A body at rest will remain at rest unless acted on by an outside force. In falls, which section of the spinal column is the MOST prone to compression injury? A) Sacral B) Cervical C) Thoracic D) Lumbar Lumbar Which of the following injuries is NOT associated with the use of vehicle restraint systems? A) Traumatic brain injury B) Abrasions and contusions to the clavicle and chest area C) Lumbar spine trauma D) Abdominal injury Traumatic brain injury Applying Newton's second law of motion to a vehicle traveling 70 miles per hour, crashing into which of the following would transfer the most force to the patient? A) Bridge abutment B) Shrubbery C) A body of water D) Signpost Bridge abutment Which of the following is TRUE of the differences between adult and pediatric pedestrians when struck by a vehicle? A) Adults tend to be thrown under the vehicle. B) Children tend to be thrown onto the hood of the vehicle. C) Children tend to turn toward the vehicle. D) Adults tend to turn toward the vehicle. Children tend to turn toward the vehicle. Which of the following is most likely to be fractured from a fall onto outstretched hands? A) Carpals B) Metacarpals C) Clavicle D) Ulna Clavicle Your patient, a 23-year-old woman who is 6 months pregnant, was the unrestrained driver of a vehicle that rear-ended a parked car. The air bag deployed. Considering the likelihood of organ collision, for which of the following injuries should you maintain a high index of suspicion? A) Cardiac contusion B) Anterior flail segment C) Abruptio placentae D) Fractured sternum Abruptio placentae Which of the following best describes why the occupants of a vehicle moving at 50 miles per hour will be injured when the vehicle strikes a tree but not when it brakes to a stop? A) Braking allows the kinetic energy to be absorbed evenly into the frame of the vehicle, rather than concentrating it at the point of impact. B) The energy gradually dissipates as heat due to the friction of braking, rather than transferring to the vehicle and its occupants. C) The inertia of the tree increases the kinetic energy transmitted to the occupants by a factor of 10. D) None of the above describes why. The energy gradually dissipates as heat due to the friction of braking, rather than transferring to the vehicle and its occupants. In frontal impact collisions which pathway of patient travel results in higher mortality? A) Vertical B) Straight C) Up-and-over D) Down-and-under Up-and-over Upon arriving at the scene of a single-vehicle collision in which the vehicle struck a utility pole, you note that the windshield is "spidered," or "starred," and that the driver was not restrained. Which of the following injuries is most likely? A) Whiplash injury of the neck muscles B) Compression injury of the cervical spine C) Distraction injury of the cervical spine D) Ligamentous neck injury due to rotation beyond the range of motion Compression injury of the cervical spine Which of the following factors is NOT a consideration in the severity of injury related to falls? A) Landing surface B) Wind resistance C) The initial point of impact D) Distance of the fall Wind resistance Which of the following is TRUE of motorcycle collisions? A) Frontal impact can result in intraabdominal, pelvic, and femur injuries. B) A rider who "lays down the bike" will generally receive more severe injuries than a rider who stays with the bike. C) The structural steel of the vehicle absorbs most of the kinetic energy in a motorcycle collision. D) The use of helmets has drastically reduced the incidence of cervical spine injuries. Frontal impact can result in intraabdominal, pelvic, and femur injuries. In which of the following types of impact should you have a higher index of suspicion because the degree of injury may be greater than the damage alone indicates? A) Rear-end B) Oblique C) Lateral D) Frontal Lateral Which of the following best defines the term energy? A) The ability to deform solid objects B) The rate of motion related to time C) The capacity to do work D) The amount of heat generated through friction The capacity to do work Which of the following contributes to a greater degree of injury than anticipated from vehicle damage alone in a lateral-impact motor vehicle collision? A) Increased gravitational forces due to multiple changes in direction and velocity B) Lack of a crumple zone C) Taking the up-and-over pathway D) The force of side-impact air bag deployment Lack of a crumple zone Which of the following injuries is NOT commonly related to snowmobiling? A) Ejections B) Crush injuries C) Drowning D) Glancing blows against obstructions in the snow Drowning Which of the following is the most important priority when caring for a patient with a shallow-water diving injury? A) Assessing the cervical spine for deformity B) Maintaining cervical spine stabilization while opening the airway C) Removing the patient from the water as soon as possible D) Initiating rescue breathing once out of the water Maintaining cervical spine stabilization while opening the airway Which of the following impacts the severity of injury sustained in a motor vehicle collision? A) Gross vehicle weight B) Rate of acceleration or deceleration C) Vehicle speed D) All of the above All of the above Which of the following is NOT a type of collision that must be considered when analyzing a motor vehicle collision? A) The vehicle strikes an object B) The occupants' organs strike the interior of the body cavity C) The body of the occupant strikes the interior of the vehicle D) A hubcap flies off and strikes a tree A hubcap flies off and strikes a tree Which of the following best describes what happens to the kinetic energy of a vehicle traveling at 65 miles per hour when it collides into a concrete barrier wall? A) The energy dissipates as sound waves. B) The body of the vehicle and its occupants absorb the energy. C) The wall's foundation absorbs the energy. D) The energy converts to heat through friction. The body of the vehicle and its occupants absorb the energy. Which two of the following factors proportionately affect the kinetic energy of a bullet fired from a gun? A) Friction and distance B) Mass and friction C) Velocity and mass D) Friction and velocity Velocity and mass Which of the following injuries is associated with the pressure wave produced by a blast? A) Pneumothorax B) Lacerated liver C) Fractures D) Ruptured spleen Pneumothorax Axial loading is most likely to occur in which type of impact? A) Frontal with an up-and-over pathway B) Frontal with a down-and-under pathway C) Rear with the headrest too low D) Lateral on the side of the vehicle opposite the occupant Frontal with an up-and-over pathway Which of the following "paper bag syndrome" injuries may occur due to sudden compression of the thorax or abdomen? A) Pulmonary and myocardial contusions B) Pneumothorax and diaphragmatic rupture C) Cardiac tamponade and aortic dissection D) Pneumothorax and myocardial contusion Pneumothorax and diaphragmatic rupture Which of the following statements about lateral impact collisions is TRUE? A) The substantial lateral crumple zone prevents most injuries. B) Damage to the vehicle is a reliable indication of the seriousness of injuries. C) The degree of injury may be greater than the damage alone would indicate. D) Fatalities are rare because the upper extremities absorb the energy. The degree of injury may be greater than the damage alone would indicate. Which of the following mechanisms is most consistent with fractured vertebrae from a rapid lateral twisting motion? A) Direct trauma, such as from a blow to the head B) Low-velocity penetrating trauma from an ice pick C) High-velocity penetrating trauma from a gunshot wound D) Lateral-impact motor vehicle collision Lateral-impact motor vehicle collision Frontal impacts in which the patient takes a "down-and-under" pathway typically result in which of the following injury patterns? A) Traumatic brain injury B) Hip and femur fractures C) Rupture of the diaphragm D) Rupture of hollow organs Hip and femur fractures You are dispatched to a building collapse with an entrapped patient who will require a lengthy extrication. Which of the following medications should you consider for this patient while awaiting extrication? A) Sodium bicarbonate B) Diazepam C) Furosemide D) Calcium channel blockers Sodium bicarbonate Which of the following is TRUE of the injuries sustained by the elderly due to falls? A) The injuries sustained by the elderly are less likely to result in hospitalization. B) Only more significant falls cause fractures. C) Less significant falls may cause fractures. D) The elderly sustain injuries similar to other age groups in comparable falls. Less significant falls may cause fractures. Which of the following is NOT one of the major types of recreational vehicles involved in crashes? A) Snowmobiles B) Jet Skis C) All-terrain vehicles D) Go-carts Go-carts Which of the following traumas contributes most significantly to motor vehicle collision mortality? A) Chest B) Head C) Abdominal D) Cervical spine Head In a motor vehicle collision, when the driver's chest strikes the steering wheel, what produces injury next? A) The air bag deploys a second time. B) The steering column shears off, causing penetrating trauma. C) Unsecured objects in the vehicle become projectiles. D) The heart continues its forward motion until it strikes the chest wall. The steering column shears off, causing penetrating trauma. When inspecting the interior of a vehicle involved in a frontal collision, you note that the dash panel beneath the steering wheel is broken. Which of the following injuries might this indicate? A) Fracture of the acetabulum B) Femur fracture C) Knee injury D) All of the above All of the above Which of the following injuries is associated with the tertiary phase of a blast? A) Crush injuries B) Barotrauma C) Burns D) Projectile injuries Crush injuries Which of the following statements about the impact of motorcycle helmet usage is TRUE? A) Helmet use moderately increases the incidence of cervical spine injury. B) Helmet use moderately decreases the incidence of cervical spine injury. C) Helmet use substantially decreases the incidence of cervical spine injury. D) Helmet use neither increases nor decreases the incidence of cervical spine injury. Helmet use neither increases nor decreases the incidence of cervical spine injury. Which of the following mechanisms in a motor vehicle collision would most likely result in a tear of the liver at the ligamentum teres? A) Gradual deceleration B) Sudden acceleration C) Sudden deceleration D) Gradual acceleration Sudden deceleration Which of the following statements is NOT true of occupant ejection in motor vehicle collisions? A) Ejection accounts for 27 percent of motor vehicle fatalities. B) The number of occupant impacts increases with ejection. C) Ejection has not been reported with lateral-impact collisions. D) Ejection is most often associated with frontal-impact collisions. Ejection has not been reported with lateral-impact collisions. Which of the following may result from aggressive ventilation of the blast patient? A) Emboli B) Pericardial tamponade C) Hemorrhage D) Acidosis Emboli A vehicle is struck in its right front as it passes through an intersection, resulting in an oblique impact. Which of the passengers is subjected to the greatest acceleration forces? A) The right-rear passenger B) The left-rear passenger C) The front-seat passenger D) The driver The left-rear passenger You have responded to a soccer field on which two 13-year-olds have collided during a game. Which of the following findings in either patient requires ambulance transport for further evaluation in the emergency department? A) Weakness in the upper extremities B) Complaint of "getting the wind knocked out of me" C) Contusion to the thigh D) Minor epistaxis Weakness in the upper extremities Which type of motor vehicle collision is most common in rural areas? A) Frontal B) Lateral C) Rollover D) Rear-end Frontal You are the first arriving unit for injured persons due to a propane tank explosion. The first patient you notice is a young adult male who appears to be seriously injured. Which of the following should you do first? A) Request an arson investigator to come to the scene. B) Locate all patients. C) Do a scene size-up and establish incident command. D) Begin resuscitation of any patients who are apneic and/or pulseless. Do a scene size-up and establish incident command. Which of the following is TRUE of supplemental restraint systems? A) They may deploy during rescue operations, injuring the patient and/or EMS personnel. B) When worn incorrectly, they may cause spinal injury or decapitation. C) They guard against thoracic impact with the steering wheel. D) They are primarily useful in preventing injury to infants and children riding in the front seat. They may deploy during rescue operations, injuring the patient and/or EMS personnel. Which of the following mechanisms may result in a conventional explosion? A) Fumes B) Dust C) Aerosol propellants D) All of the above All of the above CHAPTER 3 Which of the following statements about low-velocity penetrating trauma is TRUE? A) Shorter knives and ice picks may be removed if they are left in the wound. B) There is no pressure shock wave with a knife wound as there is with an arrow wound. C) More injuries are sustained from arrows than from knives. D) Knives, arrows, ice picks, and similar weapons cause damage only in their direct path. Knives, arrows, ice picks, and similar weapons cause damage only in their direct path. Your patient is an eight-year-old male with a pencil impaled 2 centimeters inferior to the xiphoid process. You note that the pencil is pulsating. Which of the following is the best action? A) Start an IV and request orders for analgesia and sedation. B) Remove the pencil and apply direct pressure to the wound; transport to a trauma center if the bleeding does not stop with direct pressure. C) Stabilize the pencil in place and transport to a trauma center. D) Stabilize the pencil and transport to the nearest medical facility. Stabilize the pencil in place and transport to a trauma center. The pathway of injury left in the wake of a penetrating mechanism of injury is called: A) Cone of injury B) Cavitation C) Profile D) Trajectory Cavitation The passage through tissue of a high-energy bullet creates a temporary cavity and a permanent cavity. Which of the following statements is TRUE of the permanent cavity created by penetrating trauma? A) It is filled with disrupted tissues, some air, fluid, and debris. B) It is the damage done when the projectile fragments penetrate. C) It is a space created by a projectile as tissue moves rapidly away in its path. D) It is a potential space, not an actual space. It is filled with disrupted tissues, some air, fluid, and debris. Which of the following is TRUE of the pressure wave that accompanies high-velocity penetrating trauma? A) Hollow organs are less tolerant of the stress than solid organs are. B) Pressure waves cause no injury to surrounding tissues; they only momentarily disrupt function. C) Elastic tissues are less tolerant of the stress than nonelastic tissues. D) The pressure wave may be transmitted through blood, resulting in damage to blood vessels some distance from the primary wound. The pressure wave may be transmitted through blood, resulting in damage to blood vessels some distance from the primary wound. Your patient is a 50-year-old male with a gunshot wound to the right anterior chest. He is unresponsive. Which of the following should you do first? A) Check for a carotid pulse. B) Seal the chest wound. C) Auscultate breath sounds. D) Check for breathing. Check for breathing Your patient is a 30-year-old female with a stab wound to the neck. She is sitting up and appears very anxious and short of breath. There is minimal external bleeding noted, but there is bubbling from the wound. Which of the following should you suspect, based on the mechanism of injury and assessment findings? A) Laceration of the trachea B) An injury to the spinal cord at the level of the stab wound C) Laceration of the ipsilateral carotid artery D) All of the above Laceration of the trachea If you were to design a bullet to have the highest energy exchange, what would you do? A) Decrease the drag B) Increase the caliber C) Decrease the bullet's trajectory D) Design the bullet to become more unstable Design the bullet to become more unstable Which of the following is most important when assessing the damage done by a gunshot? A) The type of gun used B) The size of the bullet C) The distance from the shooter D) Whether there was an upward or a downward trajectory when the bullet was fired The distance from the shooter A penetrating injury to which of the following organs is LEAST likely to result in severe hemorrhage? A) Liver B) Kidney C) Spleen D) Ureter Ureter Which of the following is TRUE of shotgun ammunition? A) A shotgun may either fire one slug or use ammunition with multiple pellets. B) The shot is dispersed from the cartridge with high velocity. C) The closer the shooter is to the victim, the larger the area of visible damage. D) "Double ought" or #00 shot contains a large number of relatively small pellets. A shotgun may either fire one slug or use ammunition with multiple pellets. Which of the following abdominal organs is the least affected by the pressure wave associated with penetrating trauma? A) Spleen B) Bowel C) Kidneys D) Liver Bowel The study of the characteristics of projectiles in motion and their effects on the objects they impact is called: A) Trajectory B) Cavitation C) Ballistics D) Forensics Ballistics You have arrived on the scene of a 17-year-old male with a gunshot wound to the thigh. Police are on the scene. There is significant ongoing hemorrhage from the wound. The patient is screaming for someone to help him. Which of the following should you do first? A) Control hemorrhage with direct pressure. B) Perform a rapid trauma assessment. C) Ask the police if they have searched the patient for weapons yet. D) Begin high-concentration oxygen administration. Ask the police if they have searched the patient for weapons yet. As a bullet tumbles, its potential to inflict damage: A) Increases B) Remains the same C) Is determined by the trajectory D) Decreases Increases The path a projectile follows during a flight is called its: A) Cavity B) Ballistics C) Trajectory D) Drag Trajectory Which of the following is TRUE of body armor use? A) There are no reported cases of penetrating trauma among victims who were shot while wearing body armor. B) Blunt trauma may be significant, but the potential for life-threatening injury is less than if armor had not been worn. C) Blunt trauma only occurs if ceramic inserts are placed in the vest. D) Ceramic inserts are dangerous and should not be used, because they generally fragment and create secondary projectiles when they are struck by a bullet. Blunt trauma may be significant, but the potential for life-threatening injury is less than if armor had not been worn. Which of the following is most susceptible to damage from the pressure wave when a bullet enters it? A) Intestines B) Femoral artery C) Liver D) Lungs Liver Which of the following is TRUE about determining the pathway of the bullet when assessing a patient with a gunshot wound? A) You should try to determine the bullet's pathway. B) The purpose of determining the bullet's pathway is to anticipate which organs may have been affected, which will help to guide your priorities for on-scene care or rapid transport. C) It is difficult to determine the pathway of a bullet because it may not travel in a straight line, possibly being deflected by structures in its path or being shifted by natural movements of the diaphragm and other organs and structures of the body. D) All of the above All of the above Which statement about ballistics is TRUE? A) Damage is less when the bullet does not exit the body. B) When a bullet tumbles, it decreases the damage. C) In penetrating trauma, the mass of a projectile is more significant than its velocity when determining kinetic energy. D) When a bullet yaws, it increases the damage. When a bullet yaws, it increases the damage. When you are assessing someone with a gunshot wound from a rifle, which of the following is important to remember? A) The zone of injury is larger than that expected with other types of weapons. B) The muzzle velocity is less than that of a handgun. C) The trajectory is longer, allowing more energy to be dissipated by drag before it strikes the victim. D) The cavitation is limited to the direct path of the bullet. The zone of injury is larger than that expected with other types of weapons. Which of the following is typical of the trajectory of a knife when a female assailant stabs someone? A) The trajectory is lateral: right-to-left if she is right-handed and left-to-right if she is left-handed. B) The movement is downward as the assailant raises the knife and swings downward. C) The movement is upward as the assailant drives upward with the knife. D) The trajectory tends to be in a horizontal plane at the level of the assailant's shoulder. The movement is downward as the assailant raises the knife and swings downward. Greater velocity of a bullet will cause a ________ path of travel and a ________ trajectory. A) Wavier, straighter B) Flatter, wavier C) More rounded, curved D) Flatter, straighter Flatter, straighter Which of the following is TRUE of the temporary cavity formed by penetrating trauma? A) It heals more slowly than the permanent cavity because of the nature of the tissue damage. B) It fills with disrupted tissues, some air, fluid, and debris. C) It is a space indirectly created by a projectile as tissue moves rapidly away from its path. D) It is the damage that occurs when the projectile fragments. It is a space indirectly created by a projectile as tissue moves rapidly away from its path. Which of the following is TRUE of defense wounds in the victim of a knife attack? A) They usually occur to the shoulder as the victim attempts to turn away from the attack. B) They often occur to the neck and head as the victim doubles over into a protective posture. C) They usually occur to the hands and arms as the victim raises them to ward off the attacker. D) They rarely occur because the victim is usually taken by surprise. They usually occur to the hands and arms as the victim raises them to ward off the attacker. To gain an appreciation for the potential for trauma from high-velocity projectiles, it is important to remember that the shock wave produced can exceed atmospheric pressure by up to ________ times. A) 25 B) 100 C) 50 D) 80 100 Which of the following is associated with assault rifle wounds but not hunting rifle wounds? A) Permanent cavitation B) Multiple wounds C) Smaller exit wounds D) Larger exit wounds Multiple wounds Which of the following statements about bullets is TRUE? A) A high-velocity bullet is three times less likely to do major harm. B) The larger the bullet the smaller its energy. C) A small, light bullet does the most harm. D) The hunting rifle's bullet is usually a lighter bullet, but it travels faster. A small, light bullet does the most harm. During the scene size-up on a call for a patient with penetrating trauma due to a stab wound, which of the following should you do? A) Collect anything that could be used as evidence. B) Check for weapons on or near the patient. C) Try to find out in which direction the assailant fled. D) Assume that the patient has no weapons if law enforcement is on the scene. Check for weapons on or near the patient. Which of the following statements about stab wounds is TRUE? A) The presence of defense wounds decreases the likelihood of trauma to the neck, thorax, and abdomen. B) Damage is usually limited to physical injury caused by direct contact between the blade and the victim's tissue. C) The size and shape of the weapon allow precise prediction of the injury. D) Stab wounds by female attackers are seldom lethal. Damage is usually limited to physical injury caused by direct contact between the blade and the victim's tissue. Which of the following statements about entrance and exit wounds is TRUE? A) Exit wounds are usually the size of the bullet's profile. B) Entrance wounds most often appear as stellate. C) Cavitational wave energy is greatest at a bullet's point of entrance. D) Only a thorough forensic examination by a qualified expert can determine with certainty whether a given wound is an entrance wound or an exit wound. Only a thorough forensic examination by a qualified expert can determine with certainty whether a given wound is an entrance wound or an exit wound. Which of the following organs would be most likely to be injured by a stab wound to the sixth intercostal space in the midaxillary line on the right side? A) Liver, bladder, kidney, small intestine B) Stomach, pancreas, lung C) Liver, diaphragm, lung, kidney D) Spleen, diaphragm, lung, kidney Liver, diaphragm, lung, kidney Which of the following is best described as "the area of contused tissue resulting from penetrating trauma that may be slow to heal due to disrupted blood flow and tissue damage"? A) Temporary cavity B) Zone of injury C) Zone of coagulation D) Permanent cavity Zone of injury Penetrating trauma to the face can complicate airway management by which of the following mechanisms? A) Laryngotracheal edema B) Airway obstruction C) Destruction of anatomical landmarks D) B and C B and C The initial assessment of a patient with a gunshot wound to the chest should focus on detecting which of the following? A) Pancreatitis B) Tension pneumothorax C) Cardiac contusion D) Peritonitis Tension pneumothorax Which two factors related to kinetic energy proportionately affect the damage a projectile will do? A) Velocity and yaw B) Velocity and mass C) Mass and fragmentation D) Fragmentation and velocity Velocity and mass Which type of firearm usually limits trauma to direct injury? A) Hunting rifle B) Military rifle C) Automatic weapon D) Handgun Handgun Your patient is a construction worker who fell 15 feet and has a 3-foot metal concrete reinforcement bar (rebar) impaled in his right thigh. Which of the following is the best action? A) Administer sodium bicarbonate to combat acidosis resulting from the destruction of muscle tissue. B) If the proper tools and personnel are present, have rescuers cut the rebar to a manageable length. C) If you can see both ends of the rebar, gently remove it and irrigate the wound with sterile saline. D) Transport the patient without attempting to shorten or remove the rebar. If the proper tools and personnel are present, have rescuers cut the rebar to a manageable length. Which of the following bullet characteristics would create the most damage? A) Lack of tumble B) A small profile C) A full metal jacket D) "Mushrooming" or flattening on impact "Mushrooming" or flattening on impact As the mass of an object increases, which of the following occurs? A) The maximum speed it can attain increases. B) The amount of energy decreases. C) The maximum speed it can attain decreases. D) The amount of energy increases. The amount of energy increases. Your patient is a 60-year-old male with a gunshot wound in the second intercostal space anteriorly on the left. You note that he has frothy blood coming from his mouth. For which of the following must you have the highest index of suspicion? A) Tension pneumothorax B) A history of congestive heart failure C) Pericardial tamponade D) Traumatic asphyxia Tension pneumothorax Which of the following statements about rifles is TRUE? A) Assault rifles generally increase the number of wounds the victim sustains. B) Hunting rifles have larger magazines and operate semiautomatically. C) Assault rifles do not accept domestic hunting ammunition and thus create a projectile profile that is smaller and causes less damage. D) Assault rifles have greater velocity than hunting rifles and only operate automatically. Assault rifles generally increase the number of wounds the victim sustains Your patient has a gunshot wound to the left posterior thorax. Which of the following is NOT appropriate in initial assessment? A) Beginning bag-valve-mask ventilations B) Auscultating breath sounds bilaterally in six places, anteriorly and posteriorly C) Stabilizing a flail segment, should one be noted D) Placing a gloved hand over a sucking chest wound Auscultating breath sounds bilaterally in six places, anteriorly and posteriorly Which of the following is NOT considered penetrating trauma? A) Receiving a wood splinter in the foot while walking on an unfinished deck B) A superficial wound resulting from a pellet from a pellet gun being lodged under the skin C) A laceration from a kitchen knife D) A laceration on the forehead as a result of being struck with a metal pipe A laceration on the forehead as a result of being struck with a metal pipe Which of the following increases a bullet's profile? A) "Mushrooming" on impact B) The use of rifling in the barrel of the firearm C) Tumbling 180 degrees on impact D) A and C A and C As the energy from a medium- or high-velocity projectile pushes tissue from its path, which of the following occurs? A) Damage depends on the net difference between pressure at the entrance wound and pressure at the exit wound. B) There is no vacuum created when there is both an entrance and an exit wound. C) Negative pressure is generated inside the cavity, drawing debris into the wound. D) There is negative pressure at the entrance wound and positive pressure at the exit wound. Negative pressure is generated inside the cavity, drawing debris into the wound. Which of the following is most likely to occur when military ammunition is used? A) It will "mushroom" or flatten. B) It will remain intact. C) It will fragment. D) It will explode. It will remain intact. Which of the following is considered a high-velocity weapon? A) Shotgun B) Arrow C) Handgun D) Rifle Rifle

In a previously healthy individual, which of the following types of shock may NOT result in the typical signs of cool, pale, moist skin; tachycardia; and narrowed pulse pressure? A) Neurogenic B) Cardiogenic C) Hypovolemic D) Hemorrhagic Neurogenic Which of the following guidelines applies to the prehospital administration of IV fluids in the patient with hemorrhagic shock? A) Administer hypertonic saline solution or colloids at a keep-open rate. B) Administer synthetic oxygen-carrying fluids as necessary to increase the level of consciousness. C) Begin with a 2,000 ml bolus of isotonic crystalloid solution infused under pressure. D) Administer isotonic crystalloid fluids only as necessary to maintain perfusion. Administer isotonic crystalloid fluids only as necessary to maintain perfusion. Your patient is a 23-year-old male with a gunshot wound to the abdomen and an exit wound in the right flank. He responds to verbal stimuli; has pale, cool, diaphoretic skin; and has a heart rate of 128, respirations at 24, and a blood pressure of 82/60. These findings indicate which of the following kind of shock? A) Compensated B) Irreversible C) Decompensated D) Neurogenic Decompensated Your patient is a 42-year-old male with multiple lacerations on his arms, head, and torso after falling through a plate-glass window. On your arrival he appears to be unresponsive, lying prone on the sidewalk. Which of the following is the correct sequence of actions in caring for this patient? 1. Control major hemorrhage. 2. Take body-substance-isolation precautions. 3. Check the area for broken glass before kneeling next to the patient. 4. Turn him to a supine position. 5. Open his airway. A) 2, 3, 1, 4, 5 B) 2, 5, 1, 3, 4 C) 3, 2, 4, 1, 5 D) 2, 3, 4, 5, 1 3, 2, 4, 1, 5 Which of the following results from anaerobic metabolism in shock? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory alkalosis D) Respiratory acidosis Metabolic acidosis Which of the following, located in the aortic arch, monitor blood pressure and send feedback to the medulla oblongata to maintain homeostasis? A) Volume receptors B) Proprioceptors C) Baroreceptors D) Chemoreceptors Baroreceptors Managing a laceration with arterial bleeding most often requires: A) Cauterization B) A tourniquet C) PASG D) Direct pressure Direct pressure In which of the following patients with hemorrhagic shock can you employ aggressive fluid resuscitation? A) A 50-year-old male with a stab wound to the right upper quadrant of the abdomen B) A 45-year-old woman with a suspected ruptured ectopic pregnancy C) A 38-year-old male with an open femur fracture and a developing bruise beneath the right scapula following an assault D) A 26-year-old male with a gunshot wound involving the popliteal artery A 26-year-old male with a gunshot wound involving the popliteal artery Which of the following results from the beta 1 actions of epinephrine in response to shock? 1. Positive inotropy 2. Positive chronotropy 3. Positive dromotrophy 4. Bronchiolar smooth muscle relaxation 5. Increased peripheral vascular resistance A) 1, 2, 3 B) 1, 2, 5 C) 1, 2, 3, 4 D) 2 and 4 1, 2, 3 In anaphylactic shock, a massive _______ release causes general vasodilation, precapillary sphincter dilation, capillary engoregement, and fluid movement into the interstitial compartment. A) norepinephrine B) epinephrine C) histamine D) insulin histamine Which of the following results from relaxation of the postcapillary sphincters in shock? A) Diffuse intravascular coagulation B) Melena C) "Washout" of microemboli and lactic acid D) Septicemia "Washout" of microemboli and lactic acid Which of the following is defined as the volume of blood ejected from the heart with each beat? A) Stroke volume B) Ventricular capacitance C) Cardiac output D) Afterload Stroke volume A fracture of the femur may result in a hematoma that contains enough blood to make it a Class ________ hemorrhage. A) I B) III C) IV D) II III Your patient is a 45-year-old male who has received several stab wounds to the chest and abdomen. Although bleeding was significant at first, the rate of bleeding had slowed considerably before your arrival. The patient is agitated and confused, pale, diaphoretic, and cool to the touch. He lacks a radial pulse, and his carotid pulse is weak and rapid. Respirations are 28 and shallow. Which of the following is certain with this patient? A) He is in irreversible shock. B) He is in decompensated shock. C) He is in compensated shock. D) None of the above is certain. He is in decompensated shock. Your patient has a possible pelvic fracture from a frontal motor vehicle collision. She has a blood pressure of 78 by palpation, has a heart rate of 130, and responds only to painful stimuli. Before you arrived BLS providers immobilized the patient to a long backboard. Which of the following should you do next? A) Apply PASG B) Initiate rapid transport C) Perform a rapid trauma assessment D) Start a large-bore IV of lactated Ringer's solution Initiate rapid transport Peripheral vascular resistance (afterload) is measured as which of the following? A) Pulse pressure B) Mean arterial pressure C) Hydrostatic pressure D) Oncotic pressure Mean arterial pressure Which of the following substances has the most rapid effect when compensating for hemorrhage? A) Glucocorticoids B) Catecholamines C) Antidiuretic hormone D) Angiotensin II Catecholamines Which of the following is the preferred in-hospital fluid for resuscitation in hemorrhagic shock? A) Fresh frozen plasma B) Lactated Ringer's C) Whole blood D) Normal saline Whole blood Which of the following best describes the importance of oxygen in cellular metabolism? A) It prevents pyruvic acid from being converted to lactic acid. B) It prevents the formation of pyruvic acid in the Krebs cycle. C) It is necessary for glycolysis. D) It limits the overproduction of energy in the citric acid cycle. It prevents pyruvic acid from being converted to lactic acid. When cells become hypoxic and the amount of carbon dioxide in them increases, reducing tissue pH, which of the following occurs to restore homeostasis? A) Mast cells release serotonin, resulting in dilation of the capillary sphincters and an increase in tissue perfusion. B) Mast cells release histamine, resulting in dilation of capillary sphincters and an increase in tissue perfusion. C) The sympathetic nervous system constricts the capillary sphincters to prevent washout of the accumulated lactic acid. D) The precapillary sphincters open, increasing blood flow to the tissues. The postcapillary sphincters remain closed so that increased hydrostatic pressure forces lactic acid into the interstitial fluid, where it is buffered. Mast cells release histamine, resulting in dilation of capillary sphincters and an increase in tissue perfusion. The phase of blood clotting in which the smooth muscle of an injured blood vessel contracts is known as the ________ phase. A) Hemolytic B) Hemostatic C) Vascular D) Ischemic Vascular Which of the following findings indicates a progression from compensated shock to decompensated shock? A) Narrowing pulse pressure B) Tachycardia C) Altered mental status D) Diaphoresis Altered mental status When assessing the chest during rapid trauma survey, what is most likely to indicate major internal hemorrhage? A) Hyperresonance to percussion B) Increased respiratory rate C) Distended neck veins D) Dullness to percussion Dullness to percussion Which of the following types of wound facilitates the effectiveness of normal blood-clotting mechanisms? A) Vessels torn by stretching, such as when a limb is caught in farm machinery B) Transverse laceration of the vessel C) Longitudinal laceration of the vessel D) Crushing injuries Transverse laceration of the vessel Which of the following mechanisms is responsible for accumulating lactic acid in shock? A) The citric acid cycle B) Gluconeogenesis C) Hemostasis D) Anaerobic metabolism Anaerobic metabolism

The alternate pathway that reacts quickly to foreign bodies and uses antibodies and inflammation to combat pathogens is the ________ system. a. Complement b. Lymphatic c. Humoral d. Cell-mediated

a.Complement

The following are all examples of repetitive motion injury except: a. Tennis elbow b. Tenosynovitis c. Carpal tunnel syndrome d. Osteoarthritis

a.Tennis elbow

Your patient is an 18-year-old female who is alert and in moderate distress, complaining of abdominal pain and light-headedness. She describes a four-week history of worsening unilateral lower quadrant abdominal pain with onset of malaise, nausea andvomiting, this week.. Today, she is experiencing faintness and near-syncope with exertion. She denies pain or difficulty with urination. Her last menstrual period was two weeks ago. She is sexually active and uses oral contraceptives. Physical examination reveals marked tenderness and guarding with palpation of her abdomen. Her skin is cool and diaphoretic. HR = 121, BP = 90/58, RR = 18. The patient's presentation is most consistent with: a. ectopic pregnancy b. pelvic inflammatory disease c. spontaneous abortion d. pyelonephritis.

a.ectopic pregnancy

Endometritis is a complication LEAST likely to be associated with: a. ectopic pregnancy. b. elective abortion. c. childbirth. d. spontaneous abortion.

a.ectopic pregnancy.

Cushing's syndrome is a disorder of the: a. Posterior pituitary gland b. Adrenal glands c. Thyroid gland d. Ovaries

b.Adrenal glands

A feeling of dizziness or whirling in space is called ________. a. Purulence b. Vertigo c. Eczema d. Tinnitus

b.Vertigo

The term used to describe how many times a women has been pregnant is: a. parity b. gravida. c. menarche d. para

b.gravida.

Of the following, which would be the most likely dysfunction experienced by a patient with multiple myeloma? a. Increased T cell production b. Decreased T cell production c. Decreased blood cell production d. Increased blood cell production

c.Decreased blood cell production

Your patient has a history of benign prostatic hypertrophy. Which of the following complaints is most consistent with this history? a. "It seems like I urinate a gallon at a time." b. "My urine is cloudy and has a strong odor." c. "I can't seem to urinate." d. "I have blood in my urine first thing in the morning."

c."I can't seem to urinate."

Which of the following would most increase the likelihood of a urinary tract infection? a. Prior history of renal calculi b. Lack of sexual activity c. Urinary retention d. Male gender

c.Urinary retention

Which of the following best describes a state of disorientation or inability to easily make decisions? a. Delusion b. Confabulation c. Neurosis d. Confusion

d.Confusion

An inflammation of the thin, transparent membrane covering the visible portion of the sclera and lining the inside of the eyelids results in ________. a. Cornea abrasion b. Lens distortion c. Choroiditis d. Conjunctivitis

d.Conjunctivitis

The time from ovulation to menstruation is approximately ________ days. a. 28 b. 7 c. 21 d. 14

d.14

fd

df

All of the following statements about the physiologic changes during pregnancy are true, EXCEPT: a. pelvic joints loosen, causing postural changes and low back pain. b. renal tubular absorption increases. c. the urinary bladder is displaced posteriorly and inferiorly. d. gastrointestinal peristalsis is slowed. c.the urinary bladder is displaced posteriorly and inferiorly.

The umbilical cord should be clamped in two places and cut ________ cm from the newborn. a. 5-10 b. 2-5 c. 5-7 d. 10-15 d.10-15

The purpose of determining the mechanism of injury and the index of suspicion for the trauma patient at the same time is to allow you to: A) Decide whether to transport the patient B) Identify comorbid factors C) Document a complete scene size-up D) Anticipate your patient's injuries Anticipate your patient's injuries Which of the following accounts for the highest number of trauma deaths in the United States of America? A) Motor vehicle crashes B) Falls C) Assaults D) Firearms injuries Motor vehicle crashes Which of the following acts resulted in the development of modern EMS systems? A) Ryan White Act B) Highway Safety Act of 1966 C) Good Samaritan Act D) The Trauma Care Systems Planning and Development Act of 1990 Highway Safety Act of 1966 In addition to handling all types of specialty trauma, which level of trauma center provides continuing medical and public education programs? A) IV B) III C) I D) II I Upon arriving on a scene where the mechanism of injury indicates a potentially life-threatening injury, you should employ which of the following interventions to BEST help deliver the care that is needed? A) Reevaluate the scene size-up. B) Initiate transport immediately, delaying more extensive care until you are en route. C) Ask a surgeon to respond to the scene. D) Call immediately for air medical transport to reduce the "Golden Period." Initiate transport immediately, delaying more extensive care until you are en route. Which of the following physical findings indicates the need for immediate transport? A) Vital signs: systolic blood pressure 80, respiratory rate 8 B) Glasgow Coma Scale Score of 15 C) Second-degree burns involving 9 percent of total body surface area in an adult patient D) Fractured right femur Vital signs: systolic blood pressure 80, respiratory rate 8 Which of the following requires immediate transport to a trauma center? A) A 40-year-old who fell 12 feet from a garage roof with a radius fracture B) A 36-year-old female in a motor vehicle crash who has a blood pressure of 100/60 C) A 22-year-old motorcyclist with a tibia fracture D) A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger As a paramedic your role in trauma care consists of all of the following EXCEPT: A) Providing rapid transport to appropriate facilities B) Promoting injury prevention C) Providing care to seriously injured trauma patients D) Providing surgical interventions to stop hemorrhage Providing surgical interventions to stop hemorrhage Which of the following is NOT true of trauma triage criteria? A) For patients who meet trauma triage criteria, the appropriate facility is the largest trauma center in your region. B) Assessment of vital signs/level of consciousness, anatomy of injury, mechanism of injury, and age of the patient are key elements of trauma triage criteria. C) Trauma triage criteria are geared to help you formulate an index of suspicion when making decisions about your trauma patient. D) Trauma triage criteria are guidelines to help you determine whether your patient needs transport to a trauma center. For patients who meet trauma triage criteria, the appropriate facility is the largest trauma center in your region. Which of the following is NOT considered a significant mechanism of injury in pediatric patients? A) Vehicle collision with intrusion into compartment where child is a passenger B) Fall of 5 feet C) Bicycle-vehicle collision at 30 mph D) Any collision in which a child is ejected from the vehicle Fall of 5 feet Which of the following is NOT an example of trauma? A) An abrasion to the knee B) Chest pain C) Cerebral contusion D) A stab wound to the abdomen Chest pain Which of the following is NOT a consideration when assessing a trauma patient? A) SAMPLE history B) MedicAlert bracelets C) Underlying medical conditions D) Medical insurance coverage Medical insurance coverage Which level of trauma facility has minimal surgical support but can stabilize before transferring to a higher-level trauma facility? A) III B) II C) IV D) I III Which of the following statements about trauma is TRUE? A) Life-threatening injuries may exist with little external evidence. B) Dramatic-appearing extremity injuries may draw the paramedic's focus from life-threatening injuries. C) Life-threatening injury occurs in less than 10 percent of trauma patients. D) All of the above are true. All of the above are true. The leading cause of death in people under age 44 is: A) Heart attack. B) Trauma. C) Cancer. D) Cardiovascular disease. Trauma. Which of the following patients is NOT a candidate for air medical transport? A) Combative trauma patient B) Seriously injured patient with cardiac tamponade C) Patient with prolonged extrication time D) Burn patient with over 50 percent second-degree burns Combative trauma patient Which of the following is more relevant to the assessment and history of the medical patient than to the trauma patient? A) AVPU B) SAMPLE C) OPQRST D) DCAP-BTLS OPQRST Modern medicine treats trauma as a ________. A) Crisis B) Disease C) Life threat D) Medical problem Disease A trauma center that has surgical care capability available at all times and can handle all but the most seriously injured specialty and multisystem trauma patients is a Level ________ trauma center. A) III B) I C) IV D) II II Which of the following is the best, most cost-effective way for EMS personnel to help reduce trauma-related morbidity and mortality? A) Participate in injury-prevention programs B) Keep up-to-date on trauma management knowledge and skills C) Transport all trauma patients to a trauma center D) Provide complete patient care reports so that accurate data can be entered into the trauma registry Participate in injury-prevention programs Which level of trauma facility stabilizes and prepares to transport trauma patients to a higher-level facility but does NOT necessarily have surgical capabilities? A) I B) II C) IV D) III IV Which of the following mechanisms would yield the greatest index of suspicion for serious injury? A) Helmeted bicyclist losing control and falling off his bike onto a gravel surface at 15 miles per hour B) Adult falling 12 feet from a ladder landing in the mud C) Fifty-mile-per-hour motor vehicle crash with partial ejection D) Roll-over motor vehicle collision with a restrained driver Fifty-mile-per-hour motor vehicle crash with partial ejection Which level of trauma facility can provide neurosurgery, microsurgery, and care for multisystem trauma? A) III B) II C) I D) IV I Which of the following patients does NOT require specialty-center capabilities beyond that offered by a trauma center? A) A 67-year-old with second- and third-degree burns over 50 percent of the body B) A 25-year-old with amputation of three fingers C) A 4-year-old with a closed-head injury D) A 22-year-old with bilateral open femur fractures A 22-year-old with bilateral open femur fractures Which of the following best differentiates medical and trauma patient assessment? A) There is no concept for "medical load and go" patients. B) Palpation is frequently not as crucial when assessing the medical patient. C) Scene safety is not an issue with the medical patient. D) Assessing breath sounds is not crucial to trauma assessment. Palpation is frequently not as crucial when assessing the medical patient. Which of the following mechanisms of injury does NOT call for immediate transport to a trauma center? A) Motor vehicle crash with a 20-mile-per-hour impact B) Pedestrian struck by a vehicle at 25 miles per hour C) Thirty-foot fall from a tree D) Motor vehicle crash requiring 1 hour for patient extrication Motor vehicle crash with a 20-mile-per-hour impact Which of the following is an acceptable way of reducing prehospital time to maximize the use of the "Golden Period" for trauma patients? A) Skip spinal immobilization in the blunt trauma patient B) Start all IVs on the scene to allow for more rapid transport C) Load the patients and begin transport before doing a primary assessment D) Call for air medical transport, if indicated Call for air medical transport, if indicated Which of the following means "the anticipation of injury to a body region or organ"? A) Index of injury B) Index of suspicion C) Newton's First Law of Motion D) Mechanism of injury Index of suspicion Which of the following is generally considered to be important reassessment of both medical and trauma patients (the others being generally reserved for a trauma patient)? A) The detailed exam B) The reassessment C) The identification of mechanism of injury D) The rapid trauma assessment The reassessment According to the Haddon Matrix, which of the following would be a pre-event host factor impacting the risk for injury in a vehicle collision? A) Level of EMS providers responding B) The type of vehicle C) Using a cellular phone while driving D) Road design Using a cellular phone while driving Vehicle supplemental restraint systems (air bags) are meant to: A) Prevent unrestrained occupants from taking the down-and-under pathway in frontal impacts B) Protect infants and children who ride in the front seat of the vehicle C) Prevent injury from secondary impacts D) Absorb the energy exchange of rapid deceleration Absorb the energy exchange of rapid deceleration When assessing a patient with a crush injury, which of the following findings would indicate that toxins have entered the central circulation? A) Hot, red skin B) Increased urine output C) Cardiac arrhythmia D) Central hyperventilation syndrome Cardiac arrhythmia People in which of the following age groups are prone to significant trauma due to falls? A) College-aged adults B) Geriatric population C) Pediatric population Geriatric population Which of the following is NOT a complication of crush syndrome? A) Renal failure B) Difficult-to-control hemorrhage C) Cardiac arrhythmias D) Systemic alkalosis Systemic alkalosis The two factors that refer to the rate of change of speed are: A) Deceleration and velocity B) Mass and weight C) Acceleration and deceleration D) Acceleration and inertia Acceleration and deceleration Which of the following injuries is most likely in a rear-end collision? A) Thoracic and abdominal injuries B) Head and neck injuries C) Pelvic fractures D) Lumbar spine injuries Head and neck injuries You are called to the scene of a vehicle crash in which a car was rear-ended while stopped at a stop sign. Which of the following laws of physics serves as the basis for analyzing the mechanism of injury and the associated index of suspicion for injuries? A) The amount of energy transmitted to an object is inversely proportional to its rate of deceleration. B) Energy can neither be created nor destroyed. C) A body at rest will remain at rest unless acted on by an outside force. D) A body in motion will remain in motion unless acted on by an outside force. A body at rest will remain at rest unless acted on by an outside force. In falls, which section of the spinal column is the MOST prone to compression injury? A) Sacral B) Cervical C) Thoracic D) Lumbar Lumbar Which of the following injuries is NOT associated with the use of vehicle restraint systems? A) Traumatic brain injury B) Abrasions and contusions to the clavicle and chest area C) Lumbar spine trauma D) Abdominal injury Traumatic brain injury Applying Newton's second law of motion to a vehicle traveling 70 miles per hour, crashing into which of the following would transfer the most force to the patient? A) Bridge abutment B) Shrubbery C) A body of water D) Signpost Bridge abutment Which of the following is TRUE of the differences between adult and pediatric pedestrians when struck by a vehicle? A) Adults tend to be thrown under the vehicle. B) Children tend to be thrown onto the hood of the vehicle. C) Children tend to turn toward the vehicle. D) Adults tend to turn toward the vehicle. Children tend to turn toward the vehicle. Which of the following is most likely to be fractured from a fall onto outstretched hands? A) Carpals B) Metacarpals C) Clavicle D) Ulna Clavicle Your patient, a 23-year-old woman who is 6 months pregnant, was the unrestrained driver of a vehicle that rear-ended a parked car. The air bag deployed. Considering the likelihood of organ collision, for which of the following injuries should you maintain a high index of suspicion? A) Cardiac contusion B) Anterior flail segment C) Abruptio placentae D) Fractured sternum Abruptio placentae Which of the following best describes why the occupants of a vehicle moving at 50 miles per hour will be injured when the vehicle strikes a tree but not when it brakes to a stop? A) Braking allows the kinetic energy to be absorbed evenly into the frame of the vehicle, rather than concentrating it at the point of impact. B) The energy gradually dissipates as heat due to the friction of braking, rather than transferring to the vehicle and its occupants. C) The inertia of the tree increases the kinetic energy transmitted to the occupants by a factor of 10. D) None of the above describes why. The energy gradually dissipates as heat due to the friction of braking, rather than transferring to the vehicle and its occupants. In frontal impact collisions which pathway of patient travel results in higher mortality? A) Vertical B) Straight C) Up-and-over D) Down-and-under Up-and-over Upon arriving at the scene of a single-vehicle collision in which the vehicle struck a utility pole, you note that the windshield is "spidered," or "starred," and that the driver was not restrained. Which of the following injuries is most likely? A) Whiplash injury of the neck muscles B) Compression injury of the cervical spine C) Distraction injury of the cervical spine D) Ligamentous neck injury due to rotation beyond the range of motion Compression injury of the cervical spine Which of the following factors is NOT a consideration in the severity of injury related to falls? A) Landing surface B) Wind resistance C) The initial point of impact D) Distance of the fall Wind resistance Which of the following is TRUE of motorcycle collisions? A) Frontal impact can result in intraabdominal, pelvic, and femur injuries. B) A rider who "lays down the bike" will generally receive more severe injuries than a rider who stays with the bike. C) The structural steel of the vehicle absorbs most of the kinetic energy in a motorcycle collision. D) The use of helmets has drastically reduced the incidence of cervical spine injuries. Frontal impact can result in intraabdominal, pelvic, and femur injuries. In which of the following types of impact should you have a higher index of suspicion because the degree of injury may be greater than the damage alone indicates? A) Rear-end B) Oblique C) Lateral D) Frontal Lateral Which of the following best defines the term energy? A) The ability to deform solid objects B) The rate of motion related to time C) The capacity to do work D) The amount of heat generated through friction The capacity to do work Which of the following contributes to a greater degree of injury than anticipated from vehicle damage alone in a lateral-impact motor vehicle collision? A) Increased gravitational forces due to multiple changes in direction and velocity B) Lack of a crumple zone C) Taking the up-and-over pathway D) The force of side-impact air bag deployment Lack of a crumple zone Which of the following injuries is NOT commonly related to snowmobiling? A) Ejections B) Crush injuries C) Drowning D) Glancing blows against obstructions in the snow Drowning Which of the following is the most important priority when caring for a patient with a shallow-water diving injury? A) Assessing the cervical spine for deformity B) Maintaining cervical spine stabilization while opening the airway C) Removing the patient from the water as soon as possible D) Initiating rescue breathing once out of the water Maintaining cervical spine stabilization while opening the airway Which of the following impacts the severity of injury sustained in a motor vehicle collision? A) Gross vehicle weight B) Rate of acceleration or deceleration C) Vehicle speed D) All of the above All of the above Which of the following is NOT a type of collision that must be considered when analyzing a motor vehicle collision? A) The vehicle strikes an object B) The occupants' organs strike the interior of the body cavity C) The body of the occupant strikes the interior of the vehicle D) A hubcap flies off and strikes a tree A hubcap flies off and strikes a tree Which of the following best describes what happens to the kinetic energy of a vehicle traveling at 65 miles per hour when it collides into a concrete barrier wall? A) The energy dissipates as sound waves. B) The body of the vehicle and its occupants absorb the energy. C) The wall's foundation absorbs the energy. D) The energy converts to heat through friction. The body of the vehicle and its occupants absorb the energy. Which two of the following factors proportionately affect the kinetic energy of a bullet fired from a gun? A) Friction and distance B) Mass and friction C) Velocity and mass D) Friction and velocity Velocity and mass Which of the following injuries is associated with the pressure wave produced by a blast? A) Pneumothorax B) Lacerated liver C) Fractures D) Ruptured spleen Pneumothorax Axial loading is most likely to occur in which type of impact? A) Frontal with an up-and-over pathway B) Frontal with a down-and-under pathway C) Rear with the headrest too low D) Lateral on the side of the vehicle opposite the occupant Frontal with an up-and-over pathway Which of the following "paper bag syndrome" injuries may occur due to sudden compression of the thorax or abdomen? A) Pulmonary and myocardial contusions B) Pneumothorax and diaphragmatic rupture C) Cardiac tamponade and aortic dissection D) Pneumothorax and myocardial contusion Pneumothorax and diaphragmatic rupture Which of the following statements about lateral impact collisions is TRUE? A) The substantial lateral crumple zone prevents most injuries. B) Damage to the vehicle is a reliable indication of the seriousness of injuries. C) The degree of injury may be greater than the damage alone would indicate. D) Fatalities are rare because the upper extremities absorb the energy. The degree of injury may be greater than the damage alone would indicate. Which of the following mechanisms is most consistent with fractured vertebrae from a rapid lateral twisting motion? A) Direct trauma, such as from a blow to the head B) Low-velocity penetrating trauma from an ice pick C) High-velocity penetrating trauma from a gunshot wound D) Lateral-impact motor vehicle collision Lateral-impact motor vehicle collision Frontal impacts in which the patient takes a "down-and-under" pathway typically result in which of the following injury patterns? A) Traumatic brain injury B) Hip and femur fractures C) Rupture of the diaphragm D) Rupture of hollow organs Hip and femur fractures You are dispatched to a building collapse with an entrapped patient who will require a lengthy extrication. Which of the following medications should you consider for this patient while awaiting extrication? A) Sodium bicarbonate B) Diazepam C) Furosemide D) Calcium channel blockers Sodium bicarbonate Which of the following is TRUE of the injuries sustained by the elderly due to falls? A) The injuries sustained by the elderly are less likely to result in hospitalization. B) Only more significant falls cause fractures. C) Less significant falls may cause fractures. D) The elderly sustain injuries similar to other age groups in comparable falls. Less significant falls may cause fractures. Which of the following is NOT one of the major types of recreational vehicles involved in crashes? A) Snowmobiles B) Jet Skis C) All-terrain vehicles D) Go-carts Go-carts Which of the following traumas contributes most significantly to motor vehicle collision mortality? A) Chest B) Head C) Abdominal D) Cervical spine Head In a motor vehicle collision, when the driver's chest strikes the steering wheel, what produces injury next? A) The air bag deploys a second time. B) The steering column shears off, causing penetrating trauma. C) Unsecured objects in the vehicle become projectiles. D) The heart continues its forward motion until it strikes the chest wall. The steering column shears off, causing penetrating trauma. When inspecting the interior of a vehicle involved in a frontal collision, you note that the dash panel beneath the steering wheel is broken. Which of the following injuries might this indicate? A) Fracture of the acetabulum B) Femur fracture C) Knee injury D) All of the above All of the above Which of the following injuries is associated with the tertiary phase of a blast? A) Crush injuries B) Barotrauma C) Burns D) Projectile injuries Crush injuries Which of the following statements about the impact of motorcycle helmet usage is TRUE? A) Helmet use moderately increases the incidence of cervical spine injury. B) Helmet use moderately decreases the incidence of cervical spine injury. C) Helmet use substantially decreases the incidence of cervical spine injury. D) Helmet use neither increases nor decreases the incidence of cervical spine injury. Helmet use neither increases nor decreases the incidence of cervical spine injury. Which of the following mechanisms in a motor vehicle collision would most likely result in a tear of the liver at the ligamentum teres? A) Gradual deceleration B) Sudden acceleration C) Sudden deceleration D) Gradual acceleration Sudden deceleration Which of the following statements is NOT true of occupant ejection in motor vehicle collisions? A) Ejection accounts for 27 percent of motor vehicle fatalities. B) The number of occupant impacts increases with ejection. C) Ejection has not been reported with lateral-impact collisions. D) Ejection is most often associated with frontal-impact collisions. Ejection has not been reported with lateral-impact collisions. Which of the following may result from aggressive ventilation of the blast patient? A) Emboli B) Pericardial tamponade C) Hemorrhage D) Acidosis Emboli A vehicle is struck in its right front as it passes through an intersection, resulting in an oblique impact. Which of the passengers is subjected to the greatest acceleration forces? A) The right-rear passenger B) The left-rear passenger C) The front-seat passenger D) The driver The left-rear passenger You have responded to a soccer field on which two 13-year-olds have collided during a game. Which of the following findings in either patient requires ambulance transport for further evaluation in the emergency department? A) Weakness in the upper extremities B) Complaint of "getting the wind knocked out of me" C) Contusion to the thigh D) Minor epistaxis Weakness in the upper extremities Which type of motor vehicle collision is most common in rural areas? A) Frontal B) Lateral C) Rollover D) Rear-end Frontal You are the first arriving unit for injured persons due to a propane tank explosion. The first patient you notice is a young adult male who appears to be seriously injured. Which of the following should you do first? A) Request an arson investigator to come to the scene. B) Locate all patients. C) Do a scene size-up and establish incident command. D) Begin resuscitation of any patients who are apneic and/or pulseless. Do a scene size-up and establish incident command. Which of the following is TRUE of supplemental restraint systems? A) They may deploy during rescue operations, injuring the patient and/or EMS personnel. B) When worn incorrectly, they may cause spinal injury or decapitation. C) They guard against thoracic impact with the steering wheel. D) They are primarily useful in preventing injury to infants and children riding in the front seat. They may deploy during rescue operations, injuring the patient and/or EMS personnel. Which of the following mechanisms may result in a conventional explosion? A) Fumes B) Dust C) Aerosol propellants D) All of the above All of the above CHAPTER 3 Which of the following statements about low-velocity penetrating trauma is TRUE? A) Shorter knives and ice picks may be removed if they are left in the wound. B) There is no pressure shock wave with a knife wound as there is with an arrow wound. C) More injuries are sustained from arrows than from knives. D) Knives, arrows, ice picks, and similar weapons cause damage only in their direct path. Knives, arrows, ice picks, and similar weapons cause damage only in their direct path. Your patient is an eight-year-old male with a pencil impaled 2 centimeters inferior to the xiphoid process. You note that the pencil is pulsating. Which of the following is the best action? A) Start an IV and request orders for analgesia and sedation. B) Remove the pencil and apply direct pressure to the wound; transport to a trauma center if the bleeding does not stop with direct pressure. C) Stabilize the pencil in place and transport to a trauma center. D) Stabilize the pencil and transport to the nearest medical facility. Stabilize the pencil in place and transport to a trauma center. The pathway of injury left in the wake of a penetrating mechanism of injury is called: A) Cone of injury B) Cavitation C) Profile D) Trajectory Cavitation The passage through tissue of a high-energy bullet creates a temporary cavity and a permanent cavity. Which of the following statements is TRUE of the permanent cavity created by penetrating trauma? A) It is filled with disrupted tissues, some air, fluid, and debris. B) It is the damage done when the projectile fragments penetrate. C) It is a space created by a projectile as tissue moves rapidly away in its path. D) It is a potential space, not an actual space. It is filled with disrupted tissues, some air, fluid, and debris. Which of the following is TRUE of the pressure wave that accompanies high-velocity penetrating trauma? A) Hollow organs are less tolerant of the stress than solid organs are. B) Pressure waves cause no injury to surrounding tissues; they only momentarily disrupt function. C) Elastic tissues are less tolerant of the stress than nonelastic tissues. D) The pressure wave may be transmitted through blood, resulting in damage to blood vessels some distance from the primary wound. The pressure wave may be transmitted through blood, resulting in damage to blood vessels some distance from the primary wound. Your patient is a 50-year-old male with a gunshot wound to the right anterior chest. He is unresponsive. Which of the following should you do first? A) Check for a carotid pulse. B) Seal the chest wound. C) Auscultate breath sounds. D) Check for breathing. Check for breathing Your patient is a 30-year-old female with a stab wound to the neck. She is sitting up and appears very anxious and short of breath. There is minimal external bleeding noted, but there is bubbling from the wound. Which of the following should you suspect, based on the mechanism of injury and assessment findings? A) Laceration of the trachea B) An injury to the spinal cord at the level of the stab wound C) Laceration of the ipsilateral carotid artery D) All of the above Laceration of the trachea If you were to design a bullet to have the highest energy exchange, what would you do? A) Decrease the drag B) Increase the caliber C) Decrease the bullet's trajectory D) Design the bullet to become more unstable Design the bullet to become more unstable Which of the following is most important when assessing the damage done by a gunshot? A) The type of gun used B) The size of the bullet C) The distance from the shooter D) Whether there was an upward or a downward trajectory when the bullet was fired The distance from the shooter A penetrating injury to which of the following organs is LEAST likely to result in severe hemorrhage? A) Liver B) Kidney C) Spleen D) Ureter Ureter Which of the following is TRUE of shotgun ammunition? A) A shotgun may either fire one slug or use ammunition with multiple pellets. B) The shot is dispersed from the cartridge with high velocity. C) The closer the shooter is to the victim, the larger the area of visible damage. D) "Double ought" or #00 shot contains a large number of relatively small pellets. A shotgun may either fire one slug or use ammunition with multiple pellets. Which of the following abdominal organs is the least affected by the pressure wave associated with penetrating trauma? A) Spleen B) Bowel C) Kidneys D) Liver Bowel The study of the characteristics of projectiles in motion and their effects on the objects they impact is called: A) Trajectory B) Cavitation C) Ballistics D) Forensics Ballistics You have arrived on the scene of a 17-year-old male with a gunshot wound to the thigh. Police are on the scene. There is significant ongoing hemorrhage from the wound. The patient is screaming for someone to help him. Which of the following should you do first? A) Control hemorrhage with direct pressure. B) Perform a rapid trauma assessment. C) Ask the police if they have searched the patient for weapons yet. D) Begin high-concentration oxygen administration. Ask the police if they have searched the patient for weapons yet. As a bullet tumbles, its potential to inflict damage: A) Increases B) Remains the same C) Is determined by the trajectory D) Decreases Increases The path a projectile follows during a flight is called its: A) Cavity B) Ballistics C) Trajectory D) Drag Trajectory Which of the following is TRUE of body armor use? A) There are no reported cases of penetrating trauma among victims who were shot while wearing body armor. B) Blunt trauma may be significant, but the potential for life-threatening injury is less than if armor had not been worn. C) Blunt trauma only occurs if ceramic inserts are placed in the vest. D) Ceramic inserts are dangerous and should not be used, because they generally fragment and create secondary projectiles when they are struck by a bullet. Blunt trauma may be significant, but the potential for life-threatening injury is less than if armor had not been worn. Which of the following is most susceptible to damage from the pressure wave when a bullet enters it? A) Intestines B) Femoral artery C) Liver D) Lungs Liver Which of the following is TRUE about determining the pathway of the bullet when assessing a patient with a gunshot wound? A) You should try to determine the bullet's pathway. B) The purpose of determining the bullet's pathway is to anticipate which organs may have been affected, which will help to guide your priorities for on-scene care or rapid transport. C) It is difficult to determine the pathway of a bullet because it may not travel in a straight line, possibly being deflected by structures in its path or being shifted by natural movements of the diaphragm and other organs and structures of the body. D) All of the above All of the above Which statement about ballistics is TRUE? A) Damage is less when the bullet does not exit the body. B) When a bullet tumbles, it decreases the damage. C) In penetrating trauma, the mass of a projectile is more significant than its velocity when determining kinetic energy. D) When a bullet yaws, it increases the damage. When a bullet yaws, it increases the damage. When you are assessing someone with a gunshot wound from a rifle, which of the following is important to remember? A) The zone of injury is larger than that expected with other types of weapons. B) The muzzle velocity is less than that of a handgun. C) The trajectory is longer, allowing more energy to be dissipated by drag before it strikes the victim. D) The cavitation is limited to the direct path of the bullet. The zone of injury is larger than that expected with other types of weapons. Which of the following is typical of the trajectory of a knife when a female assailant stabs someone? A) The trajectory is lateral: right-to-left if she is right-handed and left-to-right if she is left-handed. B) The movement is downward as the assailant raises the knife and swings downward. C) The movement is upward as the assailant drives upward with the knife. D) The trajectory tends to be in a horizontal plane at the level of the assailant's shoulder. The movement is downward as the assailant raises the knife and swings downward. Greater velocity of a bullet will cause a ________ path of travel and a ________ trajectory. A) Wavier, straighter B) Flatter, wavier C) More rounded, curved D) Flatter, straighter Flatter, straighter Which of the following is TRUE of the temporary cavity formed by penetrating trauma? A) It heals more slowly than the permanent cavity because of the nature of the tissue damage. B) It fills with disrupted tissues, some air, fluid, and debris. C) It is a space indirectly created by a projectile as tissue moves rapidly away from its path. D) It is the damage that occurs when the projectile fragments. It is a space indirectly created by a projectile as tissue moves rapidly away from its path. Which of the following is TRUE of defense wounds in the victim of a knife attack? A) They usually occur to the shoulder as the victim attempts to turn away from the attack. B) They often occur to the neck and head as the victim doubles over into a protective posture. C) They usually occur to the hands and arms as the victim raises them to ward off the attacker. D) They rarely occur because the victim is usually taken by surprise. They usually occur to the hands and arms as the victim raises them to ward off the attacker. To gain an appreciation for the potential for trauma from high-velocity projectiles, it is important to remember that the shock wave produced can exceed atmospheric pressure by up to ________ times. A) 25 B) 100 C) 50 D) 80 100 Which of the following is associated with assault rifle wounds but not hunting rifle wounds? A) Permanent cavitation B) Multiple wounds C) Smaller exit wounds D) Larger exit wounds Multiple wounds Which of the following statements about bullets is TRUE? A) A high-velocity bullet is three times less likely to do major harm. B) The larger the bullet the smaller its energy. C) A small, light bullet does the most harm. D) The hunting rifle's bullet is usually a lighter bullet, but it travels faster. A small, light bullet does the most harm. During the scene size-up on a call for a patient with penetrating trauma due to a stab wound, which of the following should you do? A) Collect anything that could be used as evidence. B) Check for weapons on or near the patient. C) Try to find out in which direction the assailant fled. D) Assume that the patient has no weapons if law enforcement is on the scene. Check for weapons on or near the patient. Which of the following statements about stab wounds is TRUE? A) The presence of defense wounds decreases the likelihood of trauma to the neck, thorax, and abdomen. B) Damage is usually limited to physical injury caused by direct contact between the blade and the victim's tissue. C) The size and shape of the weapon allow precise prediction of the injury. D) Stab wounds by female attackers are seldom lethal. Damage is usually limited to physical injury caused by direct contact between the blade and the victim's tissue. Which of the following statements about entrance and exit wounds is TRUE? A) Exit wounds are usually the size of the bullet's profile. B) Entrance wounds most often appear as stellate. C) Cavitational wave energy is greatest at a bullet's point of entrance. D) Only a thorough forensic examination by a qualified expert can determine with certainty whether a given wound is an entrance wound or an exit wound. Only a thorough forensic examination by a qualified expert can determine with certainty whether a given wound is an entrance wound or an exit wound. Which of the following organs would be most likely to be injured by a stab wound to the sixth intercostal space in the midaxillary line on the right side? A) Liver, bladder, kidney, small intestine B) Stomach, pancreas, lung C) Liver, diaphragm, lung, kidney D) Spleen, diaphragm, lung, kidney Liver, diaphragm, lung, kidney Which of the following is best described as "the area of contused tissue resulting from penetrating trauma that may be slow to heal due to disrupted blood flow and tissue damage"? A) Temporary cavity B) Zone of injury C) Zone of coagulation D) Permanent cavity Zone of injury Penetrating trauma to the face can complicate airway management by which of the following mechanisms? A) Laryngotracheal edema B) Airway obstruction C) Destruction of anatomical landmarks D) B and C B and C The initial assessment of a patient with a gunshot wound to the chest should focus on detecting which of the following? A) Pancreatitis B) Tension pneumothorax C) Cardiac contusion D) Peritonitis Tension pneumothorax Which two factors related to kinetic energy proportionately affect the damage a projectile will do? A) Velocity and yaw B) Velocity and mass C) Mass and fragmentation D) Fragmentation and velocity Velocity and mass Which type of firearm usually limits trauma to direct injury? A) Hunting rifle B) Military rifle C) Automatic weapon D) Handgun Handgun Your patient is a construction worker who fell 15 feet and has a 3-foot metal concrete reinforcement bar (rebar) impaled in his right thigh. Which of the following is the best action? A) Administer sodium bicarbonate to combat acidosis resulting from the destruction of muscle tissue. B) If the proper tools and personnel are present, have rescuers cut the rebar to a manageable length. C) If you can see both ends of the rebar, gently remove it and irrigate the wound with sterile saline. D) Transport the patient without attempting to shorten or remove the rebar. If the proper tools and personnel are present, have rescuers cut the rebar to a manageable length. Which of the following bullet characteristics would create the most damage? A) Lack of tumble B) A small profile C) A full metal jacket D) "Mushrooming" or flattening on impact "Mushrooming" or flattening on impact As the mass of an object increases, which of the following occurs? A) The maximum speed it can attain increases. B) The amount of energy decreases. C) The maximum speed it can attain decreases. D) The amount of energy increases. The amount of energy increases. Your patient is a 60-year-old male with a gunshot wound in the second intercostal space anteriorly on the left. You note that he has frothy blood coming from his mouth. For which of the following must you have the highest index of suspicion? A) Tension pneumothorax B) A history of congestive heart failure C) Pericardial tamponade D) Traumatic asphyxia Tension pneumothorax Which of the following statements about rifles is TRUE? A) Assault rifles generally increase the number of wounds the victim sustains. B) Hunting rifles have larger magazines and operate semiautomatically. C) Assault rifles do not accept domestic hunting ammunition and thus create a projectile profile that is smaller and causes less damage. D) Assault rifles have greater velocity than hunting rifles and only operate automatically. Assault rifles generally increase the number of wounds the victim sustains Your patient has a gunshot wound to the left posterior thorax. Which of the following is NOT appropriate in initial assessment? A) Beginning bag-valve-mask ventilations B) Auscultating breath sounds bilaterally in six places, anteriorly and posteriorly C) Stabilizing a flail segment, should one be noted D) Placing a gloved hand over a sucking chest wound Auscultating breath sounds bilaterally in six places, anteriorly and posteriorly Which of the following is NOT considered penetrating trauma? A) Receiving a wood splinter in the foot while walking on an unfinished deck B) A superficial wound resulting from a pellet from a pellet gun being lodged under the skin C) A laceration from a kitchen knife D) A laceration on the forehead as a result of being struck with a metal pipe A laceration on the forehead as a result of being struck with a metal pipe Which of the following increases a bullet's profile? A) "Mushrooming" on impact B) The use of rifling in the barrel of the firearm C) Tumbling 180 degrees on impact D) A and C A and C As the energy from a medium- or high-velocity projectile pushes tissue from its path, which of the following occurs? A) Damage depends on the net difference between pressure at the entrance wound and pressure at the exit wound. B) There is no vacuum created when there is both an entrance and an exit wound. C) Negative pressure is generated inside the cavity, drawing debris into the wound. D) There is negative pressure at the entrance wound and positive pressure at the exit wound. Negative pressure is generated inside the cavity, drawing debris into the wound. Which of the following is most likely to occur when military ammunition is used? A) It will "mushroom" or flatten. B) It will remain intact. C) It will fragment. D) It will explode. It will remain intact. Which of the following is considered a high-velocity weapon? A) Shotgun B) Arrow C) Handgun D) Rifle Rifle CHAPTER 4 In a previously healthy individual, which of the following types of shock may NOT result in the typical signs of cool, pale, moist skin; tachycardia; and narrowed pulse pressure? A) Neurogenic B) Cardiogenic C) Hypovolemic D) Hemorrhagic Neurogenic Which of the following guidelines applies to the prehospital administration of IV fluids in the patient with hemorrhagic shock? A) Administer hypertonic saline solution or colloids at a keep-open rate. B) Administer synthetic oxygen-carrying fluids as necessary to increase the level of consciousness. C) Begin with a 2,000 ml bolus of isotonic crystalloid solution infused under pressure. D) Administer isotonic crystalloid fluids only as necessary to maintain perfusion. Administer isotonic crystalloid fluids only as necessary to maintain perfusion. Your patient is a 23-year-old male with a gunshot wound to the abdomen and an exit wound in the right flank. He responds to verbal stimuli; has pale, cool, diaphoretic skin; and has a heart rate of 128, respirations at 24, and a blood pressure of 82/60. These findings indicate which of the following kind of shock? A) Compensated B) Irreversible C) Decompensated D) Neurogenic Decompensated Your patient is a 42-year-old male with multiple lacerations on his arms, head, and torso after falling through a plate-glass window. On your arrival he appears to be unresponsive, lying prone on the sidewalk. Which of the following is the correct sequence of actions in caring for this patient? 1. Control major hemorrhage. 2. Take body-substance-isolation precautions. 3. Check the area for broken glass before kneeling next to the patient. 4. Turn him to a supine position. 5. Open his airway. A) 2, 3, 1, 4, 5 B) 2, 5, 1, 3, 4 C) 3, 2, 4, 1, 5 D) 2, 3, 4, 5, 1 3, 2, 4, 1, 5 Which of the following results from anaerobic metabolism in shock? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory alkalosis D) Respiratory acidosis Metabolic acidosis Which of the following, located in the aortic arch, monitor blood pressure and send feedback to the medulla oblongata to maintain homeostasis? A) Volume receptors B) Proprioceptors C) Baroreceptors D) Chemoreceptors Baroreceptors Managing a laceration with arterial bleeding most often requires: A) Cauterization B) A tourniquet C) PASG D) Direct pressure Direct pressure In which of the following patients with hemorrhagic shock can you employ aggressive fluid resuscitation? A) A 50-year-old male with a stab wound to the right upper quadrant of the abdomen B) A 45-year-old woman with a suspected ruptured ectopic pregnancy C) A 38-year-old male with an open femur fracture and a developing bruise beneath the right scapula following an assault D) A 26-year-old male with a gunshot wound involving the popliteal artery A 26-year-old male with a gunshot wound involving the popliteal artery Which of the following results from the beta 1 actions of epinephrine in response to shock? 1. Positive inotropy 2. Positive chronotropy 3. Positive dromotrophy 4. Bronchiolar smooth muscle relaxation 5. Increased peripheral vascular resistance A) 1, 2, 3 B) 1, 2, 5 C) 1, 2, 3, 4 D) 2 and 4 1, 2, 3 In anaphylactic shock, a massive _______ release causes general vasodilation, precapillary sphincter dilation, capillary engoregement, and fluid movement into the interstitial compartment. A) norepinephrine B) epinephrine C) histamine D) insulin histamine Which of the following results from relaxation of the postcapillary sphincters in shock? A) Diffuse intravascular coagulation B) Melena C) "Washout" of microemboli and lactic acid D) Septicemia "Washout" of microemboli and lactic acid Which of the following is defined as the volume of blood ejected from the heart with each beat? A) Stroke volume B) Ventricular capacitance C) Cardiac output D) Afterload Stroke volume A fracture of the femur may result in a hematoma that contains enough blood to make it a Class ________ hemorrhage. A) I B) III C) IV D) II III Your patient is a 45-year-old male who has received several stab wounds to the chest and abdomen. Although bleeding was significant at first, the rate of bleeding had slowed considerably before your arrival. The patient is agitated and confused, pale, diaphoretic, and cool to the touch. He lacks a radial pulse, and his carotid pulse is weak and rapid. Respirations are 28 and shallow. Which of the following is certain with this patient? A) He is in irreversible shock. B) He is in decompensated shock. C) He is in compensated shock. D) None of the above is certain. He is in decompensated shock. Your patient has a possible pelvic fracture from a frontal motor vehicle collision. She has a blood pressure of 78 by palpation, has a heart rate of 130, and responds only to painful stimuli. Before you arrived BLS providers immobilized the patient to a long backboard. Which of the following should you do next? A) Apply PASG B) Initiate rapid transport C) Perform a rapid trauma assessment D) Start a large-bore IV of lactated Ringer's solution Initiate rapid transport Peripheral vascular resistance (afterload) is measured as which of the following? A) Pulse pressure B) Mean arterial pressure C) Hydrostatic pressure D) Oncotic pressure Mean arterial pressure Which of the following substances has the most rapid effect when compensating for hemorrhage? A) Glucocorticoids B) Catecholamines C) Antidiuretic hormone D) Angiotensin II Catecholamines Which of the following is the preferred in-hospital fluid for resuscitation in hemorrhagic shock? A) Fresh frozen plasma B) Lactated Ringer's C) Whole blood D) Normal saline Whole blood Which of the following best describes the importance of oxygen in cellular metabolism? A) It prevents pyruvic acid from being converted to lactic acid. B) It prevents the formation of pyruvic acid in the Krebs cycle. C) It is necessary for glycolysis. D) It limits the overproduction of energy in the citric acid cycle. It prevents pyruvic acid from being converted to lactic acid. When cells become hypoxic and the amount of carbon dioxide in them increases, reducing tissue pH, which of the following occurs to restore homeostasis? A) Mast cells release serotonin, resulting in dilation of the capillary sphincters and an increase in tissue perfusion. B) Mast cells release histamine, resulting in dilation of capillary sphincters and an increase in tissue perfusion. C) The sympathetic nervous system constricts the capillary sphincters to prevent washout of the accumulated lactic acid. D) The precapillary sphincters open, increasing blood flow to the tissues. The postcapillary sphincters remain closed so that increased hydrostatic pressure forces lactic acid into the interstitial fluid, where it is buffered. Mast cells release histamine, resulting in dilation of capillary sphincters and an increase in tissue perfusion. The phase of blood clotting in which the smooth muscle of an injured blood vessel contracts is known as the ________ phase. A) Hemolytic B) Hemostatic C) Vascular D) Ischemic Vascular Which of the following findings indicates a progression from compensated shock to decompensated shock? A) Narrowing pulse pressure B) Tachycardia C) Altered mental status D) Diaphoresis Altered mental status When assessing the chest during rapid trauma survey, what is most likely to indicate major internal hemorrhage? A) Hyperresonance to percussion B) Increased respiratory rate C) Distended neck veins D) Dullness to percussion Dullness to percussion Which of the following types of wound facilitates the effectiveness of normal blood-clotting mechanisms? A) Vessels torn by stretching, such as when a limb is caught in farm machinery B) Transverse laceration of the vessel C) Longitudinal laceration of the vessel D) Crushing injuries Transverse laceration of the vessel Which of the following mechanisms is responsible for accumulating lactic acid in shock? A) The citric acid cycle B) Gluconeogenesis C) Hemostasis D) Anaerobic metabolism Anaerobic metabolism A hematoma resulting from a fracture of the humerus may contain enough blood to make it a Class ________ hemorrhage. A) II B) IV C) III D) I I Which of the following does NOT indicate compensated shock? A) Anxiety B) Altered mental status C) Weakness D) Thirst Altered mental status Which of the following is NOT a benefit of PASG? A) An autotransfusion of up to 2,000 ml of blood from the lower extremities B) Minimizing movement of the pelvis and lower extremities C) Increasing peripheral vascular resistance D) Decreasing the size of the vascular container An autotransfusion of up to 2,000 ml of blood from the lower extremities Even with intervention, survival is unlikely with blood loss over ________ percent of the total blood volume. A) 25 B) 15 C) 50 D) 35 35 Which of the following indicates that a patient has transitioned from compensated to decompensated shock? A) Widening pulse pressure B) Increased respiratory rate C) Hypotension D) Peripheral vasoconstriction Hypotension Red blood cells make up approximately ________ percent of whole blood volume. A) 45 B) 60 C) 30 D) 15 45 Which of the following is a manifestation of orthostatic hypotension? A) Your patient's pulse is 76 when he is supine but 88 when he sits up. B) Your patient's blood pressure is 142/90 when she is supine but 116/88 when she sits up. C) Your patient's blood pressure is 150/100 when he is supine but 134/90 when he sits up. D) Your patient's pulse is 80 when she is supine but 96 when she sits up. Your patient's blood pressure is 142/90 when she is supine but 116/88 when she sits up. Assuming all of the following patients have experienced significant blood loss and are hypotensive, in which would the use of PASG be absolutely contraindicated? A) A 19-year-old female with an unstable pelvis after being thrown from a horse B) A 35-year-old pregnant woman with bilateral femur fractures sustained in a head-on motor vehicle collision C) A 16-year-old male with massive blood loss from a severed popliteal artery as a result of being struck by a piece of metal debris ejected by a lawn mower D) A 31-year-old man with a stab wound between his thoracic vertebral column and right scapula A 31-year-old man with a stab wound between his thoracic vertebral column and right scapula The blood flowing to the heart best describes: A) Contractility B) Afterload C) Preload D) Vascular phase Preload Under normal circumstances, at any given moment most of the blood is in the ________ system. A) Venous B) Capillary C) Hematopoietic D) Arterial Venous Which of the following best describes definitive care for the trauma patient with ongoing, significant hemorrhage? A) Administration of blood or blood products B) Administration of hypertonic crystalloid or colloid solution C) Invasive hemodynamic monitoring and serial hematocrits D) Immediate surgery Immediate surgery Which of the following impairs blood clotting? A) Hypothermia B) Administration of IV fluids C) Use of nonsteroidal, anti-inflammatory medications D) All of the above All of the above For which of the following mechanisms of injury should you maintain the highest index of suspicion for hemorrhagic shock? A) Ten-foot fall from a ladder B) Frontal-impact motor vehicle collision at 45 miles per hour C) Gunshot wound resulting in an open tibia fracture D) Blunt trauma to the head, resulting in a full-thickness laceration to the forehead Frontal-impact motor vehicle collision at 45 miles per hour The rapid trauma exam focuses on finding injuries that may cause shock by quickly assessing which of the following body areas? 1. Head 2. Neck 3. Chest 4. Abdomen 5. Pelvis 6. Proximal extremities 7. Distal extremities A) 1, 2, 3, 4, and 5 B) 1, 4, 5, and 6 C) 1, 2, 3, 4, 5, 6, and 7 D) 3, 4, 5, and 6 1, 2, 3, 4, and 5 Which of the following measures effectively controls bleeding in body cavities? A) PASG B) Administration of platelets and clotting factors C) Surgery D) Therapeutic hypotension Surgery Septic shock results from massive infection releasing what substances into the vascular system? A) Toxins B) Lactic acid C) Catecholamines D) Aldosterone Toxins Which of the following statements about the patient in neurogenic shock is NOT true? A) Signs of hypovolemic shock may be masked. B) Unopposed sympathetic nervous stimulation results in generalized pallor and diaphoresis. C) The heart rate may be normal. D) Neurogenic shock may be temporary, even if spinal cord damage is permanent. Unopposed sympathetic nervous stimulation results in generalized pallor and diaphoresis. Your patient is an obese 39-year-old woman involved in a lateral-impact motor vehicle collision. Which of the following should you remember when assessing and treating this patient? A) Relative to body size, this patient can tolerate a larger amount of hemorrhage before showing signs of shock. B) This patient will tolerate blood loss well, as only nonvital tissues will become ischemic. C) Relative to body weight, a smaller amount of hemorrhage may result in shock. D) Blood volume increases proportionally with body weight, and the patient will experience signs of shock consistent with the classic stages of hemorrhage. Relative to body weight, a smaller amount of hemorrhage may result in shock. Which of the following fluids is appropriate for the prehospital management of hypovolemic shock? A) Five percent dextrose in water B) Lactated Ringer's C) A 0.2% sodium chloride solution D) A 0.45% sodium chloride solution Lactated Ringer's Which of the following would be the most likely cause of neurogenic shock? A) Pericardial tamponade B) Spinal cord injury C) Systemic infection D) Massive histamine release Spinal cord injury Rapid volume replacement is best achieved under which of the following conditions? A) Use of a long catheter with a large internal diameter B) Use of a long catheter with a small internal diameter C) Use of a short catheter with a small internal diameter D) Use of a short catheter with a large internal diameter Use of a short catheter with a large internal diameter Which of the following vessels has the greatest ability to change diameter? A) Arterioles B) Capillaries C) Systemic arteries D) Aorta Arterioles Your patient is a 29-year-old male who works in a meat-processing plant. He received a knife wound in the proximal anteromedial thigh, which is continuing to bleed on your arrival. He is restless and thirsty and has pale, cool skin. He has a weak radial pulse of 130 and a blood pressure of 118/88. This patient is exhibiting signs and symptoms consistent with a Class ________ hemorrhage. A) III B) II C) IV D) I II Which of the following early signs of shock is easily missed? A) Tachycardia B) Decrease in respiratory rate and volume C) Decrease in blood pressure D) Narrowing pulse pressure Tachycardia Which of the following is TRUE of the elderly trauma patient? A) The elderly trauma patient is more likely to experience myocardial ischemia as a result of hemorrhage. B) Medications like beta-blockers may interfere with normal compensatory mechanisms. C) Hemorrhage may not result in tachycardia as expected. D) All of the above are true. All of the above are true. Your patient is a 24-year-old male who was struck just below the left scapula with a 3-inch diameter metal pipe. He is awake but having difficulty breathing. His pulse is 112 at the radial artery, and his respiratory rate is 28 per minute and shallow. His breath sounds are present bilaterally but diminished on the left. He has a blood pressure of 108/68. The patient is coughing up some bloody sputum. He has no other complaints, and a rapid trauma survey reveals no additional life-threatening injuries. Which of the following represents the best sequence of intervention for this patient? A) Begin transport immediately, oxygen 15 lpm by nonrebreathing mask, a large-bore IV of isotonic solution to maintain a systolic blood pressure of 120 mmHg or greater B) Oxygen 10-12 lpm by nonrebreathing mask, a large-bore IV of normal saline solution at a keep-open rate, transport C) Oxygen, 15 lpm by nonrebreathing mask, begin transport, a 14-gauge IV of lactated Ringer's solution, wide open D) Oxygen 10-12 lpm by nonrebreathing mask, begin transport, 16-gauge IV at a keep-open rate Oxygen 10-12 lpm by nonrebreathing mask, begin transport, 16-gauge IV at a keep-open rate Which of the following is NOT a characteristic of arterial bleeding? A) Rapid blood loss B) Spurting or pumping as it leaves the body C) Clots quickly on its own D) Bright red Clots quickly on its own In responding to a trauma patient at the scene of a motor vehicle crash, which of the following is an early sign or signs of shock you might encounter during the primary assessment? A) Rapid heart rate and anxiety B) Rapidly dropping blood pressure C) Rapid breathing and air hunger D) Rapidly dropping level of responsiveness Rapid heart rate and anxiety Which of the following represents the correct sequence for controlling hemorrhage from an extremity? A) Direct pressure on the dressing and wound, finger pressure through the dressing to the leaking vessel, and, if pressure fails, application of a tourniquet B) Direct pressure on the dressing and wound, elevation, ice C) Finger pressure through the dressing to the leaking vessel, splinting, ice, elevation D) Direct pressure on the dressing and wound , elevation, ice, tourniquet as a last resort Direct pressure on the dressing and wound, finger pressure through the dressing to the leaking vessel, and, if pressure fails, application of a tourniquet Which of the following terms is best described as the loss of blood from the vascular space? A) Hypovolemia B) Hemorrhage C) Hemostasis D) Shock Hemorrhage CHAPTER 5 You are called to a commercial creamery where an employee got his arm trapped in the ice cream-mixing machinery. You note that the skin has been pulled off his hand and arm from the midforearm down. The patient's muscles, tendons, and bones are exposed. This type of injury is a(n): A) Amputation B) Skinning injury C) Degloving injury D) Crush injury Degloving injury You are assessing an assault victim and note a contusion over the abdomen. Which of the following should you remember while caring for this patient? A) Unless the contusion is over a critical area, such as the spleen or liver, the likelihood of serious injury is minimal. B) A contusion to the abdomen should always increase your index of suspicion for underlying injury. C) If there is no rigidity or distension of the abdomen, serious injury is unlikely. D) The significance of the trauma is related to the amount of pain the patient experiences on palpation. A contusion to the abdomen should always increase your index of suspicion for underlying injury. A nonpenetrating injury caused by blunt trauma that damages blood vessels, causing pain and discoloration, is a(n): A) Ecchymosis B) Strain C) Abrasion D) Contusion Contusion You have responded for an injured person at an address you know to be a motorcycle clubhouse. Your patient was attacked by another party with a broken beer bottle. Your patient has a large laceration on her neck with moderate bleeding. Which property of your dressing material is most important in caring for this patient? A) Occlusive B) Sterile C) Absorbent D) Adherent Occlusive The tough, fibrous sheaths that bundle skeletal muscle are called: A) Tendons B) Fibers C) Sarcolemma D) Fascia Fascia Which of the following statements about crush injuries is most accurate? A) Only closed injuries can be classified as crush injuries. B) The actual source of bleeding in crush injuries may be hard to identify. C) A spongy sensation on palpation of the injured area indicates crush injury. D) Crush injuries are easily identifiable because they invariably result in deformity. The actual source of bleeding in crush injuries may be hard to identify. Which of the following is best described as the accumulation of a pocket of blood in the tissues? A) Hematoma B) Abrasion C) Compartment syndrome D) Contusion Hematoma The acute breakdown of muscle fibers in crushing injury is called: A) Myoglobinemia B) Sarcoidosis C) Rouleaux formation D) Rhabdomyolysis Rhabdomyolysis When caring for an amputated part, which of the following principles apply? 1. Place the unwrapped part in a dry plastic bag, and seal it. 2. Place the part in a plastic bag with the part wrapped in gauze moistened with lactated Ringer's solution or normal saline, and seal it. 3. Always transport the part with the patient. 4. Keep the part moist, and place it in a container of cold water. 5. Keep the part dry, and place it in an ice-filled container. A) 2, 4 B) 2, 3, 4 C) 1, 3, 5 D) 2, 5 2, 4 You arrive on the scene of a patient with severe blunt trauma to the face. You hear gurgling as you approach the patient. After opening the airway with a manual maneuver, what should your next action be? A) Ventilate B) Apply a cervical collar C) Control the source of hemorrhage D) Suction Suction

Which of the following are likely to accumulate in the bloodstream following a large crush injury? A) Myoglobin B) Potassium C) Lactic acid D) All of the above All of the above Your patient is an 18-year-old male who stepped on a nail in the barnyard. The nail penetrated his tennis shoe and punctured his foot. On your arrival, the patient has removed the nail and the shoe. The wound is about 2 mm in diameter with minor bleeding that has been controlled. The skin around the wound is red. The patient does not want to be transported but asks if you can give him "some ointment and a Band-Aid." You should explain to the patient that this type of injury is associated with an increased risk of: A) Infection B) Delayed bleeding C) Scarring D) Nerve damage Infection In which of the following ways does the integumentary system prevent pathogens from entering the body? A) Via humoral immunity B) Via cell-mediated immunity C) Secretes chemotactic factors D) Provides a barrier to the environment Provides a barrier to the environment In which type of soft-tissue injury is the skin cut or torn, leaving a flap of skin attached? A) Avulsion B) Laceration C) Amputation D) Abrasion Avulsion Your patient is a 35-year-old male who has his leg trapped under a section of concrete from an industrial accident. While awaiting removal of the concrete, which type of IV fluid is indicated for administration to this patient? A) Five percent dextrose in water B) Normal saline C) Lactated Ringer's D) Whole blood Normal saline The layer of skin that contains adipose tissue is the ________ layer. A) Dermal B) Connective C) Epidermal D) Subcutaneous Subcutaneous Which of the following medications may be indicated in the treatment of a patient with a crush injury? A) Mannitol B) Potassium chloride C) Lactated Ringer's solution D) Furosemide Mannitol For most open, soft-tissue wounds managed by the paramedic in the prehospital setting, which of the following is a desirable characteristic of the dressing applied? A) Occlusive B) Dry C) Adherent D) Nonabsorbent Dry Your patient is a 19-year-old male who received a penetrating knife wound to his chest. On your arrival he is lying supine with a visible chest wound that is bleeding slightly. You can hear the sucking sound of air moving in and out of the wound. This wound is best managed with: A) A bulky dressing held in place with adhesive strips B) An occlusive bandage sealed on three sides, open on the fourth side C) A dry dressing covered by an adherent bandage D) A sterile, wet dressing held in place with an elastic bandage An occlusive bandage sealed on three sides, open on the fourth side The first stage of wound healing is: A) Hemostasis B) Neovascularization C) Inflammation D) Epithelialization Hemostasis A laceration that is perpendicular to the tension lines of the body is more likely to: A) Become infected B) Heal without a scar C) Be caused by blunt trauma D) Leave a noticeable scar Leave a noticeable scar Your patient is a 30-year-old machinist who had his right hand caught in a press. Upon extrication there is no evidence of significant trauma. You should: A) Splint the hand in the position found, elevate above the heart, apply ice B) Splint in position of function, start an IV of normal saline, consider morphine for analgesia C) Wrap the hand in a bulky dressing held in place by an elastic bandage D) Apply oxygen by nonrebreather, splint using a sling and swath, insert a large-bore IV of lactated Ringer's Splint in position of function, start an IV of normal saline, consider morphine for analgesia Which of the following most accurately describes the bleeding you would expect from an abrasion? A) Bright red, steady flow B) Dark red, steady flow C) Dark red, oozing D) Bright red, oozing Bright red, oozing Which of the following is a principle that should be used when considering application of a tourniquet to control bleeding? A) A tourniquet should be used for severe bleeding that cannot be controlled by any other means. B) Every 15 minutes the tourniquet will need to be removed for 5 minutes, then reapplied. C) A narrow, nonelastic material is best for generating the pressure needed to stop bleeding. D) A blood pressure cuff used as a tourniquet will maintain its pressure if it has been properly applied. A tourniquet should be used for severe bleeding that cannot be controlled by any other means. Your patient is a 15-year-old soccer player who was kicked in the calf by another player. She has a contusion on her calf, but the amount of pain she is experiencing seems out of proportion to the apparent injury. You note that, although you can palpate a pedal pulse, there is swelling in the foot and ankle, and the skin is cool to the touch. You should suspect which of the following at this time? A) Compartment syndrome B) Volkmann's ischemic contracture C) Crush syndrome D) Degloving injury Compartment syndrome The bacteria most often associated with infection of open soft-tissue injury is: A) Streptococcus B) Pseudomonas aeruginosa C) Staphylococcus D) Clostridium tetani Staphylococcus Your patient is a three-year-old male who has struck his head on a concrete patio. He has a linear wound that penetrates the dermis and is approximately 2 cm long. This wound would be best described as a(n): A) Contusion B) Puncture C) Avulsion D) Laceration Laceration Your patient is a 45-year-old type II diabetic who has a nonhealing wound on his right foot. You note that the right leg is discolored and edematous and has subcutaneous emphysema and a foul odor. Which of the following should you suspect? A) MRSA B) Gangrene C) Tetanus D) Compartment syndrome Gangrene CHAPTER 6 The three primary factors that determine the severity of radiation are: A) Distance, shielding, and symptoms B) Duration, shielding, and dose C) Duration, distance, and shielding D) Dose, symptoms, and shielding Duration, distance, and shielding Which of the following has contributed most significantly to the decline in US burn mortality? A) Public service announcements on radio, television, and billboards B) Paramedic involvement in public education C) Visits to elementary schools by firefighters D) Improved building codes and construction and sprinkler and smoke detector use Improved building codes and construction and sprinkler and smoke detector use Which classification of burn is characterized mainly by blisters? A) Full-thickness B) Superficial C) Partial-thickness D) Minor Partial-thickness Based on total body surface area and burn depth, you have determined that an 88-year-old female has a moderate burn. Considering the age of the patient, this burn is classified as: A) Critical B) Significant C) Fatal D) Moderate Critical An area of burned tissue that is not painful is most likely a ________ burn injury. A) Second-degree B) Full-thickness C) Superficial D) Partial-thickness Full-thickness You have been dispatched to a call for a burn patient. Upon arriving, you find a 23-year-old female who was sunbathing and fell asleep. She is alert and oriented and in moderate pain. She has blisters covering her extremities, abdomen, face, and chest. This patient's burns fall into which one of the following categories? A) Superficial B) Critical C) Minor D) Moderate Critical Which of the following stages of burn injury is best described as including a pain response, an outpouring of catecholamines, tachycardia, tachypnea, mild hypertension, and anxiety? A) Resolution B) Emergent C) Fluid shift D) Hypermetabolic Emergent Which tissue layer(s) is (are) affected by partial thickness burns? 1. Epidermis 2. Dermis 3. Subcutaneous 4. Muscle A) 1, 2, 3, and 4 B) 1 and 2 C) 1, 2, and 3 D) 1 1 and 2

The substance within the body that is responsible for preventing atelectasis is: A) Aveolar fluid B) Surfactant C) Pleural fluid D) Atelectasis fluid Surfactant All of the following are part of the drowning sequence of a conscious person EXCEPT: A) Attempted breath holding B) Violent swallowing efforts C) PaCO2 in the blood falling below 50 D) PaO2 in the blood falling below 50 PaCO2 in the blood falling below 50 You and your partner are treating a drowning patient who had a submersion time of 10 minutes. Your partner wants to perform the Heimlich maneuver; you should: A) Advise your partner that the Heimlich maneuver should not be utilized for drowning victims B) Agree with your partner and begin performing the Heimlich maneuver C) Agree with your partner, as you know the Heimlich maneuver should only be performed on patients with a submersion time of less than 15 minutes. D) Advise your partner that the Heimlich maneuver should only be performed on patients with a submersion time of greater than 15 minutes Advise your partner that the Heimlich maneuver should not be utilized for drowning victims Boyle's law states that ________ the pressure of a gas will _______ its volume: A) Decreasing, decrease B) Decreasing, increase C) Increasing, increase D) Increasing, decrease Increasing, decrease Which law of gases states that the amount of gas dissolved in a given volume of fluid is proportional to the pressure of the gas above it? A) Boyle's law B) Dalton's law C) Henry's law D) Winston's law Henry's law A diving injury commonly called "the squeeze" occurs during which phase of diving? A) Descent B) Ascent C) On the surface D) On the bottom Descent Decompression sickness commonly occurs in divers who are diving below what level? A) 44 feet B) 33 feet C) 22 feet D) 11 feet 33 feet Which of the following is an essential factor to consider when assessing a patient suspected of having a diving emergency? A) Type of breathing apparatus utilized B) Depth of the dive C) Aircraft travel following a dive D) All of the above All of the above You and your partner are treating a 35-year-old female who is complaining of severe pain in her joints and abdomen. The patient tells you that she went diving approximately 12 hours prior to the onset of complaint. Which of the following would be part of a correct course of treatment for this patient? A) Oxygen via nonrebreather mask to maintain SpO2 of > 96 percent, IV fluid replacement with lactated Ringer's, transport B) Oxygen via nasal cannula to maintain SpO2 of > 96 percent, fluid replacement with lactated Ringer's, transport C) Oxygen via nonrebreather mask regardless of SpO2 reading, IV fluid replacement with 5 percent dextrose, transport to hyperbaric chamber D) Oxygen via nonrebreather mask regardless of SpO2 reading, fluid replacement with lactated Ringer's, transport Oxygen via nonrebreather mask regardless of SpO2 reading, fluid replacement with lactated Ringer's, transport At what depth do most divers experience nitrogen narcosis? A) 70 to 100 feet B) 60 to 70 feet C) 200 to 250 feet D) 300 to 350 feet 70 to 100 feet At what altitude do altitude illnesses start to manifest? A) 8,000 feet B) 4,000 feet C) 6,000 feet D) 12,000 feet 8,000 feet During the hypoxic ventilatory response, what do the kidneys do? A) Shut down B) Function normally C) Decrease the removal of bicarbonate D) Increase the removal of bicarbonate Increase the removal of bicarbonate Which of the following is a medication used in the treatment of high-altitude conditions? A) Dextrose B) Methylprednisolone C) Atropine D) Diamox Diamox Your patient is the 24-year-old male victim of a drive-by shooting. He is sitting on the ground on your arrival, with his legs stretched in front of him. You note his sweatpants are bloody below the right knee. He is alert, though complaining of right leg pain, and has adequate ventilation, as well as a radial pulse of 88. To decide if this patient should be transported quickly to a trauma center, you should consider if he meets which of the following? A) A Glasgow Coma Scale score of at least 15 B) CDC Guidelines for Field Triage of Injured Patients C) A Revised Trauma Score of at least 20 D) All of the above CDC Guidelines for Field Triage of Injured Patients All the following are complications of hypothermia in the trauma patient EXCEPT: A) Inhibited clotting cascade B) Release of anticoagulant agents C) Reduction in blood loss D) Increased energy use Reduction in blood loss Which of the following should lead you to suspect spinal-cord injury? A) Altered mental status B) Odor of alcohol C) Distracting injuries D) All of the above All of the above Your patient is a 55-year-old male with a gunshot wound to the abdomen. Which of the following does NOT have a bearing on the mechanism of injury analysis? A) The distance of the shooter from the victim at the time of injury B) The type of ammunition used C) Whether the shooter is right- or left-handed D) The type of firearm used Whether the shooter is right- or left-handed Which of the following best describes the appropriate timing of the rapid trauma assessment? A) After the focused history and assessment of the stable trauma patient B) After establishing airway, ventilation, and hemorrhage control in a critical trauma patient C) Upon making initial contact with the unresponsive trauma patient D) When considering accepting a refusal of treatment and transport from a stable trauma patient After establishing airway, ventilation, and hemorrhage control in a critical trauma patient Your patient is a 40-year-old male driver of a vehicle that was struck in the driver's-side door by another vehicle at an intersection. The estimated speed of the vehicle that struck the patient's car is 30 miles per hour. The patient was restrained, but his vehicle lacks side-impact airbags. On your arrival, he is awake and complaining of head pain. He has a 4 cm laceration to the left posterior parietal area of the head. There was moderate bleeding before your arrival, but the bleeding is now minor. Witnesses state that there was no loss of consciousness, but immediately following the collision, the patient seemed confused and did not immediately understand that witnesses wanted him to unlock his door and use his cellular phone to call for help. The patient's skin is warm and dry, his respirations are 16, and the radial pulse is strong at 88 per minute. Which of the following most accurately describes how to best remove the patient from the vehicle? A) Place a cervical collar, maintain manual stabilization of the cervical spine, place a vest-type extrication device, and remove the patient onto a long backboard. B) Place a cervical collar, assist the patient in standing up, and then use a "standing take down" to place him on a long backboard. C) Place a cervical collar, place a long backboard on the stretcher, and position it next to the driver's door. Instruct the patient to slide onto the board as you maintain manual stabilization of the cervical spine. D) Place a cervical collar, maintain manual stabilization of the cervical spine, and use rapid extrication onto a long backboard. Place a cervical collar, maintain manual stabilization of the cervical spine, place a vest-type extrication device, and remove the patient onto a long backboard. Which of the following probably contributes to injury-related morbidity and mortality in the young male population (those aged 13 to 35 years)? A) The tendency to put small objects in the mouth B) Disregard for safety practices C) Poor physiological compensatory mechanisms D) None of the above Disregard for safety practices Paramedics should do everything possible to ensure that they are on the scene of a traumatic emergency for no more than _____ minutes: A) 15 B) 20 C) 10 D) 25 10 Which of the following offers a valuable model for EMS to consider when trying to reduce injury-related morbidity and mortality? A) The Pan American Health Organization B) American Society for Testing Materials (ASTM) C) The fire service D) Drug Abuse Resistance Education (DARE) The fire service The uncritical use of which of the following when caring for the trauma patient has been questioned by research? A) PASG B) Rapid isotonic fluid infusion C) Capillary refill as an indicator of tissue perfusion D) All of the above All of the above The elderly patient in shock may be less likely to exhibit which of the following expected manifestations of shock? A) Cardiac arrhythmias B) Hypothermia C) Altered mental status D) Tachycardia Tachycardia Which of the following statements about the pediatric pedestrian who is struck by a vehicle is NOT true? A) A child commonly turns toward the oncoming vehicle at the moment of impact. B) Smaller children are likely to suffer fractures of the tibia and fibula as a result of impact with the vehicle's bumper. C) A smaller child is more likely to be thrown to the ground following initial impact, versus being thrown onto the hood. D) Anatomically, the injuries caused by the initial impact of the vehicle will be higher on the body than in an adult. Smaller children are likely to suffer fractures of the tibia and fibula as a result of impact with the vehicle's bumper. Which of the following best describes the significance of finding an abrasion during the prehospital assessment of the trauma patient? A) Abrasions are superficial wounds and not of particular concern in the prehospital setting. B) There is a risk of infection. C) It increases the risk of hemorrhagic shock. D) It is a possible indication of more significant trauma beneath the abrasion. It is a possible indication of more significant trauma beneath the abrasion. A thorough inspection of the trauma patient can be best performed if which of the following guidelines is used? A) Assess for tenderness, the ability to move, and distal sensation and circulation. B) Assess for abnormalities in skin color, deformity of any part of the body, and any disruption of the skin. C) Assess for deformity, swelling, and angulation of any part of the body. D) Assess for pulse, paresthesia, pallor, and pain. Assess for abnormalities in skin color, deformity of any part of the body, and any disruption of the skin. Your patient is a 24-year-old female driver of a vehicle in a motor vehicle collision. She rear-ended a vehicle stopped at a traffic light at about 25 miles per hour. She was restrained, and the front airbags deployed. She is 32 weeks pregnant. She is anxious because she has not felt the baby move since the impact, and she is complaining of constant pain on the left side of her abdomen. Palpation of the abdomen reveals unusual firmness over the left side of the abdomen. The patient has a pulse of 116, a blood pressure of 92/60, and respirations of 28. Her skin is cool but dry, and she has no other complaints. For which of the following should you have the highest index of suspicion? A) Placenta previa B) Placenta accreta C) Abruptio placentae D) Stress-induced onset of labor Abruptio placentae Which of the following has the greatest potential for reducing injury-related morbidity and mortality? A) Injury-prevention activities B) Increased funding for rural EMS system development C) Increasing the scope of practice of paramedics to include such lifesaving procedures as pericardiocentesis and trephination of the skull to reduce intracranial pressure D) Using physicians and physician's assistants as prehospital care providers Injury-prevention activities Which of the following is the most likely indicator of intraabdominal hemorrhage in the prehospital setting? A) Distension and/or rigidity of the abdomen on palpation B) Rebound tenderness of the abdomen on palpation C) Ecchymosis of the abdomen or flanks D) Signs and symptoms of hypovolemia unexplained by other injuries Signs and symptoms of hypovolemia unexplained by other injuries Your patient is a 23-year-old female victim of an attempted abduction at knifepoint. The assailant was interrupted and drew his knife across the victim's throat as he fled the scene. A first responder on the scene immediately applied direct pressure to the neck wound. Your assessment reveals a very agitated young woman with ongoing blood loss despite direct pressure to the wound. There appears to be both bright-red bleeding and slower but steady dark-red bleeding. It appears that the trachea has not been penetrated but that there is a hematoma around the laceration. Which of the following is the most appropriate sequence of intervention for this patient? A) Apply a pressure dressing to the wound, accompanied by pressure-point compression. B) Use rapid sequence intubation of the patient to protect the trachea from the expanding hematoma while maintaining direct pressure on the wound. C) Apply an occlusive dressing to the wound, and continue direct pressure. D) Apply direct pressure, and request an order from medical control to decompress the hematoma. Use rapid sequence intubation of the patient to protect the trachea from the expanding hematoma while maintaining direct pressure on the wound. A critical trauma patient should be reassessed every ________ minute(s) en route to the trauma center. A) 5 B) 10 C) 15 D) 1 5 Assuming none of the following patients has any neurological deficits, which patient requires cervical spinal immobilization? A) A 19-year-old male who has a gunshot wound to the right thigh B) A three-year-old female who fell on the sidewalk while running and who has a bite injury to her tongue C) A ten-year-old male skateboarder who fell while skating down a hill and received abrasions to his hands, elbows, chest, and knees D) A 70-year-old female involved in a moderate-speed, lateral-impact motor vehicle collision who is complaining of left arm pain A 70-year-old female involved in a moderate-speed, lateral-impact motor vehicle collision who is complaining of left arm pain ) Which of the following best describes definitive care for the pregnant trauma patient with ongoing, significant hemorrhage? A) Invasive hemodynamic monitoring and serial hematocrits B) Administration of hypertonic crystalloid or colloid solution C) Immediate surgery D) Administration of blood or blood products Immediate surgery Which of the following groups has the highest trauma morbidity and mortality rates? A) Males aged 13 to 35 years B) Males aged 45 to 70 C) Both genders aged 60 to 75 years D) Children aged 1 to 12 years Males aged 13 to 35 years During which part of your assessment would you note the need for additional resources? A) Scene size-up B) Primary assessment C) Secondary assessment D) None of the above Scene size-up In which type of vehicle impact are patients afforded the most protection? A) Frontal impacts B) Side impacts C) Lateral impacts D) None of the above Frontal impacts All of the following are components of the revised trauma score EXCEPT: A) Glasgow Coma Scale B) Systolic blood pressure C) Pulse rate D) Respiratory rate Pulse rate Which of the following best explains the importance of determining the trauma patient's level of consciousness and orientation in the initial assessment? A) It determines whether the patient requires further assessment. B) It provides immediate information about the severity of the patient's injury. C) It immediately rules in or out the need for spinal immobilization. D) It serves as a baseline for determining improvement or deterioration in the patient's condition. It serves as a baseline for determining improvement or deterioration in the patient's condition. Which of the following patients' mechanisms of injury meets trauma triage criteria for transport to a trauma center? A) A 17-year-old male with a gunshot wound to the arm B) A 31-year-old male involved in a medium-velocity motor vehicle collision C) A ten-year-old male soccer player with a laceration over his right eye after colliding with another player's head D) A nine-year-old female who fell 15 feet from grandstand bleachers at a baseball game A nine-year-old female who fell 15 feet from grandstand bleachers at a baseball game Your patient is a 19-year-old male who was thrown from a horse while riding in a rodeo. After throwing the patient off, the horse stepped on the patient's abdomen. When you reach the patient, you note that his face, neck, and shoulders are pale, cool, and diaphoretic but that the patient's skin is otherwise warm and dry. The patient has some movement and sensation in his forearms and hands but otherwise no movement or sensation below the shoulders. He is anxious and has a respiratory rate of 24, a heart rate of 68, and a blood pressure of 106/66. Which of the following should be the primary concern when determining this patient's transport priority? A) The potential for neurologic shock, requiring immediate surgery B) The potential for intraabdominal hemorrhage that may be masked by loss of sympathetic nervous function C) The potential for traumatic brain injury D) The potential for respiratory failure secondary to paralysis of the diaphragm The potential for intraabdominal hemorrhage that may be masked by loss of sympathetic nervous function Your patient is a 45-year-male who was found sitting in a chair in a residence. He responds to painful stimuli with incoherent speech and has an odor of alcohol on his clothing and breath. There is an empty bottle of tricyclic antidepressants next to the patient, as well as a nearly empty bottle of liquor. Because there is no electricity in the residence and light is insufficient, you move the patient to your stretcher so you can perform your examination in a better environment. The patient has a blood pressure of 130/70, a heart rate of 124, and respirations of 8 per minute. There were no obvious signs of trauma, but your detailed examination reveals a fresh laceration to the right parietal area of the head. The laceration has been cleaned and appears to be several hours old. Which of the following is the best course of action? A) Transport the patient on the assumption that his condition is more consistent with a tricyclic overdose than with trauma. His reported history of alcoholism probably accounts for the laceration on his head. B) Right now the patient's condition seems more consistent with tricyclic overdose, but because a history of the head laceration cannot be obtained, the patient should be monitored closely for signs of increased intracranial pressure. C) Place a cervical collar on the patient and secure him to a long backboard before transport. The empty medication bottle was likely an incidental finding. Intubate, using RSI if necessary. Begin transport to a trauma center, and start a large-bore IV of lactated Ringer's solution infusing at a wide-open rate. D) Place a cervical collar on the patient and secure him to a long backboard before transport. His level of consciousness does not allow for better assessment of the mechanism of injury. His signs and symptoms are consistent with a tricyclic overdose and alcohol abuse, but his reported history of alcohol abuse puts him at increased risk of intracranial bleeding due to fairly minor trauma. Place a cervical collar on the patient and secure him to a long backboard before transport. His level of consciousness does not allow for better assessment of the mechanism of injury. His signs and symptoms are consistent with a tricyclic overdose and alcohol abuse, but his reported history of alcohol abuse puts him at increased risk of intracranial bleeding due to fairly minor trauma. When administering fluid to a multisystem trauma patient with no signs of head injury but with signs of hypoperfusion, the paramedic should only administer fluid to maintain a systolic blood pressure equal to _____ mmHg. A) 70 B) 80 C) 60 D) 100 80 Which of the following should the paramedic assess when performing palpation during examination of a trauma patient? A) Discoloration, such as erythema or ecchymosis B) Skin temperature C) Hyporesonance or hyperresonance of the thorax and abdomen D) The depth of open wounds Skin temperature Your patient is a four-year-old child. He has received an accidental gunshot wound to the groin and has lost a significant amount of blood. He responds to painful stimuli and has a heart rate of 150 with no radial pulse. Respirations are 32 and shallow. What is the total amount of intravenous fluid you should administer to this patient, assuming his condition does NOT improve with intervention? A) 10 ml/kg B) 20 ml/kg C) 30 ml/kg D) 40 ml/kg 20 ml/kg Which of the following is NOT an element of the scene size-up on a trauma response? A) Assessing for scene hazards B) Determining the number of patients C) Setting up an IV D) Evaluating the mechanism of injury Setting up an IV Bariatric patients are at greater risk for all of the following EXCEPT: A) Arrhythmias B) Cardiac failure C) Systemic hypertension D) Bradycardia Bradycardia Bariatric trauma patients have a mortality of up to ____________ times greater than normal weight patients. A) Two B) Six C) Three D) Four Six The blood pressure of the pregnant female falls by 5 to 15 mmHg during which trimester? A) First B) Second C) Third D) Fourth Second

Which of the following best describes shear injuries to the abdominal organs? A) Sudden compression of gas-containing hollow organs resulting in their rupture B) Sudden decompression of solid or hollow organs C) Tearing of the organ in which the organ is fixed at its point of attachment but free to move otherwise D) Impact of solid organs with the abdominal wall in rapid deceleration Tearing of the organ in which the organ is fixed at its point of attachment but free to move otherwise The liver is injured ________ percent of the time with penetrating abdominal trauma. A) 10 B) 40 C) 25 D) 75 40 Your patient is a 30-year-old pregnant woman at 36 weeks' gestation. She was injured in a fall from a horse and is complaining of painful contractions. Her abdomen is tender to palpation over the uterus, and the uterus becomes firm with contractions, but she denies vaginal bleeding. The patient is anxious, but her skin is warm and dry. Her blood pressure is 112/70, her heart rate is 92, and her respirations are 24. Which of the following statements best describes this situation? A) The mechanism and patient complaints are suspicious for placental abruption. The mother's condition is not life threatening, but fetal demise has most likely already occurred. B) The mechanism and patient complaints are consistent with placenta previa. The mother is stable, but the fetus is in jeopardy. C) The mechanism and patient complaints are consistent with uterine rupture. Both the mother and fetus are in jeopardy. D) The mechanism and patient complaints are suspicious for placental abruption. Both the mother and the fetus are in jeopardy. The mechanism and patient complaints are suspicious for placental abruption. Both the mother and the fetus are in jeopardy. Which of the following can reduce the potential for abdominal injury? A) Proper placement of automobile lap belts in adults B) Side-impact airbags C) Proper placement of automobile lap belts in children D) All of the above All of the above Which of the following is TRUE of abdominal trauma? A) A soft, nontender, nondistended abdomen with intact bowel sounds reliably rules out hollow organ injury. B) Due to the vascular nature of abdominopelvic organs, the onset of signs and symptoms is abrupt and severe. C) A soft, nontender, nondistended abdomen reliably rules out solid organ injury. D) A significant amount of blood can accumulate in the abdominal cavity before signs and symptoms of abdominal injury appear. A significant amount of blood can accumulate in the abdominal cavity before signs and symptoms of abdominal injury appear. Which of the following describes definitive care of the patient with traumatic intraabdominal hemorrhage? A) Admission to the ICU for observation B) Aggressive oxygenation and fluid resuscitation C) Administration of blood or blood products D) Rapid surgical intervention Rapid surgical intervention The suspicion of blunt abdominal trauma should be based primarily on: A) The mechanism of injury B) Distension of the abdomen on palpation C) The patient's complaint of abdominal pain D) The presence of contusions The mechanism of injury Which of the following is a special consideration when managing the pregnant trauma patient? A) She is at increased risk for vomiting and aspiration. B) She may have a 30 percent blood volume loss before experiencing signs and symptoms of shock. C) Placing her supine may decrease cardiac output. D) All of the above are special considerations. All of the above are special considerations. Your patient is a 17-year-old male driver of a vehicle that received a lateral impact at the driver's side door. There are no side-impact airbags, and there is about 8 inches of intrusion into the passenger compartment at the left door. Your patient is complaining of left shoulder pain and pain "in his left side." He has a contusion on the left shoulder and deformity of the left clavicle. He has erythema over the left lateral thorax from ribs 6 through 12 with crepitus on palpation. Which of the following injuries should you suspect? 1. Blunt trauma to the spleen 2. Blunt trauma to the liver 3. Penetrating trauma to the spleen 4. Penetrating trauma to the liver 5. Left pneumothorax 6. Fracture of the left clavicle 7. Soft tissue injury to the left shoulder A) 1, 5, 6 B) 2, 4, 6, 7 C) 1, 3, 5, 6, 7 D) 2, 5, 6 1, 3, 5, 6, 7 Which of the following guidelines applies to prehospital fluid resuscitation of hypotensive patients with intraabdominal hemorrhage? A) In most cases fluid administration should be limited to 3 liters. B) IV access should be obtained using a saline lock, but fluid resuscitation is contraindicated in the prehospital setting. C) Fluid administration rate should be titrated to maintain a systolic blood pressure of 60 mmHg. D) IV access is only necessary if the use of PASG fails to improve the patient's clinical condition. In most cases fluid administration should be limited to 3 liters. Which of the following organs is NOT part of the digestive system? A) Liver B) Spleen C) Stomach D) Pancreas Spleen Damage to which of the following organs is most likely to induce severe infection in the abdominal cavity? A) Urinary bladder B) Colon C) Stomach D) Ureter Colon Your patient is an 18-year-old male who was slashed across the abdomen with a machete. He has a mass of omentum and small bowel protruding from the wound. Which of the following is your primary concern with this patient? A) Immediately covering the wound with an occlusive dressing, using your gloved hand if nothing else is available B) Irrigating the exposed organs with sterile saline to remove debris and gently tucking them back into the opening to keep them warm and moist and to prevent further contamination C) Covering the wound with a sterile, saline-moistened dressing covered by an occlusive dressing D) Ensuring an open airway by anticipating vomiting, providing oxygen, keeping the patient warm, and monitoring for and treating shock Ensuring an open airway by anticipating vomiting, providing oxygen, keeping the patient warm, and monitoring for and treating shock Which of the following may impact the pattern of injury in abdominal trauma? A) Breathing B) A full stomach C) A full bladder D) All of the above All of the above Which of the following is TRUE of the epidemiology of abdominal trauma? A) Morbidity and mortality due to blunt trauma is decreasing, but morbidity and mortality due to penetrating trauma is increasing. B) Morbidity and mortality due to blunt trauma is increasing, but morbidity and mortality due to penetrating is decreasing. C) Morbidity and mortality due to blunt and penetrating trauma are both increasing. D) Mortality and morbidity due to blunt and penetrating trauma are both decreasing. Morbidity and mortality due to blunt trauma is decreasing, but morbidity and mortality due to penetrating trauma is increasing. Which of the following organs is LEAST likely to be injured in penetrating trauma to the abdomen? A) Spleen B) Kidney C) Pancreas D) Small intestine Pancreas The injury in which abdominal organs protrude through a large, deep laceration of the abdominal wall is best described as: A) Disimpaction B) A gutting injury C) Herniation D) Evisceration Evisceration Your patient is a 60-year-old female restrained driver involved in a moderate-speed, frontal-impact collision. When you arrive at the scene, she is sitting up in the driver's seat with a chief complaint of a burning sensation of her face. You note abrasions from deployment of the airbag. After immobilizing the patient on a long backboard, you begin transport. As you perform a detailed examination, the patient complains of developing right shoulder pain. Which of the following should you suspect? A) Myocardial contusion B) Intraabdominal bleeding C) Exacerbation of the patient's arthritis due to immobilization on the backboard D) Shoulder contusion or possible clavical fracture due to restraint by the shoulder harness Intraabdominal bleeding The largest reserve of blood of any body organ is contained in the: A) Liver B) Kidneys C) Spleen D) Pancreas Liver Which of the following is most likely to occur as a result of rapid deceleration without actual contact between the patient's body and the interior of the vehicle? A) Blunt trauma to the pancreas B) Rupture of the colon C) Kidney contusion D) Shearing injury of the liver Shearing injury of the liver Which of the following is TRUE of the patient with a suspected penetrating injury to or rupture of the diaphragm? A) This is the only abdominal injury in which removal of an impaled object is recommended. B) This is one of the primary indications for the use of PASG. C) Pneumothorax may occur even if the thoracic cage is intact. D) Breathing is not impaired unless abdominal organs migrate into the thoracic cavity. Pneumothorax may occur even if the thoracic cage is intact. Which of the following is NOT part of the prehospital examination of the patient with suspected abdominal trauma? A) Asking the patient about abdominal pain first, then palpating the abdomen in all four quadrants B) Auscultating bowel sounds C) Checking for stability of the pelvis D) Assessment of the thorax for injury Auscultating bowel sounds CHAPTER 10 Which of the following best describes the effect of hyperventilation in the brain-injured patient? A) It is beneficial, because vasodilation results in increased cerebral blood flow. B) It is detrimental, because vasodilation causes an increase in tissue edema. C) It is beneficial, because vasoconstriction results in decreased tissue edema. D) It is detrimental, because vasoconstriction results in decreased cerebral perfusion. It is detrimental, because vasoconstriction results in decreased cerebral perfusion. Your patient is a 45-year-old male with extensive blunt trauma to the face. He has decorticate posturing in response to pain; weak, irregular respiratory effort at 6 per minute; and a heart rate of 50 with a good radial pulse. The patient appears to have nasal and mandibular fractures, and an oropharyngeal airway is insufficient to keep the tongue from the posterior pharynx. Which of the following has the MOST potential to negatively impact the patient? A) Retrograde intubation B) Oral intubation under direct laryngoscopy C) Nasotracheal intubation D) A nonvisualized dual-lumen airway Nasotracheal intubation Which of the following medications may be indicated in the prehospital management of the patient with traumatic brain injury? A) Methylprednisolone B) Diazoxide C) Mannitol D) Furosemide Furosemide Circulation to the face is provided by the ________ artery A) External carotid artery B) Internal carotid artery C) Midfacial artery D) Mandibular artery External carotid artery Which of the following correctly describes the impact of motorcycle helmet use? A) Helmet usage is associated with a 10 percent reduction in serious head injuries. B) There have been no reported fatalities from motorcycle collisions in which the riders were wearing helmets. C) Helmet usage decreases the risk of serious head injuries but increases the risk of cervical-spine injuries. D) Helmet usage results in a more than 50 percent reduction in serious head injuries. Helmet usage results in a more than 50 percent reduction in serious head injuries. Which of the following parameters should be used to guide the oxygenation and ventilation of the patient with a traumatic brain injury? A) Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg. B) Maintain an oxygen saturation level of at least 90 percent and a capnography level < 45 mmHg. C) Maintain an oxygen saturation level of at least 98 percent and a capnography reading > 45 mmHg. D) Maintain an oxygen saturation level of at least 90 percent and a capnography reading < 35 mmHg. Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg. You are caring for a 22-year-old amateur boxer who complained of a sudden obstruction of part of his visual field. This complaint is most consistent with which of the following conditions? A) Extrusion of the eyeball B) Subconjunctival hemorrhage C) Hyphema D) Retinal detachment Retinal detachment Regarding the primary assessment of the patient with suspected traumatic brain injury, which of the following describes the best approach to assessing the patient's neurological functioning? A) The use of AVPU B) Assessing the patient for level of consciousness and orientation to person, place, and time C) Assessing a revised trauma score D) Assessing a Champion trauma scale score Assessing the patient for level of consciousness and orientation to person, place, and time Your patient is a 26-year-old male who suffered a shotgun wound to the neck and face. Your assessment reveals obstruction of the upper airway because of extensive soft-tissue damage and fractures of the mandible, maxilla, and hard palate. The patient has a bubbling open wound to the anterior neck about 1 centimeter inferior to the cricoid cartilage, opening the trachea to the environment. Which of the following describes the best way to manage this patient's airway? A) Control bleeding around the neck wound, using suction if necessary to prevent aspiration. Assess whether it is possible to introduce an endotracheal tube into the trachea through the wound. B) Control bleeding around the neck wound, apply an occlusive dressing over it, and attempt nasotracheal intubation. C) Control bleeding from the wound, and apply an occlusive dressing over it. Perform a percutaneous cricothyrotomy, and use transtracheal jet insufflation to ventilate. D) Control bleeding around the neck wound, and apply an occlusive dressing over it. Insert a nonvisualized dual-lumen airway (e.g., CombiTube) for ventilation. Control bleeding around the neck wound, using suction if necessary to prevent aspiration. Assess whether it is possible to introduce an endotracheal tube into the trachea through the wound. Which of the following may confound the assessment of the patient who has a mechanism of injury consistent with significant brain injury? A) Slow development of the brain-injury process B) The patient's use of alcohol, marijuana, or other drugs C) The nature of the patient's injuries D) All of the above All of the above Which of the following best describes the percentage of mortality from penetrating gunshot wounds to the cranium? A) 35 to 50 B) 75 to 80 C) 90 to 95 D) 10 to 15 75 to 80 Your patient has received blunt facial trauma due to an assault. For which of the following injuries should you maintain a high index of suspicion? 1. Airway obstruction 2. Hypoxia due to aspiration of blood 3. Basilar skull fracture 4. Cervical spine trauma A) 1, 2, 3 B) 1, 2 C) 1, 4 D) 1, 2, 3, 4 1, 2, 3, 4 The ________ is one of the thinnest and most frequently fractured cranial bones. A) Temporal B) Ethmoid C) Parietal D) Occipital Temporal Which of the following patients fit the criteria for application of spinal precautions in the prehospital setting? A) An 85-year-old male who has fallen down three steps and has a large laceration to the occipital region of the skull but no complaints of pain B) A 21-year-old male who was diving into a pool and states he hit his head but is out of the pool and ambulatory upon your arrival with no complaint of neck or back pain C) A 36-year-old female who was involved in a minor motor vehicle crash with an obvious closed tibia fracture D) None of the above None of the above During the early care for a patient with a basilar skull fracture in the prehospital setting, which of the following would be an unexpected finding? A) Periorbital ecchymoses or "raccoon eyes" B) CSF otorrhea C) Blood mixed with cerebral spinal fluid flowing from the mouth D) CSF rhinorrhea Periorbital ecchymoses or "raccoon eyes" Which of the following skull fractures is most common? A) Linear B) Basilar C) Depressed D) Comminuted Linear All the following are acceptable methods of moving a patient onto a long spine board EXCEPT: A) Rope-sling slide B) Straddle slide C) Log roll D) Side slide Side slide Which of the following features of the cranium exacerbates the severity of intracranial trauma? A) It is rigid and unyielding. B) It is formed of dense, heavy bone. C) It is relatively thin in the frontal region. D) The sutures allow for separation of the bones. It is rigid and unyielding. Your patient is a seven-year-old male pedestrian who was struck by a vehicle. Your assessment reveals bleeding from the right auditory canal. Which of the following describes the most appropriate way to manage this? A) Determining the presence or absence of cerebrospinal fluid is a low priority. Pack the auditory canal with sterile gauze to control bleeding. B) Use a "halo" test to determine whether cerebrospinal fluid is in the blood. If it is, loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If cerebrospinal fluid is not present, pack the ear canal with sterile gauze to control bleeding. C) Determining the presence or absence of cerebrospinal fluid in the blood is a low priority. Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. D) Check the glucose level in the blood draining from the ear. If it is less than the patient's blood glucose level, there is cerebrospinal fluid present. Cover the ear loosely with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If the glucose level of the blood from the ear is the same as the patient's blood glucose level, pack the auditory canal with sterile gauze to control bleeding. Determining the presence or absence of cerebrospinal fluid in the blood is a low priority. Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. When developing a spinal clearance policy, age _____ A) Should never be considered, as age does not matter B) Should only be considered when the patient is a male between the ages of 21 and 35 C) Should be considered, as the very old may not be able to describe their symptoms accurately D) Should only be considered if the patient is a minor Should be considered, as the very old may not be able to describe their symptoms accurately Your patient is a 22-year-old female assault victim. She has blunt trauma to the face with swelling around the right eye and zygomatic area. Upon assessing her eye movement, you note that the right eye cannot follow your finger and does not move. Which of the following most likely explains this finding? A) She has a fracture of the orbit that has trapped the optic nerve, thereby paralyzing her gaze. B) She has direct trauma to the eyeball that has damaged the intrinsic muscles of the eye. C) She has a fracture of the orbit that has trapped the extrinsic eye muscles. D) She has direct trauma to the eyeball that has damaged the optic nerve, thereby paralyzing her gaze. She has a fracture of the orbit that has trapped the extrinsic eye muscles. Which of the following groups is NOT among those with the highest incidence of serious head trauma? A) The elderly B) Young males C) Middle-aged males D) Infants Middle-aged males Which of the following is TRUE of the basilar skull? A) The foramen magnum is part of the basilar skull. B) It is relatively weaker than other portions of the skull. C) It provides a rough surface that may lacerate the brain in acceleration/deceleration mechanisms. D) All of the above are true. All of the above are true. When placing the patient's head in the neutral position, the occiput should be ____ the plane made by the buttocks and the shoulder blades (or greater for an obese patient). A) Even with B) 3 to 4 inches above C) 1 to 3 inches above D) 2 to 6 inches above 1 to 3 inches above The term head injury refers to which of the following? A) Trauma to the brain B) Soft-tissue injuries to the scalp C) Skull fractures D) All of the above All of the above For the head-injury patient without signs of herniation, adjust ventilation rates to maintain an end-tidal CO2 reading of between: A) 15 and 20 mmHg B) 25 and 30 mmHg C) 45 and 50 mmHg D) 35 and 40 mmHg 35 and 40 mmHg Your patient is a 37-year-old male unrestrained driver of a vehicle. You find him with his upper body across the console and his head hanging down into the passenger's side floorboard area. You note pooled blood from a scalp wound. After immobilizing him and loading him into the ambulance where you have more light for your examination, you note that he has a large, full-thickness avulsion of the scalp. The patient's heart rate is 112, respirations are 20, and blood pressure is 82/50. Which of the following statements about this patient is/are TRUE? 1. The scalp wound itself cannot account for the patient's vital signs. 2. The scalp wound itself may account for the patient's vital signs. 3. The patient's vital signs are consistent with increasing intracranial pressure. 4. Nothing about the vital signs indicates increased intracranial pressure. A) 1, 4 B) 2, 3 C) 1, 3 D) 2, 4 2, 4 In cases of face and neck trauma where the region is so distorted that oral and nasal intubation are impossible, the only prehospital means to provide a life-saving airway may be performing which of the following? A) Digital intubation B) Percutaneous cricothyrotomy C) Bag-valve hyperventilation D) Surgical tracheostomy Percutaneous cricothyrotomy CHAPTER 11 When palpating the spine of a patient during your assessment, you are feeling the: A) Spinous processes B) Vertebral bodies C) Transverse vertebral processes D) Vertebral pedicles Spinous processes A patient who has dived into a shallow pool and hit his head on the bottom is most likely to have which of the following types of injuries? A) Cervical hyperextension B) Cervical hyperflexion C) Axial distraction D) Axial loading Axial loading Recent research has provided evidence of which of the following regarding spinal-injury assessment? A) Only trauma patients with signs and symptoms of neurological deficit need to receive spinal immobilization. B) Paramedics cannot reliably identify patients who are likely to have spinal injuries. C) All trauma patients should be assumed to have spinal injuries. D) There are reliable criteria for determining the likelihood of spinal injury. There are reliable criteria for determining the likelihood of spinal injury. Which of the following is a common mechanism of injury associated with spinal-cord injuries? A) Penetrating injuries B) Sports-related injuries C) Auto accidents D) All of the above All of the above Your patient is a 30-year-old male who was playing a backyard game of football and was tackled forcefully from the left side by his brother at the level of the shoulder. Based on this mechanism of injury, you should suspect which of the following patterns? A) Compression fractures on the left side of the cervical spine; torn ligaments on the right side of the cervical spine B) An axial distraction injury of the cervical region C) Compression fractures of the thoracic spine D) Subluxation of one or more thoracic vertebrae Compression fractures on the left side of the cervical spine; torn ligaments on the right side of the cervical spine Which of the following best describes the goals of manual cervical spine stabilization? A) Preventing movement of the head in any direction; applying a gentle lifting force of just enough to relieve some of the pressure the head exerts on the cervical spine B) Keeping the head in an "eyes forward" position; applying enough traction to cause axial unloading, which is 18 to 22 pounds in the average adult C) Preventing rotation of the head; avoiding any upward lifting or downward pressure on the cervical spine D) Preventing movement of the head in any direction; applying gentle axial pressure to stabilize the vertebral column Preventing movement of the head in any direction; applying a gentle lifting force of just enough to relieve some of the pressure the head exerts on the cervical spine Which of the following statements about the administration of dextrose to the patient with a traumatic brain injury is TRUE? A) Hypoglycemia is associated with a poorer neurological outcome; if the blood glucose level is less than 60 mg/dl, administer 25 grams of dextrose. B) Hypoglycemia is inconsequential to neurological outcome; assessing the blood glucose level is not a priority. C) Hyperglycemia is associated with a poorer neurological outcome; never administer dextrose to a patient with traumatic brain injury. D) Hypoglycemia is associated with a poorer neurological outcome. All patients with suspected traumatic brain injury who have an altered mental status should receive 25 grams of dextrose intravenously. Hypoglycemia is associated with a poorer neurological outcome; if the blood glucose level is less than 60 mg/dl, administer 25 grams of dextrose. You are caring for a 20-year-old skateboarder who crashed into a brick retaining wall at the bottom of a steep hill. He has blunt trauma to his face with nose deformity, loose teeth, and bleeding from the nose and mouth. Although you have answered him several times, he keeps repeating to you, "What happened? It seems like I'm having a bad day." This is most indicative of which of the following? A) Aphasia B) Retrograde amnesia C) Decorticate disorientation D) Anterograde amnesia Anterograde amnesia Which of the following are the two most important prehospital considerations for head injury patients? A) Cervical spine immobilization and ventilation B) ICP monitoring and administering corticosteroids C) Ventilation and administering corticosteroids D) Ventilation and maintaining adequate blood pressure Ventilation and maintaining adequate blood Your patient states that he had a traumatic brain injury from a motorcycle collision three years ago. You notice that his gait is unsteady and his movements are a bit jerky. You suspect that he has damage to which of the following structures? A) Falx cerebri B) Reticular activating system C) Third cranial nerve D) Cerebellum Cerebellum Which of the following is NOT a component of the Glasgow Coma Scale? A) Eye opening B) Motor ability C) Pupillary reaction D) Verbal response Pupillary reaction Which of the following is the largest element of the nervous system? A) Cerebellum B) Pons C) Medulla oblongata D) Cerebrum Cerebrum Which of the following Glasgow Coma Scale scores indicates serious brain injury? A) < 3 B) Between 12 and 15 C) < 8 D) < 15 < 8 The cerebral perfusion pressure is represented by which of the following equations? A) CPP = MAP - CVP B) CPP = CVP - ICP C) CPP = MAP - ICP D) CPP = ICP - MAP CPP = MAP - ICP Which of the following mechanisms causes indirect brain injury? A) Coup/contrecoup injuries B) Systemic hypotension combined with increasing intracranial pressure C) Cushing's reflex D) Acceleration/deceleration forces without a direct blow to the cranium Systemic hypotension combined with increasing intracranial pressure Which of the following best describes consensual reactivity of the pupils? A) It is a pathological phenomenon. When a penlight is shone into one eye, both pupils constrict. B) It is a normal phenomenon. When a penlight is shone into one eye, only that pupil will constrict, while the other pupil is unaffected. C) It is a normal phenomenon. When a penlight is shone into one eye, both pupils constrict. D) It is a pathological phenomenon. When a penlight is shone into one eye, only that pupil constricts, while the other pupil is unaffected. It is a normal phenomenon. When a penlight is shone into one eye, both pupils constrict. Your patient is a 12-year-old male who was struck in the right temporal area of the head with a baseball. He had a brief loss of consciousness and is alert on your arrival. You note that he is becoming drowsy and has a strong radial pulse of 60, a blood pressure of 140/70, and a respiratory rate of 12. Which of the following best describes this patient's condition? A) He is stable, and he most likely has a subarachnoid hemorrhage with no increase in intracranial pressure. B) He is critical, and he most likely has an epidural hematoma with rapidly increasing intracranial pressure. C) He is stable, and he most likely has a mild diffuse axonal injury with no increase in intracranial pressure. D) He is serious, and he most likely has a subdural hematoma with an increase in intracranial pressure. He is critical, and he most likely has an epidural hematoma with rapidly increasing intracranial pressure. The shearing, stretching, and tearing associated with rapid acceleration/deceleration forces acting on the brain result in which of the following types of brain injury? A) Direct, diffuse B) Indirect, diffuse C) Indirect, focal D) Direct, focal Direct, diffuse A concussion is best described as which of the following types of brain injuries? A) Indirect, diffuse B) Indirect, focal C) Direct, focal D) Direct, diffuse Direct, diffuse For the patient with suspected traumatic brain injury, the ideal positioning of the patient for transport is: A) In a left lateral recumbent position on the backboard B) On a long backboard with the foot of the backboard in a 15-degree Trendelenburg position C) On a long backboard with the patient's feet elevated on pillows to achieve a 15-degree angle D) On a long backboard with the head of the backboard elevated 15 to 30 degrees On a long backboard with the head of the backboard elevated 15 to 30 degrees When CPP falls below the critical level of 50 mmHG, autoregulation does which of the following to maintain CPP and cerebral perfusion? A) Decreases blood pressure B) Increases blood pressure C) Decreases intracranial pressure D) Increases intracranial pressure Increases blood pressure Which of the following would explain tachycardia and hypotension in the patient with a closed traumatic brain injury? 1. An undiscovered source of hemorrhage resulting in shock 2. Cushing's reflex 3. Massive blood loss due to tearing of the middle meningeal artery 4. Loss of compensatory mechanisms maintaining CPP A) 1, 3, 4 B) 1 C) 1, 4 D) 1, 2, 3, 4 1, 4 Which of the following about the use of prehospital fluid resuscitation in the patient with a traumatic brain injury is TRUE? A) Administer fluids aggressively regardless of the patient's blood pressure. B) Do not administer fluids unless the patient's blood pressure drops below 60 mmHg, because the administration of fluids leads to increased cerebral edema. C) Administer fluids as needed to maintain a systolic blood pressure above 90 mmHg. D) The use of hypertonic fluids is indicated to maintain vascular volume while reducing tissue edema. Administer fluids as needed to maintain a systolic blood pressure above 90 mmHg. Which of the following best describes the role of rapid sequence intubation (RSI) in the prehospital management of patients with traumatic brain injury? A) It is beneficial and should be used for all patients with traumatic brain injury who are experiencing trismus or who have an intact gag reflex. B) It is supported by anecdotal evidence, but no studies have been done to determine its feasibility or usefulness. C) It is controversial because of conflicting study results. D) It is detrimental, resulting in poorer neurological outcomes than in patients who received standard airway management. It is controversial because of conflicting study results. Which of the following statements about the patient in neurogenic shock is NOT true? A) The patient's heart rate may be normal. B) Neurogenic shock may be temporary, even if spinal-cord injury is permanent. C) Signs of hypovolemic shock may be masked. D) Unopposed sympathetic nervous system stimulation results in generalized pallor and diaphoresis. Unopposed sympathetic nervous system stimulation results in generalized pallor and diaphoresis. Coup injuries commonly occur in which region of the brain? A) Frontal region B) Occipital region C) Temporal region D) Neuronal region Frontal region Anterior cord syndrome is caused by which of the following mechanisms? A) Tearing of the anterior cord due to hyperextension mechanisms B) Disruption of arterial blood supply to the anterior cord C) Laceration of the anterior cord caused by bone fragments D) Contusion of the anterior cord caused by blunt trauma Disruption of arterial blood supply to the anterior cord The diaphragm is controlled by peripheral nerve roots ________ through ________. A) C-3, C-7 B) C-3, C-5 C) C-1, C-7 D) C-1, C-5 C-1, C-5 The spinal cord is continuous from the brain to the level of: A) T-12 or T-13 B) L-5 or L-6 C) The coccyx D) L-1 or L-2 L-1 or L-2 You are treating a 16-year-old male who fell while practicing a new move on his skateboard. Bystanders relate that the patient was not wearing a helmet. The bystanders also relate that the patient was alert and oriented following the fall; however, while waiting for you to arrive, the patient became unconscious. While performing your physical exam, you note that the patient has a hematoma to the right temporal area. Your assessment leads you to believe that your patient has an epidural hematoma. You know that an epidural hematoma is caused by what type of bleeding? A) Venous bleeding B) Capillary bleeding C) Arterial bleeding D) Venous and capillary bleeding Arterial bleeding You have intubated a five-year-old girl with a suspected head injury. You note that the patient is exhibiting signs of herniation. What is the desired range for this patient's end-tidal CO2? A) 35 to 40 B) 30 to 35 C) 25 to 30 D) 40 to 45 35 to 40 The phrenic nerve consists of peripheral nerve roots ________ through ________. A) C-1, C-3 B) C-5, C-8 C) C-3, C-5 D) C-1, C-8 C-3, C-5 Your patient is a 17-year-old female who fell from a horse. She is complaining of being unable to move. During your assessment, you have placed her arms at her sides, but her arms keeping returning to a "stick-up" or "hold-up" position. Based on this, which of the following is most likely? A) The patient has a spinal-cord injury at T-1. B) The patient has Brown-Sequard Syndrome. C) The patient is feigning the injury. D) The patient has a spinal-cord injury in the midcervical region. The patient has a spinal-cord injury in the midcervical region. All the following are seen in Cushing's Triad EXCEPT: A) Increased blood pressure B) Irregular respirations C) Tachycardia D) All of the above are seen in Cushing's Triad Tachycardia Which of the following spinal-cord injuries is LEAST likely to result in residual neurological deficit? A) Compression B) Transection C) Contusion D) Laceration Contusion Pediatric patients are _____ likely to become hypovolemic from head injuries than adult patients. A) More B) Less C) Equally D) Due to the movable fontanels, pediatric patients always become hypovolemic More A spinal-cord lesion may result in paralysis of both lower extremities. This condition is known as: A) Hemiplegia B) Hemiparesis C) Quadriplegia D) Paraplegia Paraplegia When assessing an individual who has lost sensation below the umbilicus, at what level do you suspect injury? A) T-10 B) T-4 C) L-1 D) T-8 T-10 Which of the following statements most accurately compares or contrasts nerve-root injuries and spinal-cord injuries? A) A nerve-root injury affects one dermatome unilaterally; a spinal-cord injury affects one dermatome bilaterally. B) Nerve-root injuries affect one dermatome; spinal-cord injuries affect multiple dermatomes. C) A nerve-root injury affects multiple dermatomes unilaterally; a spinal-cord injury affects multiple dermatomes bilaterally. D) Nerve-root injuries affect multiple dermatomes; spinal-cord injuries affect one dermatome. Nerve-root injuries affect one dermatome; spinal-cord injuries affect multiple dermatomes. Which of the following best explains the presentation and prognosis of partial spinal-cord transection injuries? A) The areas of the spinal cord damaged by partial transection can regenerate as long as some cord tissue remains intact at the level of injury. B) Partial cord transections result in only temporary loss of function, because the intact portions of the spinal cord will take over the functions of the injured areas. C) Different functions of the spinal tracts are located in anatomically different areas of the spinal cord, resulting in specific patterns of dysfunction depending on the location and mechanism of injury. D) The spinal cord functions as an "all or none" conduit for nerve impulses. Therefore, whether cord transection is partial or complete has no practical significance. Different functions of the spinal tracts are located in anatomically different areas of the spinal cord, resulting in specific patterns of dysfunction depending on the location and mechanism of injury. Which of the following is a function of the sympathetic nervous system? A) Digestion B) Sexual functioning C) Constriction of the pupils D) Increased heart rate Increased heart rate All of the following are used in the sedation of patients for rapid sequence intubation EXCEPT: A) Morphine B) Romazicon C) Etomidate D) Fentanyl Romazicon A patient unable to extend the leg or flex the hip is most likely to have incurred an injury in which nerve plexus? A) Cervical B) Lumbar C) Brachial D) Sacral Lumbar Which of the following is noted in the patient with a positive Babinski reflex? A) Fanning of the toes with plantar flexion of the great toe B) Dorsiflexion of the second to fifth toes with plantar flexion of the great toe C) Fanning of the toes with dorsiflexion of the great toe D) Plantar flexion of the second to fifth toes with dorsiflexion of the great toe Fanning of the toes with dorsiflexion of the great toe The cerebrum, cerebellum, and brainstem account for what percentage of the cranial volume? A) 60 percent B) 80 percent C) 50 percent D) 75 percent 80 percent A patient who had a spinal cord T-4 injury two years ago calls 911 for a pounding headache, blurred vision, and flushing. On arrival her vital signs include a blood pressure of 240/120 and pulse of 58. What is this condition called? A) Autonomic hyperreflexia syndrome B) Spinal shock C) Malignant hypertension D) Brown- Séquard s Syndrome Autonomic hyperreflexia syndrome You are on the scene of a domestic assault in which the female victim defended herself against further attack by stabbing her attacker. Your patient is a 36-year-old male who has been stabbed in the posterior thorax about 1 centimeter to the right of the spinous process of T6. Your assessment reveals loss of motor and sensory function on the right side distal to T6 but intact motor function with some loss of sensation on the left side distal to T6. Which of the following best explains this patient's presentation? A) "Pseudoneurological" deficit to avoid being arrested B) Brown- Séquard Syndrome C) Central cord syndrome D) Autonomic hyperreflexia Brown- Séquard Syndrome In a subdural hematoma the vessel most commonly involved is the: A) Superior sagittal sinus B) Inferior sagittal sinus C) Middle meningeal artery D) Superior meningeal artery Superior sagittal sinus Concussion is a(n) ______ injury: A) Direct B) Indirect C) Diffuse D) Delayed Diffuse Which of the following mechanisms is involved in neurogenic shock? 1. Unopposed vasodilation 2. Loss of innervation to the adrenal medulla 3. Decreased preload 4. Unopposed sympathetic tone A) 1, 2, 3 B) 1, 3, 4 C) 1, 2, 3, 4 D) 1, 3 1, 2, 3 When providing fluid resuscitation for a one-year-old child with hypovolemia from a head injury, the goal is to maintain a systolic blood pressure of: A) 90 mmHg B) 85 mmHg C) 75 mmHg D) 65 mmHg 65 mmHg The difference in temperature between the environment and the body is known as the: A) Thermal gradient B) Ambient temperature C) Thermal temperature D) Ambient gradient Thermal gradient Heat loss occurs in all the following ways EXCEPT: A) Conduction B) Evaporation C) Convection D) Ingestion Ingestion Although the hypothalamus plays a key role in body temperature regulation, there are two types of thermoreceptors elsewhere in the body. They are the: A) Peripheral thermoreceptors and central thermoreceptors B) Appendicular thermoreceptors and axial thermoreceptors C) Internal thermoreceptors and external thermoreceptors D) Aortic thermoreceptors and carotid thermoreceptors Peripheral thermoreceptors and central thermoreceptors You and your partner are working a day shift. It is a sunny day, and the temperature is 95°F. You are dispatched to the town soccer field for an 85-year-old female complaining of cramping to her fingers. The patient denies any other complaint of dizziness, nausea, or vomiting. The patient tells you it feels like her arthritis but much worse. Her vital signs are all within normal limits, and her skin is warm and moist. What is the most likely problem this patient is experiencing? A) Heat stroke B) Heat exhaustion C) Heat cramps D) Arthritis Heat cramps Individuals working in hot environments will lose 1 to 2 liters of water an hour. Each liter of water lost will result in how much sodium loss? A) 20 to 50 milliequivalents B) 10 to 20 milliequivalents C) 20 to 50 milligrams D) 10 to 20 milligrams 20 to 50 milliequivalents To treat for the excessive loss of sodium in patients with hyperthermic emergencies, the paramedic should: A) Always administer salt tablets B) Never administer salt tablets C) Only administer salt tablets to patients experiencing heat exhaustion D) Only administer salt tablets to patients if they are conscious and alert and have an intact gag reflex. Never administer salt tablets Pyrexia is another term for __________. A) Fever B) Altitude sickness C) Heat emergency D) Sunburn Fever The pediatric dose of ibuprofen is: A) 10 mg B) 15 mg C) 10 mg/kg D) 15 mg/kg 10 mg/kg Patients are considered to be hypothermic when their core temperature drops below: A) 40°C B) 35°C C) 30°C D) None of the above 35°C All of the following are signs of mild hypothermia EXCEPT: A) Tachycardia B) Vasodilation C) Impaired judgment D) Fatigue Vasodilation In which of the following patients would you expect to see a subacute exposure to cold? A) A homeless person B) A mountain climber C) The chronically ill patient D) Patients falling through ice into water A mountain climber The most common arrhythmia seen in hypothermia is: A) Ventricular fibrillation B) Ventricular tachycardia C) Atrial fibrillation D) Ventricular bradycardia Atrial fibrillation In the prehospital setting active rewarming should not be attempted unless the emergency department is greater than ____ minutes away. A) 10 B) 30 C) 45 D) 15 15 According to the American Heart Association, if a hypothermic patient who is in cardiac arrest does not respond to initial defibrillation and initial drug therapy, subsequent defibrillation and medication administration should be avoided until the patient's core temperature is about ____°F or higher: A) 86 B) 90 C) 96 D) 80 86 When providing fluid resuscitation to a hypothermic patient the rate of infusion should be: A) 150 to 200 mL/hour B) 500 to 600 mL/hour C) 100 to 125 mL/hour D) 250 to 275 mL/hour 150 to 200 mL/hour In superficial frostbite the tissue affected is the: A) Epidermal B) Subdural C) Intradural D) Subcutaneous Epidermal You and your partner are treating a 25-year-old male with frostbite to the left hand. Your BLS unit is going to be delayed because of a severe winter storm that is occurring. You and your partner decide that you must rewarm the patient's hand while waiting for your BLS unit. You are in the patient's house, and there is no chance of the hand being refrozen. To rewarm the patient's hand, you are going to submerse the hand in water. You know that the water must be between ____ and ____°F. A) 98; 102 B) 104; 108 C) 102; 104 D) 110; 112 102; 104 What percentage of drowning victims are children under five years of age? A) 10 B) 20 C) 40 D) 60 40 What percentage of drowning victims are males? A) 85 B) 80 C) 90 D) 75 85 Which of the following is a predisposing factor to hypothermia? A) Age of the patient B) Overall health of the patient C) Medications the patient takes D) All of the above are predisposing factors All of the above are predisposing factors A reflex that occurs when a person dives into cold water in which her breathing is inhibited, her heart rate becomes bradycardic, and vasoconstriction occurs is known as the: A) Diving reflex B) Mammalian diving reflex C) Submersion reflex D) Mammalian submersion reflex Mammalian diving reflex The amount of fluid that enters the lungs in a drowning case is: A) < 30 mL B) > 30 mL C) < 20 mL D) > 20 mL < 30 mL

When palpating the spine of a patient during your assessment, you are feeling the: A) Spinous processes B) Vertebral bodies C) Transverse vertebral processes D) Vertebral pedicles Spinous processes A patient who has dived into a shallow pool and hit his head on the bottom is most likely to have which of the following types of injuries? A) Cervical hyperextension B) Cervical hyperflexion C) Axial distraction D) Axial loading Axial loading Recent research has provided evidence of which of the following regarding spinal-injury assessment? A) Only trauma patients with signs and symptoms of neurological deficit need to receive spinal immobilization. B) Paramedics cannot reliably identify patients who are likely to have spinal injuries. C) All trauma patients should be assumed to have spinal injuries. D) There are reliable criteria for determining the likelihood of spinal injury. There are reliable criteria for determining the likelihood of spinal injury. Which of the following is a common mechanism of injury associated with spinal-cord injuries? A) Penetrating injuries B) Sports-related injuries C) Auto accidents D) All of the above All of the above Your patient is a 30-year-old male who was playing a backyard game of football and was tackled forcefully from the left side by his brother at the level of the shoulder. Based on this mechanism of injury, you should suspect which of the following patterns? A) Compression fractures on the left side of the cervical spine; torn ligaments on the right side of the cervical spine B) An axial distraction injury of the cervical region C) Compression fractures of the thoracic spine D) Subluxation of one or more thoracic vertebrae Compression fractures on the left side of the cervical spine; torn ligaments on the right side of the cervical spine Which of the following best describes the goals of manual cervical spine stabilization? A) Preventing movement of the head in any direction; applying a gentle lifting force of just enough to relieve some of the pressure the head exerts on the cervical spine B) Keeping the head in an "eyes forward" position; applying enough traction to cause axial unloading, which is 18 to 22 pounds in the average adult C) Preventing rotation of the head; avoiding any upward lifting or downward pressure on the cervical spine D) Preventing movement of the head in any direction; applying gentle axial pressure to stabilize the vertebral column Preventing movement of the head in any direction; applying a gentle lifting force of just enough to relieve some of the pressure the head exerts on the cervical spine Which of the following statements about the administration of dextrose to the patient with a traumatic brain injury is TRUE? A) Hypoglycemia is associated with a poorer neurological outcome; if the blood glucose level is less than 60 mg/dl, administer 25 grams of dextrose. B) Hypoglycemia is inconsequential to neurological outcome; assessing the blood glucose level is not a priority. C) Hyperglycemia is associated with a poorer neurological outcome; never administer dextrose to a patient with traumatic brain injury. D) Hypoglycemia is associated with a poorer neurological outcome. All patients with suspected traumatic brain injury who have an altered mental status should receive 25 grams of dextrose intravenously. Hypoglycemia is associated with a poorer neurological outcome; if the blood glucose level is less than 60 mg/dl, administer 25 grams of dextrose. You are caring for a 20-year-old skateboarder who crashed into a brick retaining wall at the bottom of a steep hill. He has blunt trauma to his face with nose deformity, loose teeth, and bleeding from the nose and mouth. Although you have answered him several times, he keeps repeating to you, "What happened? It seems like I'm having a bad day." This is most indicative of which of the following? A) Aphasia B) Retrograde amnesia C) Decorticate disorientation D) Anterograde amnesia Anterograde amnesia Which of the following are the two most important prehospital considerations for head injury patients? A) Cervical spine immobilization and ventilation B) ICP monitoring and administering corticosteroids C) Ventilation and administering corticosteroids D) Ventilation and maintaining adequate blood pressure Ventilation and maintaining adequate blood Your patient states that he had a traumatic brain injury from a motorcycle collision three years ago. You notice that his gait is unsteady and his movements are a bit jerky. You suspect that he has damage to which of the following structures? A) Falx cerebri B) Reticular activating system C) Third cranial nerve D) Cerebellum Cerebellum Which of the following is NOT a component of the Glasgow Coma Scale? A) Eye opening B) Motor ability C) Pupillary reaction D) Verbal response Pupillary reaction Which of the following is the largest element of the nervous system? A) Cerebellum B) Pons C) Medulla oblongata D) Cerebrum Cerebrum Which of the following Glasgow Coma Scale scores indicates serious brain injury? A) < 3 B) Between 12 and 15 C) < 8 D) < 15 < 8 The cerebral perfusion pressure is represented by which of the following equations? A) CPP = MAP - CVP B) CPP = CVP - ICP C) CPP = MAP - ICP D) CPP = ICP - MAP CPP = MAP - ICP Which of the following mechanisms causes indirect brain injury? A) Coup/contrecoup injuries B) Systemic hypotension combined with increasing intracranial pressure C) Cushing's reflex D) Acceleration/deceleration forces without a direct blow to the cranium Systemic hypotension combined with increasing intracranial pressure Which of the following best describes consensual reactivity of the pupils? A) It is a pathological phenomenon. When a penlight is shone into one eye, both pupils constrict. B) It is a normal phenomenon. When a penlight is shone into one eye, only that pupil will constrict, while the other pupil is unaffected. C) It is a normal phenomenon. When a penlight is shone into one eye, both pupils constrict. D) It is a pathological phenomenon. When a penlight is shone into one eye, only that pupil constricts, while the other pupil is unaffected. It is a normal phenomenon. When a penlight is shone into one eye, both pupils constrict. Your patient is a 12-year-old male who was struck in the right temporal area of the head with a baseball. He had a brief loss of consciousness and is alert on your arrival. You note that he is becoming drowsy and has a strong radial pulse of 60, a blood pressure of 140/70, and a respiratory rate of 12. Which of the following best describes this patient's condition? A) He is stable, and he most likely has a subarachnoid hemorrhage with no increase in intracranial pressure. B) He is critical, and he most likely has an epidural hematoma with rapidly increasing intracranial pressure. C) He is stable, and he most likely has a mild diffuse axonal injury with no increase in intracranial pressure. D) He is serious, and he most likely has a subdural hematoma with an increase in intracranial pressure. He is critical, and he most likely has an epidural hematoma with rapidly increasing intracranial pressure. The shearing, stretching, and tearing associated with rapid acceleration/deceleration forces acting on the brain result in which of the following types of brain injury? A) Direct, diffuse B) Indirect, diffuse C) Indirect, focal D) Direct, focal Direct, diffuse A concussion is best described as which of the following types of brain injuries? A) Indirect, diffuse B) Indirect, focal C) Direct, focal D) Direct, diffuse Direct, diffuse For the patient with suspected traumatic brain injury, the ideal positioning of the patient for transport is: A) In a left lateral recumbent position on the backboard B) On a long backboard with the foot of the backboard in a 15-degree Trendelenburg position C) On a long backboard with the patient's feet elevated on pillows to achieve a 15-degree angle D) On a long backboard with the head of the backboard elevated 15 to 30 degrees On a long backboard with the head of the backboard elevated 15 to 30 degrees When CPP falls below the critical level of 50 mmHG, autoregulation does which of the following to maintain CPP and cerebral perfusion? A) Decreases blood pressure B) Increases blood pressure C) Decreases intracranial pressure D) Increases intracranial pressure Increases blood pressure Which of the following would explain tachycardia and hypotension in the patient with a closed traumatic brain injury? 1. An undiscovered source of hemorrhage resulting in shock 2. Cushing's reflex 3. Massive blood loss due to tearing of the middle meningeal artery 4. Loss of compensatory mechanisms maintaining CPP A) 1, 3, 4 B) 1 C) 1, 4 D) 1, 2, 3, 4 1, 4 Which of the following about the use of prehospital fluid resuscitation in the patient with a traumatic brain injury is TRUE? A) Administer fluids aggressively regardless of the patient's blood pressure. B) Do not administer fluids unless the patient's blood pressure drops below 60 mmHg, because the administration of fluids leads to increased cerebral edema. C) Administer fluids as needed to maintain a systolic blood pressure above 90 mmHg. D) The use of hypertonic fluids is indicated to maintain vascular volume while reducing tissue edema. Administer fluids as needed to maintain a systolic blood pressure above 90 mmHg. Which of the following best describes the role of rapid sequence intubation (RSI) in the prehospital management of patients with traumatic brain injury? A) It is beneficial and should be used for all patients with traumatic brain injury who are experiencing trismus or who have an intact gag reflex. B) It is supported by anecdotal evidence, but no studies have been done to determine its feasibility or usefulness. C) It is controversial because of conflicting study results. D) It is detrimental, resulting in poorer neurological outcomes than in patients who received standard airway management. It is controversial because of conflicting study results. Which of the following statements about the patient in neurogenic shock is NOT true? A) The patient's heart rate may be normal. B) Neurogenic shock may be temporary, even if spinal-cord injury is permanent. C) Signs of hypovolemic shock may be masked. D) Unopposed sympathetic nervous system stimulation results in generalized pallor and diaphoresis. Unopposed sympathetic nervous system stimulation results in generalized pallor and diaphoresis. Coup injuries commonly occur in which region of the brain? A) Frontal region B) Occipital region C) Temporal region D) Neuronal region Frontal region Anterior cord syndrome is caused by which of the following mechanisms? A) Tearing of the anterior cord due to hyperextension mechanisms B) Disruption of arterial blood supply to the anterior cord C) Laceration of the anterior cord caused by bone fragments D) Contusion of the anterior cord caused by blunt trauma Disruption of arterial blood supply to the anterior cord The diaphragm is controlled by peripheral nerve roots ________ through ________. A) C-3, C-7 B) C-3, C-5 C) C-1, C-7 D) C-1, C-5 C-1, C-5 The spinal cord is continuous from the brain to the level of: A) T-12 or T-13 B) L-5 or L-6 C) The coccyx D) L-1 or L-2 L-1 or L-2 You are treating a 16-year-old male who fell while practicing a new move on his skateboard. Bystanders relate that the patient was not wearing a helmet. The bystanders also relate that the patient was alert and oriented following the fall; however, while waiting for you to arrive, the patient became unconscious. While performing your physical exam, you note that the patient has a hematoma to the right temporal area. Your assessment leads you to believe that your patient has an epidural hematoma. You know that an epidural hematoma is caused by what type of bleeding? A) Venous bleeding B) Capillary bleeding C) Arterial bleeding D) Venous and capillary bleeding Arterial bleeding You have intubated a five-year-old girl with a suspected head injury. You note that the patient is exhibiting signs of herniation. What is the desired range for this patient's end-tidal CO2? A) 35 to 40 B) 30 to 35 C) 25 to 30 D) 40 to 45 35 to 40 The phrenic nerve consists of peripheral nerve roots ________ through ________. A) C-1, C-3 B) C-5, C-8 C) C-3, C-5 D) C-1, C-8 C-3, C-5 Your patient is a 17-year-old female who fell from a horse. She is complaining of being unable to move. During your assessment, you have placed her arms at her sides, but her arms keeping returning to a "stick-up" or "hold-up" position. Based on this, which of the following is most likely? A) The patient has a spinal-cord injury at T-1. B) The patient has Brown-Sequard Syndrome. C) The patient is feigning the injury. D) The patient has a spinal-cord injury in the midcervical region. The patient has a spinal-cord injury in the midcervical region. All the following are seen in Cushing's Triad EXCEPT: A) Increased blood pressure B) Irregular respirations C) Tachycardia D) All of the above are seen in Cushing's Triad Tachycardia Which of the following spinal-cord injuries is LEAST likely to result in residual neurological deficit? A) Compression B) Transection C) Contusion D) Laceration Contusion Pediatric patients are _____ likely to become hypovolemic from head injuries than adult patients. A) More B) Less C) Equally D) Due to the movable fontanels, pediatric patients always become hypovolemic More A spinal-cord lesion may result in paralysis of both lower extremities. This condition is known as: A) Hemiplegia B) Hemiparesis C) Quadriplegia D) Paraplegia Paraplegia When assessing an individual who has lost sensation below the umbilicus, at what level do you suspect injury? A) T-10 B) T-4 C) L-1 D) T-8 T-10 Which of the following statements most accurately compares or contrasts nerve-root injuries and spinal-cord injuries? A) A nerve-root injury affects one dermatome unilaterally; a spinal-cord injury affects one dermatome bilaterally. B) Nerve-root injuries affect one dermatome; spinal-cord injuries affect multiple dermatomes. C) A nerve-root injury affects multiple dermatomes unilaterally; a spinal-cord injury affects multiple dermatomes bilaterally. D) Nerve-root injuries affect multiple dermatomes; spinal-cord injuries affect one dermatome. Nerve-root injuries affect one dermatome; spinal-cord injuries affect multiple dermatomes. Which of the following best explains the presentation and prognosis of partial spinal-cord transection injuries? A) The areas of the spinal cord damaged by partial transection can regenerate as long as some cord tissue remains intact at the level of injury. B) Partial cord transections result in only temporary loss of function, because the intact portions of the spinal cord will take over the functions of the injured areas. C) Different functions of the spinal tracts are located in anatomically different areas of the spinal cord, resulting in specific patterns of dysfunction depending on the location and mechanism of injury. D) The spinal cord functions as an "all or none" conduit for nerve impulses. Therefore, whether cord transection is partial or complete has no practical significance. Different functions of the spinal tracts are located in anatomically different areas of the spinal cord, resulting in specific patterns of dysfunction depending on the location and mechanism of injury. Which of the following is a function of the sympathetic nervous system? A) Digestion B) Sexual functioning C) Constriction of the pupils D) Increased heart rate Increased heart rate All of the following are used in the sedation of patients for rapid sequence intubation EXCEPT: A) Morphine B) Romazicon C) Etomidate D) Fentanyl Romazicon A patient unable to extend the leg or flex the hip is most likely to have incurred an injury in which nerve plexus? A) Cervical B) Lumbar C) Brachial D) Sacral Lumbar Which of the following is noted in the patient with a positive Babinski reflex? A) Fanning of the toes with plantar flexion of the great toe B) Dorsiflexion of the second to fifth toes with plantar flexion of the great toe C) Fanning of the toes with dorsiflexion of the great toe D) Plantar flexion of the second to fifth toes with dorsiflexion of the great toe Fanning of the toes with dorsiflexion of the great toe The cerebrum, cerebellum, and brainstem account for what percentage of the cranial volume? A) 60 percent B) 80 percent C) 50 percent D) 75 percent 80 percent A patient who had a spinal cord T-4 injury two years ago calls 911 for a pounding headache, blurred vision, and flushing. On arrival her vital signs include a blood pressure of 240/120 and pulse of 58. What is this condition called? A) Autonomic hyperreflexia syndrome B) Spinal shock C) Malignant hypertension D) Brown- Séquard s Syndrome Autonomic hyperreflexia syndrome You are on the scene of a domestic assault in which the female victim defended herself against further attack by stabbing her attacker. Your patient is a 36-year-old male who has been stabbed in the posterior thorax about 1 centimeter to the right of the spinous process of T6. Your assessment reveals loss of motor and sensory function on the right side distal to T6 but intact motor function with some loss of sensation on the left side distal to T6. Which of the following best explains this patient's presentation? A) "Pseudoneurological" deficit to avoid being arrested B) Brown- Séquard Syndrome C) Central cord syndrome D) Autonomic hyperreflexia Brown- Séquard Syndrome In a subdural hematoma the vessel most commonly involved is the: A) Superior sagittal sinus B) Inferior sagittal sinus C) Middle meningeal artery D) Superior meningeal artery Superior sagittal sinus Concussion is a(n) ______ injury: A) Direct B) Indirect C) Diffuse D) Delayed Diffuse Which of the following mechanisms is involved in neurogenic shock? 1. Unopposed vasodilation 2. Loss of innervation to the adrenal medulla 3. Decreased preload 4. Unopposed sympathetic tone A) 1, 2, 3 B) 1, 3, 4 C) 1, 2, 3, 4 D) 1, 3 1, 2, 3 When providing fluid resuscitation for a one-year-old child with hypovolemia from a head injury, the goal is to maintain a systolic blood pressure of: A) 90 mmHg B) 85 mmHg C) 75 mmHg D) 65 mmHg 65 mmHg The difference in temperature between the environment and the body is known as the: A) Thermal gradient B) Ambient temperature C) Thermal temperature D) Ambient gradient Thermal gradient Heat loss occurs in all the following ways EXCEPT: A) Conduction B) Evaporation C) Convection D) Ingestion Ingestion Although the hypothalamus plays a key role in body temperature regulation, there are two types of thermoreceptors elsewhere in the body. They are the: A) Peripheral thermoreceptors and central thermoreceptors B) Appendicular thermoreceptors and axial thermoreceptors C) Internal thermoreceptors and external thermoreceptors D) Aortic thermoreceptors and carotid thermoreceptors Peripheral thermoreceptors and central thermoreceptors You and your partner are working a day shift. It is a sunny day, and the temperature is 95°F. You are dispatched to the town soccer field for an 85-year-old female complaining of cramping to her fingers. The patient denies any other complaint of dizziness, nausea, or vomiting. The patient tells you it feels like her arthritis but much worse. Her vital signs are all within normal limits, and her skin is warm and moist. What is the most likely problem this patient is experiencing? A) Heat stroke B) Heat exhaustion C) Heat cramps D) Arthritis Heat cramps Individuals working in hot environments will lose 1 to 2 liters of water an hour. Each liter of water lost will result in how much sodium loss? A) 20 to 50 milliequivalents B) 10 to 20 milliequivalents C) 20 to 50 milligrams D) 10 to 20 milligrams 20 to 50 milliequivalents To treat for the excessive loss of sodium in patients with hyperthermic emergencies, the paramedic should: A) Always administer salt tablets B) Never administer salt tablets C) Only administer salt tablets to patients experiencing heat exhaustion D) Only administer salt tablets to patients if they are conscious and alert and have an intact gag reflex. Never administer salt tablets Pyrexia is another term for __________. A) Fever B) Altitude sickness C) Heat emergency D) Sunburn Fever The pediatric dose of ibuprofen is: A) 10 mg B) 15 mg C) 10 mg/kg D) 15 mg/kg 10 mg/kg Patients are considered to be hypothermic when their core temperature drops below: A) 40°C B) 35°C C) 30°C D) None of the above 35°C All of the following are signs of mild hypothermia EXCEPT: A) Tachycardia B) Vasodilation C) Impaired judgment D) Fatigue Vasodilation In which of the following patients would you expect to see a subacute exposure to cold? A) A homeless person B) A mountain climber C) The chronically ill patient D) Patients falling through ice into water A mountain climber The most common arrhythmia seen in hypothermia is: A) Ventricular fibrillation B) Ventricular tachycardia C) Atrial fibrillation D) Ventricular bradycardia Atrial fibrillation In the prehospital setting active rewarming should not be attempted unless the emergency department is greater than ____ minutes away. A) 10 B) 30 C) 45 D) 15 15 According to the American Heart Association, if a hypothermic patient who is in cardiac arrest does not respond to initial defibrillation and initial drug therapy, subsequent defibrillation and medication administration should be avoided until the patient's core temperature is about ____°F or higher: A) 86 B) 90 C) 96 D) 80 86 When providing fluid resuscitation to a hypothermic patient the rate of infusion should be: A) 150 to 200 mL/hour B) 500 to 600 mL/hour C) 100 to 125 mL/hour D) 250 to 275 mL/hour 150 to 200 mL/hour In superficial frostbite the tissue affected is the: A) Epidermal B) Subdural C) Intradural D) Subcutaneous Epidermal You and your partner are treating a 25-year-old male with frostbite to the left hand. Your BLS unit is going to be delayed because of a severe winter storm that is occurring. You and your partner decide that you must rewarm the patient's hand while waiting for your BLS unit. You are in the patient's house, and there is no chance of the hand being refrozen. To rewarm the patient's hand, you are going to submerse the hand in water. You know that the water must be between ____ and ____°F. A) 98; 102 B) 104; 108 C) 102; 104 D) 110; 112 102; 104 What percentage of drowning victims are children under five years of age? A) 10 B) 20 C) 40 D) 60 40 What percentage of drowning victims are males? A) 85 B) 80 C) 90 D) 75 85 Which of the following is a predisposing factor to hypothermia? A) Age of the patient B) Overall health of the patient C) Medications the patient takes D) All of the above are predisposing factors All of the above are predisposing factors A reflex that occurs when a person dives into cold water in which her breathing is inhibited, her heart rate becomes bradycardic, and vasoconstriction occurs is known as the: A) Diving reflex B) Mammalian diving reflex C) Submersion reflex D) Mammalian submersion reflex Mammalian diving reflex The amount of fluid that enters the lungs in a drowning case is: A) < 30 mL B) > 30 mL C) < 20 mL D) > 20 mL < 30 mL The substance within the body that is responsible for preventing atelectasis is: A) Aveolar fluid B) Surfactant C) Pleural fluid D) Atelectasis fluid Surfactant All of the following are part of the drowning sequence of a conscious person EXCEPT: A) Attempted breath holding B) Violent swallowing efforts C) PaCO2 in the blood falling below 50 D) PaO2 in the blood falling below 50 PaCO2 in the blood falling below 50 You and your partner are treating a drowning patient who had a submersion time of 10 minutes. Your partner wants to perform the Heimlich maneuver; you should: A) Advise your partner that the Heimlich maneuver should not be utilized for drowning victims B) Agree with your partner and begin performing the Heimlich maneuver C) Agree with your partner, as you know the Heimlich maneuver should only be performed on patients with a submersion time of less than 15 minutes. D) Advise your partner that the Heimlich maneuver should only be performed on patients with a submersion time of greater than 15 minutes Advise your partner that the Heimlich maneuver should not be utilized for drowning victims Boyle's law states that ________ the pressure of a gas will _______ its volume: A) Decreasing, decrease B) Decreasing, increase C) Increasing, increase D) Increasing, decrease Increasing, decrease Which law of gases states that the amount of gas dissolved in a given volume of fluid is proportional to the pressure of the gas above it? A) Boyle's law B) Dalton's law C) Henry's law D) Winston's law Henry's law A diving injury commonly called "the squeeze" occurs during which phase of diving? A) Descent B) Ascent C) On the surface D) On the bottom Descent Decompression sickness commonly occurs in divers who are diving below what level? A) 44 feet B) 33 feet C) 22 feet D) 11 feet 33 feet Which of the following is an essential factor to consider when assessing a patient suspected of having a diving emergency? A) Type of breathing apparatus utilized B) Depth of the dive C) Aircraft travel following a dive D) All of the above All of the above You and your partner are treating a 35-year-old female who is complaining of severe pain in her joints and abdomen. The patient tells you that she went diving approximately 12 hours prior to the onset of complaint. Which of the following would be part of a correct course of treatment for this patient? A) Oxygen via nonrebreather mask to maintain SpO2 of > 96 percent, IV fluid replacement with lactated Ringer's, transport B) Oxygen via nasal cannula to maintain SpO2 of > 96 percent, fluid replacement with lactated Ringer's, transport C) Oxygen via nonrebreather mask regardless of SpO2 reading, IV fluid replacement with 5 percent dextrose, transport to hyperbaric chamber D) Oxygen via nonrebreather mask regardless of SpO2 reading, fluid replacement with lactated Ringer's, transport Oxygen via nonrebreather mask regardless of SpO2 reading, fluid replacement with lactated Ringer's, transport At what depth do most divers experience nitrogen narcosis? A) 70 to 100 feet B) 60 to 70 feet C) 200 to 250 feet D) 300 to 350 feet 70 to 100 feet At what altitude do altitude illnesses start to manifest? A) 8,000 feet B) 4,000 feet C) 6,000 feet D) 12,000 feet 8,000 feet During the hypoxic ventilatory response, what do the kidneys do? A) Shut down B) Function normally C) Decrease the removal of bicarbonate D) Increase the removal of bicarbonate Increase the removal of bicarbonate Which of the following is a medication used in the treatment of high-altitude conditions? A) Dextrose B) Methylprednisolone C) Atropine D) Diamox Diamox Your patient is the 24-year-old male victim of a drive-by shooting. He is sitting on the ground on your arrival, with his legs stretched in front of him. You note his sweatpants are bloody below the right knee. He is alert, though complaining of right leg pain, and has adequate ventilation, as well as a radial pulse of 88. To decide if this patient should be transported quickly to a trauma center, you should consider if he meets which of the following? A) A Glasgow Coma Scale score of at least 15 B) CDC Guidelines for Field Triage of Injured Patients C) A Revised Trauma Score of at least 20 D) All of the above CDC Guidelines for Field Triage of Injured Patients All the following are complications of hypothermia in the trauma patient EXCEPT: A) Inhibited clotting cascade B) Release of anticoagulant agents C) Reduction in blood loss D) Increased energy use Reduction in blood loss Which of the following should lead you to suspect spinal-cord injury? A) Altered mental status B) Odor of alcohol C) Distracting injuries D) All of the above All of the above Your patient is a 55-year-old male with a gunshot wound to the abdomen. Which of the following does NOT have a bearing on the mechanism of injury analysis? A) The distance of the shooter from the victim at the time of injury B) The type of ammunition used C) Whether the shooter is right- or left-handed D) The type of firearm used Whether the shooter is right- or left-handed Which of the following best describes the appropriate timing of the rapid trauma assessment? A) After the focused history and assessment of the stable trauma patient B) After establishing airway, ventilation, and hemorrhage control in a critical trauma patient C) Upon making initial contact with the unresponsive trauma patient D) When considering accepting a refusal of treatment and transport from a stable trauma patient After establishing airway, ventilation, and hemorrhage control in a critical trauma patient Your patient is a 40-year-old male driver of a vehicle that was struck in the driver's-side door by another vehicle at an intersection. The estimated speed of the vehicle that struck the patient's car is 30 miles per hour. The patient was restrained, but his vehicle lacks side-impact airbags. On your arrival, he is awake and complaining of head pain. He has a 4 cm laceration to the left posterior parietal area of the head. There was moderate bleeding before your arrival, but the bleeding is now minor. Witnesses state that there was no loss of consciousness, but immediately following the collision, the patient seemed confused and did not immediately understand that witnesses wanted him to unlock his door and use his cellular phone to call for help. The patient's skin is warm and dry, his respirations are 16, and the radial pulse is strong at 88 per minute. Which of the following most accurately describes how to best remove the patient from the vehicle? A) Place a cervical collar, maintain manual stabilization of the cervical spine, place a vest-type extrication device, and remove the patient onto a long backboard. B) Place a cervical collar, assist the patient in standing up, and then use a "standing take down" to place him on a long backboard. C) Place a cervical collar, place a long backboard on the stretcher, and position it next to the driver's door. Instruct the patient to slide onto the board as you maintain manual stabilization of the cervical spine. D) Place a cervical collar, maintain manual stabilization of the cervical spine, and use rapid extrication onto a long backboard. Place a cervical collar, maintain manual stabilization of the cervical spine, place a vest-type extrication device, and remove the patient onto a long backboard. Which of the following probably contributes to injury-related morbidity and mortality in the young male population (those aged 13 to 35 years)? A) The tendency to put small objects in the mouth B) Disregard for safety practices C) Poor physiological compensatory mechanisms D) None of the above Disregard for safety practices Paramedics should do everything possible to ensure that they are on the scene of a traumatic emergency for no more than _____ minutes: A) 15 B) 20 C) 10 D) 25 10 Which of the following offers a valuable model for EMS to consider when trying to reduce injury-related morbidity and mortality? A) The Pan American Health Organization B) American Society for Testing Materials (ASTM) C) The fire service D) Drug Abuse Resistance Education (DARE) The fire service The uncritical use of which of the following when caring for the trauma patient has been questioned by research? A) PASG B) Rapid isotonic fluid infusion C) Capillary refill as an indicator of tissue perfusion D) All of the above All of the above The elderly patient in shock may be less likely to exhibit which of the following expected manifestations of shock? A) Cardiac arrhythmias B) Hypothermia C) Altered mental status D) Tachycardia Tachycardia Which of the following statements about the pediatric pedestrian who is struck by a vehicle is NOT true? A) A child commonly turns toward the oncoming vehicle at the moment of impact. B) Smaller children are likely to suffer fractures of the tibia and fibula as a result of impact with the vehicle's bumper. C) A smaller child is more likely to be thrown to the ground following initial impact, versus being thrown onto the hood. D) Anatomically, the injuries caused by the initial impact of the vehicle will be higher on the body than in an adult. Smaller children are likely to suffer fractures of the tibia and fibula as a result of impact with the vehicle's bumper. Which of the following best describes the significance of finding an abrasion during the prehospital assessment of the trauma patient? A) Abrasions are superficial wounds and not of particular concern in the prehospital setting. B) There is a risk of infection. C) It increases the risk of hemorrhagic shock. D) It is a possible indication of more significant trauma beneath the abrasion. It is a possible indication of more significant trauma beneath the abrasion. A thorough inspection of the trauma patient can be best performed if which of the following guidelines is used? A) Assess for tenderness, the ability to move, and distal sensation and circulation. B) Assess for abnormalities in skin color, deformity of any part of the body, and any disruption of the skin. C) Assess for deformity, swelling, and angulation of any part of the body. D) Assess for pulse, paresthesia, pallor, and pain. Assess for abnormalities in skin color, deformity of any part of the body, and any disruption of the skin. Your patient is a 24-year-old female driver of a vehicle in a motor vehicle collision. She rear-ended a vehicle stopped at a traffic light at about 25 miles per hour. She was restrained, and the front airbags deployed. She is 32 weeks pregnant. She is anxious because she has not felt the baby move since the impact, and she is complaining of constant pain on the left side of her abdomen. Palpation of the abdomen reveals unusual firmness over the left side of the abdomen. The patient has a pulse of 116, a blood pressure of 92/60, and respirations of 28. Her skin is cool but dry, and she has no other complaints. For which of the following should you have the highest index of suspicion? A) Placenta previa B) Placenta accreta C) Abruptio placentae D) Stress-induced onset of labor Abruptio placentae Which of the following has the greatest potential for reducing injury-related morbidity and mortality? A) Injury-prevention activities B) Increased funding for rural EMS system development C) Increasing the scope of practice of paramedics to include such lifesaving procedures as pericardiocentesis and trephination of the skull to reduce intracranial pressure D) Using physicians and physician's assistants as prehospital care providers Injury-prevention activities Which of the following is the most likely indicator of intraabdominal hemorrhage in the prehospital setting? A) Distension and/or rigidity of the abdomen on palpation B) Rebound tenderness of the abdomen on palpation C) Ecchymosis of the abdomen or flanks D) Signs and symptoms of hypovolemia unexplained by other injuries Signs and symptoms of hypovolemia unexplained by other injuries Your patient is a 23-year-old female victim of an attempted abduction at knifepoint. The assailant was interrupted and drew his knife across the victim's throat as he fled the scene. A first responder on the scene immediately applied direct pressure to the neck wound. Your assessment reveals a very agitated young woman with ongoing blood loss despite direct pressure to the wound. There appears to be both bright-red bleeding and slower but steady dark-red bleeding. It appears that the trachea has not been penetrated but that there is a hematoma around the laceration. Which of the following is the most appropriate sequence of intervention for this patient? A) Apply a pressure dressing to the wound, accompanied by pressure-point compression. B) Use rapid sequence intubation of the patient to protect the trachea from the expanding hematoma while maintaining direct pressure on the wound. C) Apply an occlusive dressing to the wound, and continue direct pressure. D) Apply direct pressure, and request an order from medical control to decompress the hematoma. Use rapid sequence intubation of the patient to protect the trachea from the expanding hematoma while maintaining direct pressure on the wound. A critical trauma patient should be reassessed every ________ minute(s) en route to the trauma center. A) 5 B) 10 C) 15 D) 1 5 Assuming none of the following patients has any neurological deficits, which patient requires cervical spinal immobilization? A) A 19-year-old male who has a gunshot wound to the right thigh B) A three-year-old female who fell on the sidewalk while running and who has a bite injury to her tongue C) A ten-year-old male skateboarder who fell while skating down a hill and received abrasions to his hands, elbows, chest, and knees D) A 70-year-old female involved in a moderate-speed, lateral-impact motor vehicle collision who is complaining of left arm pain A 70-year-old female involved in a moderate-speed, lateral-impact motor vehicle collision who is complaining of left arm pain ) Which of the following best describes definitive care for the pregnant trauma patient with ongoing, significant hemorrhage? A) Invasive hemodynamic monitoring and serial hematocrits B) Administration of hypertonic crystalloid or colloid solution C) Immediate surgery D) Administration of blood or blood products Immediate surgery Which of the following groups has the highest trauma morbidity and mortality rates? A) Males aged 13 to 35 years B) Males aged 45 to 70 C) Both genders aged 60 to 75 years D) Children aged 1 to 12 years Males aged 13 to 35 years During which part of your assessment would you note the need for additional resources? A) Scene size-up B) Primary assessment C) Secondary assessment D) None of the above Scene size-up In which type of vehicle impact are patients afforded the most protection? A) Frontal impacts B) Side impacts C) Lateral impacts D) None of the above Frontal impacts All of the following are components of the revised trauma score EXCEPT: A) Glasgow Coma Scale B) Systolic blood pressure C) Pulse rate D) Respiratory rate Pulse rate Which of the following best explains the importance of determining the trauma patient's level of consciousness and orientation in the initial assessment? A) It determines whether the patient requires further assessment. B) It provides immediate information about the severity of the patient's injury. C) It immediately rules in or out the need for spinal immobilization. D) It serves as a baseline for determining improvement or deterioration in the patient's condition. It serves as a baseline for determining improvement or deterioration in the patient's condition. Which of the following patients' mechanisms of injury meets trauma triage criteria for transport to a trauma center? A) A 17-year-old male with a gunshot wound to the arm B) A 31-year-old male involved in a medium-velocity motor vehicle collision C) A ten-year-old male soccer player with a laceration over his right eye after colliding with another player's head D) A nine-year-old female who fell 15 feet from grandstand bleachers at a baseball game A nine-year-old female who fell 15 feet from grandstand bleachers at a baseball game Your patient is a 19-year-old male who was thrown from a horse while riding in a rodeo. After throwing the patient off, the horse stepped on the patient's abdomen. When you reach the patient, you note that his face, neck, and shoulders are pale, cool, and diaphoretic but that the patient's skin is otherwise warm and dry. The patient has some movement and sensation in his forearms and hands but otherwise no movement or sensation below the shoulders. He is anxious and has a respiratory rate of 24, a heart rate of 68, and a blood pressure of 106/66. Which of the following should be the primary concern when determining this patient's transport priority? A) The potential for neurologic shock, requiring immediate surgery B) The potential for intraabdominal hemorrhage that may be masked by loss of sympathetic nervous function C) The potential for traumatic brain injury D) The potential for respiratory failure secondary to paralysis of the diaphragm The potential for intraabdominal hemorrhage that may be masked by loss of sympathetic nervous function Your patient is a 45-year-male who was found sitting in a chair in a residence. He responds to painful stimuli with incoherent speech and has an odor of alcohol on his clothing and breath. There is an empty bottle of tricyclic antidepressants next to the patient, as well as a nearly empty bottle of liquor. Because there is no electricity in the residence and light is insufficient, you move the patient to your stretcher so you can perform your examination in a better environment. The patient has a blood pressure of 130/70, a heart rate of 124, and respirations of 8 per minute. There were no obvious signs of trauma, but your detailed examination reveals a fresh laceration to the right parietal area of the head. The laceration has been cleaned and appears to be several hours old. Which of the following is the best course of action? A) Transport the patient on the assumption that his condition is more consistent with a tricyclic overdose than with trauma. His reported history of alcoholism probably accounts for the laceration on his head. B) Right now the patient's condition seems more consistent with tricyclic overdose, but because a history of the head laceration cannot be obtained, the patient should be monitored closely for signs of increased intracranial pressure. C) Place a cervical collar on the patient and secure him to a long backboard before transport. The empty medication bottle was likely an incidental finding. Intubate, using RSI if necessary. Begin transport to a trauma center, and start a large-bore IV of lactated Ringer's solution infusing at a wide-open rate. D) Place a cervical collar on the patient and secure him to a long backboard before transport. His level of consciousness does not allow for better assessment of the mechanism of injury. His signs and symptoms are consistent with a tricyclic overdose and alcohol abuse, but his reported history of alcohol abuse puts him at increased risk of intracranial bleeding due to fairly minor trauma. Place a cervical collar on the patient and secure him to a long backboard before transport. His level of consciousness does not allow for better assessment of the mechanism of injury. His signs and symptoms are consistent with a tricyclic overdose and alcohol abuse, but his reported history of alcohol abuse puts him at increased risk of intracranial bleeding due to fairly minor trauma. When administering fluid to a multisystem trauma patient with no signs of head injury but with signs of hypoperfusion, the paramedic should only administer fluid to maintain a systolic blood pressure equal to _____ mmHg. A) 70 B) 80 C) 60 D) 100 80 Which of the following should the paramedic assess when performing palpation during examination of a trauma patient? A) Discoloration, such as erythema or ecchymosis B) Skin temperature C) Hyporesonance or hyperresonance of the thorax and abdomen D) The depth of open wounds Skin temperature Your patient is a four-year-old child. He has received an accidental gunshot wound to the groin and has lost a significant amount of blood. He responds to painful stimuli and has a heart rate of 150 with no radial pulse. Respirations are 32 and shallow. What is the total amount of intravenous fluid you should administer to this patient, assuming his condition does NOT improve with intervention? A) 10 ml/kg B) 20 ml/kg C) 30 ml/kg D) 40 ml/kg 20 ml/kg Which of the following is NOT an element of the scene size-up on a trauma response? A) Assessing for scene hazards B) Determining the number of patients C) Setting up an IV D) Evaluating the mechanism of injury Setting up an IV Bariatric patients are at greater risk for all of the following EXCEPT: A) Arrhythmias B) Cardiac failure C) Systemic hypertension D) Bradycardia Bradycardia Bariatric trauma patients have a mortality of up to ____________ times greater than normal weight patients. A) Two B) Six C) Three D) Four Six The blood pressure of the pregnant female falls by 5 to 15 mmHg during which trimester? A) First B) Second C) Third D) Fourth Second

Which of the following best describes the effect of hyperventilation in the brain-injured patient? A) It is beneficial, because vasodilation results in increased cerebral blood flow. B) It is detrimental, because vasodilation causes an increase in tissue edema. C) It is beneficial, because vasoconstriction results in decreased tissue edema. D) It is detrimental, because vasoconstriction results in decreased cerebral perfusion. It is detrimental, because vasoconstriction results in decreased cerebral perfusion. Your patient is a 45-year-old male with extensive blunt trauma to the face. He has decorticate posturing in response to pain; weak, irregular respiratory effort at 6 per minute; and a heart rate of 50 with a good radial pulse. The patient appears to have nasal and mandibular fractures, and an oropharyngeal airway is insufficient to keep the tongue from the posterior pharynx. Which of the following has the MOST potential to negatively impact the patient? A) Retrograde intubation B) Oral intubation under direct laryngoscopy C) Nasotracheal intubation D) A nonvisualized dual-lumen airway Nasotracheal intubation Which of the following medications may be indicated in the prehospital management of the patient with traumatic brain injury? A) Methylprednisolone B) Diazoxide C) Mannitol D) Furosemide Furosemide Circulation to the face is provided by the ________ artery A) External carotid artery B) Internal carotid artery C) Midfacial artery D) Mandibular artery External carotid artery Which of the following correctly describes the impact of motorcycle helmet use? A) Helmet usage is associated with a 10 percent reduction in serious head injuries. B) There have been no reported fatalities from motorcycle collisions in which the riders were wearing helmets. C) Helmet usage decreases the risk of serious head injuries but increases the risk of cervical-spine injuries. D) Helmet usage results in a more than 50 percent reduction in serious head injuries. Helmet usage results in a more than 50 percent reduction in serious head injuries. Which of the following parameters should be used to guide the oxygenation and ventilation of the patient with a traumatic brain injury? A) Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg. B) Maintain an oxygen saturation level of at least 90 percent and a capnography level < 45 mmHg. C) Maintain an oxygen saturation level of at least 98 percent and a capnography reading > 45 mmHg. D) Maintain an oxygen saturation level of at least 90 percent and a capnography reading < 35 mmHg. Maintain an oxygen saturation level of at least 96 percent and a capnography reading between 35 and 40 mmHg. You are caring for a 22-year-old amateur boxer who complained of a sudden obstruction of part of his visual field. This complaint is most consistent with which of the following conditions? A) Extrusion of the eyeball B) Subconjunctival hemorrhage C) Hyphema D) Retinal detachment Retinal detachment Regarding the primary assessment of the patient with suspected traumatic brain injury, which of the following describes the best approach to assessing the patient's neurological functioning? A) The use of AVPU B) Assessing the patient for level of consciousness and orientation to person, place, and time C) Assessing a revised trauma score D) Assessing a Champion trauma scale score Assessing the patient for level of consciousness and orientation to person, place, and time Your patient is a 26-year-old male who suffered a shotgun wound to the neck and face. Your assessment reveals obstruction of the upper airway because of extensive soft-tissue damage and fractures of the mandible, maxilla, and hard palate. The patient has a bubbling open wound to the anterior neck about 1 centimeter inferior to the cricoid cartilage, opening the trachea to the environment. Which of the following describes the best way to manage this patient's airway? A) Control bleeding around the neck wound, using suction if necessary to prevent aspiration. Assess whether it is possible to introduce an endotracheal tube into the trachea through the wound. B) Control bleeding around the neck wound, apply an occlusive dressing over it, and attempt nasotracheal intubation. C) Control bleeding from the wound, and apply an occlusive dressing over it. Perform a percutaneous cricothyrotomy, and use transtracheal jet insufflation to ventilate. D) Control bleeding around the neck wound, and apply an occlusive dressing over it. Insert a nonvisualized dual-lumen airway (e.g., CombiTube) for ventilation. Control bleeding around the neck wound, using suction if necessary to prevent aspiration. Assess whether it is possible to introduce an endotracheal tube into the trachea through the wound. Which of the following may confound the assessment of the patient who has a mechanism of injury consistent with significant brain injury? A) Slow development of the brain-injury process B) The patient's use of alcohol, marijuana, or other drugs C) The nature of the patient's injuries D) All of the above All of the above Which of the following best describes the percentage of mortality from penetrating gunshot wounds to the cranium? A) 35 to 50 B) 75 to 80 C) 90 to 95 D) 10 to 15 75 to 80 Your patient has received blunt facial trauma due to an assault. For which of the following injuries should you maintain a high index of suspicion? 1. Airway obstruction 2. Hypoxia due to aspiration of blood 3. Basilar skull fracture 4. Cervical spine trauma A) 1, 2, 3 B) 1, 2 C) 1, 4 D) 1, 2, 3, 4 1, 2, 3, 4 The ________ is one of the thinnest and most frequently fractured cranial bones. A) Temporal B) Ethmoid C) Parietal D) Occipital Temporal Which of the following patients fit the criteria for application of spinal precautions in the prehospital setting? A) An 85-year-old male who has fallen down three steps and has a large laceration to the occipital region of the skull but no complaints of pain B) A 21-year-old male who was diving into a pool and states he hit his head but is out of the pool and ambulatory upon your arrival with no complaint of neck or back pain C) A 36-year-old female who was involved in a minor motor vehicle crash with an obvious closed tibia fracture D) None of the above None of the above During the early care for a patient with a basilar skull fracture in the prehospital setting, which of the following would be an unexpected finding? A) Periorbital ecchymoses or "raccoon eyes" B) CSF otorrhea C) Blood mixed with cerebral spinal fluid flowing from the mouth D) CSF rhinorrhea Periorbital ecchymoses or "raccoon eyes" Which of the following skull fractures is most common? A) Linear B) Basilar C) Depressed D) Comminuted Linear All the following are acceptable methods of moving a patient onto a long spine board EXCEPT: A) Rope-sling slide B) Straddle slide C) Log roll D) Side slide Side slide Which of the following features of the cranium exacerbates the severity of intracranial trauma? A) It is rigid and unyielding. B) It is formed of dense, heavy bone. C) It is relatively thin in the frontal region. D) The sutures allow for separation of the bones. It is rigid and unyielding. Your patient is a seven-year-old male pedestrian who was struck by a vehicle. Your assessment reveals bleeding from the right auditory canal. Which of the following describes the most appropriate way to manage this? A) Determining the presence or absence of cerebrospinal fluid is a low priority. Pack the auditory canal with sterile gauze to control bleeding. B) Use a "halo" test to determine whether cerebrospinal fluid is in the blood. If it is, loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If cerebrospinal fluid is not present, pack the ear canal with sterile gauze to control bleeding. C) Determining the presence or absence of cerebrospinal fluid in the blood is a low priority. Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. D) Check the glucose level in the blood draining from the ear. If it is less than the patient's blood glucose level, there is cerebrospinal fluid present. Cover the ear loosely with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. If the glucose level of the blood from the ear is the same as the patient's blood glucose level, pack the auditory canal with sterile gauze to control bleeding. Determining the presence or absence of cerebrospinal fluid in the blood is a low priority. Loosely cover the ear with a sterile dressing to prevent contamination while allowing blood to flow freely from the ear. When developing a spinal clearance policy, age _____ A) Should never be considered, as age does not matter B) Should only be considered when the patient is a male between the ages of 21 and 35 C) Should be considered, as the very old may not be able to describe their symptoms accurately D) Should only be considered if the patient is a minor Should be considered, as the very old may not be able to describe their symptoms accurately Your patient is a 22-year-old female assault victim. She has blunt trauma to the face with swelling around the right eye and zygomatic area. Upon assessing her eye movement, you note that the right eye cannot follow your finger and does not move. Which of the following most likely explains this finding? A) She has a fracture of the orbit that has trapped the optic nerve, thereby paralyzing her gaze. B) She has direct trauma to the eyeball that has damaged the intrinsic muscles of the eye. C) She has a fracture of the orbit that has trapped the extrinsic eye muscles. D) She has direct trauma to the eyeball that has damaged the optic nerve, thereby paralyzing her gaze. She has a fracture of the orbit that has trapped the extrinsic eye muscles. Which of the following groups is NOT among those with the highest incidence of serious head trauma? A) The elderly B) Young males C) Middle-aged males D) Infants Middle-aged males Which of the following is TRUE of the basilar skull? A) The foramen magnum is part of the basilar skull. B) It is relatively weaker than other portions of the skull. C) It provides a rough surface that may lacerate the brain in acceleration/deceleration mechanisms. D) All of the above are true. All of the above are true. When placing the patient's head in the neutral position, the occiput should be ____ the plane made by the buttocks and the shoulder blades (or greater for an obese patient). A) Even with B) 3 to 4 inches above C) 1 to 3 inches above D) 2 to 6 inches above 1 to 3 inches above The term head injury refers to which of the following? A) Trauma to the brain B) Soft-tissue injuries to the scalp C) Skull fractures D) All of the above All of the above For the head-injury patient without signs of herniation, adjust ventilation rates to maintain an end-tidal CO2 reading of between: A) 15 and 20 mmHg B) 25 and 30 mmHg C) 45 and 50 mmHg D) 35 and 40 mmHg 35 and 40 mmHg Your patient is a 37-year-old male unrestrained driver of a vehicle. You find him with his upper body across the console and his head hanging down into the passenger's side floorboard area. You note pooled blood from a scalp wound. After immobilizing him and loading him into the ambulance where you have more light for your examination, you note that he has a large, full-thickness avulsion of the scalp. The patient's heart rate is 112, respirations are 20, and blood pressure is 82/50. Which of the following statements about this patient is/are TRUE? 1. The scalp wound itself cannot account for the patient's vital signs. 2. The scalp wound itself may account for the patient's vital signs. 3. The patient's vital signs are consistent with increasing intracranial pressure. 4. Nothing about the vital signs indicates increased intracranial pressure. A) 1, 4 B) 2, 3 C) 1, 3 D) 2, 4 2, 4 In cases of face and neck trauma where the region is so distorted that oral and nasal intubation are impossible, the only prehospital means to provide a life-saving airway may be performing which of the following? A) Digital intubation B) Percutaneous cricothyrotomy C) Bag-valve hyperventilation D) Surgical tracheostomy Percutaneous cricothyrotomy

Which accurately describes the prognosis of sensorineural deafness? a. It is usually a permanent condition. b. It can be reversed, but only with advanced surgery. c. It is a commonly reversible condition. d. The patient will grow out of it. a.It is usually a permanent condition.

You have responded to a report of an injured person. When you arrive, you find a 55-year-old blind woman who has fallen and sustained a small laceration to her forehead. She has a guide dog. What is the most appropriate action to take regarding transport? a. Explain to the patient that the ambulance is a sterile area and that she will have to call a friend to come and get the dog. b. It is not your responsibility nor is it appropriate for you to accommodate the dog. c. Call animal control to hold the dog until the owner can retrieve it. d. Transport the guide dog with the patient. d.Transport the guide dog with the patient.

Which of the following is not associated with the retina? a. Lens b. Photopigments c. Rods d. Cones

a.Lens

HIV attacks and destroys the: a. B lymphocytes b. T lymphocytes c. Pluripotent stem cells d. Macrophages

b.T lymphocytes

Your patient is complaining of pain secondary to epididymitis. Where should you expect the pain to be located? a. Flank b. Testes c. Suprapubic region d. Lower left or right quadrant, depending on which side is affected

b.Testes

Which of the following is a mobile, single-celled, parasitic organism? a. Fungus b. Virus c. Protozoan d. Bacterium

c.Protozoan

A 56-year-old female is conscious and alert and complaining of diarrhea and nausea. The patient describes a two-day history of her symptoms and states that the pain is "all over her abdomen." All four quadrants are tender to palpation. She also describes hematochezia. PMH includes CAD, and she recently began taking 325 mg of ASA once a day. Of the following, which is the most likely cause of her clinical condition? a. Diverticulitis b. Peptic ulcer c. Acute pancreatitis d. Acute gastroenteritis

d.Acute gastroenteritis

Prehospital management of an unresponsive patient with hypoglycemia should NOT include: a. Administration of D50 IV b. Administration of glucagon IM c. BVM ventilations with 100 percent O2 and an OPA d. Administration of oral glucose

d.Administration of oral glucose

Which of the following best explains why the use of an intrauterine device (IUD) increases the risk of developing pelvic inflammatory disease? a. The absorbent cotton string of the IUD acts as a wick for bacteria to enter the uterus. b. The use of a copper IUD weakens the user's immune system. c. Women with an IUD are more likely than other women to have multiple sexual partners. d. An IUD may cause irritation of the endometrium, allowing microorganisms to invade the uterine wall.

d.An IUD may cause irritation of the endometrium, allowing microorganisms to invade the uterine wall.

Which of the following is a narcotic? a. Mescaline b. Crack c. Cocaine d. Heroin

d.Heroin

Another name for tennis elbow is: a. Tenosynovitis b. Medial epicondylitis c. Bursitis d. Lateral epicondylitis

d.Lateral epicondylitis

All the following pathogens typically cause meningitis in children EXCEPT: a. Haemophilus influenza type B b. Streptococcus pneumoniae c. Neisseria meningitides d. Paramyxovirus

d.Paramyxovirus

34. Oxygen can benefit patients with chronic renal failure because it is common for patients with chronic renal failure to be: a. Anemic due to the blood loss associated with hemodialysis b. Anemic due to decreased production of RBCs c. Hypoxic secondary to associated congestive heart failure d. Hypoxic secondary to associated hypotension 35. On-scene you are presented with a confused patient suffering from altered mental status. Additionally, in front of the family, the patient is very irritable and verbally abusive toward all present, including EMS. His wife states that his "kidneys are no good" and he also has "sugar" problems. Your assessment indicates that he is dyspneic with pale skin that is covered with a fine white sediment. His radial pulse is weak, rapid, and irregular. Additionally, you note edema to his hands, feet, and face. Crackles are noted to the lungs bilaterally and he has a dialysis graft on his right forearm. Your partner reports that his heart rate is 164, respirations 26, blood pressure 176/90, and SpO2 89%. After applying high-concentration oxygen, which of the following would you perform next? a. Administer furosemide, 120 mg b. Infuse a 1000 mL bolus of NS c. Determine the blood glucose level d. Administer sodium bicarbonate, 50 mEq 36. In order for hemodialysis to be effective in ridding the body of excess electrolytes, which of the following statements must be true? a. The dialysate must contain electrolytes in the same concentration as in the patient's blood. b. The dialysate must contain electrolytes in a concentration lower than in the patient's blood. c. The dialysate must contain electrolytes in a concentration higher than in the patient's blood. d. The dialysate must not contain electrolytes. 37. Which of the following statements regarding a dialysis fistula is TRUE? a. A fistula is a surgical anastomosis of an artery and a vein. b. The fistula is the preferred site of venous access in an emergency situation. c. A fistula uses a dual lumen tube to connect an artery and a vein. d. The fistula is inserted peripherally, but the end of it is placed near the right atrium. 38. When assessing a fistula used for hemodialysis, which of the following should concern you? a. Pulsation with each heartbeat b. A bruit on auscultation c. Bruising around the fistula d. Lack of a palpable vibration 39. A 40-year-old female presents with hemorrhage from her dialysis graft. She states that she just got back from dialysis when the bleeding started. There is a significant amount of blood on the chair and floor. To control the bleeding, you would immediately: a. Place a tourniquet proximal to the graft b. Place a tourniquet distal to the graft c. Apply direct pressure over the graft d. Apply ice to the area and elevate the extremity 40. Which of the following is associated with CAPD? a. Catheter placed in the central circulation b. Catheter providing access to the abdominal cavity c. Dialysis shunt in either arm d. Dialysis fistula in either arm 41. Which of the following is a prerenal cause of acute renal failure? a. Pyelonephritis b. Embolism of the renal vein c. Ureteral obstruction due to renal calculi d. Massive overdose of ibuprofen 42. Which of the following chemistry findings would suggest acute renal failure? a. Elevated blood urea nitrogen (BUN) b. Decreased creatinine c. Decreased potassium d. Elevated iron 1. c.Urethra, bladder, kidney 2. c.The female urethra is shorter than those in males, more easily allowing bacteria to enter the rest of the urinary tract. 3. c.250 mL fluid challenge, 50 percent dextrose 4. d.Uremia and creatinine levels increase. 5. c.Urinary retention 6. d.Just lateral to the spine slightly inferior to the 12th rib 7. c."Is it painful when you urinate?" 8. c.Hypotension 9. d.Painful urination 10. d.Potassium 11. c.IV with fluid administration 12. b.Net movement of water from side B to side A will occur. 13. c.Decreased GFR results in retention of water, electrolytes, and metabolic waste. 14. b.BLS transport in position of comfort 15. d.Dialysis approximates the physiology of the nephron by placing blood on one side of a semipermeable membrane and dialysate on the other side. 16. a.Excretion of glucose 17. c.Air embolism 18. b.Suprapubic tenderness to palpation 19. c.Lasix IV 20. b.Cholecystitis

21. d.Intravenous fluid therapy with normal saline 22. a.Pneumonia 23. b.250 mL fluid bolus 24. a.Passing hard, granular material in the urine 25. d.Toxic damage to the nephrons 26. c.They inhibit the conversion of angiotensin I to angiotensin II. 27. b.Testes 28. b.12-lead ECG, IV of NS KVO 29. c."I can't seem to urinate." 30. d.Fever 31. a.IV sodium bicarbonate, 1 mEq/kg 32. c.Uncontrolled diabetes mellitus and hypertension 33. a.CRF is diagnosed when 70 percent of the nephrons are lost and the patient is clinically unstable. 34. b.Anemic due to decreased production of RBCs 35. c.Determine the blood glucose level 36. b.The dialysate must contain electrolytes in a concentration lower than in the patient's blood. 37. a.A fistula is a surgical anastomosis of an artery and a vein. 38. d.Lack of a palpable vibration 39. c.Apply direct pressure over the graft 40. b.Catheter providing access to the abdominal cavity 41. b.Embolism of the renal vein 42. a.Elevated blood urea nitrogen (BUN)

Your patient is a 25-year-old female who is 38 weeks pregnant and complaining of contractions. She states that she has been feeling contractions every 6 to 8 minutes for the past hour, has a cramping in her lower abdomen and is leaking amniotic fluid. She states that she has been receiving prenatal care and has been identified as high risk for placenta previa. HR = 100, BP = 122/76, RR = 18, SpO2 = 99%. Which of the following is most appropriate? a. Start a large-bore IV at a keep-open rate and monitor maternal vitals and FHT's. b. Administer oxygen by nonrebreather mask and start a large-bore IV at 100 mL/hour. c. Start an IV of normal saline at a keep-open rate and consult with medical direction about administering terbutaline. d. Administer oxygen by nonrebreather mask. a.Start a large-bore IV at a keep-open rate and monitor maternal vitals and FHT's.

A newborn presents with a heart rate of 58 and does not respond to 30 seconds of BVM ventilation with 100 percent O2. The next step would be to: a. ventilate with 100 percent O2 for 30 seconds more and reassess b. continue ventilations, cannulate the umbilical vein, and administer epinephrine. c. initiate chest compressions and reassess. d. perform endotracheal intubation and administer epinephrine. c.initiate chest compressions and reassess.

Which of the following is the etiology of glaucoma? a. Increased blood sugar b. Increased intraocular pressure c. Peripheral and secondary blindness d. Increased optic nerve density b.Increased intraocular pressure

A person who has suffered a stroke could have which of the following types of speech impairment? a. Sensory aphasia b. Motor aphasia c. Aphasia d. One or a combination of the above impairments d.One or a combination of the above impairments

Your patient is a four-year-old male with a history of asthma. He ran out of his inhaled bronchodilator while visiting his grandparent's farm. On your arrival, you learn that the patient has been having increasing respiratory distress for 20 minutes. The patient has pale, cool, moist skin with cyanosis of his nail beds. He is sitting on the edge of a kitchen chair, leaning forward to breathe. He has a respiratory rate of 50 with the use of accessory muscles and a heart rate of 130. He is anxious and unable to speak more than one or two words at a time. Auscultation of the chest reveals scattered wheezing. As you prepare to treat the patient, he becomes drowsy and his respiratory rate decreases to 12. You can no longer auscultate his wheezes. Which of the following best explains the significance of the change in your patient's status? a. Because of decreased respiratory, cardiovascular, and stored energy reserves, the child's muscles have fatigued and he is now in respiratory failure. b. The child has realized that you are going to treat him, and he is more relaxed than he was initially and has stopped hyperventilating. c. This makes no sense in an asthma patient, and it is likely that the child ingested or was exposed to a toxic substance, which explains the decreased level of consciousness. d. The absence of wheezing indicates that bronchospasm has resolved spontaneously and the child now only needs supplemental oxygen. a.Because of decreased respiratory, cardiovascular, and stored energy reserves, the child's muscles have fatigued and he is now in respiratory failure.

All of the following are associated with an increased incidence of SIDS, EXCEPT: a. female infant. b. age between two and four months. c. low birth weight. d. fall and winter months. a.female infant.

Your patient is a nine-year-old female who was injured when her hand slipped into a hole in the ground while she was turning a cartwheel. She is upset and has an obvious deformity of her left humerus. She asks you if her arm is broken. Which of the following is the best response? a. "I'm sure you'll be fine." b. "I think it may be badly bruised." c. "It looks that way, but an X-ray at the hospital will let us know for sure." d. "I can't tell you what I think. I'm not a doctor." c."It looks that way, but an X-ray at the hospital will let us know for sure."

As the pediatric patient progresses from respiratory distress to respiratory failure, which of the following occurs? a. Hyperactivity b. Increased arterial carbon dioxide tension c. Peripheral cyanosis d. Muscular rigidity b.Increased arterial carbon dioxide tension

Your patient is a two-year-old male who has ingested approximately 30 tablets of children's chewable acetaminophen tablets anywhere from 15 to 30 minutes before your arrival. He is awake and appears stable, but he is intermittently crying. You have a 20-minute transport time to the hospital. The child weighs 18 pounds. Which of the following would be the best prehospital treatment option for this child? a. Magnesium citrate, po b. Syrup of ipecac followed by 16 ounces of water; if vomiting ensues, follow with activated charcoal in a slurry with sorbitol c. Insertion of an orogastric tube, lavage with tap water until return is clear d. Activated charcoal mixed in a slurry with sorbitol d.Activated charcoal mixed in a slurry with sorbitol

At which of the following ages does the risk of foreign body airway obstruction become a significant concern in the normally developing infant? a. three months b. 18 months c. one month d. six months d.six months

What is one of the most important indicators of child abuse? a. Child's behavior b. Family finances c. Attitude of the family members d. Absence of one parent a.Child's behavior

Children raised in families with domestic violence are how many times more likely to be sexually molested than children in families with no domestic violence? a. 3 b. 8 c. 6 d. 0; there is no correlation between the two crimes b.8

You are called to the home of a 75-year-old patient in end-stage lung cancer. A 24-hour home hospice health care provider is on scene and states she called because the patient is experiencing increasing dyspnea. The patient is on home oxygen at 4 liters per minute. The patient has a signed DNR order that specifies no intubation, CPR, or medications. Your assessment brings you to conclude that this patient is in acute CHF. What would be the best course of action in this situation? a. Ignore the DNR because the patient is not in cardiac arrest. b. Call your medical control and consult. c. Give the home health care provider a nonrebreather mask and have her sign a release. d. Explain to the patient that the need for immediate care is indicated and that simple measures could ease the dyspnea. d.Explain to the patient that the need for immediate care is indicated and that simple measures could ease the dyspnea.

Commonly found medical therapies for children who are home care patients include all of the following, EXCEPT: a. mechanical ventilators b. feeding tubes c. dialysis shunts d. apnea monitors c.dialysis shunts

The term elderly applies to a person beginning at age: a. 70. b. 55. c. 80. d. 65 a.70.

Elderly people who live alone are more likely to be: a. male, under age 80. b. female, age 85 or older. c. female, under age 80. d. male, age 85 or older. b.female, age 85 or older.

You have been dispatched with the neonatal resuscitation team to an outlying hospital to stabilize and then transport a 30-week-gestation newborn to a neonatal intensive care unit. Which of the following methods should you use to maintain this newborn's body temperature? a. Dress the newborn lightly in a T-shirt and diaper and cover loosely with a light blanket. b. Activate two or three chemical hot packs, place them against the newborn's body, and secure them by wrapping him in a receiving blanket. c. Wrap the newborn in a receiving blanket, covering the body and head but leaving the face exposed, and hold him securely against your body for warmth. d. Wrap the newborn in receiving blankets, covering the body and head but leaving the face exposed, and place 104°F hot water bottles next to him. d.Wrap the newborn in receiving blankets, covering the body and head but leaving the face exposed, and place 104°F hot water bottles next to him.

In which of the following situations would the administration of epinephrine be indicated in a newborn? a. Heart rate of 60 with no response to ventilations after 30 seconds b. Heart rate of 80 to 100 with no response from ventilations and chest compressions c. Heart rate of 60 to 80 with no response to blow-by oxygen d. Heart rate less than 60 after ventilations and chest compressions d.Heart rate less than 60 after ventilations and chest compressions

Which of the following statements about neonatal resuscitation is NOT true? a. An HR below 60 bpm that is not responding to ventilation with 100 percent O2 indicates the need for chest compressions. b. The umbilical vein is an acceptable intravenous access site. c. Factors that increase the likelihood of the need for resuscitation include maternal health problems, prematurity, and inadequate prenatal care. d. The percentage of neonates needing to be resuscitated out-of-hospital is less than in-hospital. d.The percentage of neonates needing to be resuscitated out-of-hospital is less than in-hospital.

Management of the birth of twins is often made difficult by: a. rapid succession of the births. b. one infant presenting vertex and the other breech. c. the infants sharing the placenta. d. low birth weight of both infants. b.one infant presenting vertex and the other breech.

Which of the following differentiates fetal alcohol syndrome (FAS) from Down syndrome? a. Down syndrome is a genetic disorder and FAS is a preventable disease. b. FAS can be reversed, while Down syndrome cannot. c. Children will "grow out" of FAS but not Down syndrome. d. FAS is genetic and Down syndrome is acquired. a.Down syndrome is a genetic disorder and FAS is a preventable disease.

Many of the complications of cystic fibrosis are due to thickening of which of the following? a. Osteocytes b. Sickle cells c. Mucus d. Red blood cells c.Mucus

You have just assisted in the birth of an infant. After suctioning the airway and cutting the cord, you determine that the APGAR score is 7. Which of the following is MOST appropriate in the care of this infant? a. Dry, ventilation with 100 percent oxygen, keep warm b. Dry, blow-by oxygen and tactile stimulation to encourage breathing, keep warm c. Dry, tactile stimulation, wrap in warm blankets, lay on the mother's chest, reassess APGAR in 5 minutes while en route to ED d. Dry, ventilation with 100 percent oxygen, chest compressions, keep warm c.Dry, tactile stimulation, wrap in warm blankets, lay on the mother's chest, reassess APGAR in 5 minutes while en route to ED

Meconium staining indicates: a. gestational diabetes. b. fetal hypoxic incident. c. prematurity. d. eclampsia. b.fetal hypoxic incident.

What is enucleation? a. Removal and replacement of the patient's eyeball with a prosthetic eye b. Corrective laser surgery c. Loss of vision in one eye due to trauma d. Removal of the eyeball d.Removal of the eyeball

Multiple sclerosis is classified as which of the following types of disorders? a. Acquired immunodeficiency b. Autoimmune c. Autoinflammatory d. Autotoxic b.Autoimmune

Muscular dystrophy is classified as which of the following types of disorders? a. Brain b. Traumatic c. Hereditary d. Acquired c.Hereditary

People are classified as obese when their weight is ________ percent heavier than is normal for people the same age and height. a. 20-30 b. 10-20 c. 40-50 d. 40-60 a.20-30

A 33-year-old female who is 30 weeks pregnant is alert and complaining of steady, bright red vaginal bleeding that began a half hour ago. She denies pain and contractions, but states that she has had spotting "on and off" during her pregnancy. Which of the following is most likely? a. Placenta previa b. Eclampsia c. Abruptio placentae d. Uterine rupture a.Placenta previa

Place the following neonatal resuscitation procedures in the correct order. 1. Tactile stimulation 2. CPR 3. Assisting ventilations 4. Oxygen administration 5. Suctioning 6. Administration of cardiac medications a. 1, 5, 4, 2, 3, 6 b. 5, 1, 4, 3, 2, 6 c. 4, 1, 5, 3, 6, 2 d. 4, 5, 1, 3, 2, 6 b.5, 1, 4, 3, 2, 6

Which of the following statements BEST describes secondary apnea in newborns? a. Primary apnea is due to respiratory failure, while secondary apnea is due to cardiac arrhythmia. b. Primary apnea occurs only at birth, while secondary apnea occurs anytime during the first month of life. c. Secondary apnea results from primary apnea. d. Secondary apnea is a less serious condition and responds well to tactile stimulation and an oxygen-enriched atmosphere. c.Secondary apnea results from primary apnea.

The appearance of your newborn patient leads you to suspect that he has Pierre Robin syndrome. Which of the following should be your most immediate concern? a. Upper airway obstruction b. Lower airway obstruction c. Compression of the lungs by the abdominal contents d. Shunting of blood through a patent foramen ovale a.Upper airway obstruction

Which of the following is an intrapartum risk factor for newborn distress? a. Gestational diabetes b. Inadequate prenatal care c. Post-term gestation d. Prolonged labor d.Prolonged labor

The most common cause of bradycardia in the newborn is ________, which should be treated with ________. a. hypoxia; basic resuscitation procedures such as tactile stimulation, oxygen, and ventilation b. hypoxia; aggressive suctioning, intubation, and ventilation c. increased vagal tone; atropine d. maternal narcotic use; naloxone a.hypoxia; basic resuscitation procedures such as tactile stimulation, oxygen, and ventilation

Which of the following is NOT useful to the prehospital care provider when obtaining the history of a pregnant patient? a. Estimated due date b. The father's general health c. History of prenatal care d. Outcomes of previous pregnancies b.The father's general health

The most important consideration when managing a premature infant is: a. preventing the loss of body heat. b. administering 100 percent oxygen. c. determining blood glucose. d. continuously suctioning the airway. a.preventing the loss of body heat.

The structure that connects the umbilical vein directly to the inferior vena cava is the: a. foramen arteriosus. b. ductus arteriosus. c. foramen ovale. d. ductus venosus. d.ductus venosus.

The premature separation of the placenta from the uterine wall is called: a. placenta previa. b. spontaneous placentae. c. abruptio placentae. d. abortion. c.abruptio placentae.

The designer date rape drug that can cause psychological symptoms weeks after use is: a. MDMA (Ecstasy). b. rohypnol. c. GHB. d. ketamine. a.MDMA (Ecstasy).

What characteristics of date rape drugs make them attractive to assailants? a. They are not illegal and therefore assailants can't be charged with giving them to someone. b. They are cheap and make the victim want to have physical contact more. c. They facilitate the assault by making the victim unresponsive and have amnesia. d. They are undetectable with a drug screen. c.They facilitate the assault by making the victim unresponsive and have amnesia.

What is your primary role as an ALS provider when you respond to home health care patients in need of assistance? a. Identify and treat any life-threatening conditions. b. Act as a liaison between the patients and any services they may need. c. Educate the home health care providers on when calling 911 is appropriate. d. Contact the patient's family and inform them of any problems with the patient's care. a.Identify and treat any life-threatening conditions.

What has been the primary reason for the increase of home health care? a. Increased number of health care professionals b. Medicare rule changes c. Decrease in the number of available hospital beds d. Cost containment d.Cost containment

Which of the following is NOT a common sign of sepsis? a. Nausea and vomiting b. Fever c. Altered mental status d. Hyperactivity d.Hyperactivity

What is Guillain-Barré syndrome? a. A buildup of mucus in the lungs and GI systems b. An autoimmune syndrome thought to be caused by a viral infection c. A rare disease due to breakdown of acetylcholine receptors d. An increase in organ size b.An autoimmune syndrome thought to be caused by a viral infection

What is NOT a goal of management for potentially abused or neglected children? a. Protection of the child from further abuse b. Speaking with the parents about the cause of the potential abuse c. Treating the patient's injuries d. Notifying the proper authorities of this situation b.Speaking with the parents about the cause of the potential abuse

What is NOT one of the objectives of JumpSTART? a. To optimize the primary triage of injured children in the MCI setting b. To reduce the emotional burden on triage personnel who may have to make rapid life-or-death decisions about the injured c. To allow responders to "think with their hearts" when treating the injured children d. To enhance the effectiveness of resource allocation of all MCI victims c.To allow responders to "think with their hearts" when treating the injured children

You have responded to a residence, and on arrival you encounter a woman who is visibly upset. She says she is caring for her grandfather, who has a feeding tube, and she "just can't get the stuff to go in." You evaluate the problem and find that the PEG tube appears to be blocked. What action should be taken? a. You as a paramedic are not trained to flush or evaluate gastric feeding tubes, so transport to the ER. b. Massage the abdomen. c. Attempt to flush and/or aspirate the tube with a 60-cc syringe. d. Pull the tube out and find the blockage, then flush and reinsert the tube c.Attempt to flush and/or aspirate the tube with a 60-cc syringe.

What is PEEP? a. Positive exhalation and excretion pressure b. Preliminary exhaustive expiratory plan c. Pulmonary expulsion/end perfusion d. Positive end expiratory pressure d.Positive end expiratory pressure

Which of the following is TRUE of abuse reporting? a. You only have a responsibility to report child abuse cases. b. All 50 states require that health care workers report suspected cases of abuse. c. When talking with the patient, use closed-ended questions. d. The only agency that suspected abuse can be reported to is the police. b.All 50 states require that health care workers report suspected cases of abuse.

What is areason abused partners do not seek assistance? a. They lack the knowledge and financial means to seek assistance. b. They have tried and no one would help. c. They were abused as children and think it is part of life. d. They really don't mind the situations they are in. a.They lack the knowledge and financial means to seek assistance.

An injury to which cervical vertebra(e) may prevent a person from breathing? a. C5-C7 b. C1-C3 c. C1 only d. C3-C5 d.C3-C5

What is the cause of conductive deafness? a. Any condition that prevents voice or vibration from being transmitted to the brain from the outer ear due to nerve damage b. A condition that prevents sound from traveling from the inner to the outer ear c. A decrease in the sensory threshold voltage of the ear d. Any condition that prevents sound from being transmitted from the external ear to the middle or inner ear d.Any condition that prevents sound from being transmitted from the external ear to the middle or inner ear

What is your primary responsibility when you are involved in an abuse call? a. Attending to your safety, then to your patient's b. Adequately assessing the patient; any type of injury is possible c. Figuring out who committed the abuse; they may be able to be caught more quickly d. Writing proper documentation; it keeps people out of trouble a.Attending to your safety, then to your patient's

What is the estimated percent range of sexual assaults that are NOT reported? a. 25-35 b. 63-74 c. 0-22 d. 52-63 b.63-74

What are the two types of deafness? a. Outer ear and inner ear deafness b. Temporary and permanent c. Sensorimotor and conduction deficit d. Conductive deafness and sensorineural deafness d.Conductive deafness and sensorineural deafness

What is the more common cause of conductive deafness in children? a. Otitis media b. Otitis externa c. Media inflammation d. Otitis cochlea a.Otitis media

You arrive at the scene to find a patient who has fallen. She appears to be homeless. After introducing yourself, you begin to assess her. However, she states that she does not want your help because she cannot afford it. What would be an appropriate response? a. "Don't worry, health care in the United States is free." b. "There is a public hospital that we can bring you to nearby." c. "I'm sorry I can't help you then." d. "You shouldn't worry about the cost, you need to see medical attention." d."You shouldn't worry about the cost, you need to see medical attention."

What is the primary reason paramedics should be interested and diligent in becoming familiar with common home health care equipment items and the underlying need for them? a. A general knowledge can be vital to the health of the patient. b. Most jurisdictions are requiring paramedics to become "expanded scope." c. Paramedics are required to know how to operate all home health care equipment. d. There is no reason for a paramedic to know about such devices. a.A general knowledge can be vital to the health of the patient.

Which of the following is an important point to remember regarding patients with home respiratory care and their response to emergency medications? a. You always need to double your dose if they are on the same drug at home. b. They may be on experimental drugs that could interact badly with common emergency medications. c. They may be using high doses of medications, such as albuterol, and your normal standing dose may not be as effective. d. There is nothing significant to keep in mind. c.They may be using high doses of medications, such as albuterol, and your normal standing dose may not be as effective.

What is/are common blockage(s) of a gastrostomy tube? a. Liquid feeding products/pill fragments b. Gallstones c. Feces d. Chewed food a.Liquid feeding products/pill fragments

What group is NOT commonly affected by hate crimes? a. Racial b. Religious c. Educational fraternities d. Those who are disabled c.Educational fraternities

When dealing with hate crimes you should consider: a. They are dangerous situations. b. Involve law enforcement in order to protect your safety. c. They can result in widespread violence. d. All of the above d.All of the above

Which of the following is NOT part of the pediatric assessment triangle when forming your general impression of the patient's condition? a. Blood glucose level b. Breathing c. Appearance d. Circulation a.Blood glucose level

When selecting an appropriately sized blood pressure cuff for a pediatric patient, which of the following guidelines will help you? a. The width of the cuff should equal the circumference of the arm. b. The width of the cuff should equal the distance from the antecubital fossa to the axilla. c. The width of the cuff should equal the length of the little finger. d. The width of the cuff should be 2/3 the circumference of the arm. d.The width of the cuff should be 2/3 the circumference of the arm.

Which type of questioning is appropriate when assessing the battered patient? a. Leading b. Coaxing c. Direct d. Indirect c.Direct

Which characteristic makes rib fractures in children raise a high index of abuse suspicion? a. The ribs are very pliable and fractures are very unusual. b. Children usually get hit in the head because it is a bigger target. c. Children will have arm fractures first as they are defensive wounds. d. Rib fractures usually are seen in car accidents only. a.The ribs are very pliable and fractures are very unusual.

What condition can result from an airbag, a piece of dirt, or a contact lens? a. Glaucoma b. A corneal abrasion c. Corneal retinopathy d. A corneal stricture b.A corneal abrasion

Which condition(s) predispose preterm infants to sensorineural deafness? a. Drug addictions b. Births outside the hospital c. Heart defects d. Severe asphyxia or recurrent apnea d.Severe asphyxia or recurrent apnea

What is the most common physical sign of abuse in children? a. Soft-tissue injuries b. Head injuries c. Burns d. Fractures a.Soft-tissue injuries

Which factor makes abuse statistics inaccurate? a. Poor data-collection techniques b. Overreporting c. Underreporting d. Noncompliance with reporting by law enforcement c.Underreporting

Which is TRUE of poliomyelitis? a. Most patients recover from the disease, but they are left with permanent paralysis. b. Although there is a vaccine, polio is still found in underdeveloped nations. c. It is highly contagious. d. All of the above are true. d.All of the above are true.

Which hearing impairment would you expect to find in abundance at a nursing home? a. Labyrinthitis b. Labiomycosis c. Presbycusis d. Presbyopia c.Presbycusis

You are about to transport a cancer patient who complains of dyspnea. She is hemodynamically stable and has a history of asthma. On assessment, you note she has some diffuse wheezes. You are going to administer an albuterol treatment and your protocol states that you should start an IV when you give a breathing treatment. The patient says she has very bad veins, but she has an implanted port under the skin of her left chest. What is the best course of action? a. There is no urgent need for an IV, and attempting to access the implanted port without the correct equipment and training could harm the patient and the device. So, administer the albuterol but withhold the IV. b. Withhold the albuterol treatment, because it cannot be given without an IV. c. Contact medical control for orders to access the port before beginning the albuterol treatment. d. Some implanted ports require special catheters, so try for a peripheral line. a.There is no urgent need for an IV, and attempting to access the implanted port without the correct equipment and training could harm the patient and the device. So, administer the albuterol but withhold the IV.

Which of the following accurately describes cerumen? a. Any foreign body the ear b. Exposed nerves in the inner ear c. Earwax d. Insect larvae deposited in the middle ear c.Earwax

Your 12-month-old patient has burns covering the full length of both lower extremities circumferentially. Which of the following is the most accurate estimate of the percentage of total body surface area involved? a. 20 percent b. 36 percent c. 14 percent d. 28 percent d.28 percent

Which of the following anatomic differences dictate changes in airway management for the pediatric patient? 1. The occiput is proportionally larger. 2. The face is small and has a flat nose. 3. The trachea is softer and more flexible. 4. The larynx is lower, at the level of the sternal notch. a. 1 and 2 b. 1, 2, and 3 c. 1 and 3 d. 1, 2, 3, and 4 b.1, 2, and 3

Which organization has mandated that all patients be screened for abuse when they arrive at the emergency department? a. National Association of Emergency Physicians b. The Department of Justice c. The Joint Commission d. SANE c.The Joint Commission

Which of the following are common date rape drugs? a. Ketamine, monosodium glutamate, and tropine b. Rohypnol, GHB, and MDMA c. Sodium pentathol, thiamine, and HDT d. Phenobarbital, glucosamine, and ketamine b.Rohypnol, GHB, and MDMA

Which of the following is TRUE of elderly Americans? a. The fastest-growing segment of the elderly population is 65 to 75 years old. b. Individuals over age 75 are considered "old-old." c. The numbers of elderly people are increasing, but they are decreasing in proportion to the total population. d. The elderly are not only living longer, they are living healthier, more active lives. d.The elderly are not only living longer, they are living healthier, more active lives.

Which of the following are risk factors for depression and suicide in the elderly? 1. Death of friends and family members 2. Decreased serotonin levels 3. Chronic pain 4. Financial issues 5. Stress a. 1, 3, and 4 b. 1, 2, 3, 4, and 5 c. 1, 4, and 5 d. 1, 3, 4, and 5 b.1, 2, 3, 4, and 5

Which of the following best describes a tracheostomy? a. An opening from the esophagus to the trachea b. A temporary opening made from the posterior neck through the trachea c. A surgical opening from the anterior neck into the trachea d. An opening made by incision from the larynx through the neck c.A surgical opening from the anterior neck into the trachea

Which of the following best describes a dialysis shunt? a. Cannulation of a vein, such as the A/C, under fluoroscopy b. An implanted device requiring a special needle for access c. A surgically implanted catheter in the subclavian vein d. A loop connecting an artery and a vein d.A loop connecting an artery and a vein

What are physical impairments? a. Problems with the body caused by birth defects b. Temporary disabilities that reduce function of a body part c. Chronic conditions that are untreatable and make a person "handicapped" d. Conditions that limit the use of one or more body parts d.Conditions that limit the use of one or more body parts

Which of the following best describes the etiology of cerebral palsy? a. A genetic disorder related to the chromosomes b. German measles, cerebral hypoxia, head injury, or any number of diseases c. Drug and alcohol abuse by the mother d. Typhoid, head injury, or rubella b.German measles, cerebral hypoxia, head injury, or any number of diseases

Which of the following is NOT part of the axial skeleton? A) Sacrum B) Pubis C) Sternum D) Mandible Pubis Your patient is a 27-year-old male ice skater whose left skate was planted when he was struck and knocked down by another skater. He is agitated and complaining of severe pain in his leg. Your examination reveals an open fracture 6 inches proximal to the ankle joint. Which of the following describes the most appropriate management of this patient? A) Focused exam, oxygen, spinal immobilization, splint from the foot to above the knee, begin transport, start a large-bore IV, and request orders for analgesia B) Focused exam, cover the open wound, apply a lower extremity traction splint, begin transport, start an IV, and request orders for analgesia C) Focused exam, cover the open wound, splint from the foot to above the knee, begin transport, start an IV, and request orders for analgesia D) Rapid trauma exam, high-concentration oxygen, cervical spine immobilization, cover the open wound, use the long backboard for initial splinting, initiate transport, start a large-bore IV, perform a detailed examination, use padded board splints to immobilize from the ankle to above the knee, and reassess the patient every 5 minutes Focused exam, cover the open wound, splint from the foot to above the knee, begin transport, start an IV, and request orders for analgesia Your patient is a football player who had his right foot planted and was tackled from the left rear, causing his body to rotate around the axis of his right lower extremity. This mechanism is most consistent with which of the following types of fractures? A) Oblique B) Spiral C) Impacted D) Comminuted Spiral Which of the following is the highest priority when managing a patient with bilateral closed femur fractures? A) Assessing distal neurovascular function B) Anticipating hypovolemia C) Providing analgesia D) Anticipating pulmonary embolism as a complication Anticipating hypovolemia Upon assessing a patient with a hip injury, you find that his right lower extremity is moved away from the midline of the body. You should describe the right lower extremity as being: A) Abducted B) Externally rotated C) Angulated D) Adducted Abducted Your patient is a 60-year-old female driver of a vehicle involved in a moderate-speed frontal collision. She was unrestrained, but airbags deployed. There is no damage to the windshield, but the bottom of the steering wheel ring is deformed. On your initial approach to the vehicle, you see that an EMT is in the back seat with manual cervical spine stabilization. The patient is anxious and complaining of pain in her legs. She is pale with cool, dry skin. The radial pulse is thready at 116, respirations are 24, and the breath sounds are clear bilaterally and equal. The abdomen is soft and nontender, and there is no pain or instability on assessment of the pelvis. You are 15 minutes from a Level I trauma center. In addition to oxygen, application of a cervical collar, and a large-bore IV of isotonic crystalloids started en route, which of the following is the best management of this patient? A) Seated-spinal immobilization device, extrication onto a long backboard, analgesia B) Rapid extrication onto a long backboard C) Rapid extrication onto a long backboard, bilateral traction splints D) Seated-spinal immobilization device, extrication onto a long backboard, bilateral traction splints, analgesia Rapid extrication onto a long backboard Your patient is a 20-year-old female complaining of ankle pain after stepping off a curb. She states that she is concerned because she had a grade III sprain a year and a half ago that required extensive treatment and rehabilitation. Which of the following most accurately describes the patient's previous injury? A) The ankle ligaments were stretched but not torn. B) The ankle ligaments had a minor tear. C) The ankle ligaments were torn but not all the way. D) The ankle ligaments were completely torn. The ankle ligaments were completely torn. Tendons connect ________ to ________. A) Muscles, bones B) Bones, bones C) Cartilage, bones D) Muscles, fascia Muscles, bones The use of PASG is indicated in the treatment of which of the following musculoskeletal injuries? A) Bilateral tibia/fibula fractures B) Knee dislocation C) Lumbar vertebral compression fracture D) Pelvic fracture Pelvic fracture Which of the following supplies articular cartilage with oxygen and nutrients? A) Bursae B) Capillary beds C) Synovial fluid D) The Haversian system Synovial fluid A partial displacement of a bone end from its position in the joint is called a: A) Sprain B) Dislocation C) Subluxation D) Contracture Subluxation A fracture in which significant energy exchange shatters or splinters bone, creating many fragments, is called a(n) ________ fracture. A) Impacted B) Comminuted C) Oblique D) Spiral Comminuted Your patient is a seven-year-old male with a fracture of the proximal tibia. Which of the following is the most likely and serious complication of this injury? A) Juvenile onset arthritis B) Formation of a bone callus C) Disruption of the epiphyseal plate D) Fat embolism Disruption of the epiphyseal plate

Which of the following best describes the function of cancellous bone? A) It produces erythrocytes. B) It acts as a growth plate in long bones. C) Its dense, compact structure is well adapted to weight bearing. D) It contains yellow bone marrow. It produces erythrocytes. A dislocated knee is most likely to damage which of the following vascular structures? A) Femoral vein B) Popliteal artery C) Femoral artery D) Great saphenous vein Popliteal artery Which of the following types of fractures occurs in pediatric age groups but not in adults? A) Oblique B) Transverse C) Greenstick D) Impacted Greenstick Your patient is a 50-year-old motorcyclist who received a lateral impact from an automobile as he went through an intersection. He has a deformity of the right midthigh and an open right tibia/fibula fracture. He also has a fracture of his left forearm and some abrasions. He was wearing a helmet and suffered no loss of consciousness. He currently has a strong radial pulse of 100, his skin is warm and moist, and he has adequate respirations at 20 per minute. Assuming no significant findings during a rapid trauma exam and intact distal neurovascular status, which of the following is the best way to manage this patient's lower-extremity trauma? A) Use anatomical splinting provided by placing the patient on a long backboard. B) Secure padded long board splints laterally and medially. C) Apply PASG. D) Apply a traction splint. Secure padded long board splints laterally and medially. Not considering other injuries, which of the following musculoskeletal findings warrants immediate transport of your patient? A) Unstable pelvis B) Clavicle fracture C) Posterior shoulder dislocation D) Open fracture of the tibia and fibula Unstable pelvis

Which of the following is a reliable sign of impending delivery? a. Meconium-stained amniotic fluid b. Crowning c. Loss of the cervical mucus plug d. Spontaneous rupture of the membranes d.6

Which of the following best describes the routine care of a newborn? a. Deep suctioning of the airway with an ETT and meconium aspirator, ventilation with 100 percent O2, CPR b. Suctioning of the airway with a bulb syringe, as needed, tactile stimulation, drying, warming, APGAR determination c. Tactile stimulation, drying, warming d. Drying, warming, allowing for suckling at the mother's breast b.Suctioning of the airway with a bulb syringe, as needed, tactile stimulation, drying, warming, APGAR determination

Which of the following is TRUE of asthma in the pediatric patient? a. Bronchodilators are more effective in pediatric patients than in adults, and steroids are rarely indicated. b. Oxygen and nebulized beta agonists are indicated in the initial phase of an asthma attack. c. Bronchodilators are primarily effective when treating the second phase of an asthma attack. d. The primary therapeutic goal in the initial phase of an asthma attack is to rehydrate and administer mucolytic and anti-inflammatory agents. b.Oxygen and nebulized beta agonists are indicated in the initial phase of an asthma attack.

Which of the following childhood respiratory diseases has increased dramatically over the past few decades? a. Pneumonia b. Croup c. Asthma d. Epiglottitis c.Asthma

You have responded to a residence for an injured child. The mother presents you with a two-year-old boy who is crying loudly. She says he fell off the family playground equipment and won't stop crying. You ask the boy what happened, and he points to the jungle-gym outside and cries more. You notice some seven- to ten-day-old bruises on his shins, but no other signs of injury. What impression could you form using your knowledge of child abuse? a. The child indicates the same story as the mother, and children of that age tend to injure themselves playing. b. Continual crying is a sign of abuse, and so are the old bruises. c. The child was obviously unsupervised and is probably abused. d. There are some warning signs, and the police should be involved. a.The child indicates the same story as the mother, and children of that age tend to injure themselves playing.

Which of the following common conditions may be mistaken for child abuse? a. Diaper rash b. Rug burns c. Mosquito bites d. Chicken pox d.Chicken pox

Your patient is a nine-month-old infant in respiratory distress with grunting respirations of 50 per minute, nasal flaring, and intercostal retractions. He is pale, and you note scattered bilateral wheezing on auscultation of the lungs. The mother states that the child is healthy and up-to-date on all his immunizations. Which of the following conditions is most likely, based on this information? a. New onset asthma b. Bacterial tracheitis c. Bronchiolitis due to respiratory syncytial virus d. Epiglottitis due to Haemophilus influenzae type b c.Bronchiolitis due to respiratory syncytial virus

Which of the following conditions does NOT cause an upper airway obstruction? a. Epiglottitis b. Croup c. Bacterial tracheitis d. Asthma d.Asthma

Which of the following is related to a higher mortality due to burns in elderly patients? a. Increase in complications due to comorbid factor b. Thinner skin leading to deeper tissue destruction c. Greater risk of infection than in younger patients d. All of the above d.All of the above

Which of the following contribute to malnutrition in the elderly? 1. alcohol abuse 2. breathing problems 3. Low income 4. Anorexia 5. Decreased senses of taste and smell a. 1, 2, 4, and 5 b. 1, 3, 4, and 5 c. 1, 2, 3, 4, and 5 d. 2, 3, and 5 c.1, 2, 3, 4, and 5

Which of the following statements regarding drug abuse in the elderly is NOT true? a. The elderly are unlikely to abuse prescription drugs. b. Changes in hearing and vision may be due to drug abuse. c. Drug abuse in the elderly may include over-the-counter drugs. d. Drug abuse is a possibility to consider when dealing with elderly patients with changes in their mental status. a.The elderly are unlikely to abuse prescription drugs.

Which of the following contributes to choking and aspiration in the elderly? a. dyskinesia b. gross involuntary motor movements c. Poor dentition d. All of the above d.All of the above

How many patients receive paid professional home health care each year? a. 500,000 b. 8 million c. 20 million d. 2 million b.8 million

Which of the following could be used for vascular access if necessary? a. An arterial line b. A PEG tube c. a urostomy d. A PICC line d.A PICC line

Which of the following conditions may result in persistent fetal circulation? a. Failure to cut the umbilical cord b. Down syndrome c. Hypoxia d. Overaggressive administration of blow-by oxygen c.Hypoxia

Which of the following describes the appropriate administration of intravenous fluids in a newborn? a. Normal saline or lactated Ringer's solution 40 mL/kg using a pressure infuser b. Normal saline, 10 mL/kg, slow IV push c. 10 percent dextrose in water, 20 mL/kg, slow IV push d. 5 percent dextrose in 0.45 percent saline solution, 30 mL/kg b.Normal saline, 10 mL/kg, slow IV push

What might you notice before entering a residence that would lead you to assume that a home health care situation might exist? a. A "No Smoking, Oxygen in Use" sign b. A wheelchair ramp c. A vehicle in the driveway that appears to be used for convalescent transport d. All of the above d.All of the above

Which of the following devices does NOT deliver nutrients to the chronically ill patient? a. Groshong catheter b. PEG tube c. NG tube d. Jejunal tube a.Groshong catheter

Which of the following may result from using oropharyngeal airways in pediatric patients? 1. Airway obstruction 2. Hypoxia 3. Soft tissue trauma 4. Vomiting 5. Bradycardia a. 1, 3, and 4 b. 2, 3, and 4 c. 3 and 4 d. All of the above d.All of the above

Which of the following differences in the pediatric respiratory system should be considered when assessing the pediatric patient? 1. You will most likely note that the child's abdomen rises and falls during respiration, more than that of an adult. 2. Breath sounds from functional areas of the lung may be transmitted through the chest wall such that a pneumothorax may go undetected. 3. The resiliency of the pediatric ribs causes them to absorb most of the energy from blunt trauma, thereby protecting the underlying organs. 4. Although a child's smaller ribs fracture more easily, it is uncommon to see rib fractures in the abused child. 5. The pediatric patient will more readily display mediastinal shift with a tension pneumothorax. a. 1, 4, and 5 b. 1, 2, 3, and 5 c. 1, 2, and 5 d. 2, 3, and 4 c.1, 2, and 5

The study of the effects of aging and age-related diseases in human beings is called: a. dementiology. b. geriatrics. c. gerontology. d. senescence. c.gerontology.

Which of the following does NOT cause lower gastrointestinal bleeding? a. Mallory-Weiss tear b. ischemic colitis c. Diverticulosis d. A-V malformation a.Mallory-Weiss tear

The elderly patient in shock may be less likely to exhibit which of the following expected manifestations of shock? a. Altered mental status b. Cardiac dysrhythmias c. Hypothermia d. Tachycardia d.Tachycardia

Which of the following does NOT complicate history-taking in the elderly patient? a. The patient has impaired pain perception. b. The patient may be reluctant to give you important details. c. The patient reports multiple, vague complaints. d. A family member gives you information the patient failed to report. d.A family member gives you information the patient failed to report.

Which of the following is NOT a factor in altered pharmacokinetics in the elderly? a. Decreased hepatic function b. Slowed drug absorption from the gastrointestinal tract c. Increased total body water d. Decreased renal function c.Increased total body water

Which of the following does NOT contribute to an increased risk of hyperthermia in the elderly? a. Increased functioning of the thermoregulatory center b. Use of diuretics c. Limited income d. Alcoholism a.Increased functioning of the thermoregulatory center

Which of the following may cause constipation in the elderly? a. Malignancy b. Poor diet c. Antihistamines d. All of the above d.All of the above

Which of the following does NOT contribute to poor nutrition in the elderly? a. Living in congregate care facilities b. COPD c. Depression d. Medication side effects a.Living in congregate care facilities

You have just delivered a newborn who has a meningomyelocele. How should you position this patient? a. In a lateral recumbent position with a pressure bandage over the defect b. Supine, head and chest elevated c. Prone d. Supine, head lower than body c.Prone

Which of the following endotracheal tubes described is appropriate for a full-term infant weighing over 3,000 grams? a. 4.0, cuffed b. 4.0, uncuffed c. 3.0, cuffed d. 3.0, uncuffed b.4.0, uncuffed

Your patient is a 75-year-old female who is complaining of generalized weakness and loss of appetite. Your physical exam reveals no remarkable findings, and the patient has no significant past medical history. You reassure the patient that these are common complaints among people in her age group. Which of the following should you do next? a. Advise the patient to make an appointment with her doctor if a good night's sleep does not make her feel better. b. Transport the patient for evaluation of a potentially serious medical problem. c. Call a family member to come and stay with the patient. d. Reassure the patient that there is nothing to worry about; these things happen as you get older. b.Transport the patient for evaluation of a potentially serious medical problem.

Which of the following factors increase the likelihood of stroke in the elderly? 1. Atherosclerosis 2. Atrial fibrillation 3. Hypertension 4. Transient ischemic attacks a. 1, 2, 3, and 4 b. 2, 3, and 4 c. 1, 2, and 3 d. 1, 3, and 4 a.1, 2, 3, and 4

Which of the following medications does NOT cause constipation in the elderly? a. Diphenhydramine b. Docusate sodium c. Furosemide d. Codeine b.Docusate sodium

Which of the following factors is NOT associated with diabetes in the elderly? a. Diet b. Increased cellular resistance to insulin c. Decreased physical activity d. Increased production of insulin d.Increased production of insulin

Which of the following best describes the difference between cellulitis and sepsis? a. Cellulitis and sepsis are virtually the same and are often used interchangeably. b. Sepsis involves only the connective tissue while cellulitis is systemic. c. Sepsis can lead to cellulitis but not the other way around. d. Cellulitis is the inflammation of cellular or connective tissue whereas sepsis is systemic. d.Cellulitis is the inflammation of cellular or connective tissue whereas sepsis is systemic.

Which of the following interventions would NOT be appropriate when treating a hypotensive patient due to postpartum bleeding? a. Massaging the uterus b. Administration of medication such as Pitocin c. MAST d. Fluid administration c.MAST

Which type of unique burn pattern is found when a child has been accidentally exposed to water that is too hot? a. Splash b. Dipping c. Circumferential d. Scald a.Splash

Which of the following is NOT a characteristic of a partner abuser? a. The male works more than one job. b. The male did not graduate high school. c. The income of the family is below poverty level. d. The male is unemployed. a.The male works more than one job.

Which of the following are risk factors for osteoporosis? 1. Female 2. Male 3. African American 4. Asian 5. Hormone replacement therapy a. 1 and 4 b. 1, 3, and 5 c. 2 and 3 d. 1, 3, and 4 a.1 and 4

Which of the following is NOT a common complaint among elderly patients? a. Chest pain b. Inability to urinate c. Difficulty swallowing d. Insomnia a.Chest pain

Your patient is an 82-year-old female whose daughter called EMS because the patient became very short of breath as they walked from their parking spot to the front of their church. On your arrival, the patient states that she just needed a little rest and now feels much better. On questioning, she admits to several such episodes in the last month. She denies chest pain and she says she, "Just got winded because she's getting so old." The patient has a heart rate of 84, a respiratory rate of 20, and blood pressure of 172/90. Your history and physical examination should focus on which of the following possibilities? 1. Pulmonary embolism 2. Acute myocardial infarction 3. Chronic gastrointestinal bleeding 4. Angina pectoris a. 1 and 2 b. 3 and 4 c. 2 only d. 1, 2, and 4 b.3 and 4

Which of the following is NOT a factor in decreased medication compliance in the elderly? a. Multicompartment pill boxes b. Inadequate income c. Child-proof medication containers d. Polypharmacy a.Multicompartment pill boxes

Which of the following is NOT appropriate when assisting with prehospital delivery? a. Keep the newborn at the level of the vagina until the umbilical cord is cut. b. Rotate the baby's head to the side as soon as it delivers. c. Suction the mouth as soon as the head delivers. d. Gently guide the baby's head downward to deliver the upper shoulder. b.Rotate the baby's head to the side as soon as it delivers.

Which of the following is NOT a function of the placenta? a. Supplying the developing fetus with maternal blood b. Secreting estrogen and progesterone required to maintain pregnancy c. Removing fetal waste products d. Transferring heat and nutrients to the developing fetus a.Supplying the developing fetus with maternal blood

Which of the following refers to the time interval prior to birth? a. Postpartum b. Prenatal c. Intrapartum d. Perinatal b.Prenatal

Which of the following is NOT a method of encouraging tocolysis? a. Administration of magnesium sulfate b. Administration of a beta agonist c. Fluid administration d. Administration of oxytocin d.Administration of oxytocin

Which of the following is NOT true of cardiac dysrhythmias in the elderly? a. Which of the following is NOT true of cardiac dysrhythmias in the elderly? b. Premature ventricular complexes are the most common dysrhythmias. c. Dysrhythmia may be the underlying cause of a motor vehicle collision. d. Dysrhythmia may cause a syncopal episode. b.Premature ventricular complexes are the most common dysrhythmias.

Which of the following is NOT a significant mental health disorder in the elderly? a. Affective disorders b. Drug abuse c. Borderline personality disorder d. Suicide b.Drug abuse

You arrive at a nursing facility for a "respiratory distress" call. The frantic nurse says that a patient cannot breathe. You find a 72-year-old woman who has a feeding tube visible from her mouth. She cannot speak and is having trouble breathing. Your partner asks how long the tube has been in place, and the nurse says it was just placed by the visiting doctor about 10 minutes ago. The doctor has left the building. What is your best course of action? a. Place the patient on a nonrebreather mask and prepare to transport. b. Have the patient cough to dislodge the tube. c. Intubate the patient with the tube in place. d. Gently remove the tube and assess lung sounds. d.Gently remove the tube and assess lung sounds.

Which of the following is NOT a stage of grieving? a. Sadness b. Acceptance c. Denial d. Anger a.Sadness

Toddlers are represented in which of the following age groups? a. two years to four years b. one year to two years c. one month to two years d. one year to three years d.one year to three years

Which of the following is NOT an appropriate activity for paramedics providing education aimed at reducing childhood morbidity and mortality? a. Speaking to parent groups, such as parents of children involved in athletics b. Presenting at elementary schools c. Participating in community health fair activities d. Counseling parents of seriously injured children at the scene or during transport d.Counseling parents of seriously injured children at the scene or during transport

When the fetal scalp is visible at the vaginal opening during a contraction, this is known as: a. effacement b. crowning c. stage three labor d. engagement b.crowning

Which of the following is NOT part of normal management of the mother, postdelivery? a. Inspecting the perineum for tears b. High-concentration oxygen by nonrebreather mask c. Applying direct pressure to control hemorrhaging of perineal tears d. Frequently monitoring vital signs b.High-concentration oxygen by nonrebreather mask

Which of the following is a concern regarding the elderly in nursing homes? 1. development of pressure sores 2. development of tuberculosis 3. possibility of abuse 4. pneumonia a. 1, 2, and 3 b. 1 only c. 1 and 3 d. 1, 2, 3, and 4 d.1, 2, 3, and 4

Which of the following is TRUE of aging of the cardiovascular system? a. The cardiac conduction system remains unaffected unless damaged by myocardial infarction. b. Thickening of the aorta makes aneurysm due to sudden deceleration less likely than in younger patients. c. The elderly in hemorrhagic shock may not exhibit tachycardia. d. The left ventricle atrophies due to increased systemic vascular resistance. c.The elderly in hemorrhagic shock may not exhibit tachycardia.

Your patient is a seven-month-old child whose mother called because he suddenly became lethargic and pale. Your assessment reveals that he is in a supraventricular tachycardia at a rate of 244 per minute. The patient's extremities are mottled and his capillary refill time is 4 seconds. Which of the following is the best treatment plan for this patient? a. Adenosine, 0.1 mg/kg rapid IV push, repeated at 0.2 mg/kg if unsuccessful b. Verapamil, 0.3 mg/kg over 3 to 5 minutes c. Diltiazem, 0.25 mg/kg over 2 minutes d. Synchronized cardioversion beginning at 0.5-1.0 joules/kg d.Synchronized cardioversion beginning at 0.5-1.0 joules/kg

Which of the following is TRUE of cervical spine injuries in children? a. They are more often due to penetrating trauma than in adults. b. The heavier head of the child increases the incidence of cervical distraction injuries. c. Pediatric patients do not require cervical spine immobilization unless neurologic deficit is present on assessment. d. The pediatric cervical spine should be immobilized in a position of moderate hyperextension. b.The heavier head of the child increases the incidence of cervical distraction injuries.

You have arrived on the scene outside a grocery store where an elderly woman is sitting on the sidewalk with several bystanders. She has a hematoma on her forehead, abrasions on her palms, an obvious deformity of her right forearm, and an avulsion on her right knee that is continuing to bleed. Your patient says she is 80 years old and lives alone. She takes no medications and states she is in good health. She tells you she tripped over the curb as she approached the store entrance. When assessing the patient, which of the following would be most appropriate? a. A focused physical exam and rapid trauma assessment b. A detailed physical examination c. A rapid trauma assessment d. A focused physical exam b.A detailed physical examination

Which of the following is TRUE of incontinence in the elderly? a. It can lead to rashes, skin infections, ulcers, UTI's, sepsis and falls. b. Urinary incontinence only affects female patients. c. It is normal in patients over age 80. d. It only occurs in patients with impaired cognitive functioning. a.It can lead to rashes, skin infections, ulcers, UTI's, sepsis and falls.

Which of the following is TRUE of the causes of developmental disabilities? a. They are caused by cerebral hypoxia. b. They are caused by brain injuries. c. They are caused by genetic disorders. d. All of the above can cause developmental disorders. d.All of the above can cause developmental disorders.

Which of the following is TRUE of individuals with cerebral palsy? a. They are not functional and require full-time care. b. They can perform some activities of daily living but have difficulty communicating. c. They always depend on wheelchairs because they cannot walk. d. A full one-third of CP patients are intelligent and some are highly gifted. d.A full one-third of CP patients are intelligent and some are highly gifted.

Which of the following guidelines applies to suctioning the newborn's airway with an endotracheal tube to remove particulate meconium? a. Use a meconium aspirator, and use no more than 100 mmHg of vacuum. b. Use a meconium aspirator, and use no more than 100 cm H20 of vacuum. c. Use battery-operated portable suction only, and use no more than 100 cm H20 of vacuum. d. Use portable or wall-mounted suction, and use no more than 300 mmHg of vacuum. b.Use a meconium aspirator, and use no more than 100 cm H20 of vacuum.

Which of the following is TRUE of secondary apnea in newborns? a. Epinephrine is the preferred primary intervention. b. Secondary apnea only occurs in small-for-gestational-age newborns. c. This condition requires ventilatory assistance. d. The first intervention is "blow-by" oxygen held 1/2 inch from the newborn's face. c.This condition requires ventilatory assistance.

Which of the following is NOT a sign of respiratory distress in the pediatric patient? a. Grunting b. Tachypnea c. Tachycardia d. Central cyanosis d.Central cyanosis

Which of the following is a factor in the relatively high number of burn deaths in children? a. Their skin is thinner than adult skin, and it requires less exposure to heat to induce full-thickness burns. b. Their high body-surface-area-to-volume ratio causes them to lose fluids more quickly when the skin is damaged. c. They have less subcutaneous fat than adults, which results in increased heat loss when the skin is damaged. d. All of the above are factors. d.All of the above are factors.

Which of the following is the leading cause of death in the elderly? a. Trauma b. Cardiovascular disease c. Cancer d. Multiple organ system failure b.Cardiovascular disease

Which of the following is a normal age-related change in the nervous system? a. Delirium b. Loss of intelligence c. Decreased brain size d. Dementia c.Decreased brain size

Your patient is a 32-year-old female who complains of the onset of contractions 45 minutes ago. She is 39 weeks pregnant, G3P2. She states that the contractions are 2 minutes apart but that her membranes have not ruptured. She is anxious and responds affirmatively when you ask if she feels an urge tomove her bowels. Which of the following is most likely? a. Imminent delivery b. Preterm labor c. Braxton-Hicks contractions d. Stage two of labor a.Imminent delivery

Which of the following is a reliable sign of impending delivery? a. Meconium-stained amniotic fluid b. Crowning c. Loss of the cervical mucus plug d. Spontaneous rupture of the membranes b.Crowning

Which of the following is an intrinsic factor in falls in the elderly? a. High shelving for storage b. Glaucoma c. Throw rugs in the living area d. Ice on a driveway or sidewalk b.Glaucoma

Which of the following is a rule of thumb for determining the baseline mental status of an elderly patient? a. Elderly people generally cannot remember recent events, but they should have good recall of people and past events. b. The patient should be assumed to have normal cognitive functioning until proven otherwise. c. Patients living in nursing homes should be assumed to have cognitive impairment until proven otherwise. d. Cognitive function declines 7 to 10 percent every five years after age 65. b.The patient should be assumed to have normal cognitive functioning until proven otherwise.

Which of the following actions of the paramedic may lead to decubitus ulcer development in the elderly patient? a. Failing to pad the backboard for a patient in need of spinal immobilization b. Allowing the patient to remain in the same position during an extended transport time c. Failing to remove wet or soiled clothing of the incontinent patient d. All of the above d.All of the above

Which of the following is a social problem among the elderly? a. Loneliness b. Abuse c. Poor nutrition d. All of the above d.All of the above

Which of the following medications are most commonly used to treat arthritis? a. Cutting-edge synthetic pain relievers b. Barbiturates c. NSAIDS and corticosteroids d. Opiate pain killers and steroids c.NSAIDS and corticosteroids

Which of the following is another term for an articulation disorder? a. Dysphasia b. Dysphoria c. Dysarthria d. Dysrhythmias c.Dysarthria

Which of the following is expected by the 24th week of pregnancy? a. The fetal lungs are producing sufficient surfactant. b. Fetal heart tones are audible with stethoscope. c. Fingernails and toenails are present. d. The fetal head is engaged in the pelvis b.Fetal heart tones are audible with stethoscope.

Which of the following is most likely regarding the fetus in a mother with diabetes? a. The fetus will be small for gestational age. b. The neonate is likely to be born in diabetic ketoacidosis. c. The neonate will require dextrose immediately after delivery. d. The fetus will be large for gestational age. d.The fetus will be large for gestational age.

Which of the following statements is TRUE of falls in the elderly? a. Falls in the elderly are not preventable. b. Falls are the leading cause of accidental death in the elderly. c. The elderly have the highest incidence of falls. d. All of the above are true. b.Falls are the leading cause of accidental death in the elderly.

Which of the following is recommended for improving communication with elderly patients who have age-related changes in sensation? a. Turn on lights in the room if it is too dimly lit. b. Stand 4 to 6 feet away from patients who are farsighted. c. Cup your hands around the ears of the hearing-impaired patients and speak into your cupped hands. d. Stand to one side of visually impaired patients to use their ability to hear. a.Turn on lights in the room if it is too dimly lit.

Which is NOT a factor associated with elder abuse? a. Financial stress of caretaking b. Limited long-term care options c. Violent Internet websites d. Increased life expectancy c.Violent Internet websites

Which of the following is the PRIMARY risk factor of partner abuse? a. History of abuse between parents b. Poor education of the abuser c. Many children from different fathers d. Pregnancy of the victim a.History of abuse between parents

You have been resuscitating a newborn and find that after ventilation by bag-valve-mask device with supplemental oxygen for 30 seconds that his heart rate is 78 per minute. Which of the following should you do next? a. Start an IV using the umbilical vein. b. Continue ventilations and reassess in another 30 seconds. c. Intubate the trachea. d. Begin chest compressions at a rate of 100 per minute. d.Begin chest compressions at a rate of 100 per minute.

Which of the following is the correct dosage of epinephrine in neonatal resuscitation? a. 0.1 to 0.3 mg/kg b. 0.01 to 0.03 mg/kg c. 0.01 to 0.03 mL/kg of a 1:10,000 solution d. 1 to 3 mg/kg of a 1:1,000 solution b.0.01 to 0.03 mg/kg

Which of the following is the correct dosage for sodium bicarbonate in newborn resuscitation? a. 1 mEq/kg b. 1 mL/kg c. 1 mL/g d. 1mg/g a.1 mEq/kg

Which of the following is the correct dosage of naloxone for a 2,500-g newborn? a. 0.25 mg b. 2.5 mg c. 0.025 mg d. 25 mg a.0.25 mg

Patients undergoing chemotherapy commonly suffer from which of the following conditions? a. Neutropenia b. Eosinophilia c. Cytopenia d. Megalomania a.Neutropenia

Which of the following is the etiology of Down syndrome? a. Fetal alcohol syndrome (FAS) b. A chromosomal abnormality, specifically an extra chromosome c. Alzheimer's trait d. An abnormality of the brain b.A chromosomal abnormality, specifically an extra chromosome

Your patient is a 15-year-old male who was kicked in the scrotum while playing with some friends. He is complaining of excruciating pain in his testicles. Which of the following guidelines applies to the examination of this patient? a. Perform no examination of the genitals. b. Make sure his mother is present during the exam. c. Make sure a paramedic of the same sex performs the exam. d. Make sure a paramedic of the opposite sex performs the exam. c.Make sure a paramedic of the same sex performs the exam.

Which of the following is the most common cause of cardiac emergencies in pediatric patients? a. Rheumatic fever b. Wolff-Parkinson-White syndrome c. Congenital heart anomalies d. Familial coronary artery disease c.Congenital heart anomalies

Your patient is a 13 year-old male drowning victim. He was initially in cardiac arrest with a pulseless, wide-complex bradycardia. He is intubated and being ventilated with supplemental oxygen. After CPR and intubation, the patient is now in ventricular tachycardia with a weak radial pulse. Which of the following would be an appropriate treatment for this patient? a. Amiodarone, 5 mg/kg IV push b. Lidocaine, 3 mg/kg IV bolus, followed by a 3 mg/minute drip c. Procainamide, 20 mg per minute, up to 800 mg d. Synchronized cardioversion starting at 0.5-1.0 joules/kg d.Synchronized cardioversion starting at 0.5-1.0 joules/kg

Which of the following is the most common result of blunt chest trauma in children? a. Anterior flail segment b. Intrathoracic injury without external bruising of the thorax c. Associated spinal cord injury d. Fractured ribs with a high incidence of hemothorax b.Intrathoracic injury without external bruising of the thorax

Which of the following may be a consequence of decreased mobility in the elderly? a. Constipation b. Angina pectoris c. Fewer falls d. Arthritis a.Constipation

Which of the following leaves the elderly at an increased risk of abuse? 1. Living on their own 2. Incontinence 3. Dementia 4. Age over 80 a. 2, 3, and 4 b. 1, 2, and 3 c. 1, 2, 3, and 4 d. 1, 3, and 4 a.2, 3, and 4

Preterm labor is defined as labor that begins before ________ weeks of gestation. a. 40 b. 37 c. 36 d. 38 d.38

Which of the following maternal changes is expected during pregnancy? a. Decreased stroke volume, decreased heart rate b. Increased heart rate, increased blood pressure c. Increased blood pressure, increased cardiac output d. Increased cardiac output, increased blood volume d.Increased cardiac output, increased blood volume

You are in the home of a 28-month-old male whose mother called EMS because he fell while running and struck his forehead on the corner of a table. The patient has a hematoma on his forehead but seems to have forgotten about the injury and is entertaining himself with some building blocks. Which of the following is the best way to begin assessing the child? a. To avoid upsetting him, observe him from a distance and make no physical contact with him. b. Pick him up from the floor with a cheerful, "Hey partner!" c. Sit next to him and ask if you can play with some of his toys. d. Ask his mother to pick him up and hold him on her lap. d.Ask his mother to pick him up and hold him on her lap.

Which of the following may compromise prehospital ventilation in the pediatric patient? a. Cricoid pressure b. Hyperextending the neck c. Using 100 percent oxygen for more than 30 minutes d. Placing a folded towel under the shoulders b.Hyperextending the neck

Which of the following is likely to occur due to prolonged and/or deep suctioning of the newborn's airway? a. Hypoxia, tachycardia b. Hypoxia, bradycardia c. Hypoxia, ventricular fibrillation d. Vagal stimulation, tachycardia b.Hypoxia, bradycardia

Which of the following may occur secondary to suctioning the airway of an infant? a. Clearing the airway b. Bradycardia c. Hypoxia d. All of the above d.All of the above

You have arrived on the scene of an injured person. The person has been identified by the police as a Hispanic person who has a hearing impairment. What is the best way to communicate with this person? a. Use written words or pictures; it is the most effective means of communication. b. Try to turn up the person's hearing aid so the person can understand you. c. Shout loudly and make hand gestures. d. Call for an American Sign Language interpreter to meet you at the hospital. a.Use written words or pictures; it is the most effective means of communication.

Which of the following organ systems are affected by cystic fibrosis? a. Respiratory and digestive b. Circulatory and skeletal c. Digestive and circulatory d. Respiratory and reproductive a.Respiratory and digestive

Multiple sclerosis most commonly affects which of the following populations? a. Children after puberty b. Women ages 20-40 c. Men over age 65 d. Men and women over 40 b.Women ages 20-40

Which of the following patients has the "typical" presentation of myasthenia gravis? a. A 60-year-old woman with acute onset of left-side facial drooping b. A 50-year-old woman with chronic weakness and nausea c. A 22-year-old woman with fatigue, facial drooping, and difficulty swallowing d. A 35-year-old man with abdominal pain and hives c.A 22-year-old woman with fatigue, facial drooping, and difficulty swallowing

What step could you take to assist in the psychological care of a sexual assault victim? a. Give the patient your phone number so he can call you for support. b. Refer the patient to a certified counselor as soon as possible. c. Tell the patient you will take care of all the patient's needs. d. Try to have a provider of the same sex interview, assess, and maintain contact with the patient. d.Try to have a provider of the same sex interview, assess, and maintain contact with the patient.

Which of the following situations would raise your level of suspicion that a child is being abused? a. A six-year-old with bruises on his shins in different stages of healing b. A nine-year-old with bruises to her face, arms, and back all in different stages of healing c. A ten-year-old with an isolated femur fracture resulting from "playing rough" with a family member d. An eight-month-old with a laceration above his right eye b.A nine-year-old with bruises to her face, arms, and back all in different stages of healing

Which of the following is indicated first for a pregnant patient with no medical history who is experiencing seizures? a. Diazepam b. Calcium gluconate c. Magnesium sulfate d. Naloxone c.Magnesium sulfate

Which of the following statements about changes in maternal physiology during pregnancy is TRUE? a. Renal blood flow decreases. b. The mother's respiratory rate increases significantly. c. Maternal blood volume decreases. d. Progesterone causes a decrease in airway resistance. d.Progesterone causes a decrease in airway resistance.

Which of the following is an appropriate beginning dosage of dopamine per minute for a 5-kg neonate? a. 15 mcg b. 5 mcg c. 25 mcg d. 50 mcg c.25 mcg

Which of the following statements concerning functional residual volume in newborn resuscitation is TRUE? a. You should maintain a PEEP of 2 to 4 centimeters of water with ventilations to maintain adequate functional residual volume. b. It is impossible to maintain functional residual volume without a cuffed endotracheal tube to prevent air from escaping around the tube. c. Functional residual volume can be maintained only with a mechanical ventilator. d. A manually triggered, oxygen-powered ventilation device enhances functional residual volume. a.You should maintain a PEEP of 2 to 4 centimeters of water with ventilations to maintain adequate functional residual volume.

Which of the following is NOT an antepartum or intrapartum risk factor for newborn distress? a. Multiple gestation b. Post-term gestation c. The maternal use of narcotics within 2 hours before delivery d. Maternal age between 16 and 35 years d.Maternal age between 16 and 35 years

Which of the following statements concerning suctioning the airway of the newborn is TRUE? a. In all newborns, the presence of thin, watery meconium staining requires aggressive suctioning with an endotracheal tube in place. b. Using a bulb syringe, first suction the nose, then the mouth. c. Vigorous newborns should not be suctioned unless there is meconium present. d. If the amniotic fluid is clear, no suction is required. d.If the amniotic fluid is clear, no suction is required.

Which of the following is part of the mother's routine postpartum care? a. Encouraging the mother to bear down to deliver the placenta b. 500 to 1,000 mL normal saline infusion c. Fundal massage d. Oxytocin administration c.Fundal massage

Which of the following statements regarding meconium is NOT true? a. The presence of meconium staining is often difficult to determine. b. The presence of meconium is often associated with prolonged labor. c. Thin and light meconium does not require aggressive suctioning of the airway. d. Meconium-stained fluid indicates a fetal hypoxic incident. a.The presence of meconium staining is often difficult to determine.

Which of the following is NOT a consequence of respiratory insufficiency in the newborn? a. Hypoxia b. Hyperglycemia c. Bradycardia d. Acidosis b.Hyperglycemia

Which of the following statements regarding the viability of preterm infants is TRUE? a. Infants delivered before 30 weeks gestation cannot survive. b. Gestational age does not matter as long as the infant weighs over 1,000 grams. c. An infant delivered at 23 to 24 weeks gestation can survive. d. The lower limit of viability is 20 weeks. c.An infant delivered at 23 to 24 weeks gestation can survive.

Which of the following statements about the umbilical cord is TRUE? a. The umbilical vein supplies oxygenated blood to the fetus. b. The umbilical cord is approximately 6 feet long. c. It has two veins and one artery. d. Arteries connected to the maternal circulation supply blood to the fetus. a.The umbilical vein supplies oxygenated blood to the fetus.

Which of the following structures allows the delivery of oxygen and nutrients to and removal of wastes from the fetus? a. Amniotic sac b. Allantois c. Placenta d. Morula c.Placenta

Based solely on a 1-minute APGAR score of 7, which of the following actions should you take? a. Dry, warm, position, suction, stimulate, give oxygen as needed, reevaluate b. Bag-valve-mask ventilations with supplemental oxygen for 60 seconds c. Chest compressions at 120/minute, reevaluate after 30 seconds d. Allow the mother to nurse the infant, if she desires a.Dry, warm, position, suction, stimulate, give oxygen as needed, reevaluate

Which of the following terms refers to babies during their first months of life? a. Infants b. Neonates c. Toddlers d. Newly born infants b.Neonates

Which of the following is a characteristic of osteoarthritis? a. Loss of bone density at the bone epiphyses b. Accumulation of uric acid crystals in the joints c. Ankylosing spondylitis d. presents as joint pain, worsened by exercise, improved with rest d.presents as joint pain, worsened by exercise, improved with rest

Which of the following terms refers to the act of negatively stereotyping elderly people? a. Gerontology b. Ageism c. Immoralism d. Misanthropy b.Ageism

Which of the following sets of vital signs is normal for a newborn? a. HR = 125, RR = 65 b. HR = 175, RR = 60 c. HR = 190, RR = 35 d. HR = 180, RR = 30 b.HR = 175, RR = 60

Which of the following types of congenital anomalies is most common? a. Neural tube defects b. Diaphragmatic hernia c. Heart defects d. Cleft lip and cleft palate c.Heart defects

Which of the following is the most important factor to consider when assessing the chronically ill home-bound patient? a. Deviation from baseline condition b. Access to home health care c. Mental status d. Mobility a.Deviation from baseline condition

Which of the following would NOT indicate the potential for a urinary tract infection? a. Polyuria b. Tea-colored urine c. Foul-smelling urine d. Cloudy urine a.Polyuria

Your patient is in a state of hypoperfusion secondary to cardiomyopathy. In addition to oxygenation, which of the following interventions is indicated? a. An epinephrine drip at 0.1 to 1.0 mcg/kg/minute b. Atropine, 0.02 mg/kg of atropine sulfate c. A 20 mL/kg bolus of normal saline, repeated to a total of 80 mL/kg d. A dobutamine drip starting at 2.0 mcg/kg/minute d.A dobutamine drip starting at 2.0 mcg/kg/minute

Which of the following would be acceptable choices for pediatric analgesia? 1. Fentanyl 2. Morphine 3. Nalbuphine 4. Meperidine 5. Butorphanol a. 1 and 2 only b. 2, 4, and 5 c. 1, 2, 3, and 4 d. 2, 3, and 4 a.1 and 2 only

Which of the following paramedic actions is indicated after uncomplicated delivery of the newborn? a. Performing fundal massage to maintain uterine contraction b. Placing the mother on oxygen by nonrebreather mask c. Applying gentle traction to the umbilical cord to assist with delivery of the placenta d. Administering oxytocin a.Performing fundal massage to maintain uterine contraction

Which of the following would be considered routine prehospital care of the patient who is exhibiting indications of imminent delivery? a. Rupturing the membranes b. Establishing an IV of normal saline c. Administering oxytocin d. Placing the patient fully supine for transport b.Establishing an IV of normal saline

What differentiates PEEP, BiPAP, and CPAP in the home-care setting? a. BiPAP and CPAP are for prehospital use only. b. PEEP can only be used with an ETT, while BiPAP and CPAP use a mask. c. BiPAP and CPAP require a special ventilator not available outside the hospital. PEEP can be used on a traditional ventilator and can be seen in home health care situations. d. PEEP can only be used by a respiratory therapist. b.PEEP can only be used with an ETT, while BiPAP and CPAP use a mask.

Which of the followingallows much more oxygen to be stored in the home setting? a. A liquid oxygen system b. High-volume oxygen concentrator c. A liquid nitrogen-oxygen system d. An "M" tank or larger a.A liquid oxygen system

You are on a scene where the parents of a 30-month-old female called EMS because she had a seizure. The child has a history of hydrocephalus and has recently had a new shunt placed. Which of the following causes of seizure should you investigate? 1. Fever 2. Increased intracranial pressure 3. Hypoglycemia 4. Head trauma 5. Toxic ingestion or exposure a. 1, 2, 3, 4, and 5 b. 1, 2, 4, and 5 c. 1, 3, 4, and 5 d. 1, 2, and 3 a.1, 2, 3, 4, and 5

Which one of the following statements regarding ventilation of the pediatric patient is TRUE? a. The bag valve device should not have a pop-off valve. b. The diameter of the correct-size mask is equal to the distance from the earlobe to the corner of the mouth. c. A reservoir is not needed to provide 100 percent oxygen to the pediatric patient. d. The use of a flow-restricted, oxygen-powered ventilation device is preferred. a.The bag valve device should not have a pop-off valve.

When measuring the distance from the symphysis pubis to the uterine fundus, each centimeter is roughly equal to ________ of gestation. a. one week b. one month c. two weeks d. ten days a.one week

Which stage of gestation begins at eight weeks and continues until delivery? a. Fetal b. Perinatal c. Prenatal d. Embryonic a.Fetal

How many deaths occur in the elderly each year due to a pulmonary embolism? a. 1,000,000 b. 500,000 c. 250,000 d. 100,000 d.100,000

While off-duty a friend, who knows you are a paramedic, expresses concern about her elderly parents. She knows that their health needs are changing, but does not know what to do to help. What would NOT be a resource that she could use? a. AARP b. Department of Health and Human Services c. The local community senior center d. Wait for now, and then go to the ER when it is something serious d.Wait for now, and then go to the ER when it is something serious

Which of the following statements is TRUE of prehospital newborn care? a. It is impossible to anticipate which deliveries may result in the need for newborn resuscitation. b. Newborns weighing over 2,500 grams are at higher risk of respiratory compromise. c. Sixty percent of newborns delivered outside a hospital require some form of resuscitation. d. The incidence of complications is inversely related to birth weight. d.The incidence of complications is inversely related to birth weight.

You are assessing a 1-minute APGAR score on a patient who has peripheral cyanosis and a heart rate of 98, who cried spontaneously after delivery, is actively moving his extremities, and has a strong cry. What is the APGAR score of this patient? a. 9 b. 7 c. 8 d. 10 c.8

After ventilating a newly born infant by bag-valve-mask device, you note significant gastric distention that is beginning to interfere with ventilation. On attempting to pass a nasogastric tube to decompress the stomach, you find that there is an obstruction bilaterally at the level of the posterior nasopharynx. Which of the following choices indicates the likely problem and the action that should be taken? a. Choanal atresia; rotate the nasogastric tube back and forth between your fingers as you apply steady pressure in a posterior direction b. Cleft palate; rotate the nasogastric tube back and forth between your fingers as you apply steady pressure in a posterior direction c. Cleft palate; intubate the trachea and pass an orogastric tube d. Choanal atresia; intubate the trachea and pass an orogastric tube d.Choanal atresia; intubate the trachea and pass an orogastric tube

You are assessing a newborn who presents with respiratory distress; heart sounds auscultated over the right chest; and a small, flat abdomen. Which of the following is appropriate in his care? a. Insertion of a gastric tube b. Needle chest decompression c. Elevation of the head and chest, endotracheal intubation d. Ventilation via an automatic transport ventilator c.Elevation of the head and chest, endotracheal intubation

A newborn has blue extremities, a pink torso, a strong and active cry, a heart rate of 104, and some flexion of its extremities. What is this newborn's APGAR score? a. 9 b. 5 c. 7 d. 8 d.8

You are assisting in the delivery of an infant after an extremely prolonged labor. During delivery of the head, you note the presence of thick, green meconium in the patient's airway. What should be your next course of action? a. Suction the nose and mouth with a bulb syringe, complete the delivery, then suction the hypopharynx and trachea using an endotracheal tube and a meconium aspirator. b. Do not suction the nose and mouth; complete the delivery, then suction the hypopharynx and trachea using an endotracheal tube and a meconium aspirator. c. Do not suction the nose and mouth, complete the delivery, maintain routine care d. Immediately suction the hypopharynx and trachea before completing the delivery using an endotracheal tube and a meconium aspirator. b.Do not suction the nose and mouth; complete the delivery, then suction the hypopharynx and trachea using an endotracheal tube and a meconium aspirator.

Your patient is a 77-year-old male whose wife called for EMS because he began acting confused a few hours ago. The patient has high blood pressure and benign prostatic hypertrophy. The patient is agitated and does not understand why you are there. Your assessment reveals warm, moist skin; a heart rate of 72; a respiratory rate of 24; and a blood pressure of 142/88. The patient has diminished breath sounds over the right middle lobe with coarse rhonchi in the right lower lobe; his oxygen saturation is 89 percent on room air.. Which of the following is the most likely diagnosis? a. Pulmonary embolism b. Congestive heart failure c. Pneumonia d. Emphysema c.Pneumonia

You are at the home of a 92-year-old male patient. He is alert and oriented and in good spirits and, although mildly hearing impaired, can hear you if you speak clearly and face him as you speak. He has no teeth and is not wearing dentures. His speech is indistinct and difficult to understand. Which of the following is the best course of action? a. See if he can write down what he wants to say. His speech may be impaired from a stroke rather than a lack of dentition. b. Tell him there is nothing you can do for him unless he speaks clearly. c. Ask him to put in his dentures if he has them. Locate them for him if necessary. d. Ask a family member to "translate," because the family is probably able to understand him better. c.Ask him to put in his dentures if he has them. Locate them for him if necessary.

Which of the following terms refers to babies during their first few hours of life? a. Newborns b. Pediatrics c. Infants d. Neonates a.Newborns

You are called to the home of a 72-hour-old infant whose mother is concerned because the infant has been "vomiting after she eats." Based on this information, which of the following should you include in your history and physical assessment? 1. Asking whether the infant is "spitting up" or having forceful vomiting 2. Checking the blood glucose level 3. Asking whether there were any complications with the pregnancy or delivery 4. Cardiac monitoring 5. Assessing the fontanelles a. 2, 3, and 4 b. 1, 2, 3, 4, and 5 c. 1, 2, 3, and 5 d. 1, 3, and 5 d.1, 3, and 5

Which of the following organizations was formed to improve outcomes for pediatric patients who suffer potentially life-threatening injuries and illnesses? a. Pediatric Prehospital Emergency Providers (PPEP) b. Center for Pediatric Emergency Medicine (CPEM) c. Advanced Pediatric Emergency Services (APES) d. Emergency Medical Services for Children (EMSC) d.Emergency Medical Services for Children (EMSC)

You are caring for a seven-year-old female who was run over by the neighborhood ice cream truck. Other than some abrasions, the patient appears to have an isolated right femur fracture. The child is sobbing and uncooperative, and her mother is nearly hysterical, pleading with you not to let her daughter die. Your partner and the first responding engine crew are caring for the patient. Which of the following is the best way to gain control of this situation? a. Let the mother know that you and your partner are paramedics with special training in caring for injured children. Tell her you will be stabilizing her daughter's leg to reduce her pain and that it would be very helpful if she could get a favorite toy for her daughter to take to the hospital with her. b. Let the mother know it is natural to feel guilty when her lack of supervision led to her daughter's injury. Tell her that her daughter is probably not going to die but that it's hard to say right now if her leg is permanently damaged. c. Tell the mother it is obvious from her daughter's screaming that she isn't in any immediate danger of dying. Tell her to calm down or you may have to have the police remove her from the scene. d. Tell the mother you can see how upset she is and that it would be better if she went inside the house because watching her daughter's treatment is so upsetting to her. a.Let the mother know that you and your partner are paramedics with special training in caring for injured children. Tell her you will be stabilizing her daughter's leg to reduce her pain and that it would be very helpful if she could get a favorite toy for her daughter to take to the hospital with her.

Many patients with neuromuscular degenerative diseases receive chronic respiratory support at home. Ultimately, what step may you as a paramedic have to take immediately, regardless of the type of respiratory support available in the patient's home? a. Alter dosages of medications already in use to achieve a better effect. b. Intubate and ventilate. c. Call the patient's physician and get orders not addressed by your protocols. d. Rapidly become familiar with unfamiliar equipment. b.Intubate and ventilate.

You are dispatched to an extended-care facility for a "sick person." On arrival, you speak with the staff who tells you that Ms. Johnson "just started acting differently and is slow to respond." Your assessment reveals that she is febrile and has vomited. When you move her to the cot, you notice a stage 3 ulcer on her buttock. What could you assume from her condition? a. This is most probably due to abuse. Report the facility to the appropriate authorities. b. This is an acute illness requiring rapid intervention. c. The signs could be masking a more serious issue, like a cardiac event. d. She is probably suffering from sepsis due to infection of the ulcer. She probably needs an IV and supportive care from you, but antibiotics and wound care will be needed for recovery. d.She is probably suffering from sepsis due to infection of the ulcer. She probably needs an IV and supportive care from you, but antibiotics and wound care will be needed for recovery.

What is the term for the skin's ability to return to its normal appearance after being subjected to pressure? a. Skin turgor b. Elasticity c. Skin lesion d. Epidermal stretch a.Skin turgor

You are on the scene of a motor-vehicle crash involving a van that carries patients to and from dialysis. The van has rolled over and, during the crash, the patient in the rear of the van sustained a nearly severed right arm. The patient is conscious, pale, and diaphoretic. He has an A/V shunt in the unaffected arm. Bleeding has been controlled to the best it can be and immobilization is complete. What is your most prudent action regarding IV access? a. Cannulate the shunt; the patient is obviously decompensating due to blood loss. b. Look for other sites for venipuncture. c. Now that the bleeding is controlled, there should be no need to access the shunt and risk its contamination. d. Call for a supervisor to make the decision to cannulate the shunt. b.Look for other sites for venipuncture.

You have responded to a home where a man is complaining of chest pain. A woman answers the door and states that her husband, a terminal cancer patient, is experiencing chest pain and dyspnea. She says quietly that he only has a "little while left" and she wants him to be comfortable. Your assessment reveals a 66-year-old male in unstable ventricular tachycardia. He is somewhat coherent and is adamant about not going to the hospital to die. What is your best course of action? a. This is a lethal rhythm and requires immediate ACLS. No directives have been produced. Be tactful but treat this patient like any other. b. Try and convert this rhythm and see what happens. If you can get him back into a perfusing normal sinus rhythm, he can sign a release. c. Call medical control and ask for advice. d. Explain to the woman that if she wants him to die at home, not to call 911 and just let nature take its course. a.This is a lethal rhythm and requires immediate ACLS. No directives have been produced. Be tactful but treat this patient like any other.

You are sent to a home for a cardiac arrest. You find a patient in cardiac arrest who has been under hospice care for end-stage AIDS. The nurse tells you that some family members who were present when the patient went into cardiac arrest felt that not providing care was not a prudent thing to do, so they called 911. She apologizes. A relative interrupts and says she doesn't care what the nurse says, she wants you to help her brother. What should your next action(s) be? a. Have the nurse provide the DNR. If it is in order, explain to the sister that you are bound to adhere to the orders. b. Provide all the interventions you can. You have no standing not to. c. Tell the sister that it is best to let him go. d. Start CPR and ACLS. Do a round of drugs, then call for orders for field termination of resuscitative efforts. a.Have the nurse provide the DNR. If it is in order, explain to the sister that you are bound to adhere to the orders.

Which of the following parameters is the most important indicator of neonatal distress? a. Decreased respiratory rate b. Increased respiratory rate c. Increased heart rate d. Decreased heart rate d.Decreased heart rate

You are transporting a 28-week-gestation newborn who was delivered at home. En route, the infant experiences a seizure. Which of the following possibilities should you investigate? 1. Hypoxic-ischemic encephalopathy 2. Hypoglycemia 3. Drug withdrawal 4. Intraventricular hemorrhage a. 1 and 3 b. 2 and 4 c. 2, 3, and 4 d. 1, 2, 3, and 4 d.1, 2, 3, and 4

What is the most common living situation of an abused elder? a. They live with their children. b. They live in a nursing facility. c. They live alone. d. They are homeless. c.They live alone.

You arrive on scene where you have been asked to check on the welfare of a patient. A neighbor meets you and states that she called because the elderly woman who lives in the home has not been seen outside in a while, and the neighbor is concerned. She says a relative looks after the woman but that she is unsure when the relative was last there. You gain access to the residence and find a conscious but emaciated 76-year-old woman. There is no food in the house, and the woman has been unable to reach the bathroom for days. She says her granddaughter looks after her and is a "good girl" but she cannot remember when the granddaughter was last at the home. What general conclusions could be made in this situation? a. The woman has developed an acute medical problem recently and an aggressive assessment is needed. b. Check the woman thoroughly. If you find no acute medical problems, ask the neighbor to call the granddaughter and stay with the elderly woman until her caretaker has gone to the store and come by to clean up. c. The woman has Alzheimer's and probably just can't remember to eat. Call the caretaker and have her come over. d. This could be a case of elder abuse. Although you notice no outward signs of violence, the mere act of the caretaker neglecting this woman's needs is abuse. You should transport the woman and notify the proper authorities. d.This could be a case of elder abuse. Although you notice no outward signs of violence, the mere act of the caretaker neglecting this woman's needs is abuse. You should transport the woman and notify the proper authorities.

Which of the following is TRUE of your responsibility to report child abuse? a. Consult your state EMS regulations regarding reporting abuse; all states differ. b. It is better to let your immediate supervisor report the abuse. c. It is your responsibility to report all suspected abuse to the appropriate reporting agency. d. In most states, EMS providers are not required to report abuse, just doctors. c.It is your responsibility to report all suspected abuse to the appropriate reporting agency.

You arrive on the scene of an alleged rape. The 25-year-old female has been physically assaulted quite badly and has numerous deep lacerations and fractured extremities. You must remove her clothes for a trauma assessment. What is the best procedure for handling her clothing? a. You cut her clothes off as you have been taught to in order to expose injuries. You put her clothes in a pile on the floor of the ambulance, like you do with the clothes of all trauma patients. You then drop the clothes off at the ER. The police will pick them up. b. Cut around the injury sites and leave the rest of the clothes on her. c. You understand that you and the victim's clothing are now part of the chain of evidence. You remove her clothes as carefully as possible and, if one is available, place them in a paper bag. You keep the clothes in your sight until the bag is turned over to law enforcement. d. It is not your problem; you are not the police. c.You understand that you and the victim's clothing are now part of the chain of evidence. You remove her clothes as carefully as possible and, if one is available, place them in a paper bag. You keep the clothes in your sight until the bag is turned over to law enforcement.

You are caring for a newly born infant delivered approximately 8 minutes ago. The infant had a 1-minute APGAR score of 6, which improved to 7 at 5 minutes. Despite drying, warming, suctioning, and stimulating the infant, you note he continues to have central cyanosis. His heart rate is 132, and his ventilations are 50. Which of the following is the best action in this situation? a. Administer "blow-by" oxygen. b. Begin chest compressions. c. Administer 0.01 mg/kg of epinephrine subcutaneously. d. Assist ventilations with a bag-valve-mask device. a.Administer "blow-by" oxygen.

You have arrived at a residence just as a 30-year-old woman has delivered her first baby six weeks before her due date. Assessment of the newborn reveals central cyanosis, apnea, and absence of the brachial pulse. Which of the following should you do next? a. Suction the newborn's mouth and nose with a bulb syringe and stimulate him by drying him off with a towel from the OB kit. b. Tell the mother that her newborn is not viable, wrap him in a receiving blanket, and allow her to hold the baby. c. Begin chest compressions at a rate of 120 per minute and reassess after 1 minute. d. Intubate the trachea and instill 0.04 mg of epinephrine diluted in saline into the tube. a.Suction the newborn's mouth and nose with a bulb syringe and stimulate him by drying him off with a towel from the OB kit.

When you arrive on the scene of an incident in which a home health care provider is present, which of the following is the best way to deal with the situation? a. Tell the individual that your certification overrides the individual's and that you are in charge now. b. Respect the person's position, use the person's information accordingly, and request the person's help should the need arise. c. C) Let the person talk to a member of the crew not involved in patient care to keep the person busy and out of the way. d. Ascertain the person's certification level. If the person is not an RN, ignore the person and ask the person to stand back. b.Respect the person's position, use the person's information accordingly, and request the person's help should the need arise.

You have arrived at the home of an elderly male who called 911 for pain in his penis. He has a Foley catheter in place. He is supposed to have a home health aide visiting him daily, but, although it is 1500 hours, she has not yet visited today. You visualize the catheter and bag and note that the Foley bag is full of urine, so much so that it appears to be pulling the tube taut. What could you do to remedy this situation? a. Call the home health care service and ask why they can't manage their employees better. b. Access the drain, drain the urine into a container, and see if doing so relieves the discomfort. c. Any procedure involving a Foley requires special training. Transport to the ER. d. Remove the Foley catheter. b.Access the drain, drain the urine into a container, and see if doing so relieves the discomfort.

Which of the following is NOT a common sign of neglect in children? a. Malnutrition b. Too few toys c. Severe diaper rash d. Dirty, torn, and weather-inappropriate clothing b.Too few toys

You have arrived on the scene of a sexual assault. The victim is a 21-year-old female. She is at home and very distraught. She tells you that she does not feel she is hurt and that she wants to take a shower before being examined because she "feels dirty." What is the appropriate reaction? a. Tell the patient sternly to go nowhere and wait for the police. b. Advise the patient to save the clothes she was wearing in a plastic bag and to clean up. c. Tell the patient that she will lose all chance of convicting her attacker if she does something silly like that. d. Advise the patient that it is imperative that she have a certified technician, such as a SANE nurse, examine her and that bathing can remove or destroy evidence. d.Advise the patient that it is imperative that she have a certified technician, such as a SANE nurse, examine her and that bathing can remove or destroy evidence.

You have arrived on the scene of a "sick person" call. A man meets you and says his wife won't stop crying and is acting hysterical. She gave birth to their daughter three weeks ago. She presents crying in a chair. The husband also states that she does not want to take care of the baby. She appears to be in no apparent need of emergency care. What is the best course of action? a. Explain to the woman that she needs to get herself together and take care of the baby or you will call child protective services. b. Take the woman to the ER so she can get a prescription for antidepressants. c. Tell the husband there is nothing EMS can do and that he needs to call the family doctor. d. Suggest to the husband that she could be suffering from postpartum depression and that he should contact his wife's OB/GYN for guidance. d.Suggest to the husband that she could be suffering from postpartum depression and that he should contact his wife's OB/GYN for guidance.

You have been called to a home for "severe respiratory distress." You arrive to find a hysterical young woman who says she had been asked to "watch her nephew for a little while when his mother went out." He has a tracheostomy, and she says he is having a hard time breathing. She has no idea how to care for him because the mother left no instructions. You assess the child and find a nearly totally mucus-plugged trach tube. What should you do? a. Place the child on O2 via a trach mask. Do not attempt to suction, because doing so may force more mucus into the lungs. Transport immediately. b. Call for orders to suction the trach tube. c. Suction the tube and, if available, replace it with a clean, unobstructed one. Give the young woman guidance as to basic trach care. d. Call the police and tell them the child has been put in a dangerous situation. Place the child on a nonrebreather mask and transport immediately. c.Suction the tube and, if available, replace it with a clean, unobstructed one. Give the young woman guidance as to basic trach care.

You can palpate the uterine fundus at the level of the umbilicus in your pregnant patient. You estimate the length of gestation to be ________ weeks. a. 14 to 18 b. 18 to 22 c. 22 to 26 d. 26 to 30 b.18 to 22

You have been called to the home of a one-week-old infant whose parents called EMS because the baby had a seizure. On your arrival, the infant is pale, has poor muscle tone, is lethargic, and has a high-pitched cry. The parents state that the infant has not been feeding well for the past 24 hours. Based on these findings, which of the following should be included in your continued assessment and treatment of this patient? 1. Checking the blood sugar 2. Assessing the fontanelles 3. Contacting child protective services 4. Administering 0.3 mg of naloxone, IM 5. Administering an appropriate mL bolus of normal saline IV a. 3 and 4 b. 1 and 2 c. 2 and 3 d. 1, 2, and 5 b.1 and 2

Which of the following is NOT an appropriate route of administration for naloxone in the newborn? a. Intramuscular b. Intravenous c. Intraosseous d. Endotracheal a.Intramuscular

You have been called to the residence of a five-day-old infant. His parents are concerned because he sleeps about 18 hours a day. They took a rectal temperature and got a reading of 100°F. Which of the following is the best course of action? a. Prepare a report for the child protective agency regarding your suspicions that the parents cannot care for the child properly. b. Undress the infant to his diaper and sponge him with tepid water. c. Reassure the parents that the infant's sleep patterns and temperature are normal. d. Contact medical control to order acetaminophen. c.Reassure the parents that the infant's sleep patterns and temperature are normal.

Approximately how many patients with respiratory problems are discharged from the hospital to home health care settings each year in the United States? a. 125,000 b. 1 million c. 630,000 d. 50,000 c.630,000

You have been dispatched for a medical alarm in a residence. On arrival, you speak with a home health worker who says she was unaware that the alarm went off. You ensure that the patient needs no assistance. While you look around the room, you notice an IV pump of a type you have never seen before. What prudent action could you take? a. Don't worry about it, because you probably won't ever come back. b. Ask the aide to give you a brief introduction to the pump. You never know when that information may be useful. c. Ask the aide what kind of pump it is. When she tells you, act like you knew already. d. Start familiarizing yourself with the pump by playing with the buttons. b.Ask the aide to give you a brief introduction to the pump. You never know when that information may be useful.

You are in the home of a 17-year-old female complaining of abdominal pain. Her mother and father are hovering near her and answering most of the questions you ask her. You sense that the patient is uncomfortable answering questions in front of her parents. Which of the following is the best way to handle this situation? a. Tell the patient you know she might be embarrassed but that it is imperative that she give you the whole story so you know what to do for her. b. Defer the history to the triage nurse at the emergency department so as not to cause undue discomfort to the patient. c. Ask the parents to go to the kitchen with your partner so he can get some information for your paperwork. d. Tell the parents that their daughter is a big girl and probably doesn't want to talk about her problems in front of them. c.Ask the parents to go to the kitchen with your partner so he can get some information for your paperwork.

You have just arrived on the scene where an infant stopped breathing. You find a three-month-old child being held tightly by his mother, who is sobbing uncontrollably. On examination, you find that the child is apneic and pulseless and has dependent lividity and early rigor mortis. There are no obvious signs of injury. Which of the following is the best course of action? a. Begin full resuscitative measures, then contact medical control for orders to terminate resuscitation in the field. b. Gently tell the mother that the baby is dead and that there is nothing that can be done for him; allow her to hold him. c. Tell the mother that the baby is dead but that you cannot allow her to hold him until the police verify that no crime has been committed. d. Begin CPR and continue BLS measures until you are inside the ambulance; notify the hospital that you are transporting a deceased SIDS infant. b.Gently tell the mother that the baby is dead and that there is nothing that can be done for him; allow her to hold him.

At 90 seconds after birth, based on the following findings, which newborn does NOT require resuscitative efforts beyond routine care? a. HR = 100, RR = 30, peripheral cyanosis, APGAR = 8 b. HR = 158, RR = 40, central cyanosis, APGAR = 6 c. HR = 75, RR = 25, central cyanosis, APGAR = 5 d. HR = 98, RR = 27, peripheral cyanosis, APGAR = 6 a.HR = 100, RR = 30, peripheral cyanosis, APGAR = 8

You have just assisted in the delivery of a 34-week-gestation infant in the office of a methadone clinic. The mother had been in the clinic with her boyfriend, who was there for his methadone. The infant has a 5-minute APGAR score of 5 after drying, warming, suctioning, stimulating, and providing bag-valve-mask ventilations. Your partner advises that the mother denies narcotic use but is lethargic and has constricted pupils. Which of the following is the MOST appropriate action to take at this point? a. Intubate the trachea, continue ventilations, contact medical control for consultation concerning intravenous access and administration of naloxone, and prepare to transport to a NICU. b. Intubate the trachea, administer 0.4 mg of naloxone through the endotracheal tube, ventilate, reassess, and prepare to transport to a NICU if no improvement. c. Continue bag-valve-mask ventilations, perform chest compressions for 1 minute, reassess, establish intravenous access, continue chest compressions if the heart rate remains less than 100, consult with medical control concerning administration of naloxone and transport destination. d. Continue bag-valve-mask ventilations, secure intravenous access, administer naloxone, reassess, and prepare for transport to a NICU regardless of improvement. a.Intubate the trachea, continue ventilations, contact medical control for consultation concerning intravenous access and administration of naloxone, and prepare to transport to a NICU.

Which of the following is NOT an option for prehospital vascular access in the newborn? a. Cannulation of a peripheral vein in an extremity b. Intraosseous needle placed in the proximal tibia c. Femoral vein cannulation d. Scalp vein cannulation c.Femoral vein cannulation

You have just assisted in the delivery of an approximately 4-kg newborn whose mother is a rather petite primapara. On assessment, you note that there is no spontaneous movement of the infant's right arm at the shoulder, but he moves the elbow and wrist. He otherwise exhibits vigorous movement and has a 1-minute APGAR score of 9. Which of the following should you suspect? a. Neonatal abstinence syndrome b. Spinal cord damage c. Fractured clavicle d. Caput succedaneum c.Fractured clavicle

Which of the following should be considered in the neonate whose parents report that he has diarrhea? 1. Lactose intolerance 2. Cystic fibrosis 3. Pyloric stenosis 4. The number of bowel movements that are normal in infants 5. Whether the infant is breast fed or receives formula a. 2, 3, 4, and 5 b. 1, 2, 4, and 5 c. 1, 4, and 5 d. 1 and 4 b.1, 2, 4, and 5

You have just delivered a newborn who was initially apneic and cyanotic. After suctioning, drying, warming, and stimulating the infant and administering blow-by oxygen, you find that the infant has a ventilatory rate of 35 with signs of respiratory distress, a weak brachial pulse of 70, and continuing central cyanosis. Which of the following should you do next? a. Start an IV using the umbilical vein and administer a 20 mL/kg fluid bolus. b. Begin chest compressions at a rate of 120 per minute and reevaluate after 1 minute. c. Perform ventilations with a bag-valve-mask device and supplemental oxygen. d. Intubate and instill 0.04 mg of epinephrine diluted in saline into the tube. c.Perform ventilations with a bag-valve-mask device and supplemental oxygen.

Which of the following is NOT a characteristic of dementia? a. It has a slow, progressive onset. b. It is generally reversible when the underlying cause is treated. c. Its most common cause is Alzheimer's disease. d. Memory is greatly impaired. b.It is generally reversible when the underlying cause is treated.

Your 78-year-old patient gives a history of congestive heart failure, renal insufficiency, and type II diabetes. Together, these conditions are called: a. comorbid conditions. b. confounding conditions. c. functional impairments. d. polypathophysiology. a.comorbid conditions.

Which of the following is appropriate in establishing vascular access via the umbilical vessels? a. Use a large-bore catheter-over-the-needle system. b. Insert the tip of the catheter just past the point where the vessels enter the skin. c. Leave 2 to 3 inches of umbilical cord attached to the infant. d. Select the larger of the two umbilical arteries. b.Insert the tip of the catheter just past the point where the vessels enter the skin.

Your assessment of a newborn reveals respiratory distress; heart sounds auscultated over the right chest; and a small, flat abdomen. What is your field diagnosis for this patient? a. Agenesis of the abdominal organs b. Tension pneumothorax c. Tetralogy of Fallot d. Diaphragmatic hernia d.Diaphragmatic hernia

Which of the following affects the lower airway? a. Epiglottitis b. Pneumonia c. Croup d. Pharyngitis b.Pneumonia

Your four-year-old female patient has injuries suspicious of abuse. Statistically, who is most likely the abuser? a. Her mother, who is a stay-at-home mom b. Her father, who works in a local steel mill c. Her seven-year-old brother, with whom she shares a bedroom d. Her teenaged aunt, who babysits her two evenings a week a.Her mother, who is a stay-at-home mom

Which of the following statements about the delivery of the placenta is TRUE? a. It should be placed in a biohazard bag and brought to the ED with the patient. b. Transport should be delayed until delivery of the placenta is complete. c. Gentle traction should be applied to the placenta to facilitate delivery. d. Fundal massage is contraindicated until the placenta is delivered. a.It should be placed in a biohazard bag and brought to the ED with the patient.

Your patient is 34 weeks pregnant, complaining of a headache and nausea. Her blood pressure is 150/92, and she tells you that her doctor told her she has protein in her urine. You note that her face, hands, and feet are edematous. Which of the following is most likely? a. Preeclampsia b. Hyperemesis gravidarum c. Gestational diabetes d. Eclampsia a.Preeclampsia

Which of the following best explains the cause of Sudden Infant Death Syndrome (SIDS)? a. Congenital absence of the Hering-Breuer reflex b. Considered when other causes of death have been ruled out c. Diffuse axonal injury occurring due to "shaken baby syndrome" d. Aspiration of vomited formula or breast milk b.Considered when other causes of death have been ruled out

Your patient is a 12-year-old male who was accidentally shot with a handgun by a playmate. You note one gunshot wound to the right upper quadrant of the abdomen but no exit wound. The patient is pale, with cool, mottled extremities. He is lethargic, has a heart rate of 140, a respiratory rate of 30, and a blood pressure of 92/60. Which of the following can be said for certain about this patient? a. He is in compensated shock. b. He is in irreversible shock. c. He is in decompensated shock. d. It is not possible to say anything for certain about this patient. c.He is in decompensated shock.

The most common cardiac dysrhythmias in pediatric patients are: a. ventricular tachycardias. b. bradyarrhythmias. c. supraventricular tachycardias. d. intermittent atrioventricular blocks. b.bradyarrhythmias.

Your patient is a 14 month-old child who has been taking an antibiotic for three days for an ear infection. Her parents have called EMS because the child has not been eating or drinking, is irritable, has a fever, and generally appears very sick. Which of the following should you most highly suspect? a. Herpes zoster b. Bacterial meningitis c. Fifth disease d. An allergic reaction to the antibiotic b.Bacterial meningitis

You have been unsuccessful in your basic airway procedures to remove a foreign body airway obstruction in a 12-month-old child. Which of the following should be the next intervention? a. Surgical cricothyrotomy b. Positive pressure ventilation with a manually triggered, flow-restricted, oxygen-powered ventilation device c. Direct laryngoscopy, removing the object with Magill forceps if it is visualized d. Needle cricothyrotomy c.Direct laryngoscopy, removing the object with Magill forceps if it is visualized

Your patient is a 16-year-old female cheerleader who fell while attempting a pyramid formation and struck her forehead on the back of another girl's head. She has a 2-cm laceration just above her right eyebrow. She is tearful and asks you if you think she is going to have a scar. Which of the following is the best response? a. "It's a small cut. They'll do everything they can at the emergency department to minimize scarring." b. "I really can't say. You should probably see a plastic surgeon as soon as possible." c. "You probably won't even notice it when you grow up." d. "It's likely, but it's not something to get upset about." a."It's a small cut. They'll do everything they can at the emergency department to minimize scarring."

Your patient is an 80-year-old female who fractured a vertebra while coughing. This type of fracture is best described as a(n) ________ fracture. A) Pathological B) Greenstick C) Epiphyseal D) Comminuted Pathological When assessing a long-bone injury, you should assume you are dealing with a joint injury when the site of injury is within ________ inch(es) of the joint. A) 3 B) 2 C) 1 D) 6 3 One of the earliest indications that compartment syndrome is developing in an injured extremity is: A) Burning pain B) Pallor of the overlying skin C) Loss of distal pulses D) Sensation of pressure in the limb Burning pain A sprain is an injury best defined as which of the following? A) Bone ends are not anatomically aligned B) Muscle fibers are stretched and torn C) Partial or complete tearing of the ligaments of the joint capsule D) A violent muscle spasm that tears away a small piece of bone Partial or complete tearing of the ligaments of the joint capsule Your patient has an abrasion on the bony prominence on the inside of her right ankle. This abrasion should be described as being over which of the following structures? A) Thenar eminence B) Medial malleolus C) Lateral malleolus D) Styloid process Medial malleolus The pain associated with skeletal fractures is transmitted by nerves in the: A) Epiphysis B) Yellow bone marrow C) Osteoclasts D) Periosteum Periosteum Your patient complains of elbow pain and states his doctor told him he had "the bursitis," in his elbow. The patient's condition is characterized by inflammation of the: A) Articular cartilage B) Synovial sacs C) Tendons D) Bone Synovial sacs The purpose of determining the mechanism of injury and the index of suspicion for the trauma patient at the same time is to allow you to: A) Decide whether to transport the patient B) Identify comorbid factors C) Document a complete scene size-up D) Anticipate your patient's injuries Anticipate your patient's injuries Which of the following accounts for the highest number of trauma deaths in the United States of America? A) Motor vehicle crashes B) Falls C) Assaults D) Firearms injuries Motor vehicle crashes Which of the following acts resulted in the development of modern EMS systems? A) Ryan White Act B) Highway Safety Act of 1966 C) Good Samaritan Act D) The Trauma Care Systems Planning and Development Act of 1990 Highway Safety Act of 1966 In addition to handling all types of specialty trauma, which level of trauma center provides continuing medical and public education programs? A) IV B) III C) I D) II I Upon arriving on a scene where the mechanism of injury indicates a potentially life-threatening injury, you should employ which of the following interventions to BEST help deliver the care that is needed? A) Reevaluate the scene size-up. B) Initiate transport immediately, delaying more extensive care until you are en route. C) Ask a surgeon to respond to the scene. D) Call immediately for air medical transport to reduce the "Golden Period." Initiate transport immediately, delaying more extensive care until you are en route. Which of the following physical findings indicates the need for immediate transport? A) Vital signs: systolic blood pressure 80, respiratory rate 8 B) Glasgow Coma Scale Score of 15 C) Second-degree burns involving 9 percent of total body surface area in an adult patient D) Fractured right femur Vital signs: systolic blood pressure 80, respiratory rate 8 Which of the following requires immediate transport to a trauma center? A) A 40-year-old who fell 12 feet from a garage roof with a radius fracture B) A 36-year-old female in a motor vehicle crash who has a blood pressure of 100/60 C) A 22-year-old motorcyclist with a tibia fracture D) A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger A 47-year-old involved in a motor vehicle crash that resulted in the death of his passenger As a paramedic your role in trauma care consists of all of the following EXCEPT: A) Providing rapid transport to appropriate facilities B) Promoting injury prevention C) Providing care to seriously injured trauma patients D) Providing surgical interventions to stop hemorrhage Providing surgical interventions to stop hemorrhage Which of the following is NOT true of trauma triage criteria? A) For patients who meet trauma triage criteria, the appropriate facility is the largest trauma center in your region. B) Assessment of vital signs/level of consciousness, anatomy of injury, mechanism of injury, and age of the patient are key elements of trauma triage criteria. C) Trauma triage criteria are geared to help you formulate an index of suspicion when making decisions about your trauma patient. D) Trauma triage criteria are guidelines to help you determine whether your patient needs transport to a trauma center. For patients who meet trauma triage criteria, the appropriate facility is the largest trauma center in your region. Which of the following is NOT considered a significant mechanism of injury in pediatric patients? A) Vehicle collision with intrusion into compartment where child is a passenger B) Fall of 5 feet C) Bicycle-vehicle collision at 30 mph D) Any collision in which a child is ejected from the vehicle Fall of 5 feet Which of the following is NOT an example of trauma? A) An abrasion to the knee B) Chest pain C) Cerebral contusion D) A stab wound to the abdomen Chest pain Which of the following is NOT a consideration when assessing a trauma patient? A) SAMPLE history B) MedicAlert bracelets C) Underlying medical conditions D) Medical insurance coverage Medical insurance coverage Which level of trauma facility has minimal surgical support but can stabilize before transferring to a higher-level trauma facility? A) III B) II C) IV D) I III Which of the following statements about trauma is TRUE? A) Life-threatening injuries may exist with little external evidence. B) Dramatic-appearing extremity injuries may draw the paramedic's focus from life-threatening injuries. C) Life-threatening injury occurs in less than 10 percent of trauma patients. D) All of the above are true. All of the above are true. The leading cause of death in people under age 44 is: A) Heart attack. B) Trauma. C) Cancer. D) Cardiovascular disease. Trauma. Which of the following patients is NOT a candidate for air medical transport? A) Combative trauma patient B) Seriously injured patient with cardiac tamponade C) Patient with prolonged extrication time D) Burn patient with over 50 percent second-degree burns Combative trauma patient Which of the following is more relevant to the assessment and history of the medical patient than to the trauma patient? A) AVPU B) SAMPLE C) OPQRST D) DCAP-BTLS OPQRST Modern medicine treats trauma as a ________. A) Crisis B) Disease C) Life threat D) Medical problem Disease A trauma center that has surgical care capability available at all times and can handle all but the most seriously injured specialty and multisystem trauma patients is a Level ________ trauma center. A) III B) I C) IV D) II II Which of the following is the best, most cost-effective way for EMS personnel to help reduce trauma-related morbidity and mortality? A) Participate in injury-prevention programs B) Keep up-to-date on trauma management knowledge and skills C) Transport all trauma patients to a trauma center D) Provide complete patient care reports so that accurate data can be entered into the trauma registry Participate in injury-prevention programs Which level of trauma facility stabilizes and prepares to transport trauma patients to a higher-level facility but does NOT necessarily have surgical capabilities? A) I B) II C) IV D) III IV Which of the following mechanisms would yield the greatest index of suspicion for serious injury? A) Helmeted bicyclist losing control and falling off his bike onto a gravel surface at 15 miles per hour B) Adult falling 12 feet from a ladder landing in the mud C) Fifty-mile-per-hour motor vehicle crash with partial ejection D) Roll-over motor vehicle collision with a restrained driver Fifty-mile-per-hour motor vehicle crash with partial ejection Which level of trauma facility can provide neurosurgery, microsurgery, and care for multisystem trauma? A) III B) II C) I D) IV I Which of the following patients does NOT require specialty-center capabilities beyond that offered by a trauma center? A) A 67-year-old with second- and third-degree burns over 50 percent of the body B) A 25-year-old with amputation of three fingers C) A 4-year-old with a closed-head injury D) A 22-year-old with bilateral open femur fractures A 22-year-old with bilateral open femur fractures Which of the following best differentiates medical and trauma patient assessment? A) There is no concept for "medical load and go" patients. B) Palpation is frequently not as crucial when assessing the medical patient. C) Scene safety is not an issue with the medical patient. D) Assessing breath sounds is not crucial to trauma assessment. Palpation is frequently not as crucial when assessing the medical patient. Which of the following mechanisms of injury does NOT call for immediate transport to a trauma center? A) Motor vehicle crash with a 20-mile-per-hour impact B) Pedestrian struck by a vehicle at 25 miles per hour C) Thirty-foot fall from a tree D) Motor vehicle crash requiring 1 hour for patient extrication Motor vehicle crash with a 20-mile-per-hour impact Which of the following is an acceptable way of reducing prehospital time to maximize the use of the "Golden Period" for trauma patients? A) Skip spinal immobilization in the blunt trauma patient B) Start all IVs on the scene to allow for more rapid transport C) Load the patients and begin transport before doing a primary assessment D) Call for air medical transport, if indicated Call for air medical transport, if indicated Which of the following means "the anticipation of injury to a body region or organ"? A) Index of injury B) Index of suspicion C) Newton's First Law of Motion D) Mechanism of injury Index of suspicion Which of the following is generally considered to be important reassessment of both medical and trauma patients (the others being generally reserved for a trauma patient)? A) The detailed exam B) The reassessment C) The identification of mechanism of injury D) The rapid trauma assessment The reassessment According to the Haddon Matrix, which of the following would be a pre-event host factor impacting the risk for injury in a vehicle collision? A) Level of EMS providers responding B) The type of vehicle C) Using a cellular phone while driving D) Road design Using a cellular phone while driving Vehicle supplemental restraint systems (air bags) are meant to: A) Prevent unrestrained occupants from taking the down-and-under pathway in frontal impacts B) Protect infants and children who ride in the front seat of the vehicle C) Prevent injury from secondary impacts D) Absorb the energy exchange of rapid deceleration Absorb the energy exchange of rapid deceleration When assessing a patient with a crush injury, which of the following findings would indicate that toxins have entered the central circulation? A) Hot, red skin B) Increased urine output C) Cardiac arrhythmia D) Central hyperventilation syndrome Cardiac arrhythmia People in which of the following age groups are prone to significant trauma due to falls? A) College-aged adults B) Geriatric population C) Pediatric population Geriatric population Which of the following is NOT a complication of crush syndrome? A) Renal failure B) Difficult-to-control hemorrhage C) Cardiac arrhythmias D) Systemic alkalosis Systemic alkalosis The two factors that refer to the rate of change of speed are: A) Deceleration and velocity B) Mass and weight C) Acceleration and deceleration D) Acceleration and inertia Acceleration and deceleration Which of the following injuries is most likely in a rear-end collision? A) Thoracic and abdominal injuries B) Head and neck injuries C) Pelvic fractures D) Lumbar spine injuries Head and neck injuries You are called to the scene of a vehicle crash in which a car was rear-ended while stopped at a stop sign. Which of the following laws of physics serves as the basis for analyzing the mechanism of injury and the associated index of suspicion for injuries? A) The amount of energy transmitted to an object is inversely proportional to its rate of deceleration. B) Energy can neither be created nor destroyed. C) A body at rest will remain at rest unless acted on by an outside force. D) A body in motion will remain in motion unless acted on by an outside force. A body at rest will remain at rest unless acted on by an outside force. In falls, which section of the spinal column is the MOST prone to compression injury? A) Sacral B) Cervical C) Thoracic D) Lumbar Lumbar Which of the following injuries is NOT associated with the use of vehicle restraint systems? A) Traumatic brain injury B) Abrasions and contusions to the clavicle and chest area C) Lumbar spine trauma D) Abdominal injury Traumatic brain injury Applying Newton's second law of motion to a vehicle traveling 70 miles per hour, crashing into which of the following would transfer the most force to the patient? A) Bridge abutment B) Shrubbery C) A body of water D) Signpost Bridge abutment Which of the following is TRUE of the differences between adult and pediatric pedestrians when struck by a vehicle? A) Adults tend to be thrown under the vehicle. B) Children tend to be thrown onto the hood of the vehicle. C) Children tend to turn toward the vehicle. D) Adults tend to turn toward the vehicle. Children tend to turn toward the vehicle. Which of the following is most likely to be fractured from a fall onto outstretched hands? A) Carpals B) Metacarpals C) Clavicle D) Ulna Clavicle Your patient, a 23-year-old woman who is 6 months pregnant, was the unrestrained driver of a vehicle that rear-ended a parked car. The air bag deployed. Considering the likelihood of organ collision, for which of the following injuries should you maintain a high index of suspicion? A) Cardiac contusion B) Anterior flail segment C) Abruptio placentae D) Fractured sternum Abruptio placentae Which of the following best describes why the occupants of a vehicle moving at 50 miles per hour will be injured when the vehicle strikes a tree but not when it brakes to a stop? A) Braking allows the kinetic energy to be absorbed evenly into the frame of the vehicle, rather than concentrating it at the point of impact. B) The energy gradually dissipates as heat due to the friction of braking, rather than transferring to the vehicle and its occupants. C) The inertia of the tree increases the kinetic energy transmitted to the occupants by a factor of 10. D) None of the above describes why. The energy gradually dissipates as heat due to the friction of braking, rather than transferring to the vehicle and its occupants. In frontal impact collisions which pathway of patient travel results in higher mortality? A) Vertical B) Straight C) Up-and-over D) Down-and-under Up-and-over Upon arriving at the scene of a single-vehicle collision in which the vehicle struck a utility pole, you note that the windshield is "spidered," or "starred," and that the driver was not restrained. Which of the following injuries is most likely? A) Whiplash injury of the neck muscles B) Compression injury of the cervical spine C) Distraction injury of the cervical spine D) Ligamentous neck injury due to rotation beyond the range of motion Compression injury of the cervical spine Which of the following factors is NOT a consideration in the severity of injury related to falls? A) Landing surface B) Wind resistance C) The initial point of impact D) Distance of the fall Wind resistance Which of the following is TRUE of motorcycle collisions? A) Frontal impact can result in intraabdominal, pelvic, and femur injuries. B) A rider who "lays down the bike" will generally receive more severe injuries than a rider who stays with the bike. C) The structural steel of the vehicle absorbs most of the kinetic energy in a motorcycle collision. D) The use of helmets has drastically reduced the incidence of cervical spine injuries. Frontal impact can result in intraabdominal, pelvic, and femur injuries. In which of the following types of impact should you have a higher index of suspicion because the degree of injury may be greater than the damage alone indicates? A) Rear-end B) Oblique C) Lateral D) Frontal Lateral Which of the following best defines the term energy? A) The ability to deform solid objects B) The rate of motion related to time C) The capacity to do work D) The amount of heat generated through friction The capacity to do work Which of the following contributes to a greater degree of injury than anticipated from vehicle damage alone in a lateral-impact motor vehicle collision? A) Increased gravitational forces due to multiple changes in direction and velocity B) Lack of a crumple zone C) Taking the up-and-over pathway D) The force of side-impact air bag deployment Lack of a crumple zone Which of the following injuries is NOT commonly related to snowmobiling? A) Ejections B) Crush injuries C) Drowning D) Glancing blows against obstructions in the snow Drowning Which of the following is the most important priority when caring for a patient with a shallow-water diving injury? A) Assessing the cervical spine for deformity B) Maintaining cervical spine stabilization while opening the airway C) Removing the patient from the water as soon as possible D) Initiating rescue breathing once out of the water Maintaining cervical spine stabilization while opening the airway Which of the following impacts the severity of injury sustained in a motor vehicle collision? A) Gross vehicle weight B) Rate of acceleration or deceleration C) Vehicle speed D) All of the above All of the above Which of the following is NOT a type of collision that must be considered when analyzing a motor vehicle collision? A) The vehicle strikes an object B) The occupants' organs strike the interior of the body cavity C) The body of the occupant strikes the interior of the vehicle D) A hubcap flies off and strikes a tree A hubcap flies off and strikes a tree Which of the following best describes what happens to the kinetic energy of a vehicle traveling at 65 miles per hour when it collides into a concrete barrier wall? A) The energy dissipates as sound waves. B) The body of the vehicle and its occupants absorb the energy. C) The wall's foundation absorbs the energy. D) The energy converts to heat through friction. The body of the vehicle and its occupants absorb the energy. Which two of the following factors proportionately affect the kinetic energy of a bullet fired from a gun? A) Friction and distance B) Mass and friction C) Velocity and mass D) Friction and velocity Velocity and mass Which of the following injuries is associated with the pressure wave produced by a blast? A) Pneumothorax B) Lacerated liver C) Fractures D) Ruptured spleen Pneumothorax Axial loading is most likely to occur in which type of impact? A) Frontal with an up-and-over pathway B) Frontal with a down-and-under pathway C) Rear with the headrest too low D) Lateral on the side of the vehicle opposite the occupant Frontal with an up-and-over pathway Which of the following "paper bag syndrome" injuries may occur due to sudden compression of the thorax or abdomen? A) Pulmonary and myocardial contusions B) Pneumothorax and diaphragmatic rupture C) Cardiac tamponade and aortic dissection D) Pneumothorax and myocardial contusion Pneumothorax and diaphragmatic rupture Which of the following statements about lateral impact collisions is TRUE? A) The substantial lateral crumple zone prevents most injuries. B) Damage to the vehicle is a reliable indication of the seriousness of injuries. C) The degree of injury may be greater than the damage alone would indicate. D) Fatalities are rare because the upper extremities absorb the energy. The degree of injury may be greater than the damage alone would indicate. Which of the following mechanisms is most consistent with fractured vertebrae from a rapid lateral twisting motion? A) Direct trauma, such as from a blow to the head B) Low-velocity penetrating trauma from an ice pick C) High-velocity penetrating trauma from a gunshot wound D) Lateral-impact motor vehicle collision Lateral-impact motor vehicle collision Frontal impacts in which the patient takes a "down-and-under" pathway typically result in which of the following injury patterns? A) Traumatic brain injury B) Hip and femur fractures C) Rupture of the diaphragm D) Rupture of hollow organs Hip and femur fractures You are dispatched to a building collapse with an entrapped patient who will require a lengthy extrication. Which of the following medications should you consider for this patient while awaiting extrication? A) Sodium bicarbonate B) Diazepam C) Furosemide D) Calcium channel blockers Sodium bicarbonate Which of the following is TRUE of the injuries sustained by the elderly due to falls? A) The injuries sustained by the elderly are less likely to result in hospitalization. B) Only more significant falls cause fractures. C) Less significant falls may cause fractures. D) The elderly sustain injuries similar to other age groups in comparable falls. Less significant falls may cause fractures. Which of the following is NOT one of the major types of recreational vehicles involved in crashes? A) Snowmobiles B) Jet Skis C) All-terrain vehicles D) Go-carts Go-carts Which of the following traumas contributes most significantly to motor vehicle collision mortality? A) Chest B) Head C) Abdominal D) Cervical spine Head In a motor vehicle collision, when the driver's chest strikes the steering wheel, what produces injury next? A) The air bag deploys a second time. B) The steering column shears off, causing penetrating trauma. C) Unsecured objects in the vehicle become projectiles. D) The heart continues its forward motion until it strikes the chest wall. The steering column shears off, causing penetrating trauma. When inspecting the interior of a vehicle involved in a frontal collision, you note that the dash panel beneath the steering wheel is broken. Which of the following injuries might this indicate? A) Fracture of the acetabulum B) Femur fracture C) Knee injury D) All of the above All of the above Which of the following injuries is associated with the tertiary phase of a blast? A) Crush injuries B) Barotrauma C) Burns D) Projectile injuries Crush injuries Which of the following statements about the impact of motorcycle helmet usage is TRUE? A) Helmet use moderately increases the incidence of cervical spine injury. B) Helmet use moderately decreases the incidence of cervical spine injury. C) Helmet use substantially decreases the incidence of cervical spine injury. D) Helmet use neither increases nor decreases the incidence of cervical spine injury. Helmet use neither increases nor decreases the incidence of cervical spine injury. Which of the following mechanisms in a motor vehicle collision would most likely result in a tear of the liver at the ligamentum teres? A) Gradual deceleration B) Sudden acceleration C) Sudden deceleration D) Gradual acceleration Sudden deceleration Which of the following statements is NOT true of occupant ejection in motor vehicle collisions? A) Ejection accounts for 27 percent of motor vehicle fatalities. B) The number of occupant impacts increases with ejection. C) Ejection has not been reported with lateral-impact collisions. D) Ejection is most often associated with frontal-impact collisions. Ejection has not been reported with lateral-impact collisions. Which of the following may result from aggressive ventilation of the blast patient? A) Emboli B) Pericardial tamponade C) Hemorrhage D) Acidosis Emboli A vehicle is struck in its right front as it passes through an intersection, resulting in an oblique impact. Which of the passengers is subjected to the greatest acceleration forces? A) The right-rear passenger B) The left-rear passenger C) The front-seat passenger D) The driver The left-rear passenger You have responded to a soccer field on which two 13-year-olds have collided during a game. Which of the following findings in either patient requires ambulance transport for further evaluation in the emergency department? A) Weakness in the upper extremities B) Complaint of "getting the wind knocked out of me" C) Contusion to the thigh D) Minor epistaxis Weakness in the upper extremities Which type of motor vehicle collision is most common in rural areas? A) Frontal B) Lateral C) Rollover D) Rear-end Frontal You are the first arriving unit for injured persons due to a propane tank explosion. The first patient you notice is a young adult male who appears to be seriously injured. Which of the following should you do first? A) Request an arson investigator to come to the scene. B) Locate all patients. C) Do a scene size-up and establish incident command. D) Begin resuscitation of any patients who are apneic and/or pulseless. Do a scene size-up and establish incident command. Which of the following is TRUE of supplemental restraint systems? A) They may deploy during rescue operations, injuring the patient and/or EMS personnel. B) When worn incorrectly, they may cause spinal injury or decapitation. C) They guard against thoracic impact with the steering wheel. D) They are primarily useful in preventing injury to infants and children riding in the front seat. They may deploy during rescue operations, injuring the patient and/or EMS personnel. Which of the following mechanisms may result in a conventional explosion? A) Fumes B) Dust C) Aerosol propellants D) All of the above All of the above CHAPTER 3 Which of the following statements about low-velocity penetrating trauma is TRUE? A) Shorter knives and ice picks may be removed if they are left in the wound. B) There is no pressure shock wave with a knife wound as there is with an arrow wound. C) More injuries are sustained from arrows than from knives. D) Knives, arrows, ice picks, and similar weapons cause damage only in their direct path. Knives, arrows, ice picks, and similar weapons cause damage only in their direct path. Your patient is an eight-year-old male with a pencil impaled 2 centimeters inferior to the xiphoid process. You note that the pencil is pulsating. Which of the following is the best action? A) Start an IV and request orders for analgesia and sedation. B) Remove the pencil and apply direct pressure to the wound; transport to a trauma center if the bleeding does not stop with direct pressure. C) Stabilize the pencil in place and transport to a trauma center. D) Stabilize the pencil and transport to the nearest medical facility. Stabilize the pencil in place and transport to a trauma center. The pathway of injury left in the wake of a penetrating mechanism of injury is called: A) Cone of injury B) Cavitation C) Profile D) Trajectory Cavitation The passage through tissue of a high-energy bullet creates a temporary cavity and a permanent cavity. Which of the following statements is TRUE of the permanent cavity created by penetrating trauma? A) It is filled with disrupted tissues, some air, fluid, and debris. B) It is the damage done when the projectile fragments penetrate. C) It is a space created by a projectile as tissue moves rapidly away in its path. D) It is a potential space, not an actual space. It is filled with disrupted tissues, some air, fluid, and debris. Which of the following is TRUE of the pressure wave that accompanies high-velocity penetrating trauma? A) Hollow organs are less tolerant of the stress than solid organs are. B) Pressure waves cause no injury to surrounding tissues; they only momentarily disrupt function. C) Elastic tissues are less tolerant of the stress than nonelastic tissues. D) The pressure wave may be transmitted through blood, resulting in damage to blood vessels some distance from the primary wound. The pressure wave may be transmitted through blood, resulting in damage to blood vessels some distance from the primary wound. Your patient is a 50-year-old male with a gunshot wound to the right anterior chest. He is unresponsive. Which of the following should you do first? A) Check for a carotid pulse. B) Seal the chest wound. C) Auscultate breath sounds. D) Check for breathing. Check for breathing Your patient is a 30-year-old female with a stab wound to the neck. She is sitting up and appears very anxious and short of breath. There is minimal external bleeding noted, but there is bubbling from the wound. Which of the following should you suspect, based on the mechanism of injury and assessment findings? A) Laceration of the trachea B) An injury to the spinal cord at the level of the stab wound C) Laceration of the ipsilateral carotid artery D) All of the above Laceration of the trachea If you were to design a bullet to have the highest energy exchange, what would you do? A) Decrease the drag B) Increase the caliber C) Decrease the bullet's trajectory D) Design the bullet to become more unstable Design the bullet to become more unstable Which of the following is most important when assessing the damage done by a gunshot? A) The type of gun used B) The size of the bullet C) The distance from the shooter D) Whether there was an upward or a downward trajectory when the bullet was fired The distance from the shooter A penetrating injury to which of the following organs is LEAST likely to result in severe hemorrhage? A) Liver B) Kidney C) Spleen D) Ureter Ureter Which of the following is TRUE of shotgun ammunition? A) A shotgun may either fire one slug or use ammunition with multiple pellets. B) The shot is dispersed from the cartridge with high velocity. C) The closer the shooter is to the victim, the larger the area of visible damage. D) "Double ought" or #00 shot contains a large number of relatively small pellets. A shotgun may either fire one slug or use ammunition with multiple pellets. Which of the following abdominal organs is the least affected by the pressure wave associated with penetrating trauma? A) Spleen B) Bowel C) Kidneys D) Liver Bowel The study of the characteristics of projectiles in motion and their effects on the objects they impact is called: A) Trajectory B) Cavitation C) Ballistics D) Forensics Ballistics You have arrived on the scene of a 17-year-old male with a gunshot wound to the thigh. Police are on the scene. There is significant ongoing hemorrhage from the wound. The patient is screaming for someone to help him. Which of the following should you do first? A) Control hemorrhage with direct pressure. B) Perform a rapid trauma assessment. C) Ask the police if they have searched the patient for weapons yet. D) Begin high-concentration oxygen administration. Ask the police if they have searched the patient for weapons yet. As a bullet tumbles, its potential to inflict damage: A) Increases B) Remains the same C) Is determined by the trajectory D) Decreases Increases The path a projectile follows during a flight is called its: A) Cavity B) Ballistics C) Trajectory D) Drag Trajectory Which of the following is TRUE of body armor use? A) There are no reported cases of penetrating trauma among victims who were shot while wearing body armor. B) Blunt trauma may be significant, but the potential for life-threatening injury is less than if armor had not been worn. C) Blunt trauma only occurs if ceramic inserts are placed in the vest. D) Ceramic inserts are dangerous and should not be used, because they generally fragment and create secondary projectiles when they are struck by a bullet. Blunt trauma may be significant, but the potential for life-threatening injury is less than if armor had not been worn. Which of the following is most susceptible to damage from the pressure wave when a bullet enters it? A) Intestines B) Femoral artery C) Liver D) Lungs Liver Which of the following is TRUE about determining the pathway of the bullet when assessing a patient with a gunshot wound? A) You should try to determine the bullet's pathway. B) The purpose of determining the bullet's pathway is to anticipate which organs may have been affected, which will help to guide your priorities for on-scene care or rapid transport. C) It is difficult to determine the pathway of a bullet because it may not travel in a straight line, possibly being deflected by structures in its path or being shifted by natural movements of the diaphragm and other organs and structures of the body. D) All of the above All of the above Which statement about ballistics is TRUE? A) Damage is less when the bullet does not exit the body. B) When a bullet tumbles, it decreases the damage. C) In penetrating trauma, the mass of a projectile is more significant than its velocity when determining kinetic energy. D) When a bullet yaws, it increases the damage. When a bullet yaws, it increases the damage. When you are assessing someone with a gunshot wound from a rifle, which of the following is important to remember? A) The zone of injury is larger than that expected with other types of weapons. B) The muzzle velocity is less than that of a handgun. C) The trajectory is longer, allowing more energy to be dissipated by drag before it strikes the victim. D) The cavitation is limited to the direct path of the bullet. The zone of injury is larger than that expected with other types of weapons. Which of the following is typical of the trajectory of a knife when a female assailant stabs someone? A) The trajectory is lateral: right-to-left if she is right-handed and left-to-right if she is left-handed. B) The movement is downward as the assailant raises the knife and swings downward. C) The movement is upward as the assailant drives upward with the knife. D) The trajectory tends to be in a horizontal plane at the level of the assailant's shoulder. The movement is downward as the assailant raises the knife and swings downward. Greater velocity of a bullet will cause a ________ path of travel and a ________ trajectory. A) Wavier, straighter B) Flatter, wavier C) More rounded, curved D) Flatter, straighter Flatter, straighter Which of the following is TRUE of the temporary cavity formed by penetrating trauma? A) It heals more slowly than the permanent cavity because of the nature of the tissue damage. B) It fills with disrupted tissues, some air, fluid, and debris. C) It is a space indirectly created by a projectile as tissue moves rapidly away from its path. D) It is the damage that occurs when the projectile fragments. It is a space indirectly created by a projectile as tissue moves rapidly away from its path. Which of the following is TRUE of defense wounds in the victim of a knife attack? A) They usually occur to the shoulder as the victim attempts to turn away from the attack. B) They often occur to the neck and head as the victim doubles over into a protective posture. C) They usually occur to the hands and arms as the victim raises them to ward off the attacker. D) They rarely occur because the victim is usually taken by surprise. They usually occur to the hands and arms as the victim raises them to ward off the attacker. To gain an appreciation for the potential for trauma from high-velocity projectiles, it is important to remember that the shock wave produced can exceed atmospheric pressure by up to ________ times. A) 25 B) 100 C) 50 D) 80 100 Which of the following is associated with assault rifle wounds but not hunting rifle wounds? A) Permanent cavitation B) Multiple wounds C) Smaller exit wounds D) Larger exit wounds Multiple wounds Which of the following statements about bullets is TRUE? A) A high-velocity bullet is three times less likely to do major harm. B) The larger the bullet the smaller its energy. C) A small, light bullet does the most harm. D) The hunting rifle's bullet is usually a lighter bullet, but it travels faster. A small, light bullet does the most harm. During the scene size-up on a call for a patient with penetrating trauma due to a stab wound, which of the following should you do? A) Collect anything that could be used as evidence. B) Check for weapons on or near the patient. C) Try to find out in which direction the assailant fled. D) Assume that the patient has no weapons if law enforcement is on the scene. Check for weapons on or near the patient. Which of the following statements about stab wounds is TRUE? A) The presence of defense wounds decreases the likelihood of trauma to the neck, thorax, and abdomen. B) Damage is usually limited to physical injury caused by direct contact between the blade and the victim's tissue. C) The size and shape of the weapon allow precise prediction of the injury. D) Stab wounds by female attackers are seldom lethal. Damage is usually limited to physical injury caused by direct contact between the blade and the victim's tissue. Which of the following statements about entrance and exit wounds is TRUE? A) Exit wounds are usually the size of the bullet's profile. B) Entrance wounds most often appear as stellate. C) Cavitational wave energy is greatest at a bullet's point of entrance. D) Only a thorough forensic examination by a qualified expert can determine with certainty whether a given wound is an entrance wound or an exit wound. Only a thorough forensic examination by a qualified expert can determine with certainty whether a given wound is an entrance wound or an exit wound. Which of the following organs would be most likely to be injured by a stab wound to the sixth intercostal space in the midaxillary line on the right side? A) Liver, bladder, kidney, small intestine B) Stomach, pancreas, lung C) Liver, diaphragm, lung, kidney D) Spleen, diaphragm, lung, kidney Liver, diaphragm, lung, kidney Which of the following is best described as "the area of contused tissue resulting from penetrating trauma that may be slow to heal due to disrupted blood flow and tissue damage"? A) Temporary cavity B) Zone of injury C) Zone of coagulation D) Permanent cavity Zone of injury Penetrating trauma to the face can complicate airway management by which of the following mechanisms? A) Laryngotracheal edema B) Airway obstruction C) Destruction of anatomical landmarks D) B and C B and C The initial assessment of a patient with a gunshot wound to the chest should focus on detecting which of the following? A) Pancreatitis B) Tension pneumothorax C) Cardiac contusion D) Peritonitis Tension pneumothorax Which two factors related to kinetic energy proportionately affect the damage a projectile will do? A) Velocity and yaw B) Velocity and mass C) Mass and fragmentation D) Fragmentation and velocity Velocity and mass Which type of firearm usually limits trauma to direct injury? A) Hunting rifle B) Military rifle C) Automatic weapon D) Handgun Handgun Your patient is a construction worker who fell 15 feet and has a 3-foot metal concrete reinforcement bar (rebar) impaled in his right thigh. Which of the following is the best action? A) Administer sodium bicarbonate to combat acidosis resulting from the destruction of muscle tissue. B) If the proper tools and personnel are present, have rescuers cut the rebar to a manageable length. C) If you can see both ends of the rebar, gently remove it and irrigate the wound with sterile saline. D) Transport the patient without attempting to shorten or remove the rebar. If the proper tools and personnel are present, have rescuers cut the rebar to a manageable length. Which of the following bullet characteristics would create the most damage? A) Lack of tumble B) A small profile C) A full metal jacket D) "Mushrooming" or flattening on impact "Mushrooming" or flattening on impact As the mass of an object increases, which of the following occurs? A) The maximum speed it can attain increases. B) The amount of energy decreases. C) The maximum speed it can attain decreases. D) The amount of energy increases. The amount of energy increases. Your patient is a 60-year-old male with a gunshot wound in the second intercostal space anteriorly on the left. You note that he has frothy blood coming from his mouth. For which of the following must you have the highest index of suspicion? A) Tension pneumothorax B) A history of congestive heart failure C) Pericardial tamponade D) Traumatic asphyxia Tension pneumothorax Which of the following statements about rifles is TRUE? A) Assault rifles generally increase the number of wounds the victim sustains. B) Hunting rifles have larger magazines and operate semiautomatically. C) Assault rifles do not accept domestic hunting ammunition and thus create a projectile profile that is smaller and causes less damage. D) Assault rifles have greater velocity than hunting rifles and only operate automatically. Assault rifles generally increase the number of wounds the victim sustains Your patient has a gunshot wound to the left posterior thorax. Which of the following is NOT appropriate in initial assessment? A) Beginning bag-valve-mask ventilations B) Auscultating breath sounds bilaterally in six places, anteriorly and posteriorly C) Stabilizing a flail segment, should one be noted D) Placing a gloved hand over a sucking chest wound Auscultating breath sounds bilaterally in six places, anteriorly and posteriorly Which of the following is NOT considered penetrating trauma? A) Receiving a wood splinter in the foot while walking on an unfinished deck B) A superficial wound resulting from a pellet from a pellet gun being lodged under the skin C) A laceration from a kitchen knife D) A laceration on the forehead as a result of being struck with a metal pipe A laceration on the forehead as a result of being struck with a metal pipe Which of the following increases a bullet's profile? A) "Mushrooming" on impact B) The use of rifling in the barrel of the firearm C) Tumbling 180 degrees on impact D) A and C A and C As the energy from a medium- or high-velocity projectile pushes tissue from its path, which of the following occurs? A) Damage depends on the net difference between pressure at the entrance wound and pressure at the exit wound. B) There is no vacuum created when there is both an entrance and an exit wound. C) Negative pressure is generated inside the cavity, drawing debris into the wound. D) There is negative pressure at the entrance wound and positive pressure at the exit wound. Negative pressure is generated inside the cavity, drawing debris into the wound. Which of the following is most likely to occur when military ammunition is used? A) It will "mushroom" or flatten. B) It will remain intact. C) It will fragment. D) It will explode. It will remain intact. Which of the following is considered a high-velocity weapon? A) Shotgun B) Arrow C) Handgun D) Rifle Rifle CHAPTER 4 In a previously healthy individual, which of the following types of shock may NOT result in the typical signs of cool, pale, moist skin; tachycardia; and narrowed pulse pressure? A) Neurogenic B) Cardiogenic C) Hypovolemic D) Hemorrhagic Neurogenic Which of the following guidelines applies to the prehospital administration of IV fluids in the patient with hemorrhagic shock? A) Administer hypertonic saline solution or colloids at a keep-open rate. B) Administer synthetic oxygen-carrying fluids as necessary to increase the level of consciousness. C) Begin with a 2,000 ml bolus of isotonic crystalloid solution infused under pressure. D) Administer isotonic crystalloid fluids only as necessary to maintain perfusion. Administer isotonic crystalloid fluids only as necessary to maintain perfusion. Your patient is a 23-year-old male with a gunshot wound to the abdomen and an exit wound in the right flank. He responds to verbal stimuli; has pale, cool, diaphoretic skin; and has a heart rate of 128, respirations at 24, and a blood pressure of 82/60. These findings indicate which of the following kind of shock? A) Compensated B) Irreversible C) Decompensated D) Neurogenic Decompensated Your patient is a 42-year-old male with multiple lacerations on his arms, head, and torso after falling through a plate-glass window. On your arrival he appears to be unresponsive, lying prone on the sidewalk. Which of the following is the correct sequence of actions in caring for this patient? 1. Control major hemorrhage. 2. Take body-substance-isolation precautions. 3. Check the area for broken glass before kneeling next to the patient. 4. Turn him to a supine position. 5. Open his airway. A) 2, 3, 1, 4, 5 B) 2, 5, 1, 3, 4 C) 3, 2, 4, 1, 5 D) 2, 3, 4, 5, 1 3, 2, 4, 1, 5 Which of the following results from anaerobic metabolism in shock? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory alkalosis D) Respiratory acidosis Metabolic acidosis Which of the following, located in the aortic arch, monitor blood pressure and send feedback to the medulla oblongata to maintain homeostasis? A) Volume receptors B) Proprioceptors C) Baroreceptors D) Chemoreceptors Baroreceptors Managing a laceration with arterial bleeding most often requires: A) Cauterization B) A tourniquet C) PASG D) Direct pressure Direct pressure In which of the following patients with hemorrhagic shock can you employ aggressive fluid resuscitation? A) A 50-year-old male with a stab wound to the right upper quadrant of the abdomen B) A 45-year-old woman with a suspected ruptured ectopic pregnancy C) A 38-year-old male with an open femur fracture and a developing bruise beneath the right scapula following an assault D) A 26-year-old male with a gunshot wound involving the popliteal artery A 26-year-old male with a gunshot wound involving the popliteal artery Which of the following results from the beta 1 actions of epinephrine in response to shock? 1. Positive inotropy 2. Positive chronotropy 3. Positive dromotrophy 4. Bronchiolar smooth muscle relaxation 5. Increased peripheral vascular resistance A) 1, 2, 3 B) 1, 2, 5 C) 1, 2, 3, 4 D) 2 and 4 1, 2, 3 In anaphylactic shock, a massive _______ release causes general vasodilation, precapillary sphincter dilation, capillary engoregement, and fluid movement into the interstitial compartment. A) norepinephrine B) epinephrine C) histamine D) insulin histamine Which of the following results from relaxation of the postcapillary sphincters in shock? A) Diffuse intravascular coagulation B) Melena C) "Washout" of microemboli and lactic acid D) Septicemia "Washout" of microemboli and lactic acid Which of the following is defined as the volume of blood ejected from the heart with each beat? A) Stroke volume B) Ventricular capacitance C) Cardiac output D) Afterload Stroke volume A fracture of the femur may result in a hematoma that contains enough blood to make it a Class ________ hemorrhage. A) I B) III C) IV D) II III Your patient is a 45-year-old male who has received several stab wounds to the chest and abdomen. Although bleeding was significant at first, the rate of bleeding had slowed considerably before your arrival. The patient is agitated and confused, pale, diaphoretic, and cool to the touch. He lacks a radial pulse, and his carotid pulse is weak and rapid. Respirations are 28 and shallow. Which of the following is certain with this patient? A) He is in irreversible shock. B) He is in decompensated shock. C) He is in compensated shock. D) None of the above is certain. He is in decompensated shock. Your patient has a possible pelvic fracture from a frontal motor vehicle collision. She has a blood pressure of 78 by palpation, has a heart rate of 130, and responds only to painful stimuli. Before you arrived BLS providers immobilized the patient to a long backboard. Which of the following should you do next? A) Apply PASG B) Initiate rapid transport C) Perform a rapid trauma assessment D) Start a large-bore IV of lactated Ringer's solution Initiate rapid transport Peripheral vascular resistance (afterload) is measured as which of the following? A) Pulse pressure B) Mean arterial pressure C) Hydrostatic pressure D) Oncotic pressure Mean arterial pressure Which of the following substances has the most rapid effect when compensating for hemorrhage? A) Glucocorticoids B) Catecholamines C) Antidiuretic hormone D) Angiotensin II Catecholamines Which of the following is the preferred in-hospital fluid for resuscitation in hemorrhagic shock? A) Fresh frozen plasma B) Lactated Ringer's C) Whole blood D) Normal saline Whole blood Which of the following best describes the importance of oxygen in cellular metabolism? A) It prevents pyruvic acid from being converted to lactic acid. B) It prevents the formation of pyruvic acid in the Krebs cycle. C) It is necessary for glycolysis. D) It limits the overproduction of energy in the citric acid cycle. It prevents pyruvic acid from being converted to lactic acid. When cells become hypoxic and the amount of carbon dioxide in them increases, reducing tissue pH, which of the following occurs to restore homeostasis? A) Mast cells release serotonin, resulting in dilation of the capillary sphincters and an increase in tissue perfusion. B) Mast cells release histamine, resulting in dilation of capillary sphincters and an increase in tissue perfusion. C) The sympathetic nervous system constricts the capillary sphincters to prevent washout of the accumulated lactic acid. D) The precapillary sphincters open, increasing blood flow to the tissues. The postcapillary sphincters remain closed so that increased hydrostatic pressure forces lactic acid into the interstitial fluid, where it is buffered. Mast cells release histamine, resulting in dilation of capillary sphincters and an increase in tissue perfusion. The phase of blood clotting in which the smooth muscle of an injured blood vessel contracts is known as the ________ phase. A) Hemolytic B) Hemostatic C) Vascular D) Ischemic Vascular Which of the following findings indicates a progression from compensated shock to decompensated shock? A) Narrowing pulse pressure B) Tachycardia C) Altered mental status D) Diaphoresis Altered mental status When assessing the chest during rapid trauma survey, what is most likely to indicate major internal hemorrhage? A) Hyperresonance to percussion B) Increased respiratory rate C) Distended neck veins D) Dullness to percussion Dullness to percussion Which of the following types of wound facilitates the effectiveness of normal blood-clotting mechanisms? A) Vessels torn by stretching, such as when a limb is caught in farm machinery B) Transverse laceration of the vessel C) Longitudinal laceration of the vessel D) Crushing injuries Transverse laceration of the vessel Which of the following mechanisms is responsible for accumulating lactic acid in shock? A) The citric acid cycle B) Gluconeogenesis C) Hemostasis D) Anaerobic metabolism Anaerobic metabolism A hematoma resulting from a fracture of the humerus may contain enough blood to make it a Class ________ hemorrhage. A) II B) IV C) III D) I I Which of the following does NOT indicate compensated shock? A) Anxiety B) Altered mental status C) Weakness D) Thirst Altered mental status Which of the following is NOT a benefit of PASG? A) An autotransfusion of up to 2,000 ml of blood from the lower extremities B) Minimizing movement of the pelvis and lower extremities C) Increasing peripheral vascular resistance D) Decreasing the size of the vascular container An autotransfusion of up to 2,000 ml of blood from the lower extremities Even with intervention, survival is unlikely with blood loss over ________ percent of the total blood volume. A) 25 B) 15 C) 50 D) 35 35 Which of the following indicates that a patient has transitioned from compensated to decompensated shock? A) Widening pulse pressure B) Increased respiratory rate C) Hypotension D) Peripheral vasoconstriction Hypotension Red blood cells make up approximately ________ percent of whole blood volume. A) 45 B) 60 C) 30 D) 15 45 Which of the following is a manifestation of orthostatic hypotension? A) Your patient's pulse is 76 when he is supine but 88 when he sits up. B) Your patient's blood pressure is 142/90 when she is supine but 116/88 when she sits up. C) Your patient's blood pressure is 150/100 when he is supine but 134/90 when he sits up. D) Your patient's pulse is 80 when she is supine but 96 when she sits up. Your patient's blood pressure is 142/90 when she is supine but 116/88 when she sits up. Assuming all of the following patients have experienced significant blood loss and are hypotensive, in which would the use of PASG be absolutely contraindicated? A) A 19-year-old female with an unstable pelvis after being thrown from a horse B) A 35-year-old pregnant woman with bilateral femur fractures sustained in a head-on motor vehicle collision C) A 16-year-old male with massive blood loss from a severed popliteal artery as a result of being struck by a piece of metal debris ejected by a lawn mower D) A 31-year-old man with a stab wound between his thoracic vertebral column and right scapula A 31-year-old man with a stab wound between his thoracic vertebral column and right scapula The blood flowing to the heart best describes: A) Contractility B) Afterload C) Preload D) Vascular phase Preload Under normal circumstances, at any given moment most of the blood is in the ________ system. A) Venous B) Capillary C) Hematopoietic D) Arterial Venous Which of the following best describes definitive care for the trauma patient with ongoing, significant hemorrhage? A) Administration of blood or blood products B) Administration of hypertonic crystalloid or colloid solution C) Invasive hemodynamic monitoring and serial hematocrits D) Immediate surgery Immediate surgery Which of the following impairs blood clotting? A) Hypothermia B) Administration of IV fluids C) Use of nonsteroidal, anti-inflammatory medications D) All of the above All of the above For which of the following mechanisms of injury should you maintain the highest index of suspicion for hemorrhagic shock? A) Ten-foot fall from a ladder B) Frontal-impact motor vehicle collision at 45 miles per hour C) Gunshot wound resulting in an open tibia fracture D) Blunt trauma to the head, resulting in a full-thickness laceration to the forehead Frontal-impact motor vehicle collision at 45 miles per hour The rapid trauma exam focuses on finding injuries that may cause shock by quickly assessing which of the following body areas? 1. Head 2. Neck 3. Chest 4. Abdomen 5. Pelvis 6. Proximal extremities 7. Distal extremities A) 1, 2, 3, 4, and 5 B) 1, 4, 5, and 6 C) 1, 2, 3, 4, 5, 6, and 7 D) 3, 4, 5, and 6 1, 2, 3, 4, and 5 Which of the following measures effectively controls bleeding in body cavities? A) PASG B) Administration of platelets and clotting factors C) Surgery D) Therapeutic hypotension Surgery Septic shock results from massive infection releasing what substances into the vascular system? A) Toxins B) Lactic acid C) Catecholamines D) Aldosterone Toxins Which of the following statements about the patient in neurogenic shock is NOT true? A) Signs of hypovolemic shock may be masked. B) Unopposed sympathetic nervous stimulation results in generalized pallor and diaphoresis. C) The heart rate may be normal. D) Neurogenic shock may be temporary, even if spinal cord damage is permanent. Unopposed sympathetic nervous stimulation results in generalized pallor and diaphoresis. Your patient is an obese 39-year-old woman involved in a lateral-impact motor vehicle collision. Which of the following should you remember when assessing and treating this patient? A) Relative to body size, this patient can tolerate a larger amount of hemorrhage before showing signs of shock. B) This patient will tolerate blood loss well, as only nonvital tissues will become ischemic. C) Relative to body weight, a smaller amount of hemorrhage may result in shock. D) Blood volume increases proportionally with body weight, and the patient will experience signs of shock consistent with the classic stages of hemorrhage. Relative to body weight, a smaller amount of hemorrhage may result in shock. Which of the following fluids is appropriate for the prehospital management of hypovolemic shock? A) Five percent dextrose in water B) Lactated Ringer's C) A 0.2% sodium chloride solution D) A 0.45% sodium chloride solution Lactated Ringer's Which of the following would be the most likely cause of neurogenic shock? A) Pericardial tamponade B) Spinal cord injury C) Systemic infection D) Massive histamine release Spinal cord injury Rapid volume replacement is best achieved under which of the following conditions? A) Use of a long catheter with a large internal diameter B) Use of a long catheter with a small internal diameter C) Use of a short catheter with a small internal diameter D) Use of a short catheter with a large internal diameter Use of a short catheter with a large internal diameter Which of the following vessels has the greatest ability to change diameter? A) Arterioles B) Capillaries C) Systemic arteries D) Aorta Arterioles Your patient is a 29-year-old male who works in a meat-processing plant. He received a knife wound in the proximal anteromedial thigh, which is continuing to bleed on your arrival. He is restless and thirsty and has pale, cool skin. He has a weak radial pulse of 130 and a blood pressure of 118/88. This patient is exhibiting signs and symptoms consistent with a Class ________ hemorrhage. A) III B) II C) IV D) I II Which of the following early signs of shock is easily missed? A) Tachycardia B) Decrease in respiratory rate and volume C) Decrease in blood pressure D) Narrowing pulse pressure Tachycardia Which of the following is TRUE of the elderly trauma patient? A) The elderly trauma patient is more likely to experience myocardial ischemia as a result of hemorrhage. B) Medications like beta-blockers may interfere with normal compensatory mechanisms. C) Hemorrhage may not result in tachycardia as expected. D) All of the above are true. All of the above are true. Your patient is a 24-year-old male who was struck just below the left scapula with a 3-inch diameter metal pipe. He is awake but having difficulty breathing. His pulse is 112 at the radial artery, and his respiratory rate is 28 per minute and shallow. His breath sounds are present bilaterally but diminished on the left. He has a blood pressure of 108/68. The patient is coughing up some bloody sputum. He has no other complaints, and a rapid trauma survey reveals no additional life-threatening injuries. Which of the following represents the best sequence of intervention for this patient? A) Begin transport immediately, oxygen 15 lpm by nonrebreathing mask, a large-bore IV of isotonic solution to maintain a systolic blood pressure of 120 mmHg or greater B) Oxygen 10-12 lpm by nonrebreathing mask, a large-bore IV of normal saline solution at a keep-open rate, transport C) Oxygen, 15 lpm by nonrebreathing mask, begin transport, a 14-gauge IV of lactated Ringer's solution, wide open D) Oxygen 10-12 lpm by nonrebreathing mask, begin transport, 16-gauge IV at a keep-open rate Oxygen 10-12 lpm by nonrebreathing mask, begin transport, 16-gauge IV at a keep-open rate Which of the following is NOT a characteristic of arterial bleeding? A) Rapid blood loss B) Spurting or pumping as it leaves the body C) Clots quickly on its own D) Bright red Clots quickly on its own In responding to a trauma patient at the scene of a motor vehicle crash, which of the following is an early sign or signs of shock you might encounter during the primary assessment? A) Rapid heart rate and anxiety B) Rapidly dropping blood pressure C) Rapid breathing and air hunger D) Rapidly dropping level of responsiveness Rapid heart rate and anxiety Which of the following represents the correct sequence for controlling hemorrhage from an extremity? A) Direct pressure on the dressing and wound, finger pressure through the dressing to the leaking vessel, and, if pressure fails, application of a tourniquet B) Direct pressure on the dressing and wound, elevation, ice C) Finger pressure through the dressing to the leaking vessel, splinting, ice, elevation D) Direct pressure on the dressing and wound , elevation, ice, tourniquet as a last resort Direct pressure on the dressing and wound, finger pressure through the dressing to the leaking vessel, and, if pressure fails, application of a tourniquet Which of the following terms is best described as the loss of blood from the vascular space? A) Hypovolemia B) Hemorrhage C) Hemostasis D) Shock Hemorrhage CHAPTER 5 You are called to a commercial creamery where an employee got his arm trapped in the ice cream-mixing machinery. You note that the skin has been pulled off his hand and arm from the midforearm down. The patient's muscles, tendons, and bones are exposed. This type of injury is a(n): A) Amputation B) Skinning injury C) Degloving injury D) Crush injury Degloving injury You are assessing an assault victim and note a contusion over the abdomen. Which of the following should you remember while caring for this patient? A) Unless the contusion is over a critical area, such as the spleen or liver, the likelihood of serious injury is minimal. B) A contusion to the abdomen should always increase your index of suspicion for underlying injury. C) If there is no rigidity or distension of the abdomen, serious injury is unlikely. D) The significance of the trauma is related to the amount of pain the patient experiences on palpation. A contusion to the abdomen should always increase your index of suspicion for underlying injury. A nonpenetrating injury caused by blunt trauma that damages blood vessels, causing pain and discoloration, is a(n): A) Ecchymosis B) Strain C) Abrasion D) Contusion Contusion You have responded for an injured person at an address you know to be a motorcycle clubhouse. Your patient was attacked by another party with a broken beer bottle. Your patient has a large laceration on her neck with moderate bleeding. Which property of your dressing material is most important in caring for this patient? A) Occlusive B) Sterile C) Absorbent D) Adherent Occlusive The tough, fibrous sheaths that bundle skeletal muscle are called: A) Tendons B) Fibers C) Sarcolemma D) Fascia Fascia Which of the following statements about crush injuries is most accurate? A) Only closed injuries can be classified as crush injuries. B) The actual source of bleeding in crush injuries may be hard to identify. C) A spongy sensation on palpation of the injured area indicates crush injury. D) Crush injuries are easily identifiable because they invariably result in deformity. The actual source of bleeding in crush injuries may be hard to identify. Which of the following is best described as the accumulation of a pocket of blood in the tissues? A) Hematoma B) Abrasion C) Compartment syndrome D) Contusion Hematoma The acute breakdown of muscle fibers in crushing injury is called: A) Myoglobinemia B) Sarcoidosis C) Rouleaux formation D) Rhabdomyolysis Rhabdomyolysis When caring for an amputated part, which of the following principles apply? 1. Place the unwrapped part in a dry plastic bag, and seal it. 2. Place the part in a plastic bag with the part wrapped in gauze moistened with lactated Ringer's solution or normal saline, and seal it. 3. Always transport the part with the patient. 4. Keep the part moist, and place it in a container of cold water. 5. Keep the part dry, and place it in an ice-filled container. A) 2, 4 B) 2, 3, 4 C) 1, 3, 5 D) 2, 5 2, 4 You arrive on the scene of a patient with severe blunt trauma to the face. You hear gurgling as you approach the patient. After opening the airway with a manual maneuver, what should your next action be? A) Ventilate B) Apply a cervical collar C) Control the source of hemorrhage D) Suction Suction Which of the following are likely to accumulate in the bloodstream following a large crush inju

Your patient is a 21-year-old football player who was struck in the lateral aspect of the left knee by another player's shoulder. The patient is in extreme pain, and the knee is significantly deformed and swollen. The pedal pulse is weak, but present, and capillary refill is less than 2 seconds. The patient is screaming at you to "fix" his knee. You are 10 minutes from the emergency department. You should: A) Splint the knee as found, start an IV, consider narcotic analgesia B) Apply gentle axial traction and realign the limb, splint in alignment C) Flex the knee to a 45-degree angle, splint in position of function D) Start an IV, administer narcotic analgesia, apply firm axial traction until the pulse returns to normal or resistance is met, then splint Splint the knee as found, start an IV, consider narcotic analgesia

Which of the following is appropriate in the care of the patient in the first stage of labor? a. Allowing the newborn to nurse b. Preparing for imminent delivery c. Taking a history and performing a physical exam, d. Saving the placenta in a plastic bag for transport to the hospital c.Taking a history and performing a physical exam,

Your patient is a 41-year-old female who is alert and in obvious distress, complaining of abdominal pain. The patient states that she is 32 weeks pregnant and she experienced an acute onset of tearing abdominal pain this evening. She admits to smoking cocaine this afternoon. She is G5P2 with two spontaneous abortions. Her skin is cool, moist, and pale, and you note about 50 mL of dark red vaginal bleeding. Her abdomen is rigid to palpation in all quadrants. HR = 128, BP = 90/52, RR = 22, SpO2 = 96%. Which of the following is most likely? a. Placenta previa b. Abruptio placentae c. Preeclampsia d. Preterm labor b.Abruptio placentae

Which of the following statements about trauma in pregnancy is FALSE? a. Physical abuse can occur in six to seven percent of all pregnancies. b. Signs and symptoms of shock generally occur early and consistently. c. Maternal catecholamine release can cause uterine hypoperfusion and fetal bradycardia. d. The risk of musculoskeletal injury is increased. b.Signs and symptoms of shock generally occur early and consistently.

Your patient is a 43-year-old female who is 36 weeks pregnant and alert, complaining of abdominal pain. She states that she slipped on a wet floor earlier today, striking her abdomen on a kitchen chair. She did not have any acute onset of pain, but over the next hour developed lower abdominal cramping similar to menstrual pain, as well as a lower back ache. She is G4P3, has a history of CVD, renal disease, and had abdominal surgery for a hernia four months ago. Based on this history, the patient is MOST likely experiencing: a. preterm labor. b. uterine rupture. c. placenta previa. d. Braxton-Hicks contractions. a.preterm labor.

If demographic trends continue as predicted, which of the following will be TRUE? a. By 2030, the average life span in eastern societies will be 100 years. b. By 2030, Baby Boomers will make up 17 percent of the population. c. By 2040, 20 percent of the population will be over age 65. d. By 2040, 1 in 5 Americans will be over age 85. c.By 2040, 20 percent of the population will be over age 65.

Your patient is a 75-year-old female complaining of constipation and abdominal pain for two days. Your physical examination reveals a moderately distended abdomen. Which of the following is the best course of action? a. Advise the patient to use an enema. b. Contact medical control for approval to refuse treatment and transport. c. Transport the patient, because she has a potentially serious medical problem. d. Advise the patient to use a laxative. c.Transport the patient, because she has a potentially serious medical problem.

In which of the following ways can paramedics help identify the need for more pediatric services or specialized pediatric services in their areas? a. Transport all ill and injured children to specialized children's hospitals b. Carefully document pediatric emergency calls c. Write to the editors of their local newspapers d. Participate in fund-raising events for their volunteer fire departments b.Carefully document pediatric emergency calls

Your patient is a 9-month-old male who was a restrained passenger in a motor vehicle collision. He was properly secured in his child safety seat at the time of the collision, but his mother has since taken him out of the seat and is holding him. Due to the significant mechanism of injury, you are going to provide spinal immobilization for the patient. You have found that you lack a cervical collar that fits him. Which of the following is the best way to immobilize this patient? a. Use the smallest cervical collar available, filling any voids between the collar and the patient with soft dressing material. Place him back in the car seat with padding behind his head. Place a towel roll on each side of his head. Use 2-inch tape across the front of the car seat to secure the towel rolls and the patient's head. b. Place the child back in his car seat. Pad behind his shoulders and place a folded receiving blanket around the back of his neck like a scarf, crossing the ends in front to limit the range of motion of his neck. Place towel rolls on both sides of his head and tape across the front of the car seat, securing the towel rolls and the patient's head. c. Secure a medium-length padded board splint to the patient's spine, using self-adherent roller gauze to secure it to his body and tape to secure it to his head. With the splint in place, the mother can hold him on her lap to comfort him on the way to the hospital. d. Place the child on a long backboard with a folded towel under his shoulders and a 1,000-cc bag of saline on each side of his head. Place pillows on both sides of his body and use 2-inch tape, rather than straps, to secure the patient to the backboard. b.Place the child back in his car seat. Pad behind his shoulders and place a folded receiving blanket around the back of his neck like a scarf, crossing the ends in front to limit the range of motion of his neck. Place towel rolls on both sides of his head and tape across the front of the car seat, securing the towel rolls and the patient's head.

Your patient is an 11-year-old male quadriplegic who depends on a phrenic nerve stimulator to stimulate contraction of his diaphragm and allow him to breathe. You are called to the home during a thunderstorm that has caused a power outage. Which of the following is the best course of action? a. Advise dispatch that you will be on the scene indefinitely and ask them to notify the power company that restoring power to this residence is a priority. b. Teach the patient's family members how to use the bag-valve-mask device and let them know they can call you back to the scene if they have any questions or difficulty bagging the patient. c. Request a generator from the fire department tactical support division. d. Assist his breathing with a bag-valve-mask device and transport. d.Assist his breathing with a bag-valve-mask device and transport.

Your patient is a conscious eight-month-old infant who has a severe airway obstruction as a result of choking on a slice of canned peach. Which of the following is your FIRST intervention? a. A portable suction device, using a rigid tonsil tip and no more than 100 mmHg of vacuum b. The use of a manually triggered, flow-restricted, oxygen-powered ventilation device c. Abdominal thrusts interspersed with attempts to ventilate d. An alternating series of back blows and chest thrusts d.An alternating series of back blows and chest thrusts

Your patient is a three-year-old female who has had vomiting and diarrhea for 24 hours. Which of the following is the best way to gain her cooperation when assessing her vital signs? a. Avoid explanations, and finish the assessment quickly. b. Ask if you can check her doll to "see how the doll is feeling" before repeating the same procedures on the child. c. Say, "I'm going to take your blood pressure." d. Explain that you want to give her arm a hug. b.Ask if you can check her doll to "see how the doll is feeling" before repeating the same procedures on the child.

Your patient is a five-year-old female who awoke with a harsh cough, sore throat, drooling, and high fever. She has shallow respirations of 40 and inspiratory stridor. She is completely focused on breathing, leaning forward on her outstretched arms. Which of the following is the best course of action? a. Start an IV for administration of succinylcholine and midazolam for RSI, intubate the trachea, and ventilate at a rate of 24 to 28 per minute. b. Provide high-concentration oxygen by nonrebreather mask, start an IV and repeat a full set of vital signs every 5 minutes en route to the emergency department. c. Inspect the hypopharynx for edema and be prepared for immediate surgical cricothyrotomy if airway obstruction is imminent. d. Provide blow-by oxygen, humidified if possible; transport without delay and avoid procedures that might upset her. d.Provide blow-by oxygen, humidified if possible; transport without delay and avoid procedures that might upset her.

If unable to establish an airway by any other means, in which of the following patients would needle cricothyrotomy be contraindicated? a. Three-month-old infant b. Six-month-old infant c. Both of the above d. Neither of the above d.Neither of the above

Your patient is a five-year-old male with an allergic reaction to peanuts. He has hives, complains of nausea, and is wheezing. You have already placed the patient on an albuterol treatment with supplemental oxygen. Due to the speed with which the patient's signs and symptoms developed after exposure to the antigen, you will be starting an intravenous line for medication administration and possible fluid infusion. Which of the following is the best way to communicate with the patient regarding the IV? a. Just before placing the IV, tell him you must put a needle in his arm but that it is for giving him medicine that will make him feel better. Tell him it will hurt, but only for a second. b. Tell him you are going to "start an IV in his arm" but that it won't hurt a big boy like him. c. Be honest. Tell him it will hurt but that it's okay if he wants to cry. Let him know as far in advance as possible so he has a chance to accept the idea. d. Tell him nothing. Have a parent distract him while you quickly place the IV a.Just before placing the IV, tell him you must put a needle in his arm but that it is for giving him medicine that will make him feel better. Tell him it will hurt, but only for a second.

Your patient is a 14-year-old male who was struck by a vehicle while riding his ATV. He has bilateral open femur fractures and an unstable pelvis. He is lethargic, pale, cool, and diaphoretic. He lacks a palpable radial pulse but has a carotid pulse of 130 and respirations of 28. You estimate he weighs 110 pounds. Which of the following represents the best sequence of treatment for this patient? a. Intubate the trachea with in-line stabilization of the cervical spine, ventilate with 100 percent oxygen at a rate of 20 to 24 per minute, immobilize the patient to a long spine board, start two large-bore IVs of lactated Ringer's solution, administer a 500-mL bolus, initiate transport, and reassess the patient's hemodynamic status. b. Administer oxygen by nonrebreather mask, apply bilateral traction splints for the femur fracture, immobilize to a long spine board, initiate transport, start two large-bore IVs of isotonic crystalloid solution, infuse a 2000-mL bolus, and reassess the patient's hemodynamic status. c. Assist the patient's ventilations with a bag-valve-mask device and supplemental oxygen; immobilize the patient to a long spine board; initiate transport; start two large-bore IVs, one of normal saline and one of lactated Ringer's solution, and rapidly infuse 200 mL of each; and reassess the patient's hemodynamic status. d. Administer oxygen by nonrebreather mask, immobilize the patient to a long spine board, initiate transport, start two large-bore IVs of normal saline solution, infuse a 1,000-mL bolus, and reassess the patient's hemodynamic status. d.Administer oxygen by nonrebreather mask, immobilize the patient to a long spine board, initiate transport, start two large-bore IVs of normal saline solution, infuse a 1,000-mL bolus, and reassess the patient's hemodynamic status.

Your patient is a four-year-old child whom you have intubated due to respiratory failure secondary to asthma. During reassessment of the child, which of the following would indicate increased end-organ perfusion? 1. Pupillary dilation 2. capillary refill less than 2 seconds 3. increase in heart rate 4. Warm skin a. 1, 2, and 4 b. 3 and 4 c. 2 and 4 d. 2, 3, and 4 d.2, 3, and 4

Which of the following is the leading cause of poisoning in toddlers and preschoolers? a. Medications taken for ADD/ADHD b. Iron-containing vitamins c. Hydrocarbons d. Alcohol b.Iron-containing vitamins

Your patient is a nine-year-old female who was struck by a vehicle as she ran across the street. She is unresponsive and has a hematoma over the left parietal area and an open, depressed skull fracture on the right parietal area. She has bruising on the left flank and hip. She is breathing irregularly at 8 times per minute and has a heart rate of 56. She has a faint carotid pulse but no radial pulse. Which of the following is/are most likely to account for your patient's heart rate? 1. Normal range for a healthy, fit, nine-year-old child 2. Hypoxia due to impaired respiratory status secondary to traumatic brain injury 3. Increasing intracranial pressure due to traumatic brain injury exacerbated by hypoxia 4. Myocardial contusion a. 3 b. 4 c. 1 d. 2 and 3 d.2 and 3

Which of the following provide(s) an acceptable estimate of the correct size of endotracheal tube for a pediatric patient? 1. The patient's age in years plus 16, divided by 4 2. The diameter of the little finger 3. A length-based resuscitation tape 4. The child's age in years plus 1 a. 1 and 2 b. 1, 2, and 3 c. 3 and 4 d. 1, 2, 3, and 4 b.1, 2, and 3

Your patient is a seven-year-old female with a history of bee-sting anaphylaxis. She was stung by a bee and nearly immediately began having difficulty swallowing and breathing. Her father administered her prescribed 0.15 mg epinephrine auto-injector without result. On your arrival, the patient responds to painful stimuli; has labored, rapid, wheezing respirations; a heart rate of 60; and a blood pressure of 92/60. Her father tells you that she weighs 48 pounds. Which of the following is the best sequence of treatment for this patient? a. Hyperventilate for 1 to 2 minutes, intubate the trachea, administer 1:10,000 epinephrine endotracheally, start an IV of normal saline, and administer diphenhydramine, IV b. Assist ventilations with a bag-valve-mask device and supplemental oxygen, administer diphenhydramine subcutaneously, start an IV of normal saline, and administer 1:1,000 epinephrine intravenously. c. Begin a nebulized albuterol treatment with supplemental oxygen, administer 1:1,000 epinephrine subcutaneously, start an IV of normal saline and infuse a 400-mL bolus, and administer diphenhydramine, IM d. Assist ventilations with a bag-valve-mask device and supplemental oxygen, initiate a large-bore IV of normal saline, and administer 1:10,000 epinephrine intravenously, followed by diphenhydramine, IV d.Assist ventilations with a bag-valve-mask device and supplemental oxygen, initiate a large-bore IV of normal saline, and administer 1:10,000 epinephrine intravenously, followed by diphenhydramine, IV

Your patient is a 15-year-old male with a stab wound along the right sternal border at the fourth intercostal space. The patient responds to painful stimuli, and shows little evidence of external bleeding. His respirations are 30, his breath sounds are clear and equal, and his radial pulse is weak and disappears on inspiration. The patient has distended jugular veins and is dyspneic. This patient is most likely suffering from ________ shock due to ________. a. obstructive, pericardial tamponade b. hypovolemic, hemothorax c. distributive, loss of sympathetic nervous tone d. hypoxic, tension pneumothorax a.obstructive, pericardial tamponade

Your patient is a three-year-old female who is unresponsive from ingesting several tablets of a tricyclic antidepressant. You are transporting her to the nearest hospital, which is 30 minutes away. Due to the child's lack of a gag reflex, you are preparing to intubate. If time allows before attempting laryngoscopy, you should have an assistant ventilate the child with 100 percent oxygen for: a. 30 seconds. b. 2 minutes. c. 5 minutes. d. 1 minute. b.2 minutes.

Your patient is a 24-month-old female whom you have determined to be hypoglycemic. Which of the following will cause the LEAST amount of discomfort to the patient when given IV? a. 10 mL of 25 percent dextrose b. 25 mL of 50 percent dextrose c. 10 mL of 50 percent dextrose d. 25 mL of 10 percent dextrose d.25 mL of 10 percent dextrose

Your patient is a three-year-old male who has had a mild cold for 24 hours. This evening, the parents have called EMS because the child awoke with a hoarse, "barking" cough and seems to be having some difficulty breathing. You note that the child is afebrile and his breath sounds are clear but that he has significant inspiratory stridor. His respiratory rate is 30, his pulse is 124, and he is anxious but lacks peripheral cyanosis. Which of the following responses indicates the most likely cause and the appropriate treatment of the child's problem? a. Epiglottitis, breathing cool night air b. Laryngotracheobronchitis, humidified oxygen c. Bronchiolitis, racemic epinephrine d. Asthma, albuterol b.Laryngotracheobronchitis, humidified oxygen

Your patient is a toddler who was burned when he accidentally pulled the cord of a deep fryer sitting on a countertop and spilled hot oil on his head and back. He has burns to the back half of his head, as well as his entire back. What percentage of total body surface area does this account for? a. 36 percent b. 40 percent c. 27 percent d. 18 percent c.27 percent

Your patient is an eight-year-old female. As you approach her, you note that she is holding her right arm against her body, cradling it with the left arm. To find out what happened, which of the following is the best approach? a. Ask the parents to tell you what happened while you examine the child. b. Sit next to the patient, and ask her what happened. c. Take the parents aside, and ask them what happened. d. Ask the parents to leave the room so you can talk to the patient. b.Sit next to the patient, and ask her what happened.

Your patient is a 25-year-old female who is complaining of pain in the midline of the lower abdomen. Which of the following questions helps LEAST when determining the etiology of the patient's pain? a. "Do you feel nauseated?" b. "Are you having any pain with urination?" c. "Are you experiencing pain anywhere other than your lower abdomen?" d. "When was your last menstrual period?"

a."Do you feel nauseated?"

Which of the following statements would be most typical of an undiagnosed diabetic? a. "I am so thirsty I have to keep a glass of water by my bed at night." b. "I have gained ten pounds over the past two weeks." c. "It seems like I am dehydrated because I hardly urinate at all." d. "I haven't had much of an appetite. I am not hungry at all."

a."I am so thirsty I have to keep a glass of water by my bed at night."

Your patient is a 55-year-old male whose wife called EMS after the patient complained of bright red bleeding during a bowel movement. The patient refuses transport, stating he has hemorrhoids and has had similar bleeding in the past. Which of the following statements is most appropriate? a. "I'm sure you are right; there is nothing to worry about." b. "Similar bleeding can be caused by more serious conditions." c. "This does not sound like hemorrhoids." d. "Even though this sounds like hemorrhoids, the bleeding may become life-threatening."

a."I'm sure you are right; there is nothing to worry about."

Your diabetic patient asks you why diabetics need to take insulin. Which of the following answers is most accurate? a. "Insulin helps glucose enter the cells of the body so it can be used for energy." b. "Insulin helps the body eliminate excess glucose through the kidneys." c. "Insulin breaks down glucose into proteins so it can be used by the cells for energy." d. "Without insulin glucose is converted to ketone bodies, which are toxic in large quantities."

a."Insulin helps glucose enter the cells of the body so it can be used for energy."

Which of the following questions would best help you determine if the pathology of a patient's complaint has been progressing? a. "On a scale of 0 to 10, with 10 being the worst pain possible, how would you have rated the pain when it started? How would you rate the pain now?" b. "When did your pain first start?" c. "Have you ever felt this pain before?" d. "On a scale of 1 to 10, with 10 being the worst pain possible, how would you rate this pain?"

a."On a scale of 0 to 10, with 10 being the worst pain possible, how would you have rated the pain when it started? How would you rate the pain now?"

The risk of infection from HIV positive patients after exposure to virus-containing blood is approximately ________ percent. a. 0.2 to 0.44 b. 0.5 to 1 c. 2 to 4 d. 5 to 14

a.0.2 to 0.44

Gastrointestinal emergencies account for ________ percent of emergency room visits annually. a. 5 b. 10 c. 2.5 d. 7.5

a.5

Your patient is a 56-year-old male who is conscious and exhibits slurred speech, irritability, and cool, clammy skin. Blood glucose is 54 mg/dL. Proper treatment for this patient could include all of the following EXCEPT: a. 5 to 10 mg of glucagon IM b. Consideration of D50 IV if the patient cannot follow simple commands c. IV of NS d. Administration of oral glucose if the patient is able to swallow

a.5 to 10 mg of glucagon IM

Which of the following statements regarding a dialysis fistula is TRUE? a. A fistula is a surgical anastomosis of an artery and a vein. b. The fistula is the preferred site of venous access in an emergency situation. c. A fistula uses a dual lumen tube to connect an artery and a vein. d. The fistula is inserted peripherally, but the end of it is placed near the right atrium.

a.A fistula is a surgical anastomosis of an artery and a vein.

Which of the following situations MOST clearly involves the patient's consent? a. A patient offers her left arm after the paramedic explains that he needs to start an IV to give her medication for pain. b. A patient who was at first quite agitated allows the paramedic to examine her after she is placed in four-point restraints. c. A patient shouts, "No! No! No!" when the paramedics try to move him to the cot, but his wife says that "No" is the only thing he can say after his stroke and that he really doesn't mean it. d. A patient who has been drinking wine for "two or three days," and cannot remember if he is in Nashville or New Orleans, does not object when the paramedic performs a fingerstick to check his blood glucose level.

a.A patient offers her left arm after the paramedic explains that he needs to start an IV to give her medication for pain.

A patient is experiencing severe abdominal cramping, vomiting, diarrhea, and facial flushing after eating undercooked chicken. Management of this patient should include all of the following EXCEPT: a. Activated charcoal b. IV of normal saline c. Oxygen d. Transport

a.Activated charcoal

A 63-year-old female with a history of hypothyroidism presents in a stuporous state, responsive only to pain. Physical exam reveals thin hair, a puffy face, an enlarged tongue, and cold, doughy skin. Her heart rate is 70 and regular, RR is 10 and regular, BP is 90/62, blood glucose level is 60 mg/dL, and temperature is 86°F via a tympanic thermometer. Your treatment of this patient should NOT include: a. Active rewarming b. Endotracheal intubation c. 50 percent dextrose, IV d. IV fluids at a TKO rate

a.Active rewarming

Your patient is a 24-year-old male with a history of type I diabetes. You were called to his place of employment because he was behaving bizarrely. On your arrival he is confused and combative with a blood glucose level of 41 mg/dL. Due to poor vasculature and the patient's combativeness, you have not been able to start an IV. Which of the following is the best course of action? a. Administer 1 mg glucagon, IM. b. Administer 5 mg Valium, IM, and attempt the IV again when the patient is less agitated. c. Administer half an amp (12.5 g) of 50 percent dextrose, IM.

a.Administer 1 mg glucagon, IM.

You are assessing an unresponsive patient with a MedicAlert tag that indicates he is a diabetic. The patient's airway is patent, respirations are 20 per minute and adequate, radial pulse is rapid and weak, and the skin is warm and moist. You attempt to get a blood glucose reading, but your blood glucose monitor malfunctions. Which of the following is the best course of action? a. Administer 25 g of 50 percent dextrose. b. Administer a 1 to 2 liter bolus of NS. c. Request another unit to respond to the scene with a blood glucose monitor. d. Request an order for 20 units of regular insulin.

a.Administer 25 g of 50 percent dextrose.

You are caring for a patient with a known history of sickle cell disease. The patient has severe abdominal and back pain. The patient is tachycardic and tachypneic. The blood pressure is normal. What should be one of the paramedic's first interventions? a. Administer oxygen b. Initiate an IV c. Give oral analgesics d. Put the patient in a supine position

a.Administer oxygen

Which medication would be the best choice for reducing the bronchospasm and laryngeal edema associated with anaphylaxis? a. Albuterol b. Solu-Medrol c. Oxygen d. Dexamethasone

a.Albuterol

Two 15-year-old boys have been hiking and camping and using a guide to native plants to determine which plants are edible. They drank a tea made from some plants that they picked. They are now complaining of abdominal cramping, watering eyes, vomiting, diarrhea, and sweating. Which of the following have they most likely ingested? a. Amanita b. Jimson weed c. Holly berries d. Poison sumac

a.Amanita

The current treatment for fibromyalgia is: a. Antidepressants b. Allopurinol c. Sulfonamide antibiotics d. Anti-inflammatory drugs

a.Antidepressants

Your patient is a 46-year-old male who is unconscious on his front lawn after being stung by a bee. You note angioneurotic edema. HR = 132, BP = 76/40, RR = 24 and shallow. You should first: a. Assist ventilations with 100 percent oxygen via a BVM b. Administer epinephrine 1:1000 SC c. Start an IV of NS wide open and administer epinephrine 1:10,000 IV d. Intubate the patient

a.Assist ventilations with 100 percent oxygen via a BVM

McBurney's point, a common site of pain secondary to appendicitis, is located: a. At the midway point of a line from 1 to 2 inches above the right iliac crest to the umbilicus b. Two inches above the umbilicus in the midline c. One to two inches above the iliac crest in the right midaxillary line d. At the midway point of a line from the symphysis pubis to the right anterior, superior iliac crest

a.At the midway point of a line from 1 to 2 inches above the right iliac crest to the umbilicus

Which of the following types of agents acts specifically by inhibiting bacterial growth or reproduction? a. Bacteriostatic b. Antiseptic c. Pathological d. Aseptic

a.Bacteriostatic

Restoril and Ativan are examples of: a. Benzodiazepines b. Barbiturates c. Sedatives d. Narcotics

a.Benzodiazepines

Lithium is used to treat: a. Bipolar disorder b. Schizophrenia c. Depression d. Personality disorders

a.Bipolar disorder

Which of the following statements about chronic renal failure (CRF) is accurate? a. CRF is diagnosed when 70 percent of the nephrons are lost and the patient is clinically unstable. b. The only treatment for CRF is a kidney transplant. c. CRF is reversible if the cause is found and treated. d. Hemodialysis can reverse CRF, but CAPD cannot.

a.CRF is diagnosed when 70 percent of the nephrons are lost and the patient is clinically unstable.

You are transporting a stable patient in four-point restraints. Which of the following must you do and document? a. Check radial and pedal pulses b. Release each of the restraints for 5 minutes at a time in an alternating manner c. Alternate prone and supine positions d. Check vital signs every 5 minutes

a.Check radial and pedal pulses

"Rock" and "crack" are street names for: a. Cocaine b. Marijuana c. Heroin d. Morphin

a.Cocaine

Which of the following statements about consent is accurate? a. Competent people may not be transported against their will. b. People cannot be transported against their will unless there is a court order to do so. c. People who are alert and oriented to person, place, and time may not be transported against their will. d. People cannot be transported against their will unless a first-degree relative (spouse, adult child, parent, or sibling) agrees.

a.Competent people may not be transported against their will.

Your patient is a 45-year-old male with a history of bipolar disorder. He is sitting at the kitchen table, conscious, alert, and oriented. He is pleasant and greets you as you walk in. The patient's wife called EMS because he has refused to take his lithium and is "driving her crazy with his hyperactive attitude." She insists that you transport him to the hospital. The patient admits to voluntary noncompliance with his lithium, stating, "I didn't like the way it made me feel." He denies any suicidal thoughts and states that he has not felt "this good for a long time." He is curious about your job and wants to know how he could get into a paramedic class. He states that he's also thinking about going to law school but wants to finish his Ph.D. first. The physical examination is unremarkable. HR = 82, BP = 122/80, RR = 10, SaO2 = 99%. He says, "See, I told you I'm fine. I don't need to go to the hospital." Which of the following is the best course of action? a. Contact medical control. b. Explain to the patient that he has no choice; if he is unwilling to take his medication, you must take him to the hospital for evaluation. c. Restrain the patient if necessary and transport. d. Request law enforcement assistance for legal detention of the patient for transport to the ED.

a.Contact medical control.

Your patient, who has a history of cholecystitis, is experiencing pain in her right shoulder. She is most likely experiencing ________ pain. a. Somatic b. Visceral c. Referred d. Peritoneal

a.Decreased colon motility

A common complaint from patients who are immobile is: a. Decubitus ulcers b. Cellulitis c. Gangrene d. Clostridia

a.Decubitus ulcers

A 32-year-old is conscious and in mild distress, complaining of nausea and sweating. He states that his symptoms started two days ago when he stopped drinking "cold turkey." Physical examination reveals cool, diaphoretic skin; slightly dilated pupils bilaterally; and a general weakness to all extremities. Which of the following findings would also be likely? a. Delirium tremens, hallucinations, and anxiety b. Insomnia, hyperglycemia, and difficulty breathing c. Hypertension, bradycardia, and hyperglycemia d. Depression, hypotension, and polyuria

a.Delirium tremens, hallucinations, and anxiety

Which of the following circumstances would result in activation of the coagulation cascade via the intrinsic pathway? a. Development of a plaque in a coronary artery resulting in turbulent blood flow b. Administration of warfarin c. Blunt-force trauma d. Penetrating trauma resulting in soft-tissue damage

a.Development of a plaque in a coronary artery resulting in turbulent blood flow

Which three mechanisms can produce visceral pain? a. Peritonitis, cholecystitis, and a ruptured abdominal aorta b. Blunt trauma, penetrating trauma, and medical illness c. Somatic, referred, and peritonitis d. Distension, ischemia, and inflammation

a.Diazepam

A patient has been stunned with a Taser, and as a result you note superficial skin damage from the probe. This type of injury is classified as: a. Direct injury b. Primary injury c. Secondary injury d. Teritary injury

a.Direct injury

Which of the following chemistry findings would suggest acute renal failure? a. Elevated blood urea nitrogen (BUN) b. Decreased creatinine c. Decreased potassium d. Elevated iron

a.Elevated blood urea nitrogen (BUN)

A 24-year-old female presents complaining of severe bilateral lower quadrant abdominal pain and bloody, purulent vaginal discharge three days after having a dilation and curettage. Of the following, which is the most likely clinical condition of this patient? a. Endometritis b. Mittelschmerz c. Endometriosis d. Uterine fibroids

a.Endometritis

The destructive substances released from some bacteria when they die are known as: a. Endotoxins b. Syncytia c. Prions d. Exotoxins

a.Endotoxins

Your patient is experiencing dyspnea and urticaria after ingesting penicillin. Auscultation of his lungs reveals diffuse expiratory wheezes. Which of the following medications will best help correct your patient's bronchospasm? a. Epinephrine 1:1000 SC b. Ranitidine 50 mg IV c. Solu-Medrol 125 mg IV d. 100 percent oxygen via nonrebreather mask 15 lpm

a.Epinephrine 1:1000 SC

Which of the following organisms causes mononucleosis? a. Epstein-Barr virus b. Pediculus humanus capitus c. Treponema d. Herpes zoster

a.Epstein-Barr virus

In healthy individuals, which of the following is NOT a function of the kidney? a. Excretion of glucose b. Secretion of erythropoietin c. Excretion of wastes d. Regulation of water and electrolyte balance and pH

a.Excretion of glucose

Which of the following best describes a feeling of alarm at the expectation of danger? a. Fear b. Rage c. Phobia d. Stress

a.Fear

Your patient is an 18-year-old female college student who is supine in bed and responsive only to painful stimuli. Her roommate states that they went to a party last night. She says the patient only drank soda, but now she thinks a guy who had been following them around might have put something in the patient's drink. Physical examination reveals cool, dry skin and pupils sluggish to light bilaterally. HR = 72, BP = 112/64, RR = 10, SaO2 = 98%. Which of the following drugs was most likely slipped into her drink? a. Flunitrazepam b. LSD c. Amphetamines d. Opium

a.Flunitrazepam

Your patient is a 20-year-old female who is conscious and alert, though obviously hallucinating after ingesting LSD. Her friends state that she is having a "bad trip," and you note that she is vigorously scratching her arms to the point of drawing blood. Physical examination reveals warm, slightly diaphoretic skin and dilated pupils bilaterally. Which of the following medications should be considered to manage this patient? a. Haloperidol b. Thiamine c. Narcan d. Avapro

a.Haloperidol

Which of the following should occur with the administration of insulin? a. Hepatic glycogen synthesis b. Gluconeogenesis c. Lipolysis d. Glycogenolysis

a.Hepatic glycogen synthesis

Which of the following statements about hepatitis is TRUE? a. Hepatitis is caused by a variety of infectious agents and chemicals. b. All types of hepatitis are typically fatal within six months to two years. c. The most common cause of hepatitis is alcohol abuse. d. All types of hepatitis lead to chronic liver disease.

a.Hepatitis is caused by a variety of infectious agents and chemicals.

Which of the following is NOT a difference between cellular and humoral immunity? a. Humoral immunity uses memory cells, while cell-mediated immunity does not. b. T cells mature in the thymus gland, but B cells mature in lymph tissue. c. T cells use cytotoxins to destroy pathogens, while B cells use antibodies. d. Cellular immunity concerns itself with pathogens in cells and tissue; humoral concerns itself with pathogens in the lymph.

a.Humoral immunity uses memory cells, while cell-mediated immunity does not.

Which of the following is the most direct cause of polyuria in untreated diabetes? a. Hyperglycemia b. Hypoglycemia c. Too much insulin d. Too little insulin

a.Hyperglycemia

A 16-year-old female with a history of diabetes is found unconscious in a high school bathroom following volleyball practice. She is tachycardic; has cool, clammy skin; is lethargic; is slightly combative; and is very confused. She is most likely experiencing: a. Hypoglycemia b. Diabetic ketoacidosis c. Hyperglycemia d. Diabetic coma

a.Hypoglycemia

Epinephrine administration results in all of the following EXCEPT: a. Hypotension b. Increased cardiac contractile force c. Increased peripheral vasoconstriction d. Tachycardia

a.Hypotension

Your patient is a 44-year-old male who has been in jail for three days after being arrested for driving while intoxicated. He now presents with diaphoresis, anxiety, hallucinations, insomnia, and tremors. HR = 142, BP = 132/94, RR = 34, blood glucose = 85 mg/dL. Which of the following is appropriate? a. IV of NS KVO b. Narcan 2 mg IV c. 25 gm D50 IV d. Thiamine 100 mg IV

a.IV of NS KVO

Your patient is a 20-year-old male who is conscious, alert, and in severe distress. He describes a three-day history of diffuse abdominal pain near his umbilicus that became sharp and migrated to his lower right quadrant this morning. He states that the pain became acutely worse half an hour ago and that he is now lightheaded and nauseated and has vomited numerous times. Physical examination reveals his skin to be cool, pale, and diaphoretic, and he will not let you palpate his abdomen. HR = 132, BP = 76/50, RR = 22, SaO2 = 95%. Based on his clinical presentation, the most proper treatment, in addition to giving oxygen, would be: a. IV of normal saline, fluid challenge, left lateral recumbent position, expedited transport b. IV of normal saline wide open, Trendelenburg position, rapid transport c. IV of normal saline, fluid challenge, supine position, expedited transport d. IV of normal saline wide open, left lateral recumbent position, phenergan IV, transport

a.IV of normal saline, fluid challenge, left lateral recumbent position, expedited transport

You are called to a local physician's office where you find a 52-year-old male patient with a history of chronic renal failure. He is conscious but disoriented. The physician reports that the patient's wife brought him in because he has had a "chest cold," missed dialysis yesterday, and is now "acting strangely." Physical examination reveals cool, diaphoretic skin; edema to dependent areas, and lung sounds with rhonchi in the right upper lobe. HR = 118, BP = 142/100, RR = 20 and deep, SaO2 = 97%, blood glucose = 79 mg/dL. Bloodwork performed by the physician in his office indicates a pH of 7.2. In addition to 15 liters per minute of oxygen by nonrebreathing mask and an IV of normal saline at a keep-open rate, which of the following is most appropriate for this patient in the prehospital setting? a. IV sodium bicarbonate, 1 mEq/kg b. IV magnesium sulfate, 10 gm c. IV dextrose, 25 gm d. IV furosemide, 120 mg

a.IV sodium bicarbonate, 1 mEq/kg

All of the following are roles of a poison control center EXCEPT: a. Identifying the toxin or poison b. Determining the potential toxicity of the agent c. Providing information on the most current definitive treatment d. Notifying the receiving hospital and recommending treatment

a.Identifying the toxin or poison

The ___________ system is a complicated body system responsible for combating infection. a. Immune b. Nervous c. Respiratory d. Cardiovascular

a.Immune

Which of the following statements about measles and the measles virus is FALSE? a. Immunization is ineffective until age 15. b. Measles is highly communicable. c. Measles is transmitted by inhalation of infected droplets. d. Signs of measles infection include high fever and a maculopapular rash.

a.Immunization is ineffective until age 15.

Which of the following best explains the underlying problem in diverticulitis? a. Infection in an outpouching of the distal colon b. Ulceration of the lining of the colon c. Increased motility of the colon with increased mucus production d. The presence of polyps in the sigmoid colon

a.Infection in an outpouching of the distal colon

Which of the following statements about leukemia is TRUE? a. Infections secondary to low levels of circulating neutrophils are common. b. The pediatric mortality rate is greater than 50 percent. c. Leukemia is a disease of children and young adults, not older adults. d. Leukemias are cancers of erythrocytes.

a.Infections secondary to low levels of circulating neutrophils are common

Which of the following is TRUE concerning sickle cell anemia? a. It is a hereditary disease involving abnormal hemoglobin. b. It is a hereditary disease involving lack of intrinsic factor. c. It is an autoimmune disease in which the body destroys its own hemoglobin. d. It is an acquired disease in which the body cannot absorb iron.

a.It is a hereditary disease involving abnormal hemoglobin.

Your patient is suffering from end-stage liver disease. In which of the following ways would impairment of the hematologic system most likely be evident? a. Jaundice b. Polycythemia resulting in a florid appearance c. Vaso-occlusive crisis resulting in joint pain d. Leukocytosis

a.Jaundice

Which of the following can cause particular difficulties when spinal-immobilizing an elderly patient? a. Kyphosis b. Cellulitis c. Sciatica d. Fibromyalgia

a.Kyphosis

Which of the following best describes a person's state of cognitive functioning? a. Mental status b. Affect c. Level of consciousness d. Intelligence

a.Mental status

Your patient is a 56-year-old female who is sitting on a park bench. She is conscious, though lethargic, and complaining of faintness. She states she has had a "chest cold" for the past week so had decided to stop taking her "blood pressure pills" until she felt better. She states that this morning she ingested five tablets instead of her normal one tablet dose to "catch up" after the days off. You note cool, slightly diaphoretic skin; lungs clear bilaterally; PEARL; and no motor deficits. HR = 48, BP = 76/30, RR = 12, SaO2 = 97%. Which of the following is LEAST likely to be the medication she overdosed on? a. Metaproterenol b. Procardia c. Cardizem d. Verapamil

a.Metaproterenol

Which of the following classes of drugs is commonly abused to produce alertness and euphoria? a. Methamphetamines b. Barbiturates c. Alcohol d. Benzodiazepines

a.Methamphetamines

What is the most common cause of chronic gastroenteritis? a. Microbial infection b. Floral infection c. Elevated cortisol d. Use of NSAIDs

a.Microbial infection

Narcan acts as an antagonist to all of the following medications EXCEPT: a. Midazolam b. Methadone c. Codeine d. Heroin

a.Midazolam

Upon palpation of your patient's abdomen you note that it is very tender under the right costal margin. This should be documented as a positive ________ sign. a. Murphy's b. Cullen's c. McBurney's d. Grey-Turner's

a.Murphy's

Which of the following cells play a functional role in the inflammatory response? a. Neutrophils b. T lymphocytes c. Stem cells d. B lymphocytes

a.Neutrophils

A three-year-old-has stuck a crayon in his nose. Assessment reveals the crayon to be deeply embedded in the right nostril with some irritation and swelling noted. His vital signs are pulse 124, respiration 20, and SpO2 100%. Which of the following would be most appropriate when caring for this child? a. Nonemergent transport to the hospital b. Place a warm pack to the bridge of the nose c. Attempt removal of the crayon with forceps d. Oxygen via a nonrebreather at 5 liters/minute

a.Nonemergent transport to the hospital

If your patient has type O+ blood, what other blood type(s) can she receive? a. O- b. AB- c. AB+ d. AB- and O-

a.O-

A degenerative joint disease in which the articular cartilage is damaged and breaks down is known as: a. Osteoarthritis b. Osteoporosis c. Arthritis d. Bursitis

a.Osteoarthritis

What is referred to as an infection of the bone, most commonly caused by a bacterial infection? a. Osteomyelitis b. Gout c. Septic arthritis d. Neoplastic infection

a.Osteomyelitis

The most common form of bone disease is: a. Osteoporosis b. Osteomyelitis c. Rheumatoid arthritis d. Osteoarthritis

a.Osteoporosis

A 52-year-old male is in moderate distress and complaining of nausea and vomiting. He describes a three-day history of left upper quadrant abdominal pain described as sharp and radiating to his back. You note a slightly distended abdomen. He called EMS today when he developed nausea and vomiting. He denies any change of bowel habits and states he has a history of alcoholism. Of the following, which is the most likely cause of his clinical condition? a. Pancreatitis b. Hepatitis c. Peptic ulcer disease d. Gastroenteritis

a.Pancreatitis

All of the following symptoms are consistent with urinary tract infection EXCEPT: a. Passing hard, granular material in the urine b. Difficulty beginning and continuing to void c. Tenderness over one or both flanks d. Frequent urge to urinate

a.Passing hard, granular material in the urine

Which of the following statements about patient restraint is FALSE? a. Patients should be transported in a prone position. b. Restraining the thighs just above the knees can be more effective at preventing kicking than restraining at the ankles. c. Verbal methods of de-escalation should be tried before considering physical restraint. d. Neuromuscular blocking agents should never be used to restrain a patient.

a.Patients should be transported in a prone position.

A 54-year-old female is conscious and alert and in significant pain after a rattlesnake bite to her hand. You note two small puncture wounds surrounded by a swollen, red area. She states that she is nauseous and has chills. Your management of this patient should include immobilization of the affected arm and: a. Placing it at the level of the heart b. Placing it below the level of the heart with a constricting band proximal to the wound c. Elevating it above the level of the heart d. Placing it at the level of the heart with ice packs to the affected area

a.Placing it at the level of the heart

Which of the following is LEAST likely to lead to acute renal failure? a. Pneumonia b. Urethral obstruction c. Interstitial nephritis d. Heart failure with hypotension

a.Pneumonia

A frantic mother dialed 911 for her three-year-old daughter, who stuck a small dried bean into her ear. Assessment shows the bean to be lodged firmly in the ear canal. When treating this patient, the paramedic would: a. Reassure the mother and transport the patient b. Make one attempt to remove the bean with tweezers c. Have the patient follow up with her family physician d. Gently flush the ear canal with sterile water until the bean is dislodged

a.Reassure the mother and transport the patient

20. Immediately after birth, an infant is allowed to suckle at the mother's breast. Palpation of the uterus suggests that the uterus is contracting. This finding can be attributed to: a. Secretion of oxytocin b. Secretion of estrogen and progesterone c. Inhibition of estrogen and progesterone d. Inhibition of oxytocin

a.Secretion of oxytocin

Which of the following is a potential complication of untreated pelvic inflammatory disease? a. Sepsis b. Cystitis c. Renal failure d. Primary amenorrhea

a.Sepsis

Your patient is a 26-year-old African-American male who is alert but in severe distress, complaining of pain in his hands and feet, as well as abdominal pain. The pain began this morning but has progressed from an initial rating of 5/10 to a 9/10 at the present time. The patient has a history of sickle cell anemia and denies any trauma. Physical examination reveals cool, diaphoretic skin; pain with palpation to all four abdominal quadrants; splenomegaly; and a priapism. HR = 132, BP = 140/90, RR = 16. Select the most appropriate acute diagnosis and treatment for this patient. a. Sickle cell occlusive crisis; administer oxygen by nonrebreathing mask, isotonic crystalloids, and morphine b. Sickle cell trait; administer oxygen according to pulse oximetry readings, and give a 500 mL bolus of isotonic crystalloid solution c. Sickle cell occlusive crisis; administer oxygen by nonrebreathing mask, isotonic crystalloids, and aspirin d. Sickle cell disease; administer oxygen according to pulse oximetry readings, start an IV of normal saline, and administer ketorolac for pain

a.Sickle cell occlusive crisis; administer oxygen by nonrebreathing mask, isotonic crystalloids, and morphine

A 38-year-old male is conscious and alert after a black widow spider bite to his right hand. You note pain and swelling to the hand, and the patient states that he is dizzy and nauseous. HR = 117, BP = 128/78, RR = 20. During your physical examination, you note that he begins to experience severe, painful muscle spasms in his right arm. Which of the following is NOT appropriate? a. Sodium bicarbonate b. Calcium gluconate c. Diazepam d. Midazolam

a.Sodium bicarbonate

All of the following medications should be used in the initial treatment of hypotension in patients with anaphylactic shock EXCEPT: a. Solu-Medrol b. Epinephrine c. Dopamine d. Diphenhydramine

a.Solu-Medrol

In a patient with a hematological disease resulting in production of high numbers of abnormal red blood cells, which of the following would you be most likely to find? a. Splenomegaly b. Fever c. Hepatomegaly d. Florid skin

a.Splenomegaly

A 24-year-old male is supine on the floor and unconscious with snoring respirations. You note a weak, rapid pulse and cool, diaphoretic skin. HR = 124 and regular, BP = 136/88, RR = 12 and regular. Blood glucose is 24 mg/dL. After manually opening the airway and providing oxygen, which of the following should be performed next? a. Start an IV and administer 25 gm dextrose, IV. b. Start an IV and administer 0.3 mg glucagon, IV. c. Intubate the trachea, start an IV, and administer 25 gm dextrose. d. Administer glucagon, 1 mg IM.

a.Start an IV and administer 25 gm dextrose, IV.

Which of the following findings would be most specific to mumps? a. Swelling and tenderness of the parotid glands b. Temperature of 103°F or higher c. Redness of the face that gives a "slapped cheeks" appearance d. Fluid-filled vesicles on the trunk

a.Swelling and tenderness of the parotid glands

For a patient with hemophilia B, which of the following statements is TRUE? a. The patient's father had hemophilia B, and the mother was a carrier of the defective gene. b. The patient's father had hemophilia B, and the mother was unaffected. c. The patient's father was a carrier for the defective gene, and her mother did not carry the defective gene. d. The patient's mother was a carrier for the defective gene, and her father did not carry the defective gene.

a.The patient's father had hemophilia B, and the mother was a carrier of the defective gene

Which of the following best describes why the secondary response to an antigen is faster than the primary response? a. The secondary response uses memory cells, which immediately release antibodies specific to the antigen. b. The secondary response uses memory cells, which immediately release antigens specific to the antibodies. c. The primary response uses B and T cells specific to the antigens. d. The secondary response has fewer steps than the primary response, allowing it to progress faster.

a.The secondary response uses memory cells, which immediately release antibodies specific to the antigen.

Which of the following statements about prions is TRUE? a. They are neither prokaryotes nor eukaryotes. b. Eastern equine encephalitis is the most common prion disease. c. Prions are easily destroyed by heat sterilization. d. Prions are single-celled animals capable of causing disease.

a.They are neither prokaryotes nor eukaryotes.

A patient has a fever of 105°F, irritability, delirium, tachycardia, vomiting, and hypotension. These signs and symptoms are most consistent with: a. Thyrotoxic crisis b. Myxedema c. Graves' disease d. Hypothyroidism

a.Thyrotoxic crisis

Ringing in the ears is also known as ________. a. Tinnitus b. Vertigo c. Eczema d. Purulence

a.Tinnitus

Which of the following is NOT a goal of the inflammatory process? a. To produce antibodies to combat pathogens b. To activate systemic defenses to overcome invading pathogens and facilitate repairs c. To slow the spread of pathogens from the injury site d. To perform temporary repair at the site of injury and prevent the access of additional pathogens

a.To produce antibodies to combat pathogens

Your patient is a 16-year-old female who has taken an overdose of phenobarbital. She is unresponsive. Her skin is cool and pale, BP = 92/60, HR = 60, RR = 6. You have intubated the patient and started an IV. Which of the following is appropriate? a. Transport without additional pharmacological intervention b. Sodium bicarbonate 100 mEq c. Naloxone 2mg, 25 gm dextrose, transport d. 50 gm activated charcoal through an NG tube en route to the hospital

a.Transport without additional pharmacological intervention

Which of the following correctly lists the organs and regions of the gastrointestinal tract in sequence after the stomach? a. Duodenum, jejunum, ileum, descending colon, transverse colon, ascending colon, rectum, anus b. Duodenum, ileum, jejunum, large intestine, anus, rectum c. Jejunum, duodenum, ileum, large intestine, anus, rectum d. Duodenum, jejunum, ileum, ascending colon, transverse colon, descending colon, rectum, anus

a.Visceral

While working in the emergency department, you accidentally stick yourself with the stylette of an IV needle you just used to start an IV. What should you do immediately? a. Wash the area thoroughly with soap and running water. b. Stop the bleeding with a sterile gauze pad. c. Wipe the area with a povidone-iodine swab. d. Wipe the area with an alcohol prep.

a.Wash the area thoroughly with soap and running water.

A 45-year-old female presents complaining of abdominal pain just superior to the symphysis pubis, urinary frequency, dysuria, and a fever of 99°F. Based on her complaints, the best diagnosis would be: a. cystitis b. endometriosis c. ruptured ovarian cyst d. endometritis

a.cystitis

The mortality rate of ruptured esophageal varices is ________ percent. a. over 35 b. 10 to 15 c. 20 to 30 d. 15

a.over 35

A 20-year-old sexually active female presents with right lower quadrant abdominal pain and is hypotensive. She states the pain came on acutely and is severe. She has not had her period for two months. The most likely clinical diagnosis would be: a. ruptured ectopic pregnancy. b. spontaneous abortion. c. ruptured ovarian cyst. d. torsion of an ovarian cyst.

a.ruptured ectopic pregnancy.

Your diabetic patient asks you why he "passes out" when his blood sugar gets too low. Which of the following responses is most accurate? a. "When the blood sugar is low, the brain does not get enough oxygen." b. "Brain cells need a constant supply of glucose, or sugar, to function. Without sugar the brain cells cannot work to maintain consciousness." c. "When the blood sugar is low, the blood vessels relax and the blood pressure drops, causing you to faint." d. "The cells of the heart can only use glucose, or sugar, for energy. Without sugar the heart cannot effectively pump blood to the brain."

b."Brain cells need a constant supply of glucose, or sugar, to function. Without sugar the brain cells cannot work to maintain consciousness."

Your patient is a 19-year-old female who called EMS because she awoke with "itchy red patches" on her chest, back, and arms that "seem to come and go." As you obtain the history, you learn that she started taking Keflex, an antibiotic, two days ago to prevent infection in a laceration to her hand. In explaining to your patient what is going on, which of the following statements would be the most accurate? a. "It looks like the infection in your hand has spread to the bloodstream. The toxins from the bacteria are causing a rash." b. "These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking." c. "I cannot say what this is, but it is not an allergic reaction. Hives do not come and go as you have described." d. "This is a typical side effect of Keflex. It happens in most patients who take it."

b."These look like hives. They occur during an allergic reaction. You may have developed an allergy to the antibiotic you are taking."

Your patient is a 68-year-old female who is conscious but confused and lying supine in bed without complaint. Her daughter states that the patient was recently diagnosed with a bladder infection and has been taking antibiotics. She also states that her mother has not produced urine for two days, during which she has become increasingly confused. Physical examination reveals swelling to the face, hands, and feet; cool and moist skin; and lung sounds that are clear and equal bilaterally. HR = 104 , BP = 142/88, RR = 14, SaO2 = 96%. In addition to administering oxygen and monitoring the cardiac rhythm, which of the following courses of action is most appropriate? a. IV of NS with 250 cc fluid challenge b. 12-lead ECG, IV of NS KVO c. IV of NS KVO, furosemide, 40 mg d. IV of NS KVO

b.12-lead ECG, IV of NS KVO

Your patient is a 27-year-old male who has possibly overdosed on heroin. He is unresponsive and bradypneic. Which of the following is appropriate? a. 25 mg diphenhydramine b. 2 mg of naloxone c. 1 mg of flumazenil d. 100 mg of thiamine

b.2 mg of naloxone

Your patient is a 68-year-old male who is conscious but confused and lying on his kitchen floor. The patient offers no complaint other than wishing to be helped up from the floor. The patient can tell you that he "slipped a few days ago" and has been on the floor since. Physical examination reveals dry, cool skin; dry mucous membranes; clear lung sounds bilaterally; and no indications of trauma. HR = 112, BP = 98/70, RR = 14, SaO2 = 96%. Your partner finds an appointment card indicating the patient missed a hemodialysis appointment two days ago. Which of the following is the best course for managing this patient? a. 1,000 mL fluid bolus b. 250 mL fluid bolus c. IV of NS at a keep-open rate d. Dopamine infusion

b.250 mL fluid bolus

In which of the following patients should you suspect pathological fractures? a. A young boy who fell off his bicycle, landing after hitting the curb b. A little girl who broke her arm from pulling her shirt over her head c. An older man who was struck by a car while crossing the street d. A woman who tripped and fell down a stairwell

b.A little girl who broke her arm from pulling her shirt over her head

Your patient is a 72-year-old male patient who is conscious but slow to respond to questions and commands. He has become increasingly lethargic, unemotional, and easily fatigued over the past two months. He has had a decreased appetite and has gained weight over the same period. The patient further states, "I'm constipated and always cold." Which of the following additional signs or symptoms would be consistent with this patient presentation? a. A "moon-faced" appearance and hyperpigmentation of the skin b. A puffy face, an enlarged tongue, and pale, doughy skin c. Hypothermia, tachycardia, and hypertension d. Goiter, atrial fibrillation, nausea, and vomiting

b.A puffy face, an enlarged tongue, and pale, doughy skin

Which of the following best describes four-point restraints? a. Straps restraining the patient across the chest, hips, thighs, and legs b. A separate restraint on each of the four extremities c. A commercially manufactured restraint device d. Restraint of the head, torso, arms, and legs

b.A separate restraint on each of the four extremities

Which of the following mechanisms is not characteristic for a rectal foreign body? a. Sexual gratification b. Accidental trauma c. Accidental swallowing of something d. Psychosis on the part of the patient

b.Accidental trauma

Which of the following correctly pairs a toxin with its antidote? a. Benzodiazepine: naloxone b. Acetaminophen: N-acetylcysteine c. Carbon monoxide: amyl nitrite d. Aspirin: magnesium citrate

b.Acetaminophen: N-acetylcysteine

A 19-year-old male has ingested fifty 325 mg aspirin tablets 20 minutes before your arrival. He is alert and complaining of burning abdominal pain. Which of the following is appropriate in the prehospital management of this patient? a. Syrup of ipecac b. Activated charcoal c. Sodium bicarbonate d. N-acetylcysteine

b.Activated charcoal

Your patient is a 60-year-old male who is conscious and alert and sitting on a toilet. He appears to be in moderate distress and complains of nausea and diarrhea. The patient states that he is allergic to eggs and accidentally ate pancakes made with eggs this morning. He describes a 4-hour history of severe diarrhea and vomiting. HR = 124, BP = 92/60, RR = 16, SaO2 = 98%. The physical examination reveals no urticaria or angioedema; his skin is cool and clammy, and his lung sounds are clear. Based on these findings, what should be your greatest concern? a. Respiratory failure b. Acute dehydration c. The patient's discomfort d. Ventricular dysrhythmia

b.Acute dehydration

Your patient was in the building when a fire started at a factory that manufactures plastics. He is complaining of a headache, palpitations, and a burning sensation in his throat. His airway, breathing, and circulation are intact. Heart rate = 128, respirations = 22, blood pressure = 148/84, and SaO2 = 93%. You should immediately: a. Administer amyl and sodium nitrate b. Administer high-concentration oxygen c. Apply the cardiac monitor d. Prepare to intubate

b.Administer high-concentration oxygen

Your patient is undergoing chemotherapy and is complaining of bleeding from the gums and blood in his stool. Which of the following will best address the patient's problem? a. Stopping the chemotherapy b. Administering platelets c. Administering erythropoietin d. Administering vitamin K

b.Administering platelets

You are called to the home of a 28-year-old male who is complaining of hoarseness, a scratchy sensation in the back of his throat, and palpitations. The symptoms began about 30 minutes ago and have grown steadily worse ever since the patient ingested prescribed penicillin 1 hour ago. Patient management should include all of the following EXCEPT: a. Epinephrine 1:1000 0.3 mg SC b. Administration of an IV beta-blocker c. IV of NS KVO d. Supplemental oxygen via nonrebreather mask

b.Administration of an IV beta-blocker

All of the following are examples of one of the three "principles of decontamination" that are specific to toxicological emergencies EXCEPT: a. Administration of N-acetylcysteine b. Administration of an NS fluid challenge c. Administration of sorbitol d. Removing a patient from a structure that is filled with carbon monoxide

b.Administration of an NS fluid challenge

Your patient is a 20-year-old female victim of a sexual assault. Her roommate came home to their dorm room to find the patient curled up in bed crying, stating that she had just been raped "5 minutes ago." Physical examination reveals no trauma or any other abnormal findings. HR = 100, BP = 130/78, RR = 20, SpO2 = 99%. The patient agrees to be transported to the ED, but would like to change her clothes and use the bathroom before she leaves. Which of the following is the most appropriate course of action? a. Ask that the patient place her clothing in a paper bag. b. Advise the patient that using the toilet, changing her clothing, brushing her hair and teeth, or washing any part of her body will destroy evidence. c. Allow the patient to do as she wishes to avoid subjecting her to additional emotional trauma. d. Ask that the patient place each article of clothing in a separate plastic bag.

b.Advise the patient that using the toilet, changing her clothing, brushing her hair and teeth, or washing any part of her body will destroy evidence.

Mushrooms from the class ________ are responsible for over 90 percent of deaths from mushroom toxicity. a. Button b. Amanita c. Shiitake d. Galerina

b.Amanita

Which of the following best describes the difference between an anaphylactic and an anaphylactoid reaction? a. An anaphylactic reaction has a slower onset. b. An anaphylactoid reaction may happen with no prior sensitization. c. An anaphylactic reaction results in more lethal airway occlusion. d. An anaphylactoid reaction typically does not cause characteristic skin hives and itching as anaphylaxis does. All of the following are considered part of the lower gastrointestinal tract EXCEPT the: a. Jejunum b. Large intestine c. Ileum d. Duodenum

b.An anaphylactoid reaction may happen with no prior sensitization.

Oxygen can benefit patients with chronic renal failure because it is common for patients with chronic renal failure to be: a. Anemic due to the blood loss associated with hemodialysis b. Anemic due to decreased production of RBCs c. Hypoxic secondary to associated congestive heart failure d. Hypoxic secondary to associated hypotension

b.Anemic due to decreased production of RBCs

Which of the following best describes an emotional reaction characterized by hostility or rage? a. Emotional lability b. Anger c. Dread d. Irrationality

b.Anger

Which of the following is a potentially life-threatening condition involving the head, neck, face, and upper airway? a. Hives b. Angioedema c. Urticaria d. Wheals

b.Angioedema

The form of arthritis that causes the bones that form the joints to become fused is: a. Osteoarthritis b. Ankylosing spondylitis c. Osteopenia d. Septic arthritis

b.Ankylosing spondylitis

Which of the following statements about using antihistamines in the treatment of anaphylaxis is TRUE? a. Antihistamines displace histamine, then block histamine receptors. b. Antihistamines block histamine receptors and reduce histamine release from mast cells and basophils. c. Blocking of H1 receptors results in mild vasoconstriction, while the blocking of H2 receptors results in bronchodilation. d. Antihistamines block H1 and H2 receptors and prevent further release of histamine from B and T cells.

b.Antihistamines block histamine receptors and reduce histamine release from mast cells and basophils.

Your patient is a 19-year-old male complaining of a two-day history of abdominal pain described as diffuse and colicky, located around his umbilical area. He also states a loss of appetite and a low-grade fever over the same period. Palpation of his abdomen reveals tenderness and guarding to the periumbilical area. Of the following, which is the most likely cause of his clinical condition? a. Bowel obstruction b. Appendicitis c. Peptic ulcer disease d. Cholecystitis

b.Appendicitis

Which hepatitis often presents with hepatitis D? a. A b. B c. C d. D

b.B

Patients with lymphoma are most likely to experience abnormal function of: a. Thrombocytes b. B cells c. Erythrocytes d. Neutrophils

b.B cells

Hyperglycemia is most likely a result of damage to the pancreatic ________ cells. a. Alpha b. Beta c. Acinar d. Delta

b.Beta

Which of the following helps assess a patient's potential for violence? a. Gender b. Body language c. Ethnicity d. Age

b.Body language

Which of the following agencies monitors national disease data and provides disease information to health care providers? a. DHHS b. CDC c. OSHA d. NIOSH

b.CDC

Which of the following is a highly toxic, odorless, tasteless gas that is a by-product of incomplete combustion? a. Carbon dioxide b. Carbon monoxide c. Cyanide d. Methane

b.Carbon monoxide

Which of the following is associated with CAPD? a. Catheter placed in the central circulation b. Catheter providing access to the abdominal cavity c. Dialysis shunt in either arm d. Dialysis fistula in either arm

b.Catheter providing access to the abdominal cavity

Inflammation of the skin, including the dermis and subcutaneous layers, usually caused by bacterial infection would be identified as: a. An abscess b. Cellulitis c. Necrotizing fasciitis d. Rhabdomyolysis

b.Cellulitis

A type II diabetic with a blood glucose of 24 mg/dL would most likely be unconscious due to: a. Insulin shock b. Cerebral hypoglycemia c. Gluconeogenesis d. Diabetic ketoacidosis

b.Cerebral hypoglycemia

All of the following may be associated with urinary tract infection EXCEPT: a. Cystitis b. Cholecystitis c. Prostatitis d. Pyelonephritis

b.Cholecystitis

Which of the following structures in the inner ear is the organ of hearing? a. Semicircular canal b. Cochlea c. Vestibule d. Bony labyrinth

b.Cochlea

Which of the following is LEAST likely to be a precipitating factor of thyrotoxic crisis? a. Trauma b. Cold environment c. Infection d. Overdose of thyroid hormone

b.Cold environment

Which of the following best describes perceived loss of physical functioning without medical or traumatic cause? a. Somatization disorder b. Conversion disorder c. Catatonia d. Body dismorphic disorder

b.Conversion disorder

A 33-year-old female presents with "a heavy menstrual flow" after not having her menstrual period for two months. What other signs and symptoms would you MOST expect with this patient? a. Dull, lower left quadrant abdominal pain b. Crampy abdominal pain and passing of clots and tissue c. Sharp, lower right quadrant abdominal pain d. Fever and purulent, foul-smelling discharge

b.Crampy abdominal pain and passing of clots and tissue

For which of the following diseases is there no vaccine? a. Measles b. Croup c. Mumps d. Rubella

b.Croup

Which of the following would directly result in decreased fibrinolysis? a. Increased factor X b. Decreased plasminogen secretion c. Increased plasmin secretion d. Hypercalcemia

b.Decreased plasminogen secretion

Which of the following medications would be most useful in the event of a transfusion reaction? a. Aspirin b. Diphenhydramine c. Magnesium sulfate d. Furosemide

b.Diphenhydramine

Your patient is a 36-year-old female who is alert and complaining of abdominal pain. She states that she is having her period and that this pain is "much different than the cramps I usually get." She describes the pain as achy throughout her pelvis and lower abdomen. She says that this has occurred the past three menstrual cycles and that she has experienced dyspareunia and spotting over the same period. She is G2P2 and has no other significant gynecologic history. Physical examination reveals pain with palpation over her entire abdomen; her skin is warm and dry. HR = 84, BP = 124/76, RR = 12, SpO2 = 99%. Which of the following is the most likely diagnosis for this patient? a. Uterine fibroids b. Endometriosis c. Primary dysmenorrhea d. Polycystic ovary disease

b.Endometriosis

Mushrooms and yeasts are examples of: a. Parasites b. Fungi c. Helminthes d. Protozoa

b.Fungi

Which of the following best explains the process of osmotic diuresis associated with hyperglycemia? a. Glucose in the urine lowers osmotic pressure inside the kidney tubule, preventing water reabsorption. b. Glucose in the urine raises osmotic pressure inside the kidney tubule, drawing water into the tubule. c. Decreased insulin levels result in decreased ADH secretion. d. Elevated blood glucose levels result in increased ADH secretion.

b.Glucose in the urine raises osmotic pressure inside the kidney tubule, drawing water into the tubule.

Which of the following is a form of arthritis that occurs from uric acid crystals being deposited in a joint? a. Bursitis b. Gout c. Osteopenia d. Rickets

b.Gout

Which of the following statements regarding hemophilia is most accurate? a. Hemophilia is a hereditary abnormality of the platelets. b. Hemophilia is a hereditary lack of certain proteins needed in the clotting cascade. c. Hemophilia is a hereditary disease that causes fibrin clots to dissolve prematurely. d. Hemophilia is a hereditary disease in which the body is unable to produce vitamin K.

b.Hemophilia is a hereditary lack of certain proteins needed in the clotting cascade.

A chemical substance that is released into the blood by a gland and that controls or affects processes in other glands or body systems is a(n): a. Enzyme b. Hormone c. Leukotriene d. Neurotransmitter

b.Hormone

Upon identifying an antigen in the bloodstream, B cells launch a chemical attack by producing antigens specific to the antibody. This is an example of ________ immunity. a. Secondary b. Humoral c. Antibody d. Cellular

b.Humoral

Which of the following is NOT an organic cause of a behavioral emergency? a. Tumor b. Hypoglycemia c. Alcoholic encephalopathy d. Dementia

b.Hypoglycemia

Your patient is a conscious and alert 22-year-old female who was stung by a hornet. She states that she has "allergies to bee stings" and has been told that she could die if stung. Your physical examination reveals a 1-cm-diameter, red, edematous area where she was stung on the left forearm. Her skin is warm and dry, and her lung sounds are clear and equal bilaterally. HR = 112 and regular, BP = 122/82, RR = 12 and regular, SaO2 = 98%. The most appropriate treatment for this patient would include: a. 100 percent oxygen via nonrebreather mask 15 lpm, IV of NS 1-2 L, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV b. IV of NS KVO c. 15 lpm oxygen by nonrebreather, epinephrine 1:1000 0.3 mg SC, diphenhydramine 25 mg IV, transport d. Transport only

b.IV of NS KVO

Which of the following best explains the cause of the histamine and heparin release in response to exposure to an antigen? a. Humoral cells have initiated a chemical attack on the antigens. b. IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation. c. IgG and IgM antibodies have activated basophils and mast cells, resulting in degranulation. d. IgE antibodies have activated the membranes of B and T cells, resulting in release of histamine and heparin.

b.IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation.

Which of the following would you expect to see immediately after the ingestion of a large meal? a. Increase of blood glucagon levels and a decrease of blood glucose levels b. Increase of blood glucose and blood insulin levels c. Decrease of blood glucose levels followed by an increase of blood insulin levels d. Increase of blood glucagon and blood glucose levels

b.Increase of blood glucose and blood insulin levels

Which of the following is associated with pelvic inflammatory disease? a. Cystitis b. Inflammation of the fallopian tubes c. Urethritis d. Nephritis

b.Inflammation of the fallopian tubes

Your patient is a 42-year-old male who is supine on the floor, responsive only to pain. His wife states that he has been extremely depressed recently and talked about suicide yesterday. The patient's skin is hot and dry, pupils are dilated and reactive to light bilaterally, and there is vomit around his mouth. HR = 138 and regular, BP = 82/52, RR = 16 and shallow. Temperature is 105.5°F. The patient has a history of hypothyroidism, for which he takes Synthroid. Your partner suctions the airway and initiates BVM ventilations with 100 percent oxygen and an oropharyngeal airway. In addition to monitoring the cardiac rhythm and starting an IV of normal saline, you should: a. Perform synchronized cardioversion and intubate if the rhythm does not convert b. Intubate the trachea and request orders for propranolol, IV c. Intubate the trachea and request orders for diltiazem d. Administer 25 g of 50 percent dextrose and intubate if the level of responsiveness does not improve

b.Intubate the trachea and request orders for propranolol, IV

Your patient is a 48-year-old female who is supine on the floor of a neighborhood health clinic. She became unconscious after receiving 250 mg of IM doxycycline. Clinic staff reports that the patient "broke out in hives and lost consciousness." The patient is being ventilated by bag-valve mask and has an IV of normal saline running wide open. A nurse practitioner on the scene informs you that, before your arrival, he administered 2 doses of 0.5 mg of epinephrine SC, 50 mg of diphenhydramine IV, and 1 L of NS. HR = 138; BP = 84/60; RR = 12/min, assisted with BVM; SaO2 = 94%. Of the following, which is the most appropriate continued treatment of this patient? a. Intubate, Solu-Medrol IV, 250 cc NS fluid challenge, transport b. Intubate, administration of dopamine IV infusion, rapid transport c. Continue administering fluids and transport to the nearest facility d. Initiate a second IV of NS wide open, intubate and hyperventilate, transport

b.Intubate, administration of dopamine IV infusion, rapid transport

The ________ of the eye works similarly to the shutter of a camera. a. Lens b. Iris c. Eyelid d. Cornea

b.Iris

The pathophysiology of toxic inhalation involves: a. Bronchodilation and destruction of cilia b. Irritation, edema, and destruction of alveolar tissue c. Pulmonary hypertension, alveolar atelectasis, and destruction of cilia d. Bronchoconstriction and dispersal of surfactant

b.Irritation, edema, and destruction of alveolar tissue

What is the underlying mechanism that causes pain in the patient with sickle cell crisis? a. Hypoglycemia b. Ischemia c. Hyperthyroidism d. Hypercapnia

b.Ischemia

If fertilization of an ovum occurs, which phases of the current menstrual cycle do NOT occur? a. Secretory and ischemic b. Ischemic and menstrual c. Secretory and menstrual d. Proliferative and menstrual

b.Ischemic and menstrual

Which of the following statements about Neisseria meningitidis is TRUE? a. The vaccine is recommended for health care workers. b. It is the bacteria that most often causes serious cases of meningitis. c. It is responsible for 90 percent of patients with a viral meningitis. d. Signs and symptoms of infection can take weeks to develop.

b.It is the bacteria that most often causes serious cases of meningitis.

Which of the following statements about Streptococcus pneumoniae is TRUE? a. Vaccines are ineffective against Streptococcus pneumoniae. b. It is the most common cause of pneumonia in adults. c. It is the leading cause of meningitis in children. d. It is an infrequent cause of otitis media in children.

b.It is the most common cause of pneumonia in adults.

Which of the following statements about Haemophilus influenzae type B is TRUE? a. It is the leading cause of conjunctivitis in adults. b. It was once the leading cause of meningitis in children aged six months to three years. c. Vaccines are ineffective against Haemophilus influenzae type B. d. It is a Gram-positive rod.

b.It was once the leading cause of meningitis in children aged six months to three years.

Esophageal varices are most associated with: a. Kidney disease b. Liver disease c. Gastroesophageal reflux disease d. Pancreatitis

b.Liver disease

You are pruning a rosebush and puncture the skin on your thumb with a thorn. The next day you note that the area is swollen. Which of the following best explains the swelling that has occurred? a. Humoral immunity activation results in localized tissue damage and edema of the tissue surrounding the injury site. b. Localized vasodilation and increased capillary permeability results in plasma leakage into the tissue surrounding the injury site. c. Cell-mediated immunity activation results in chemotaxis and increased capillary permeability. d. There is an infection, resulting in edema to the surrounding tissue.

b.Localized vasodilation and increased capillary permeability results in plasma leakage into the tissue surrounding the injury site

Your patient is a 45-year-old male who has been suffering from hypocalcemia since surgery to remove his thyroid gland six weeks ago. Of the following, which is most likely the cause of the patient's hypocalcemia? a. Increased function of residual thyroid tissue b. Loss of parathyroid gland function c. Loss of thyroid gland function d. Increase in parathyroid gland function

b.Loss of parathyroid gland function

Which of the following statements about immunity is TRUE? a. T cells mature in the bone marrow. b. Lymphocytes are the primary cells involved in the immune response. c. Humoral immunity uses cytotoxic chemicals to destroy pathogens. d. Cell-mediated immunity uses antibody formation to combat pathogens.

b.Lymphocytes are the primary cells involved in the immune response.

Which of the following medication combinations is beneficial for a lithium overdose? a. Narcan and sodium bicarbonate b. Mannitol and sodium bicarbonate c. Flumazenil and naloxone d. Haloperidol and furosemide

b.Mannitol and sodium bicarbonat

Which of the following statements about hepatitis A is TRUE? a. Hepatitis A is transmitted through direct contact with blood and body fluids. b. Many patients are asymptomatic with hepatitis A infection. c. Transmission via needle stick injury is common. d. The incubation period for hepatitis A is three to five days.

b.Many patients are asymptomatic with hepatitis A infection.

A 32-year-old female is conscious and alert at a group home for recovering alcoholics and states, "I'm having rum fits." Counselors from the home tell you that she is a chronic alcoholic who entered their program three days ago and has not had a drink since. Physical examination reveals cool, diaphoretic skin; dilated pupils bilaterally that are responsive to light; and obvious anxiety. HR = 122, BP = 156/104, RR = 20, SaO2 = 99%, blood glucose = 62 mg/dL. Based on the clinical exam findings, all of the following should be part of your patient management EXCEPT: a. 25 g of D50 IV b. Metoprolol IV c. IV of NS d. Thiamine 100 mg IM

b.Metoprolol IV

A chronic disease of the inner ear marked by a recurring syndrome of vertigo, tinnitus, and progressive hearing loss is called ________. a. Cholesteatoma b. Ménière's disease c. Otosclerosis d. Mastoiditis

b.Ménière's disease

Your patient is complaining about severe pain from a minor scratch on his arm. His medical history includes type II diabetes and hypertension. He is agonizing over the pain in his arm. You should suspect: a. Gangrene b. Necrotizing fasciitis c. Infectious cellulitis d. Ankylosing spondylosis

b.Necrotizing fasciitis

Fifty percent dextrose solution is placed on side A of a membrane, and 25 percent dextrose is placed on side B of a membrane. Assuming the membrane is permeable to water, but not solutes, what will happen? a. Water may move freely in both directions, but there will be no net movement of water. b. Net movement of water from side B to side A will occur. c. Net movement of water from side A to side B will occur. d. Water will not move in either direction.

b.Net movement of water from side B to side A will occur.

In an emergency situation if you administer blood to a patient whose blood type is unknown, you should administer type ________ blood. a. O positive b. O negative c. AB positive d. AB negative

b.O negative

A male will express hemophilia if he acquires ________ chromosome(s). a. Defective X and Y b. One defective X c. Two defective X d. One defective Y

b.One defective X

Which of the following does NOT typically enter the body through injection? a. Medication overdose b. Organophosphate c. Envenomation d. Illicit drug overdose

b.Organophosphate

Murphy's sign is: a. Bruising around the umbilicus b. Pain produced by pressing under the right costal margin in the presence of an inflamed gallbladder c. Pain produced by pushing 1 to 2 inches above the iliac crest on a line to the umbilicus d. Petechial hemorrhage of the abdominal wall

b.Pain produced by pressing under the right costal margin in the presence of an inflamed gallbladder

Your patient is a 40-year-old male. As a child he would have been LEAST likely to have suffered from: a. RSV b. Pertussis c. Measles d. Mumps

b.Pertussis

Your patient is a 20-year-old female college student who lives in a dormitory. She complains of weakness, fever, chills, nausea, a rash on her chest, and neck pain. Physical examination reveals warm, moist skin; pain with flexion of her neck; and a petechial rash on her chest. HR = 92, BP = 108/68, RR = 14, SaO2 = 99%. Which of the following is most appropriate? a. Place an N-95 respirator on the patient, transport BLS, notify the hospital before arrival b. Place a face mask on your patient and yourself, transport BLS, notify the hospital before arrival c. Administer oxygen by nonrebreather, BLS, and transport d. Administer O2 via nonrebreather mask, cardiac monitor, IV of normal saline, and transport

b.Place a face mask on your patient and yourself, transport BLS, notify the hospital before arrival

Which of the following most accurately describes the rationale for monitoring the cardiac rhythm in the hyperglycemic patient? a. The increased viscosity of the blood makes myocardial ischemia very likely. b. Polyuria can lead to electrolyte disturbances, resulting in cardiac dysrhythmias. c. Hyperglycemia causes ventricular irritability and increases the risk of ventricular fibrillation. d. All ALS patients must be monitored.

b.Polyuria can lead to electrolyte disturbances, resulting in cardiac dysrhythmias.

Bleeding in the gastrointestinal tract proximal to the ligament of Treitz is considered to be in the: a. Small intestine b. Lower GI tract c. Upper GI tract d. Colon

b.Portal vein hypertension and esophageal varices

Acute exacerbation of Addison's disease can lead to ECG changes and cardiovascular collapse as a result of electrolyte imbalance secondary to: a. Increased mineralocorticoid secretion from the adrenal glands b. Potassium retention and sodium excretion c. Fluid retention, potassium excretion, and sodium retention d. Decreased mineralocorticoid secretion with increased sodium and potassium excretion

b.Potassium retention and sodium excretion

Endogenous fibrinolysis occurs as result of the: a. Administration of heparin b. Production of plasmin c. Conversion of plasmin to plasminogen d. Administration of tissue plasminogen activator

b.Production of plasmin

From which of the following incidents would infection with Clostridium tetani be most likely? a. Eating improperly prepared, home-canned food b. Receiving a puncture wound to the foot c. Drinking contaminated well water d. Being bitten by an infected animal

b.Receiving a puncture wound to the foot

The more acidic the blood is, the more readily hemoglobin: a. Binds carbon dioxide b. Releases oxygen c. Releases carbon dioxide d. Binds oxygen

b.Releases oxygen

Clostridium botulinum has its effect primarily by: a. Altering cellular structure to create syncytia b. Releasing a toxin that results in muscular paralysis c. Creating gas through the fermentation of carbohydrates in muscle tissue d. Causing septicemia

b.Releasing a toxin that results in muscular paralysis

A patient with sickle cell disease is being transported to the hospital. What would be the preferred patient position on the wheeled cot, as long as no other contraindications exist? a. High Fowler's b. Semi-Fowler's c. Low Fowler's d. Supine

b.Semi-Fowler's

The initial exposure of an individual to an antigen is referred to as what? a. Allergy b. Sensitization c. Hypersensitivity d. Active immunity

b.Sensitization

Which of the following is the most common chief complaint related to acute pancreatitis? a. Headache b. Severe pain c. Blood in the stool d. Diarrhea

b.Severe pain

Which of the following statements about sickle cell disease is FALSE? a. Patients with chronic sickle cell disease have chronic hemolytic anemia. b. Sickled red blood cells have longer life spans than normal red blood cells. c. Sickle hemoglobin has a flawed chemical structure that results in erythrocyte deformity when oxygen levels are low. d. Splenomegaly is a common problem of sickle cell disease.

b.Sickled red blood cells have longer life spans than normal red blood cells.

Your patient is a 27-year-old female who is distraught and crying after having her children taken by child protective services. Her sister called EMS because the patient threatened to cut her wrists. On your arrival you find that she has not attempted to harm herself and has no weapons within reach. However, she does not wish to speak with you. Which of the following actions is most likely to be effective when communicating with this patient? a. Maintain a distance of 3 to 5 feet from the patient. b. Sit down so that you are at eye level with the patient. c. Tell the patient that you cannot help her unless she talks to you. d. Tell the patient that you want to help her, but you can't unless she calms down.

b.Sit down so that you are at eye level with the patient.

The primary goal in the prehospital care of a patient who has been bitten by a pit viper is to: a. Induce diuresis b. Slow absorption of the venom c. Alkalinize the urine d. Remove the venom from the surrounding tissue

b.Slow absorption of the venom

Which of the following findings is most suggestive of cystitis? a. Abdominal distension b. Suprapubic tenderness to palpation c. Flank pain radiating to the groin d. Diffuse, periumbilical abdominal pain

b.Suprapubic tenderness to palpation

Your patient is a 22-year-old male complaining of a two-day history of a sore throat. He denies difficulty breathing, nausea, vomiting, or chest pain. He has no medical history and takes no medications. HR = 72, BP = 120/78, RR = 12, SaO2 = 99%. Physical examination reveals cool, dry skin. Which of the following findings would be most likely? a. Rhonchi upon auscultation of the lungs b. Swelling of the cervical lymph nodes c. Generalized erythema d. Positive Murphy's sign

b.Swelling of the cervical lymph nodes

Humoral and cell-mediated immunity differ in that cell-mediated immunity uses: a. B cells, which generate effector cells to combat such invaders as intracellular organisms, while cellular immunity uses T cells that reside in lymph tissue and produce antibodies to combat foreign invaders b. T cells, which generate effector cells to combat such invaders as intracellular organisms, while humoral immunity uses B cells that reside in lymph tissue and produce antibodies to combat foreign invaders c. B cells, which generate effector cells to combat such invaders as intracellular organisms, while humoral immunity uses T cells that reside in lymph tissue and produce antibodies to combat foreign invaders d. T cells, which reside in lymph tissue and produce antibodies to combat foreign invaders, while humoral immunity uses B cells that generate effector cells to combat such invaders as intracellular organisms

b.T cells, which generate effector cells to combat such invaders as intracellular organisms, while humoral immunity uses B cells that reside in lymph tissue and produce antibodies to combat foreign invaders

A patient complaining of eye pain informs you that he was diagnosed with a corneal abrasion three days ago. He called 911 today because the discomfort has not yet gone away and he desires medical attention. Based on this information, which of the following is true? a. Fluid is leaking from the posterior chamber. b. The clear structure that covers the pupil has been damaged. c. The sclera must be infected. d. The lens of the eye has been abraded.

b.The clear structure that covers the pupil has been damaged.

An example of a direct injury that may be sustained by a behavioral patient who has been tasered would be: a. The muscle contractions that occur as a result of the electrical impulse b. The damage caused by the impact of the electrical probe c. The ignition of the combustible gases that are present after firing the Taser d. The resultant blunt force trauma caused by the fall that ensues after the electrical impulse

b.The damage caused by the impact of the electrical probe

In order for hemodialysis to be effective in ridding the body of excess electrolytes, which of the following statements must be true? a. The dialysate must contain electrolytes in the same concentration as in the patient's blood. b. The dialysate must contain electrolytes in a concentration lower than in the patient's blood. c. The dialysate must contain electrolytes in a concentration higher than in the patient's blood. d. The dialysate must not contain electrolytes.

b.The dialysate must contain electrolytes in a concentration lower than in the patient's blood.

Which of the following best describes the relationship between the hypothalamus and the endocrine system? a. The hypothalamus produces all of the releasing hormones that act on other endocrine organs. b. The hypothalamus is the link between the CNS and the endocrine system. c. The hypothalamus regulates most endocrine activities via positive feedback mechanisms. d. The hypothalamus is also known as the posterior pituitary gland.

b.The hypothalamus is the link between the CNS and the endocrine system.

Which of the following is the desired physiologic reaction that occurs after the administration of a vaccine that contains live, attenuated viruses? a. The antibodies in the vaccine multiply in the body. b. The immune system will create specific antibodies to the viruses in the vaccine. c. The immune system will create specific antigens to the viruses in the vaccine. d. The viruses in the vaccine act as an antigen, resulting in a nonspecific immune response.

b.The immune system will create specific antibodies to the viruses in the vaccine.

Your patient is a 32-year-old female who is depressed and tearful after a fight with her ex-husband. Which of the following would NOT increase the risk of or indicate an increased risk of the patient committing suicide? a. The patient has access to a method of suicide. b. The paramedic is using direct questioning about suicidal intentions. c. The patient has called her sister to come and get her dog. d. The patient has had three glasses of wine since the fight.

b.The paramedic is using direct questioning about suicidal intentions.

An emergency department physician tells you that the hyperglycemic diabetic you brought in earlier has a pH of 7.40. What is the likeliest explanation of this statement? a. The patient is a type II diabetic who was no longer secreting enough insulin to prevent the use of fats for energy. b. The patient is a type II diabetic who was secreting enough insulin to prevent the use of fats for energy. c. The patient is a type I diabetic who did not take his insulin and is therefore unable to use glucose for energy. d. The patient is a type I diabetic who took his insulin and did not eat, resulting in the breakdown of proteins for energy.

b.The patient is a type II diabetic who was secreting enough insulin to prevent the use of fats for energy.

Which of the following patients is most likely to be considered competent to refuse transport? a. A 33-year-old female who is alert and oriented but who made a nonlethal suicide attempt by taking ten diphenhydramine tablets b. A 44-year-old female who was found unclothed and fishing in a fountain at the mall c. A 20-year-old male who is alert and oriented and in no distress but who states he stopped taking his lithium because of the undesirable side effects d. A possibly intoxicated 24-year-old male who threatened to break his wife's neck if she tried to leave the house

b.The patient requires medical treatment.

A male patient presents with a puncture wound to his heel from stepping on a nail. He informs you that he is visiting from El Salvador and has never received a tetanus vaccination. At the emergency room he is administered tetanus immune globulin, as well as a tetanus vaccination. Which of the following best describes the rationale for this treatment? a. The tetanus immune globulin provides immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies. b. The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity. c. The tetanus immune globulin provides IgE antibodies for immediate protection, while the tetanus vaccination provides natural immunity by producing tetanus-specific antibodies. d. The tetanus immune globulin provides IgG and IgM antibodies for immediate protection, while the tetanus vaccination provides passive immunity by producing tetanus-specific antibodies.

b.The tetanus immune globulin provides passive immunity, while the tetanus vaccination provides active immunity.

Which of the following statements about rubella and the rubella virus is FALSE? a. EMS providers should receive an MMR vaccination. b. The virus is spread via contact with infected blood and body fluids. c. Immunization via the MMR vaccination is 98 to 99 percent effective. d. Infection in the first trimester of pregnancy increases the risk of birth defects.

b.The virus is spread via contact with infected blood and body fluids.

Which of the following is TRUE of the Fallopian tubes? a. This is the normal site of implantation of the blastocyst. b. This is the normal site of fertilization of the ovum. c. They secrete follicle-stimulating hormone and luteinizing hormone. d. They are strong suspensory ligaments that hold the uterus in place.

b.This is the normal site of fertilization of the ovum.

The need to progressively increase the dose of a drug to reproduce the effect originally achieved at smaller doses is: a. Addiction b. Tolerance c. Substance abuse d. Habituation

b.Tolerance

Which of the following is NOT appropriate in the care of a victim of a sexual assault? a. Approach the patient calmly, in a professional manner. b. Touch the patient's shoulder or pat her on the leg often to reassure her. c. Explain all procedures and ask for permission before beginning them. d. Be especially attentive to the victim's modesty.

b.Touch the patient's shoulder or pat her on the leg often to reassure her.

While palpating the lower abdomen of a 63-year-old male complaining of back pain, you note a pulsating mass. You should: a. Ask the patient to take a deep breath, then palpate the mass while he exhales b. Ask your partner to confirm the finding c. Determine if the mass is fixed or freely mobile in the abdomen d. Stop palpating

b.Transporting the patient in a position of comfort and giving reassurance

A 44-year-old male staying in a homeless shelter is alert and complaining of shortness of breath. He has a two-week history of cough with hemoptysis, fever, chills, and night sweats. Physical examination reveals skin to be warm and moist and lung sounds decreased in the right upper lobe with rhonchi. HR = 100, BP = 142/100, RR = 20, SaO2=95%. You should assume this patient has a high likelihood of having: a. Hantavirus pulmonary syndrome b. Tuberculosis c. Pneumonia d. RSV

b.Tuberculosis

Your patient is a 56-year-old female who is alert and sitting in a chair. She states that she accidentally took too many of her Cardizem tablets. Which of the following signs or symptoms would you LEAST expect to find? a. Cool, dry skin and mild hypotension b. Warm, dry skin and tachycardia c. Cool, diaphoretic skin and profound hypotension d. Bradycardia and altered mental status

b.Warm, dry skin and tachycardia

Which sign associated with an allergic reaction should concern a caregiver the most? a. Urticaria b. Wheezing c. Warm, flushed skin d. GI distress

b.Wheezing

After receiving the hepatitis B vaccine, the blood of a paramedic reveals no circulating antibodies for the disease. Which of the following phases would the paramedic most likely be in regarding the immunization? a. Latent b. Window c. Incubation d. Seroconversion

b.Window

While on a call you receive a laceration to your thigh from a jagged piece of metal. Which of the following is the correct recommendation for tetanus prophylaxis? a. You must receive a tetanus booster annually to be protected from tetanus. b. You should receive a tetanus booster if you have not had one in the past ten years. c. If you are over the age of 60, you should receive tetanus immune globulin but not a tetanus booster. d. If you received the entire series of tetanus immunizations as a child, you do not need a tetanus booster.

b.You should receive a tetanus booster if you have not had one in the past ten years.

Ovulation occurs: a. when the corpus luteum ruptures. b. as a result of an LH surge around day 14 of the menstrual cycle. c. secondary to a decrease in FSH and estrogen. d. when the corpus albicans ruptures.

b.as a result of an LH surge around day 14 of the menstrual cycle.

Cyclical bleeding occurs with endometriosis because the ectopic endometrial tissue responds to: a. increased FSH and LH levels. b. decreased estrogen and progesterone levels. c. decreased FSH and LH levels. d. increased estrogen and progesterone levels.

b.decreased estrogen and progesterone levels.

The muscular organ that contains the fetus, placenta, amniotic fluid, and associated structures during pregnancy is the: a. endometrium b. uterus c. rectovaginal pouch. d. oviduct.

b.uterus

Your patient states she thinks she has a UTI. Which of the following questions will provide you with useful information about the patient's problem? a. "Do you have a history of kidney stones?" b. "Are you sexually active?" c. "Is it painful when you urinate?" d. "Are you having any vaginal discharge?"

c."Is it painful when you urinate?"

Your patient is a 34-year-old male who had just finished dialysis at an outpatient dialysis center when he became unresponsive. The patient has a very weak radial pulse; cool, diaphoretic skin; and clear and equal lung sounds. HR = 112, BP = 78/44, RR = 8 and shallow, SaO2 = 90%, blood glucose = 60 mg/dL. In addition to cardiac monitoring, managing the airway, and starting an IV of normal saline, which of the following is indicated? a. 250 mL fluid challenge b. 50 percent dextrose c. 250 mL fluid challenge, 50 percent dextrose d. 2 g magnesium sulfate

c.250 mL fluid challenge, 50 percent dextrose

Which of the following patients is most likely to be considered competent to refuse transport? a. A 33-year-old female who is alert and oriented but who made a nonlethal suicide attempt by taking ten diphenhydramine tablets b. A 44-year-old female who was found unclothed and fishing in a fountain at the mall c. A 20-year-old male who is alert and oriented and in no distress but who states he stopped taking his lithium because of the undesirable side effects d. A possibly intoxicated 24-year-old male who threatened to break his wife's neck if she tried to leave the house

c.A 20-year-old male who is alert and oriented and in no distress but who states he stopped taking his lithium because of the undesirable side effects

Your patient is a 32-year-old female who is alert and sitting at her kitchen table complaining of dizziness and near-syncope with exertion. She describes a four-day history of a 104°F fever, nausea, vomiting, and diarrhea unrelieved with over-the-counter medications. Physical examination reveals dry skin and mucous membranes, lung sounds clear and equal bilaterally. HR = 131 and regular, BP = 84/60, RR = 20 and regular, SaO2 = 98%, blood glucose = 58 mg/dL. She has a history of colitis, for which she often takes prednisone, but she has been noncompliant with her prednisone therapy for the past five days because she cannot afford to refill her prescription. The treatment for this patient should include: a. A one-liter NS bolus IV b. An IV of NS, KVO, 25 g dextrose IV, and 100 mg thiamine IV c. A one-liter NS bolus, IV, and 25 g dextrose IV d. 15 lpm oxygen by nonrebreather, IV of NS, KVO, 25 g dextrose

c.A one-liter NS bolus, IV, and 25 g dextrose IV

Your patient is a 24-year-old male complaining of a one-week history of abdominal pain. He describes the pain as in the upper right quadrant, dull and reproducible with movement and palpation. He also describes a decreased appetite, weight loss, and clay-colored stool over the same period. Of the following, which is the most likely cause of his clinical condition? a. Colitis b. Cholecystitis c. Acute hepatitis d. Pancreatitis

c.Acute hepatitis

Which of the following would suggest that a patient's abdominal pain was secondary to mittelschmerz? a. Purulent vaginal discharge b. History of sexual intercourse without contraception c. Acute onset of pain 14 days after the onset of her last menstrual period d. Moderate vaginal bleeding of bright red blood

c.Acute onset of pain 14 days after the onset of her last menstrual period

A compulsive and overwhelming dependence on a chemical substance is: a. Substance abuse b. Withdrawal c. Addiction d. Habituation

c.Addiction

You are presented with a 25-year-old male complaining of mouth and stomach pain after accidentally ingesting approximately 8 ounces of benzene. Physical examination reveals irritation to the oral mucosa, skin warm and slightly diaphoretic, and lungs clear and equal bilaterally. HR = 100, BP = 118/66, RR = 14, SaO2 = 99%. Based on the clinical exam findings, treatment would consist of all of the following EXCEPT: a. O2 via nasal cannula 2 lpm b. Rapid transportation to an ED for gastric decontamination c. Administration of activated charcoal d. IV of NS KVO

c.Administration of activated charcoal

Which of the following is described as the visible indication of mood? a. Mental status b. Behavior c. Affect d. Level of consciousness

c.Affect

What ethnicity is most likely to suffer from sickle cell disease? a. Native American b. Asian c. African American d. Mediterranean Italian

c.African American

All of the following are common complications of renal dialysis EXCEPT: a. Bleeding from the needle puncture site b. Dysfunction of the fistula c. Air embolism d. Localized infection at the needle puncture site

c.Air embolism

Osgood-Schlatter disease is a painful swelling of the ____________________, seen primarily in children. a. Medial humeral epicondyle b. Femoral synovial bursae c. Anterior tibial tubercle d. Carpal tunnel sheath

c.Anterior tibial tubercle

Which of the following best describes a state of uneasiness, discomfort, apprehension, or restlessness? a. Depression b. Paranoia c. Anxiety d. Mania

c.Anxiety

Pain at McBurney's point is associated with: a. Cholecystitis b. Kidney stones c. Appendicitis d. Pancreatitis

c.Appendicitis

A 40-year-old female presents with hemorrhage from her dialysis graft. She states that she just got back from dialysis when the bleeding started. There is a significant amount of blood on the chair and floor. To control the bleeding, you would immediately: a. Place a tourniquet proximal to the graft b. Place a tourniquet distal to the graft c. Apply direct pressure over the graft d. Apply ice to the area and elevate the extremity

c.Apply direct pressure over the graft

Which of the following statements about hyperglycemic hyperosmolar nonketotic coma (HHNK) is true? a. Unlike diabetic ketoacidosis, HHNK is not life-threatening. b. Prehospital treatment of HHNK includes correcting metabolic acidosis. c. Aside from managing the ABCs, prehospital management is primarily aimed at correcting dehydration. d. Paradoxically, the definitive management of HHNK includes the administration of 50 percent dextrose.

c.Aside from managing the ABCs, prehospital management is primarily aimed at correcting dehydration.

Which of the following is MOST likely to effectively gain the cooperation of a psychologically disturbed patient for physical examinations? a. Telling the patient you cannot help him unless you do a thorough physical examination b. Standing closer to and using more physical contact with the patient than usual c. Asking the patient's permission to examine him d. Telling the patient you must examine him

c.Asking the patient's permission to examine him

Your patient is a 48-year-old female who is unconscious with snoring respirations after ingesting an unknown substance. You note cold, peripherally cyanotic skin and a weak, rapid pulse. Her pupils are equal and reactive but constricted. She has no unusual odors, and her blood glucose level is 80 mg/dl. HR = 74, BP = 100/68, RR = 4, SaO2 = 91%. Which of the following is appropriate? a. Intubate, ventilate using supplemental oxygen, IV, 1 mEq/kg sodium bicarbonate b. Intubate, ventilate using supplemental oxygen, IV, 2 mg naloxone, 100 mg thiamine, 25 gm dextrose c. Assist ventilations using supplemental oxygen, IV, 2 mg naloxone d. Assist ventilations using supplemental oxygen, IV, 2 mg naloxone, 100 mg thiamine, 25 gm dextrose

c.Assist ventilations using supplemental oxygen, IV, 2 mg naloxone

You are presented with a 42-year-old male who is unconscious with snoring respirations after a heroin overdose. HR = 64, BP = 98/50, RR = 6 and shallow, SaO2 = 91%. Which of the following is the most appropriate initial treatment? a. Intubate, ventilate with supplemental oxygen b. IV access, administer a 250 cc fluid bolus c. BLS airway management and ventilation with supplemental oxygen d. IV access, administer naloxone

c.BLS airway management and ventilation with supplemental oxygen

Your patient is a 38-year-old female with a history of Crohn's disease. She is conscious and alert and complaining of abdominal pain. She describes a one-week history of increasingly diffuse, crampy abdominal pain. She also states that she has had nausea and vomiting, fever, and diarrhea the past two days. Physical examination reveals that her skin is warm and dry and that her abdomen is tender to palpation in all quadrants with no masses or distension noted. HR = 100, BP = 118/78, RR = 14, SaO2 = 99%. Which of the following treatments is appropriate in the prehospital management of this patient? a. Diphenydramine b. Ketorolac (Toradol) c. Methylprednisolone d. None of the above

c.Bowel obstruction

You have been called to a residence by the parents of a 14-year-old boy, whom they found sniffing paint fumes in an effort to get high. The patient is agitated, coughing, and complaining of dizziness and shortness of breath. His airway is patent, respirations adequate, and radial pulse easily palpable. Closer assessment of the patient reveals paint around his mouth and breath sounds that are clear and equal. Heart rate = 96, respirations = 20, blood pressure = 116/78, and SaO2 = 96%. Oxygen via a nonrebreather has been applied and an IV established. Which of the following is the most important in the assessment and care of this patient? a. Benzodiazepines b. Antipyretics c. Cardiac monitoring d. Albuterol administration

c.Cardiac monitoring

Your patient has ingested cyanide in a suicide attempt. Which of the following is the primary threat to life you should anticipate? a. Hypotension b. Pulmonary edema c. Cellular asphyxia d. Liver failure

c.Cellular asphyxia

Immunity resulting from a direct attack on a foreign substance by specialized cells in the immune system is: a. Primary immunity b. Humoral immunity c. Cellular immunity d. Secondary response

c.Cellular immunity

Which of the following is not a bone of the middle ear? a. Malleus b. Stapes c. Cochlea d. Incus

c.Cochlea

Health care workers can best avoid hepatitis B infection by: a. Using standard precautions for all patients b. Using an alcohol-based hand sanitizer after each patient contact c. Completing the hepatitis B vaccine series d. Receiving gamma globulin in the event of an exposure

c.Completing the hepatitis B vaccine series

Hepatitis E is often associated with: a. HIV infection b. Tuberculosis infection c. Contaminated drinking water d. HBV infection

c.Contaminated drinking water

Prehospital treatment for a hemophiliac patient who is bleeding is to: a. Contact online medical control for factor VIII infusion b. Provide aggressive IV therapy with isotonic crystalloids c. Control bleeding with direct pressure d. Administer IV colloid solutions

c.Control bleeding with direct pressure

Which of the following statements about corticosteroid use in anaphylaxis treatment is TRUE? a. Administration of high-dose corticosteroids results in peripheral vasoconstriction. b. Corticosteroids stabilize mast cell and basophil membranes, preventing degranulation and histamine release. c. Corticosteroids can reduce the inflammation associated with anaphylaxis. d. Corticosteroids can help reverse bronchospasm associated with anaphylaxis.

c.Corticosteroids can reduce the inflammation associated with anaphylaxis.

Which of the following explains the profound protein catabolism and gluconeogenesis associated with Cushing's syndrome? a. Cushing's syndrome affects normal fat deposition. b. Glucocorticoids cause sodium retention and increased blood volume. c. Cortisol is an antagonist to insulin. d. Increased epinephrine and norepinephrine release result in hypermetabolism.

c.Cortisol is an antagonist to insulin.

Which of the following pathologies would necessitate the use of increased care in the preparation of an IV site because of skin fragility and increased risk of infection? a. Addison's disease b. Graves' disease c. Cushing's syndrome d. Myxedema

c.Cushing's syndrome

Your patient is a 34-year-old female in no apparent distress, complaining of dysuria. She describes a four-day history of dysuria, urinary frequency, and hematuria. She is sexually active with one partner, last menstrual period ten days ago, and G3P3. Physical examination reveals warm, dry skin and pain with palpation above the pubis. HR = 96, BP = 124/68, RR = 12, temp = 99.9°F. Which of the following is the most likely diagnosis for this patient? a. Pyelonephritis b. Pelvic inflammatory disease c. Cystitis d. Endometriosis

c.Cystitis

Your patient is a 23-year-old female who is 6 hours postpartum after a traumatic delivery resulting in a massive blood transfusion. She is to be transferred from a community hospital to a specialty hospital for further care. She is unconscious and intubated, with a number of intravenous lines. Your physical examination reveals a purpuric rash over the chest and abdomen and mottling of the fingers and toes and all of the venous access sites are oozing blood. In addition, auscultation of the lung fields reveals rales to the dependent regions. HR = 112, BP = 82/60, RR = 12 via ventilator. Which of the following best describes the patient's condition and treatment needs, in addition to continued ventilation and fluid administration? a. DIC; type O negative blood b. Idiopathic hemophilia; corticosteriods c. DIC; fresh frozen plasma and platelet administration d. Idiopathic hemophilia; factor VIIa administration

c.DIC; fresh frozen plasma and platelet administration

A 76-year-old patient with acute interstitial nephritis presents with oliguria, altered mental status, and edema to his face, hands, and feet. Of the following, which best describes the pathophysiology behind these clinical findings? a. Increased GFR results in retention of water, electrolytes, and metabolic waste. b. Na+ and K+ excretion results in diuresis and dehydration. c. Decreased GFR results in retention of water, electrolytes, and metabolic waste. d. H+ excretion results in diuresis and alkalosis.

c.Decreased GFR results in retention of water, electrolytes, and metabolic waste.

Your patient is a 32-year-old female who is alert and complaining of dysuria. She describes a three-day history of pain with urination and urinary urgency and difficulty. She describes the pain as a 5 on a scale of 0 to 10. Physical examination reveals tenderness on palpation of the lower abdomen bilaterally and warm, dry skin. HR = 88, BP = 126/78, RR = 12. The most appropriate action is: a. Oxygen, IV fluids, morphine b. BLS transport in position of comfort c. Oxygen, IV fluids d. IV fluids, morphine

c.Decreased GFR results in retention of water, electrolytes, and metabolic waste.

A patient with gangrene will have infection that causes swelling of the tissues. What can result as a consequence of the gangrene? a. Decubitus ulcers. b. Necrotizing fasciitis c. Decreased capillary perfusion d. Metabolic acidosis

c.Decreased capillary perfusion

Alcohol is classified as a(n): a. Stimulant b. Anxiolytic c. Depressant d. Hallucinogen

c.Depressan

On-scene you are presented with a confused patient suffering from altered mental status. Additionally, in front of the family, the patient is very irritable and verbally abusive toward all present, including EMS. His wife states that his "kidneys are no good" and he also has "sugar" problems. Your assessment indicates that he is dyspneic with pale skin that is covered with a fine white sediment. His radial pulse is weak, rapid, and irregular. Additionally, you note edema to his hands, feet, and face. Crackles are noted to the lungs bilaterally and he has a dialysis graft on his right forearm. Your partner reports that his heart rate is 164, respirations 26, blood pressure 176/90, and SpO2 89%. After applying high-concentration oxygen, which of the following would you perform next? a. Administer furosemide, 120 mg b. Infuse a 1000 mL bolus of NS c. Determine the blood glucose level d. Administer sodium bicarbonate, 50 mEq

c.Determine the blood glucose level

Which of the following is commonly indicated in the management of cocaine overdose? a. Thiamine b. Flumazenil c. Diazepam d. Narcan

c.Diazepam

Your patient is a 46-year-old male truck driver who is sitting on a toilet complaining of bleeding with defecation. He states that he had to strain significantly to produce a bowel movement, then noted blood on his stool afterward. He claims no significant medical history, has had no recent illness, and takes no medications. You note the presence of bright red blood on the surface of his stool. Of the following, which is the most likely cause of his clinical condition? a. Crohn's disease b. Colitis c. Upper GI bleed d. Hemorrhoids

c.Dopamine infusion

You are on the scene of an agitated male patient with a history of alcohol abuse. He is threatening to "knock your head off" if you get close to him. While you are getting a history from the patient's wife, she states that, "He had something wrong with his EKG. A long QRS, or something like that." Which of the following should you avoid in the treatment of this patient? a. Lorazepam b. Diazepam c. Droperidol d. Physical restraint

c.Droperidol

Which of the following is LEAST likely to result in hypoglycemia in a type I diabetic patient? a. Increased exercise level b. Taking insulin as usual but missing a meal c. Eating foods high in sugar d. Inadvertently administering too much insulin

c.Eating foods high in sugar

Your patient is a 48-year-old female with advanced hepatitis secondary to drug and alcohol abuse. She is confused and is noncompliant with her medications. Which of the following is the most likely cause of her confusion? a. Anemia b. Hyperglycemia c. Elevated ammonia levels d. Hypercoagulative state

c.Elevated ammonia levels

Your patient is a 25-year-old female who is alert and complaining of fever and general malaise. She has had a fever for the past two days, along with bilateral lower quadrant abdominal pain and bloody vaginal discharge. Her last menstrual period was two months ago, G5P2, with an elective abortion two days prior. Physical examination reveals hot, moist skin and pain with palpation to the lower quadrants. HR = 110, BP = 108/64, RR = 14, SpO2 = 97%. Which of the following is the most likely diagnosis for this patient? a. Menorrhagia b. Retained products of conception c. Endometritis d. Cervical dysplasia

c.Endometritis

Your patient has a hormone-secreting tumor of the adrenal medulla. What hormone is most likely to be secreted by this tumor? a. Cortisol b. Dopamine c. Epinephrine d. ACTH

c.Epinephrine

Your patient is a 72-year-old male with a history of cardiovascular disease. He presents with a mild allergic reaction induced by exposure to pet dander. Which of the following medications should you NOT administer to this patient unless absolutely needed? a. Oxygen 15 lpm via nonrebreather mask b. Promethazine c. Epinephrine 1:1000 SC d. Diphenhydramine IV

c.Epinephrine 1:1000 SC

A 46-year-old female alcoholic is hypotensive, in severe distress, complaining of dysphagia, and vomiting bright red blood. Of the following, which is the most likely cause of this patient's clinical condition? a. Hemorrhagic pancreatitis b. Acute gastroenteritis c. Esophageal varices d. Acute gastric ulcer perforation

c.Esophageal varices

When a patient receives a laceration, the clotting process that occurs is primarily mediated by the ________ pathway. a. Platelet b. Common c. Extrinsic d. Intrinsic

c.Extrinsic

Oral candidiasis, commonly called thrush, is a _______ infection of the mouth. a. Bacterial b. Viral c. Fungal d. Protozoan

c.Fungal

Your patient is a 66-year-old female who is conscious and alert, complaining of a one-week history of progressive "lightheadedness" with exertion. She also complains of mild nausea; dark, sticky stools; and pain in her lower abdomen. Which of the following is the most likely cause of this patient's condition? a. Acute cholecystitis b. Diverticulosis c. Gastrointestinal bleeding d. Ingestion of an iron or a bismuth-containing medication

c.Gastrointestinal bleeding

Your patient is a 39-year-old male with a history of alcoholism. He is unresponsive, with cool, clammy skin and a weak, rapid pulse of 108. BP = 128/92, RR = 12 and regular. Your partner manages the airway and assists ventilations, but you are unable to start an IV after three attempts. Which of the following is most appropriate at this point? a. Reattempt the IV while en route b. Dextrose, 25 g, and thiamine, 100 mg, both IM c. Glucagon, 1.0 mg, and thiamine, 100 mg, both IM d. Glucagon 1.0 mg IM

c.Glucagon, 1.0 mg, and thiamine, 100 mg, both IM

Which of the following measures is most important in protecting EMS providers from infectious disease? a. Thorough disinfection of the ambulance after every call b. Tuberculosis vaccination c. Hand washing after all patient contact d. Glove use for all patient contact

c.Hand washing after all patient contact

Mononucleosis presents with all the following signs and symptoms EXCEPT: a. Enlarged and tender lymph nodes b. Fatigue c. Hepatomegaly d. Sore throat

c.Hepatomegaly

Which of the following is NOT a modifiable risk factor for type II diabetes? a. Lack of exercise b. Obesity c. Heredity d. Poor diet

c.Heredity

The first medication administered to a patient experiencing an anaphylactic reaction should be: a. Epinephrine b. Diphenhydramine c. High-concentration oxygen d. Glucagon

c.High-concentration oxygen

Your patient is an 18-year-old female suffering from sickle cell crisis. Which of the following is the best course of treatment for this patient? a. High-flow oxygen, IV NS KVO, diphenhydramine b. High-flow oxygen, IV bolus of NS c. High-flow oxygen, IV bolus of NS, morphine sulfate d. High-flow oxygen, IV NS KVO

c.High-flow oxygen, IV bolus of NS, morphine sulfate

A memory or specific response is considered a (an)________ response. a. Cell-mediated b. Inflammatory c. Humoral d. Immune

c.Humoral

The two most common causes of fatal anaphylaxis are ________ and ________. a. Shellfish, tree nuts b. Hymenoptera stings, tree nuts c. Hymenoptera stings, injected penicillin d. Shellfish, sulfa drugs

c.Hymenoptera stings, injected penicillin

Which of the following is NOT associated with chronic alcohol ingestion? a. Decreased sensation in hands and feet b. Thiamine deficiency c. Hyperactivity d. Esophageal varices

c.Hyperactivity

A couple has been experimenting with Ecstasy. They are both complaining of anxiety, nausea, and palpitations. You would also expect: a. Dyspnea b. Seizures c. Hypertension d. Bradycardia

c.Hypertension

If a patient being treated for hypoparathyroidism stopped taking the medications prescribed for his condition, which of the following would be most likely to occur? a. Hypercalcemia b. Hyperkalemia c. Hypocalcemia d. Hypokalemia

c.Hypocalcemia

A patient undergoes neurological changes during hemodialysis. Of the following, which is the most likely cause of these neurologic abnormalities? a. Acute myocardial infarction b. Hyperglycemia c. Hypotension d. Accumulated blood urea

c.Hypotension

Your patient is a 43-year-old female with a history of peanut allergy. She is complaining of dizziness after eating a casserole that she later discovered contained peanuts. Your physical examination reveals warm, diaphoretic skin; a blotchy, red rash covering her chest and arms; and lung sounds that are clear and equal bilaterally. HR = 122, BP = 124/76, RR = 15 and regular, SaO2 = 97%. In addition to providing oxygen, appropriate treatment for this patient includes: a. IV of NS wide open, epinephrine 1:1000 SC, diphenhydramine IV b. IV of NS KVO c. IV of NS KVO, epinephrine 1:1000 SC, diphenhydramine IV d. IV of NS KVO, epinephrine 1:1000 SC, diphenhydramine IV, nebulized albuterol

c.IV of NS KVO, epinephrine 1:1000 SC, diphenhydramine IV

Your patient is a 34-year-old male who is alert and oriented after an intentional overdose of ten Wellbutrin tablets 30 minutes ago. He denies ingestion of any other drugs or alcohol. Physical examination reveals warm, dry skin; PEARL; and a slight tremor to his hands. HR = 100, BP = 128/84, RR = 14, SaO2 = 99%. Which of the following is most appropriate? a. IV of normal saline, KVO; flumazenil, IV b. IV of normal saline, KVO; sodium bicarbonate 1 mEq/kg, IV c. IV of normal saline, KVO d. IV of normal saline, KVO; activated charcoal, PO or via NG tube

c.IV of normal saline, KVO

Your patient is a 22-year-old male who is alert and in mild discomfort, complaining of left flank pain. The patient describes the pain as diffuse, located at the left flank, and he states that it has been getting increasingly more "crampy" over the past 30 minutes. He describes the pain as a 3 on a scale of 0 to 10. He denies dysuria and hematuria. HR = 88, BP = 116/70, RR = 10. Based on your clinical findings, which of the following is indicated? a. Oxygen b. Morphine c. IV with fluid administration d. Lasix

c.IV with fluid administration

Your patient is taking an immunosuppressant drug to prevent rejection of a transplanted kidney. As a consequence the patient is more prone to: a. Prolonged blood clotting time b. Aplastic anemia c. Infection d. Polycythemia

c.Infection

Your patient is a 31-year-old female complaining of dizziness and difficulty breathing after being stung by a bee. You note that she is extremely anxious, and your physical examination reveals a rapidly developing urticaria to her shoulders, neck, and face. Your partner has administered oxygen via a nonrebreather, initiated IV access, placed the patient on the cardiac monitor, and administered epinephrine SC and diphenhydramine IV. Despite this, you also note that her voice is quickly becoming more hoarse and she has developed expiratory wheezes in all lung fields. HR = 128, BP = 100/70, RR = 20, SaO2 = 99%. What should be your major concern at this point, and what is the most appropriate treatment? a. Hypotension leading to cardiovascular collapse; administer fluids wide open and initiate a dopamine infusion b. Increased bronchospasm leading to respiratory arrest; administer albuterol via nebulizer c. Laryngeal edema leading to total airway occlusion; intubate d. Increased bronchospasm leading to respiratory arrest; administer epinephrine IV

c.Laryngeal edema leading to total airway occlusion; intubate

Which of the following statements about leukocytes is FALSE? a. Leukocytes follow chemical signals to an infection site. b. Leukocytes protect against foreign invaders. c. Leukocytes engulf and destroy foreign invaders via leukopoiesis. d. Leukocytes can travel through blood vessel walls into the surrounding tissues.

c.Leukocytes engulf and destroy foreign invaders via leukopoiesis.

Your patient is a 19-year-old female college student complaining of a low-grade fever, extremely sore throat, tenderness of the cervical lymph nodes, and extreme fatigue. Examination reveals warm, moist, flushed skin. Heart rate = 88, respirations = 12, and blood pressure = 118/78. There is tenderness to palpation of the left upper quadrant of the abdomen. Which of the following is most likely? a. Bacterial meningitis b. Hantavirus pulmonary syndrome c. Mononucleosis d. Fifth disease

c.Mononucleosis

Which of the following statements about mumps is TRUE? a. Mumps are of no concern to the adult patient. b. There is no vaccine for the mumps virus. c. Mumps are characterized by enlargement of the salivary glands. d. Mumps are not highly communicable.

c.Mumps are characterized by enlargement of the salivary glands.

Your patient is a 64-year-old male who is in a rehabilitation facility. He is five days postoperative for repair of a hip fracture. He is complaining of shortness of breath, which has been progressing for the past two days. He has a fever and a cough productive of purulent sputum. Physical examination reveals hot, moist skin and bilateral lower lobe rhonchi. HR = 122, BP = 126/88, RR = 28, SaO2= 92%. Which of the following is most appropriate? a. Albuterol nebulized with oxygen, IV of normal saline b. Oxygen by nonrebreather, IV of normal saline, 40 mg furosemide c. Oxygen by nonrebreather, IV of normal saline d. Oxygen by nonrebreather, BLS transport

c.Oxygen by nonrebreather, IV of normal saline

Your patient is an 88-year-old female whose daughter called because her mother is more confused than usual and unable to care for herself. The patient is alert and pleasant but thinks you are her sister Doris's son and repeats herself frequently. The patient has a history of dementia but no acute complaints. The daughter states that while normally her mother knows who her children are today she does not recognize her. Physical examination is unremarkable. HR = 84, BP = 114/76, RR = 12, SaO2 = 98%, blood glucose = 90 mg/dL. Which of the following is MOST appropriate? a. BLS transport to the emergency department b. Contact social services for nursing home placement c. Oxygen, cardiac monitor, IV d. Oxygen, 12-lead EKG, complete neuron exam, IV

c.Oxygen, cardiac monitor, IV

Your patient is in four-point restraints and starts to spit at you during transport. You should: a. Put a nonrebreather mask on the patient but do not administer oxygen b. Place the patient prone, with his face turned away from you c. Place a surgical mask over the patient's mouth and nose d. Wear a HEPA respirator or an N-95 mask

c.Place a surgical mask over the patient's mouth and nose

To test for Brudzinski's sign you would: a. Have the patient take a deep breath while you palpate under the right costal margin b. Check for periumbilical ecchymosis c. Place the patient in a supine position and flex the neck d. Stroke the bottom of the foot from heel to toe with a pen

c.Place the patient in a supine position and flex the neck

In the presence of calcium, thrombin will encourage: a. Fibrin clot formation b. Prothrombin activation c. Platelet aggregation d. Plasminogen release

c.Platelet aggregation

A patient has accidentally ingested about 4 ounces of drain cleaner. Your primary concern should be: a. Metabolic alkalosis b. Internal bleeding c. Potential airway compromise d. Decreased level of consciousness

c.Potential airway compromise

A 19-year-old female states that she is addicted to Vicodin because it makes her feel good, and she cannot stop taking the pills. She states that she craves them all the time, and when she runs out she does not feel sick but becomes preoccupied with how she can get more. Assessment reveals no abnormalities, and vital signs are within acceptable limits. This patient's condition is most consistent with: a. Physical dependence b. Habituation c. Psychological dependence d. Tolerance

c.Psychological dependence

Light passes to the eye through what opening? a. Iris b. Eyeball c. Pupil d. Lens

c.Pupil

Your patient is a 22-year-old female in mild distress that is complaining of left lower quadrant abdominal pain and nausea. Which of the following questions would be LEAST helpful when determining the etiology of her abdominal pain? a. "When did the pain start?" b. "When did your last menstrual period start?" c. "Are you having any vomiting or diarrhea?" d. "Have you ever had a sexually transmitted disease?"

c.Referred

All of the following are malignant bone tumors except _______________. a. Chondrosarcoma b. Osteosarcoma c. Rhabdomyosarcoma d. Fibrosarcoma

c.Rhabdomyosarcoma

This is a chronic disease that leads to inflammation and injury to the joints and the surrounding tissues. It is also considered an autoimmune disease. a. Septic arthritis b. Degenerative joint disease c. Rheumatoid arthritis d. Ankylosing spondylitis

c.Rheumatoid arthritis

You are called for a 48-year-old male who is complaining of back and leg pain. Your assessment shows that he has pain and tenderness in his lower back with tingling through his left buttock and down his left leg. He tells you that he has been moving furniture. You should suspect: a. Decubitus b. Kyphosis c. Sciatica d. Osteoarthritis

c.Sciatica

Prozac, Paxil, and Zoloft are all examples of: a. Phenothiazines b. Monoamine oxidase inhibitors c. Selective serotonin reuptake inhibitors d. Tricyclic antidepressants

c.Selective serotonin reuptake inhibitors

A life-threatening medical condition that is caused by systemic inflammatory response syndrome (SIRS) is: a. Hypoglycemia b. Thrombocytopenia c. Septicemia d. Pernicious anemia

c.Septicemia

All of the following are symptoms of otitis media except ________. a. Pain b. Edema c. Sinus infection d. Pus

c.Sinus infection

All of the following would be appropriate care for a patient with nontraumatic back pain EXCEPT: a. Administration of analgesia prior to moving the patient b. Application of an ice pack to the affected area c. Spinal immobilization with careful padding of voids d. Administration of anti-inflammatory medications

c.Spinal immobilization with careful padding of voids

A 43-year-old former IV drug abuser presents with a three-week history of fever, sore throat, diarrhea, and general malaise. He denies any PMH or meds. Physical examination reveals warm, dry skin; numerous purplish skin lesions; and lung sounds with mild rhonchi in the upper right lobe. HR = 104, BP = 118/70, RR = 14, SaO2 = 97%. Based on these clinical exam findings, which of the following would you most likely expect to find with a continued exam? a. Jaundice and hepatomegaly b. Hepatomegaly and mitral regurgitation c. Splenomegaly and lymphadenopathy d. Pupils dilated bilaterally and AMS

c.Splenomegaly and lymphadenopathy

You have been called to a college dormitory where campus police are talking to a 20-year-old male who was threatening to jump from his eighteenth-floor window. The patient admits that he was upset because he is failing most of his courses and his girlfriend broke up with him but says he was just "psyching out" his roommate and had no intention of jumping. Campus police tell you that the patient was sitting on the balcony railing with his feet over the edge when they arrived. The patient was cooperative when they asked him to come back inside the room. Which of the following is the best course of action? a. Consider it a police matter, and mark in service. b. Have the police place the patient under immediate detention, and transport the patient in restraints. c. Tell the patient you must take his suicide threat seriously and transport him for evaluation. d. Have the patient sign a refusal form as long as the roommate will take responsibility for staying with him.

c.Tell the patient you must take his suicide threat seriously and transport him for evaluation.

A patient presents with a history of frequent urination, signs and symptoms of dehydration, and a blood glucose of 958 mg/dL. There is no acetone odor on his breath. To which of the following can the absence of an acetone odor most likely be attributed? a. Elimination of ketoacids by the blood buffer system b. Elimination of ketoacids through Kussmaul's respirations c. The ability to use enough glucose to meet metabolic needs d. The ability to convert to the use of amino acids for energy metabolism

c.The ability to use enough glucose to meet metabolic needs

Which of the following is NOT a common pathophysiological cause of behavioral emergencies? a. Underlying psychiatric illness b. Psychosocial stressors c. The environment d. Use of recreational drugs and alcohol

c.The environment

Which of the following statements best explains why urinary tract infections are more common in females than in males? a. The presence of estrogen in the lining of the female reproductive tract makes the mucous membranes more prone to infection. b. Bacteria from the vagina commonly enter the female urethra. c. The female urethra is shorter than those in males, more easily allowing bacteria to enter the rest of the urinary tract. d. Males have more acidic urine, which is effective in eliminating bacteria from the urinary tract.

c.The female urethra is shorter than those in males, more easily allowing bacteria to enter the rest of the urinary tract.

You have administered 25 g of 50 percent dextrose to a patient who was initially unresponsive with a blood glucose level of 23 mg/dL. Which of the following is the best indication that the patient's condition is improving? a. The heart rate decreases from 112 to 96 per minute. b. The patient seems less diaphoretic. c. The patient opens his eyes but is confused. d. The respiratory rate decreases from 24 to 16 per minute.

c.The patient opens his eyes but is confused.

Which of the following is most relevant to your decisions about how to handle a potentially violent patient? a. The fact that you have transported this patient many times and he has never become violent b. The family's reassurances that the patient never harmed anyone c. The patient's current behavior d. Whether or not the patient is taking antipsychotic medications

c.The patient's current behavior

Epidemiology is best described as the study of: a. The pathophysiology of infectious disease b. Vaccines and disease treatments c. The patterns of disease in communities d. The body's immunity to infectious disease

c.The patterns of disease in communities

Your patient has type A+ blood. Which of the following statements about the patient's blood is TRUE? a. The patient produces anti-A antibodies. b. The blood cells lack Rh antigens. c. There are type A antigens on the surface of the red blood cells. d. The patient can only receive A+ blood if a transfusion is needed.

c.There are type A antigens on the surface of the red blood cells

Which of the following best describes the mechanism of action of ACE inhibitors? a. They inhibit sodium reabsorption, causing increased excretion of sodium. b. They increase the GFR directly. c. They inhibit the conversion of angiotensin I to angiotensin II. d. They inhibit the formation of renin in the renin-angiotensin system.

c.They inhibit the conversion of angiotensin I to angiotensin II.

A finding of exophthalmos and goiter should increase your suspicion for a problem with the: a. Anterior pituitary gland b. Posterior pituitary gland c. Thyroid gland d. Parathyroid gland

c.Thyroid gland

Your patient is a two-year-old male who is alert and crying after ingesting bathroom cleaner. Physical examination reveals no obvious burns or irritation to his oropharynx, and his skin is cool and dry. HR = 112, BP = 108/60, RR = 24, SaO2 = 99%. Which of the following is most appropriate? a. Having the patient drink a glass of milk b. Administration of ipecac c. Transport d. Administration of activated charcoal

c.Transport

The leading cause(s) of end-stage renal failure is (are): a. Renal calculi and kidney infection b. Acute renal failure c. Uncontrolled diabetes mellitus and hypertension d. Kidney infection

c.Uncontrolled diabetes mellitus and hypertension

Which of the following properly accounts for the differences between visceral and somatic pain? a. Spilled organ contents and bacteria can result in visceral pain, while somatic pain is caused by organ distension. b. Visceral pain originates in the walls of hollow organs, while somatic pain originates in skeletal muscle. c. The nerves that carry somatic pain impulses enter the spinal column at various levels, while the nerves that carry visceral impulses enter the spinal column via specific nerve routes. d. The nerves that carry visceral pain impulses enter the spinal column at various levels, while the nerves that carry somatic impulses enter the spinal column via specific nerve routes.

c.Upper GI tract

You are suspicious that a patient is suffering from active tuberculosis. Which of the following would be most appropriate? a. Neither you nor the patient should wear a HEPA respirator. b. Both you and the patient should wear a HEPA respirator. c. You should wear a HEPA respirator. d. The patient should wear a HEPA respirator.

c.You should wear a HEPA respirator.

You are called to the scene of a sexual assault. You are presented with a 19-year-old female who is withdrawn and sitting in a corner in her bedroom. Which of the following questions is appropriate to ask? a. "How much alcohol did you have to drink before this happened?" b. "Do you know if you were penetrated?" c. "Did the perpetrator ejaculate?" d. "Are you injured anywhere?"

d."Are you injured anywhere?"

Your patient is a 44-year-old female complaining of a three-day history of localized abdominal pain in her midepigastric region after eating. The pain tends to subside with antacids. Today she is experiencing nausea, and the pain did not subside with antacids. The patient gives a history of smoking and moderate alcohol consumption. The patient's skin is warm and dry, and she has a blood pressure of 128/88, a heart rate of 84, and respirations of 20. Your course of treatment should consist of: a. Sodium bicarbonate IV b. Transporting the patient in a position of comfort and giving reassurance c. High-concentration oxygen by nonrebreathing mask d. IV of NS with 250 cc fluid bolus

d."Have you ever had a sexually transmitted disease?"

Your patient is a 40-year-old male who ingested 30 tablets of Lexapro and 24 tablets of Tylenol PM. Which of the following is the most important question you should ask? a. "Why did you take these medications?" b. "Have you ever done this before?" c. "Do you have a history of depression?" d. "How long ago did you take these medications?"

d."How long ago did you take these medications?"

Which of the following statements would make you suspicious that your patient has been exposed to cyanide? a. "I think I smoked some bad weed." b. "I inhaled some fumes when I was fueling my truck." c. "I think my car has an exhaust leak." d. "I have been burning carpets and old furniture all day."

d."I have been burning carpets and old furniture all day."

Which of the following statements would be most typical of a patient with hepatitis? a. "It seems like everything has a yellow tinge to it." b. "I have sharp pain on the left side of my abdomen." c. "I have to urinate all the time." d. "My stools are really light in color."

d."My stools are really light in color."

Your 43-year-old male patient is alert and oriented and complaining of abdominal pain. He states that he is experiencing nausea and has vomited twice. Which of the following is the most appropriate follow-up question? a. "What were you doing when the vomiting started?" b. "Do you drink more than three alcoholic beverages a day?" c. "Did you become dizzy or faint while you were vomiting?" d. "What did the material you vomited look like?"

d."What did the material you vomited look like?"

Your patient is a 35-year-old female who is complaining of severe abdominal pain in both lower quadrants. She states that she had a tubal ligation two years ago and "knows she can't be pregnant." Which of the following questions is appropriate to prehospital care? a. "Have you ever had a sexually transmitted disease?" b. "Do you have more than one sexual partner?" c. "Do you suspect your husband has been unfaithful to you?" d. "When was your last menstrual period?"

d."When was your last menstrual period?"

Which of the following statements about the use of vasopressors in the treatment of anaphylaxis is TRUE? a. A norepinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRS-A release by basophils and mast cells. b. A norepinephrine infusion encourages a net movement of plasma from the intravascular space to the vascular space, raising blood pressure. c. An epinephrine infusion can correct the peripheral vasodilation that occurs secondary to SRS-A release by basophils and mast cells. d. A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells.

d.A dopamine infusion can correct the peripheral vasodilation that occurs secondary to histamine release by basophils and mast cells.

Which of the following patients that have been tasered do not meet the acceptable criteria to remove the Taser darts? a. A patient with a heart rate of 105/min b. A patient with a room SpO2 of 96 percent c. A patient with the Taser dart embedded in the URQ of the abdomen d. A patient with the Taser dart embedded in the neck

d.A patient with the Taser dart embedded in the neck

Which of the following statements about disseminated intravascular coagulation (DIC) is TRUE? a. The bleeding typical of DIC is a result of an increased fibrinogen level. b. DIC most commonly results from hemophilia, hypertension, and severe tissue injury. c. Causes of DIC include reduced fibrinogen levels, consumption of coagulation factors, and thrombocytopenia. d. Activated thrombin converts fibrinogen to fibrin in the circulating blood.

d.Activated thrombin converts fibrinogen to fibrin in the circulating blood.

The administration of a vaccine results in ________ immunity. a. Passive induced b. Natural passive c. Natural induced d. Active induced

d.Active induced

Which of the following accounts for more than 90 percent of hospital admissions for toxic substance exposure? a. Pediatric overdoses b. Intentional poisoning by another person c. Pediatric accidental poisonings d. Adult poisonings and overdoses

d.Adult poisonings and overdoses

Which of the following hormones has the greatest effect on blood pressure homeostasis? a. Calcitonin b. Cortisol c. Parathyroid hormone d. Aldosterone

d.Aldosterone

In which of the following situations is hemolytic disease of the newborn most likely to occur? a. An Rh positive mother delivers a first Rh negative newborn b. An Rh positive mother delivers a second Rh negative newborn c. An Rh negative mother delivers a first Rh positive newborn d. An Rh negative mother delivers a second Rh positive newborn

d.An Rh negative mother delivers a second Rh positive newborn

A patient with hemophilia has suffered a large and deep laceration to the right forearm after cutting it on a mirror, which fell while he was hanging it. The wound is hemorrhaging a steady amount of dark red blood. Given the history of hemophilia, your immediate action on reaching the patient's side and putting on gloves would be to: a. Request that the ED have Factor VIII standing by on your arrival b. Start an IV and administer a 1 L NS bolus c. Apply a tourniquet proximal to the wound d. Apply direct pressure with a bulky dressing

d.Apply direct pressure with a bulky dressing

Which of the following is the most reliable way to differentiate between a hyperglycemic emergency and a hypoglycemic emergency? a. Determine whether or not the patient took his insulin or oral antihyperglycemic medicines. b. Determine whether the patient is a type I or type II diabetic. c. Follow the conventional wisdom, "Pale, cool, wet: low; red, hot, dry: high." d. Assess the blood glucose level.

d.Assess the blood glucose level.

Which of the following statements about the differences between viruses and bacteria is NOT true? a. Bacteria can reproduce by themselves, while viruses cannot. b. Bacteria require a food source to thrive, while viruses do not. c. Bacteria are much larger than viruses. d. Bacteria contain only DNA, and viruses contain only RNA.

d.Bacteria contain only DNA, and viruses contain only RNA.

Your patient is a 32-year-old male who has been successfully treated for depression with a selective serotonin reuptake inhibitor. The patient's wife is concerned, because over the past few days her husband has not slept and has been spending most of his time trading stocks online and making extravagant purchases. He has been talking about taking a trip to Spain to run with the bulls in Pamplona. She states that he is talking incessantly and seems "wired." The patient had a similar episode about a month ago that came on suddenly but resolved when the patient "crashed" and slept for several days. Which of the following is MOST consistent with this situation? a. Cocaine use b. Schizoaffective disorder c. Methamphetamine use d. Bipolar disorder

d.Bipolar disorder

If left untreated, glaucoma can lead to what? a. Presbyopia b. Hyperopia c. Myopia d. Blindness

d.Blindness

A patient has a hematocrit of 48 percent and a hemoglobin of 15 g/dl. Which of the following statements is TRUE? a. His hemoglobin is high, but his hematocrit is normal. b. Both are within the normal range for an adult male or female. c. His hematocrit and hemoglobin are both low. d. Both are within the normal range for an adult male.

d.Both are within the normal range for an adult male.

Your patient is a 44-year-old female with a history of hiatal hernia. She is complaining of diffuse abdominal pain. All four quadrants are tender to palpation. She also states that she has vomited numerous times and describes the presence of bile. You note that her abdomen is slightly distended, and auscultation of her abdomen reveals absent bowel sounds. Of the following, which is the most likely cause of her clinical condition? a. Pancreatitis b. Cholecystitis c. Diverticulitis d. Bowel obstruction

d.Bowel obstruction

Which of the following is considered an ominous sign late in anaphylaxis? a. Tachycardia b. Hypertension c. Hypotension d. Bradycardia

d.Bradycardia

Demographics are: a. Statistics related to the morbidity and mortality of all illnesses and injuries b. Geographical distributions of illness and injury c. Statistics related to the incidence of infectious disease d. Characteristics of human populations

d.Characteristics of human populations

A defect of the ________ results in difficulty in visual detection of color and fine detail. a. Lens b. Cones and rods c. Rods d. Cones

d.Cones

A patient who was hit in the face with a cloud of dust while working in an industrial setting is complaining of pain and discomfort to his left eye. While performing your secondary assessment on the eye, you note some redness to the globe but do not see any obvious foreign object. The most appropriate care you can provide to this patient would be: a. Gently massaging the eye to promote tearing b. Having the patient hold the eye open during transport c. Carefully wiping the eye with a soft piece of sterile gauze d. Covering both eyes with a bandage

d.Covering both eyes with a bandage

All of the following are components of the inflammatory process EXCEPT: a. Vasodilation b. Increased capillary permeability c. Increased blood flow d. Decreased chemotaxis

d.Decreased chemotaxis

Your patient is a 42-year-old male who had surgery four years ago to remove his posterior pituitary gland because of a tumor. He stopped taking replacement hormones because they caused depression. Which of the following is the most likely consequence of the patient's noncompliance with hormone replacement therapy? a. Hypoglycemia b. Hypertension c. Reduced ability to fight infection d. Dehydration

d.Dehydration

Which of the following best describes a profound melancholy characterized by a diminished interest in daily pleasures, hypersomnia, feelings of helplessness, inability to concentrate, and agitation? a. Bipolar disorder b. Schizoaffective disorder c. Dysthymia d. Depression

d.Depression

Which of the following statements about hemodialysis is TRUE? a. Blood is removed from the body, wastes are collected in a filter, and blood is then returned to the body. b. Dialysate is placed in the abdominal cavity, the peritoneum acts as a dialysis membrane, and dialysate is then removed from the abdominal cavity. c. Dialysate enters the circulation through the venous site of a fistula and leaves through the arterial side of the fistula. d. Dialysis approximates the physiology of the nephron by placing blood on one side of a semipermeable membrane and dialysate on the other side.

d.Dialysis approximates the physiology of the nephron by placing blood on one side of a semipermeable membrane and dialysate on the other side.

Which of the following is the therapeutic effect of a cathartic? a. Vomiting b. Increased protein binding of drugs c. Alkalinization of the urine d. Diarrhea

d.Diarrhea

Your patient is a 29-year-old male who is conscious, alert, and extremely hyperactive after using cocaine. HR = 134, BP = 148/102, RR = 20. Physical examination reveals warm, diaphoretic skin and dilated pupils bilaterally. Which of the following medications should be considered to manage this patient? a. Metoprolol b. Naloxone c. Propranolol d. Diazepam

d.Diazepam

Which of the following medications may relieve the abdominal cramps associated with allergic reactions and anaphylaxis? a. Ranitidine b. Dopamine c. Epinephrine d. Diphenhydramine

d.Diphenhydramine

Your partner experiences an itchy, red rash on her hands that stops at the wrists after using a new brand of glove your service purchased. Her skin is warm, dry, and nondiaphoretic; the rash is isolated to her hands; and her lung sounds are clear bilaterally. She has no other complaints. HR = 88, RR = 12, BP = 122/80. Of the following treatments, which is most appropriate? a. Oxygen via nonrebreather mask 15 lpm, cardiac monitor, IV of NS KVO, epinephrine SC, diphenhydramine IM b. Oxygen via nasal cannula 4 lpm, cardiac monitor, IV of NS KVO, epinephrine IV, diphenhydramine IM c. Advise the dispatcher you will be going out of service d. Diphenhydramine IM

d.Diphenhydramine IM

Your patient is a 68-year-old female who is being treated for colon cancer. She is conscious and alert, in mild distress, and complaining of progressive weakness over the past three days. Palpation of her abdomen reveals tenderness to the lower right quadrant. Her skin is pale, cool, and dry, and you note the smell and appearance of melena in her stool. HR = 108, BP = 100/60, RR = 12, SaO2 = 97%. Proper treatment of this patient might include: a. IV of normal saline with a 250 mL fluid challenge, repeated if necessary b. IV of 5 percent dextrose solution at 30 mL per hour c. Two large-bore IVs of lactated Ringer's solution, wide open d. Two large-bore IVs of normal saline, 20 cc/kg fluid bolus

d.Distension, ischemia, and inflammation

Which of the following medications is NOT used as a first-line drug to counter the physiologic effects of the release of slow-reacting substance of anaphylaxis (SRS-A)? a. Diphenhydramine b. Epinephrine 1:10,000 c. Albuterol d. Dopamine

d.Dopamine

All of the following contribute to the pathogenesis of diverticulosis EXCEPT: a. Decreased colon motility b. Herniation of mucosa and submucosa through the teniae coli c. Increased colon pressure d. Low-fiber diet

d.Duodenum

Your patient is a 68-year-old female complaining of diffuse abdominal pain. She has a history of intestinal hernias and adhesions from previous abdominal surgery. Your suspicion should be highest for: a. Appendicitis b. Diverticulitis c. Bowel obstruction d. Ulcerative colitis

d.Duodenum, jejunum, ileum, ascending colon, transverse colon, descending colon, rectum, anus

A 35-year-old female presents complaining of a one-year history of dull, cramping pain in her pelvis that comes with her menstrual cycle, yet is different from normal menstrual discomfort. She also describes pain with intercourse and frequent spotting. Of the following, what is the most likely clinical condition of this patient? a. Mittelschmerz b. Endometritis c. Uterine fibroids d. Endometriosis

d.Endometriosis

Which treatment would best halt the urticaria associated with an allergic reaction? a. Solu-Medrol b. Oxygen c. Dopamine and albuterol d. Epinephrine and diphenhydramine

d.Epinephrine and diphenhydramine

A Mallory-Weiss tear is a disorder of the: a. Stomach b. Liver c. Rectum d. Esophagus

d.Esophagus

A 34-year-old female, conscious, alert, and oriented, is complaining of a three-week history of increased appetite, weight loss, weakness, insomnia, and inability to tolerate heat. She has recently been frequently agitated and prone to mood swings. Based on these signs and symptoms, which of the following best describes the additional findings you could expect? a. Hyperpigmentation of the skin and hirsutism b. Heart block and hypotension c. Enlarged tongue and cool, puffy skin d. Exophthalmos and goiter

d.Exophthalmos and goiter

Your patient is a 76-year-old male who is alert and oriented. The patient's neighbor called EMS because of general concern about the patient's health. He states that the patient hasn't been himself since his wife's death six months ago. He hasn't taken care of his usually meticulous lawn and house, and he has lost a lot of weight. The patient says he misses his wife but doesn't need medical care. Which of the following is the best course of action? a. Tell the patient you cannot leave him and that if he refuses to go to the hospital, you will have to call the police and have him placed under immediate detention for psychiatric treatment. b. Explain to the neighbor that the patient is behaving as expected and the only treatment is time. c. Have the patient sign a refusal of service form, but let him know he can call you back if he changes his mind. d. Explain to the patient that it is common for people in his situation to feel depressed, and you would like to help him by transporting him to the hospital.

d.Explain to the patient that it is common for people in his situation to feel depressed, and you would like to help him by transporting him to the hospital.

Your patient is a 35-year-old male whom you suspect of having a kidney stone. All of the following would be consistent with this impression EXCEPT: a. Hematuria b. A description of "knifelike" pain c. Restlessness d. Fever

d.Fever

Your 56-year-old female patient is complaining of chronic fatigue, muscle stiffness, and tender areas on each elbow. Based on your assessment and the patient's history, you should suspect: a. Reflex sympathetic dystrophy b. Osteoporosis c. Osteoarthritis d. Fibromyalgia

d.Fibromyalgia

Which of the following statements about patient restraint is TRUE? a. Restraints can be released once the patient is in control of himself. b. Roller bandages for restraint do not cause neurovascular damage to the extremities, but leather restraints do. c. Handcuffs are an acceptable choice for prehospital care. d. Four-point restraints should be used.

d.Four-point restraints should be used

A patient has an advanced infection in his foot. There appears to be an accumulation of gas in the tissues, which causes a crackling sensation on palpation. This sign is typically seen in: a. Ankylosing spondylosis b. Cellulitis c. Necrotizing fasciitis d. Gangrene

d.Gangrene

A 63-year-old female with a history of type II diabetes presents with a four-day history of increased urination and thirst. She called EMS this morning when she experienced a brief period of dizziness while getting out of bed. Your assessment reveals a BP of 108/60, RR of 14 and regular, and a HR of 122 and regular. You also note that the patient is slightly confused and has warm, dry skin and mucous membranes. Based on this patient presentation, what other finding could you expect? a. Atrial flutter b. Fruity breath odor c. A blood glucose of 68 mg/dL d. Glucosuria

d.Glucosuria

Secretion of glucagon from the pancreas results in ________, which causes a(n) ________ in blood glucose levels. a. Glucogenesis, decrease b. Glycogenolysis, decrease c. Glucogenesis, increase d. Glycogenolysis, increase

d.Glycogenolysis, increase

Which of the following statements about the epidemiology of Graves' disease is TRUE? a. Graves's disease typically manifests late in adulthood. b. Heredity does not predispose people to Graves' disease. c. Obesity and poor dietary habits increase the risk of Graves' disease. d. Graves' disease is about six times more common in women than in men.

d.Graves' disease is about six times more common in women than in men.

Your patient is a 12-year-old male who is conscious and alert and complaining of diffuse abdominal pain. He states that the pain began about 3 hours after eating supper. He has had severe diarrhea and some vomiting. Any of the following could be therapeutic EXCEPT: a. Diazepam b. Compazine c. IV of NS d. Promethazine

d.Hemorrhoids

Your patient is a 23-year-old male prisoner who is alert and oriented, complaining of general malaise. He describes a month-long history of weakness, joint pain, nausea and occasional vomiting, and anorexia. He has no medical history and takes no medications. Physical examination reveals clear lung sounds bilaterally; warm, dry skin; several prison tattoos; a firm liver; and jaundice to his sclera. Which of the following is most likely? a. Fatty liver b. Cirrhosis of the liver c. HIV d. Hepatitis B

d.Hepatitis B

Which of the following assessment findings should you most expect in a patient with chronic pancreatitis? a. Dark-colored urine b. Right lower quadrant pain c. Clay-colored stool d. Hyperglycemia

d.Hyperglycemia

Your patient is experiencing profuse hives, itching, dyspnea, coughing, tachycardia, and dizziness after eating seafood 5 minutes ago. You might also expect to see all of the following additional signs EXCEPT: a. Laryngeal edema b. Bronchospasm c. Cyanosis d. Hypertension

d.Hypertension

Your patient is unresponsive after removal from a home in which four family members were found unconscious after having "flulike symptoms." The patient has snoring respirations at 10 per minute; a weak, rapid radial pulse; and an SaO2 of 100%. Your treatment should consist of all of the following EXCEPT: a. IV of normal saline b. Endotracheal intubation c. Considering transport to a hospital with hyperbaric oxygen treatment facilities d. Hyperventilation with 100 percent oxygen

d.Hyperventilation with 100 percent oxygen

Which of the following most accurately represents the pathophysiological sequence of untreated type I diabetes? a. Oversecretion of insulin results in hypoglycemia; cells convert to the use of fats for energy resulting in the production of ketone bodies. b. Glucose is not absorbed through the gastrointestinal tract, resulting in hyposecretion of insulin and hypoglycemia. Lack of glucose results in anaerobic metabolism and acidosis. c. Hyposecretion of insulin prevents glucose from being broken down in the gastrointestinal tract; too much glucose is absorbed from the gastrointestinal tract resulting in hyperglycemia and ketoacidosis. d. Hyposecretion of insulin results in inability of glucose to enter cells; blood glucose levels rise, and cells convert to the use of fats for energy, resulting in the production of ketone bodies.

d.Hyposecretion of insulin results in inability of glucose to enter cells; blood glucose levels rise, and cells convert to the use of fats for energy, resulting in the production of ketone bodies.

Which of the following is the best route for administering epinephrine to patients in severe anaphylactic shock refractory to initial interventions? a. SC b. ET c. IM d. IV

d.IV

A 26-year-old female is complaining of severe abdominal pain and heavy vaginal bleeding. She has used five sanitary napkins in the past hour. Her last menstrual period was six weeks ago, and she describes a history of irregular periods but never to this extent. Evaluation of her abdomen shows rebound tenderness and rigidity in the midline of the lower abdomen. Management should include: a. IV magnesium sulfate. b. IV oxytocin. c. SQ terbutaline. d. IV access and fluid infusion to maintain peripheral perfusion

d.IV access and fluid infusion to maintain peripheral perfusion

Which of the following is NOT a possible source of cyanide poisoning? a. Fume inhalation from burning plastic, synthetic carpeting, or silk b. Ingestion of apricot, pear, and cherry pits c. Long-term sodium nitroprusside therapy d. Improperly vented heating systems

d.Improperly vented heating systems

Which of the following situations would result in a right shift of the oxygen-hemoglobin dissociation curve? a. Hypothermia b. Hyperventilation c. Sepsis d. Increase in 2,3-BPG

d.Increase in 2,3-BPG

When a substance enters the body through the gastrointestinal tract, it has accessed the body by: a. Inhalation b. Surface absorption c. Injection d. Ingestion

d.Ingestion

The "bony labyrinth" is another name for the ________. a. Outer ear b. Auditory nerve c. Middle ear d. Inner ear

d.Inner ear

Which of the following is NOT a known transmission route for hepatitis B? a. Blood transfusion b. Dialysis c. Tattooing d. Insect bites

d.Insect bites

Which of the following is NOT associated with anorexia nervosa? a. An incorrect perception of obesity b. Amenorrhea c. Exercising excessively d. Intentionally inducing vomiting after eating

d.Intentionally inducing vomiting after eating

Your patient is an 83-year-old male with a fever of 103°F. In addition, the patient is confused and combative. Heart rate = 132, respirations = 20, blood pressure = 100/70, Sp O2 95% on room air, and blood glucose level = 90 mg/dL. During your examination you note that the patient has a Foley catheter and that the collection bag appears not to have been emptied for quite some time. The bag is full of dark, cloudy urine with sediment at the bottom of the bag. Which of the following is most appropriate? a. Acetaminophen suppository b. BLS transport without intervention c. Furosemide d. Intravenous fluid therapy with normal saline

d.Intravenous fluid therapy with normal saline

Your patient is a 68-year-old female who has been in a rehabilitation hospital for one week following hip replacement surgery. According to the staff, the patient is a type II diabetic and is being treated for a postoperative infection. The patient was lethargic yesterday and was found unresponsive this morning, just before your arrival. Physical exam reveals an accumulation of secretions in her airway, lung sounds clear and equal bilaterally, and skin and mucous membranes warm and dry. HR = 119, BP = 86/58, RR = 16, blood glucose = 864 mg/dL. In addition to initiating basic airway management measures and gaining IV access, which of the following is the best treatment for this patient? a. Intubate, 1 to 2 L NS bolus, 25 g dextrose IV b. Oxygen by nonrebreather mask, NS at a KVO rate, 50 mEq sodium bicarbonate IV c. BVM ventilations with supplemental oxygen, NS at a KVO rate d. Intubate, 1 to 2 L NS bolus

d.Intubate, 1 to 2 L NS bolus

You are caring for a patient that was tasered by the police for being physically aggressive. This type of restraint works by what mechanism? a. It temporarily stuns the cerebral hemispheres. b. It paralyses the lower extremities. c. It renders the patient unconscious. d. It disrupts voluntary control of skeletal muscles.

d.It disrupts voluntary control of skeletal muscles.

Which of the following statements regarding polycythemia is most accurate? a. It decreases the patient's risk of infection. b. It decreases the ability of blood to clot. c. It increases the patient's risk of infection. d. It increases the patient's risk of stroke and heart attack.

d.It increases the patient's risk of stroke and heart attack

A paramedic within your service was treating an IV drug addict when the patient spit at her, hitting her in the eye. At the hospital, when asked for blood, the patient refused to consent for testing. In this case, which of the following is TRUE? a. The patient can be placed under detention and be required to give a blood sample. b. A judge will issue a court order requiring the patient to allow his blood to be tested. c. By law the patient is required to submit blood for testing. d. It is within the patient's right to refuse blood testing.

d.It is within the patient's right to refuse blood testing.

Tenderness associated with pyelonephritis is best evaluated by percussing: a. In the midline, just superior to the symphysis pubis b. Just lateral to the spine slightly superior to the sacroiliac joint c. Laterally, just superior to the superior iliac crest d. Just lateral to the spine slightly inferior to the 12th rib

d.Just lateral to the spine slightly inferior to the 12th rib

Which of the following is classified as a helminth? a. Trichomonas b. Treponema c. Spirochete d. Liver fluke

d.Liver fluke

Your patient is a 50-year-old male who has been detained by mall security officers. The patient is distraught, stating that he needs to "get away from the terrorists." The security officers state the patient was found climbing into a trash dumpster behind the mall and became distressed when they took him away from it. Your physical exam is unremarkable except for noting neglect of hygiene and nutrition. His skin is warm and dry. HR = 98, BP = 114/78, RR = 12, SaO2 = 99%, blood glucose = 80 mg/dL. You offer him transport to the ED, which he accepts. Which of the following is most appropriate during transport of this patient? a. Apply a cardiac monitor, IV, oxygen b. Restrain the patient with four-point restraints, no ALS interventions c. Start an IV, and request orders for haloperidol d. Make the patient comfortable on the stretcher, no ALS interventions

d.Make the patient comfortable on the stretcher, no ALS interventions

With occlusion of the SMA or IMA vascular structures, what gastrointestinal emergency may occur? a. Renal infarction b. Hepatic encephalitis c. Pancreatitis d. Mesenteric ischemia

d.Mesenteric ischemia

Your patient is a 45-year-old female who became hypertensive after eating some cheese and drinking wine. Which type of medication would most likely account for this reaction? a. Phenothiazines b. Tricyclic antidepressants c. Selective serotonin reuptake inhibitors d. Monoamine oxidase inhibitors

d.Monoamine oxidase inhibitors

Your patient is a 24-year-old male complaining of a headache for the past two days. He states he has taken aspirin but cannot get rid of the headache. The patient lives in a basement apartment, which you observe is very chilly. The patient states his furnace hasn't been working and he had to use the oven to help heat the apartment. Which other findings and complaints are most likely? a. Nausea, vomiting, decreased hemoglobin saturation b. Rash, nausea, a metallic taste in the mouth c. Pale skin, sluggish pupils, tachycardia d. Nausea, vomiting, confusion, tachypnea

d.Nausea, vomiting, confusion, tachypnea

Which of the following is the most frequent cause of deterioration in a patient with a psychiatric disorder? a. Failure to keep counseling appointments b. Situational stresses c. Being released from an institution back into the public d. Noncompliance with medications

d.Noncompliance with medications

Increased hepatic resistance to blood flow, as happens in cirrhosis, results in: a. Hepatic arterial hypertension and obstruction of the common bile duct b. Portal vein hypertension and esophageal varices c. Portal artery hypertension and ascites d. Hepatic vein hypertension and hepatic vein aneurysm

d.None of the above

Which of the following agencies is the primary agency responsible for establishing guidelines and standards to regulate health care worker safety as it relates to communicable disease transmission? a. NFPA b. CDC c. FEMA d. OSHA

d.OSHA

All the following are common signs or symptoms of lice infestation EXCEPT: a. Red macules or papules on the affected areas b. White, oval-shaped nits on the hair shafts c. Itching d. Open lesions in the affected areas

d.Open lesions in the affected areas

What are the three tiny bones located in the middle ear? a. Pinnas b. Cerumen c. Cochleas d. Ossicles

d.Ossicles

Your patient is a 36-year-old female, conscious and alert, sitting at her desk and complaining of a rash and itchiness after taking a sulfa antibiotic. Physical examination reveals warm and dry skin, urticaria on her chest and back, lung sounds that are clear and equal bilaterally. HR = 100, BP = 132/78, RR = 14, SaO2 = 98%. Which of the following is the most appropriate treatment for this patient? a. Oxygen via nasal cannula, IV of NS KVO, 5 mg epinephrine IV, 25 mg diphenhydramine IV b. Transport only c. Oxygen via nonrebreather mask, IV of NS KVO, 25 mg diphenhydramine IV d. Oxygen via nonrebreather mask, IV of NS KVO, 0.3 mg epinephrine SC, 25 mg diphenhydramine IV, albuterol 2.5 mg via nebulizer

d.Oxygen via nonrebreather mask, IV of NS KVO, 0.3 mg epinephrine SC, 25 mg diphenhydramine IV, albuterol 2.5 mg via nebulizer

Your patient is a 72-year-old male who is conscious but lethargic and sitting in a chair. His son states that the patient has been a bit slow lately and has been gaining weight. The medical history includes hypothyroidism and myocardial infarction. The patient has been compliant with his Synthroid and has nitroglycerin for use as needed. The patient responds to verbal stimuli, is confused, has a large tongue, and pale, cold, doughy skin. His only complaint is constipation. HR = 60 and regular, BP = 112/80, RR = 10 and shallow, SaO2 = 92%, temperature = 88°F, blood glucose = 180 mg/dl. Your treatment of this patient should include: a. Infusion of 1 to 2 liters of warm normal saline b. Atropine 0.5 mg IV c. Rewarm with heat packs d. Oxygen, 4 lpm by nasal cannula

d.Oxygen, 4 lpm by nasal cannula

Your patient is a 30-year-old male complaining of pain radiating from the left flank into the groin. He states that it began as a vague pain in his flank, then became very sharp and radiating. Based on his description of his pain, you would also expect him to complain of: a. Inability to urinate b. Purulent urethral discharge c. Fever d. Painful urination

d.Painful urination

Which of the following statements concerning Africanized honeybees is accurate? a. Envenomation by Africanized honeybees requires treatment with specific antivenin. b. The venom of Africanized honeybees causes acute renal failure. c. The venom of Africanized honeybees is more toxic than that of other types of bees. d. Patients stung by Africanized honeybees tend to have more stings than patients stung by other types of bees.

d.Patients stung by Africanized honeybees tend to have more stings than patients stung by other types of bees.

Which of the following best describes the position or bearing of the body? a. Stature b. Facies c. Affect d. Posture

d.Posture

Treatment of a patient in acute renal failure may include all of the following EXCEPT: a. IV normal saline b. Dialysis c. Furosemide d. Potassium

d.Potassium

Diphenhydramine is administered in anaphylaxis because it: a. Blocks histamine receptors b. Possibly reduces peripheral vasodilation c. Reduces histamine release from mast cells and basophils d. Produces all of the above

d.Produces all of the above

A 36-year-old female is conscious and alert and complaining of palpitations. She denies chest pain, difficulty breathing, or loss of consciousness but becomes "dizzy" with exertion. She states that she has been experiencing agitation, insomnia, intolerance to heat, and weight loss. Physical exam reveals exophthalmos and an enlarged thyroid gland. HR = 142 and regular, BP = 110/70, RR = 14 and regular. Which of the following would be most effective in treating this patient? a. 250 cc fluid challenge b. 50 percent dextrose IV c. Synchronized cardioversion d. Propranolol

d.Propranolol

Which of the following is associated with a greater predisposition for hypoglycemia due to decreased gluconeogenesis? a. Pancreatitis b. Cholecystitis c. Cardiac failure d. Renal failure

d.Renal failure

Mrs. Baker fell in her home and lay immobile until the next day when her daughter found her lying on the tile floor. You recognize that Mrs. Baker is at a greatly increased risk of: a. Hypokalemia b. Fibromyalgia c. Renal failure d. Rhabdomyosarcoma

d.Rhabdomyosarcoma

The sensor receptive cells in the retina that function best in dim light and enable night vision is/are the ________. a. Iris b. Cones c. Pupil d. Rods

d.Rods

Your patient is a 44-year-old female who is alert and in mild distress. She states that she had an acute onset of sharp, right lower quadrant abdominal pain last evening while having intercourse and that the pain has not subsided. She states the pain radiates to her lower back and rates it as a 5 on a scale of 1-10. Physical examination reveals tenderness with palpation to the lower right abdominal quadrant, and her skin is warm and dry. HR = 100, RR = 12, BP = 116/78. Her last menstrual period was three weeks ago, she had a tubal ligation ten years ago and she states she has several small fibroid tumors. Which of the following is the most likely diagnosis for this patient? a. Ectopic pregnancy b. Pelvic inflammatory disease c. Mittelschmerz d. Ruptured ovarian cyst

d.Ruptured ovarian cyst

Your patient is a 28-year-old male who tells you his hands and arms are turning green. He states that he was held captive by some people for a month and forced to make movies. While the patient is undoubtedly convinced he is turning green, you cannot see it. The patient's brother tells you that he has not been missing for the past month but that he has stopped taking his medication. Which of the following is MOST consistent with this situation? a. Schizotypal personality disorder b. Bipolar disorder c. Acute dystonic reaction d. Schizophrenia

d.Schizophrenia

Which of the following situations would result in a more rapid response by the immune system to an infection? a. First-time exposure to an antigen with memory T cell activation b. First-time exposure to an antigen with memory B cell activation c. First-time exposure to an antigen d. Second exposure to an antigen with memory B cell activation

d.Second exposure to an antigen with memory B cell activation

Which of the following is best described as a change from the absence of antibodies to detectable levels of antibodies in the blood after exposure to an infectious disease? a. Clinical horizon b. Virulence c. Chemotaxis d. Seroconversion

d.Seroconversion

Your patient is a 22-year-old female who has increased her daily dose of lithium without her physician's knowledge. She is complaining of generalized weakness, vomiting, and diarrhea. You notice that her speech is slurred. Heart rate = 68 and irregular, respirations = 16, blood pressure = 104/70, SaO2 = 97% on room air, and the monitor shows a sinus rhythm with PACs and PJCs. Which of the following would be most beneficial to this patient? a. Oxygen b. Magnesium sulfate c. Calcium chloride d. Sodium bicarbonate

d.Sodium bicarbonate

All of the following statements concerning oral medications used in the treatment of diabetes are true EXCEPT: a. Some oral medications stimulate the pancreas to secrete insulin b. Some oral medications prevent overproduction of glucose by the liver c. Some oral medications reduce cellular resistance to insulin d. Some oral medications are forms of insulin that are not broken down by the digestive process

d.Some oral medications are forms of insulin that are not broken down by the digestive process

Your patient is a 42-year-old male with a history of alcohol abuse who is in severe distress with dysphagia and hematemesis. You note that he is becoming lethargic and is having trouble keeping his head up. His skin is cool and clammy. HR = 138, BP = 82/56, RR = 8, SaO2 = 90%. Proper treatment of this patient would include all of the following EXCEPT: a. IV of NS with fluid challenge b. Aggressive suctioning of the airway and intubation c. Dopamine infusion d. Placing the patient in shock position

d.Stop palpating

Which of the following signs indicates the need for aggressive airway management in a patient experiencing an anaphylactic reaction? a. Expiratory wheezing b. Generalized rash c. Urticaria d. Stridor

d.Stridor

Using a pharmaceutical agent for something other than its intended use is called: a. Overdose b. Addiction c. Habituation d. Substance abuse

d.Substance abuse

Which of the following best describes the correct positioning of a restrained patient? a. Prone, sandwiched between the cot and a long backboard to prevent movement b. Prone, ensuring the restraints are not loose enough to allow patient movement c. Left lateral recumbent, ensuring the restraints are not tight enough to affect breathing or circulation d. Supine on the cot, ensuring the restraints are not loose but do not restrict circulation or breathing

d.Supine on the cot, ensuring the restraints are not loose but do not restrict circulation or breathing

Your patient is a 60-year-old male complaining of chills, fever, joint pain, and vomiting. He states he was bitten by a spider yesterday morning, and now he thinks the bite might be infected. The patient has an ulcerated wound on his left leg. The best treatment for this patient would include: a. Diazepam 2.5 mg b. Magnesium sulfate, 2 g c. Calcium gluconate 0.1 mg/kg d. Supportive management

d.Supportive management

Which of the following findings would be atypical in a patient with a history of Cushing's syndrome? a. Blood glucose level of 190 mg/dL b. Blood pressure of 154/86 mmHg c. Bruising of the extremities d. Temperature of 101°F

d.Temperature of 101°F

Which of the following statements about influenza and the influenza virus is FALSE? a. High-risk individuals include the pediatric and geriatric populations. b. An influenza vaccine confers immunity against only a few strains of the virus each year. c. Influenza is the leading cause of respiratory disease worldwide. d. The disease is characterized by nausea, vomiting, and diarrhea.

d.The disease is characterized by nausea, vomiting, and diarrhea.

Pain that is well localized, allowing an examiner to pinpoint the area of irritation is ________ pain. a. Parietal b. Visceral c. Referred d. Somatic

d.The nerves that carry visceral pain impulses enter the spinal column at various levels, while the nerves that carry somatic impulses enter the spinal column via specific nerve routes. d.Somatic

Your patient is a 34-year-old male who is threatening to kill himself. Which of the following does NOT indicate an increased risk for suicide? a. The patient having ingested a substantial amount of alcohol b. The patient having a father who committed suicide when the patient was a teenager c. A previous nonlethal attempt at suicide d. The patient's being married

d.The patient's being married

Which of the following would interfere with urine production? a. Benign prostatic hypertrophy b. Renal calculi c. Tumor in the renal pelvis d. Toxic damage to the nephrons

d.Toxic damage to the nephrons

Which of the following statements about herpes simplex type 2 (HSV-2) is FALSE? a. There is a low risk of disease transmission via casual contact. b. HSV-2 is responsible for 70 to 90 percent of all genital herpes cases. c. In addition to painful lesions to the infected area, fever and enlarged lymph nodes can be present during the initial presentation of the infection. d. Treatment with acyclovir can eradicate the virus.

d.Treatment with acyclovir can eradicate the virus.

Of the following, which is TRUE of the changes in blood chemistry and composition in a patient with chronic renal failure? a. Blood glucose decreases. b. H+ excretion leads to alkalosis. c. Polycythemia occurs. d. Uremia and creatinine levels increase.

d.Uremia and creatinine levels increase.

Your patient is a 21-year-old male who is alert and oriented, complaining of a rash that started about 36 hours ago, first appearing on his trunk. The rash has now spread to his face and extremities. You notice multiple small, fluid-filled vesicles on the patient's body. The patient is concerned that he will miss work as a second-grade student teacher. He has no medical history, including childhood diseases. The patient is most likely suffering from: a. Rubella b. Epstein-Barr virus c. Herpes simplex d. Varicella

d.Varicella

Your patient was bitten on the hand by a wild raccoon he tried to capture. Which of the following is the best management for this patient? a. Irrigate the wound with sterile saline, dry the area around the wound, and apply a thin layer of antibiotic ointment. b. Clean the area with a povidone-iodine swab. c. Clean the area with an isopropyl alcohol pad. d. Wash the wound with soap and running water.

d.Wash the wound with soap and running water.

Menorrhagia is: a. irregular cycles of menstruation. b. painful menstruation. c. absence of menstruation. d. excessive menstrual flow

d.excessive menstrual flow

Your patient is a 42-year-old female who is alert and upset, complaining of vaginal bleeding. She states that the bleeding began ten hours ago and is heavier than her normal menstrual flow. Her last menstrual period was four months ago, G3P3, and there is no other significant gynecologic history. Physical exam reveals dark red blood from her vagina, a soft and non-tender abdomen and skin that is warm and dry. HR = 92, BP = 114/76, RR = 12, SpO2 = 98%. This is most consistent with: a. ectopic pregnancy. b. pelvic inflammatory disease. c. menopause-related dysfunctional uterine bleeding. d. spontaneous abortion.

d.spontaneous abortion.

Contact with strong alkalis results in burns involving ________ necrosis of the tissue. A) Coagulation B) Liquefaction C) Thermal D) Ischemic Liquefaction Your patient has circumferential full-thickness burns of the thorax. He is intubated, and you have noticed an increase in resistance as you bag him. His skin is very tight and inflexible as you try to ventilate. Which of the following is required to improve this patient's ventilatory status? A) IV sedation B) Needle thoracostomy C) Escharotomy D) Fasciotomy Escharotomy Which of the following body areas warrant special attention when burned? A) Legs B) Arms C) Abdomen D) Feet Feet Which of the following patient factors increases the criticality of the patient's burn injuries? A) Taking antidepressants B) Male gender C) Prior history of burns D) Being in the geriatric age group Being in the geriatric age group You are dispatched to a structure fire at which there is a report of a burned person. Your patient is a 32-year-old male with blisters on his anterior chest and circumferential superficial burns to both lower extremities. Using the "Rules of Nines," what percentage of burn does this patient have? A) 54 B) 27 C) 36 D) 45 45 Which of the following agents is the best choice for analgesia in a patient with 9 percent partial-thickness burns involving the right lower extremity? A) Naproxen sodium B) Ketorolac C) Acetaminophen D) Fentanyl Fentanyl The type of electricity supplied to homes is ________ current. Contact with this type of current may result in ________. A) Indirect, rhabdomyolysis B) Direct, rhabdomyolysis C) Direct, muscle tetany D) Alternating, muscle tetany Alternating, muscle tetany You are caring for a patient with 30 percent full- and partial-thickness burns. He is an 80 kg male. According to the Parkland formula, he should receive ________ liters of fluid over 24 hours, with ________ liters infused in the first 8 hours. A) 10.6, 5.3 B) 5, 3 C) 8.2, 2 D) 4.5, 1.25 10.6, 5.3 According to Jackson's theory of thermal wounds, which of the following zones has suffered the greatest damage? A) Coagulation B) Hyperemia C) Stasis D) Disintegration Coagulation Which type of radiation particle can travel through 6 to 10 feet of air, penetrate a few layers of clothing, and cause external and internal injuries? A) Gamma B) Alpha C) Neutron D) Beta Beta Which of the following accounts for the most severe thermal burns of the airway? A) Inhalation of toxic gases B) Inhalation of radioactive particles in smoke C) Inhalation of superheated steam D) Inhalation of superheated air Inhalation of superheated steam Which of the following may occur from watching arc welding without proper protection? A) Hyphema B) Retinal detachment C) Ultraviolet keratitis D) Radial keratotomy Ultraviolet keratitis For which of the following burn patients could you use local cooling? A) An 18-month-old child with partial- and full-thickness scald burns on both lower extremities, buttocks, genitalia, and lower abdomen B) A 19-year-old female with approximately 40 percent superficial and 45 percent partial-thickness burns from sunbathing C) A 15-year-old male with partial-thickness burns of his left upper extremity, anterior chest, and neck resulting from playing with gasoline and matches D) A 52-year-old male with a 1-inch-wide, full-thickness burn across the entire width of the palm of his right hand resulting from picking up a hot grate from a barbecue grill A 52-year-old male with a 1-inch-wide, full-thickness burn across the entire width of the palm of his right hand resulting from picking up a hot grate from a barbecue grill A burn patient who has signs and symptoms of inhalation injury with associated respiratory compromise should be classified as: A) Serious B) Moderate C) Critical D) Minor Critical You are assessing a 17-year-old male patient with a burn on the lateral aspect of his thigh. Which of the following guidelines is most helpful when estimating the percentage of total body surface area involved? A) The Rule of Palms B) The Parkland formula C) The Rule of Nines D) The modified pediatric Rule of Nines The Rule of Palms Which of the following is TRUE of the heat generated when electricity flows through the body? A) Dry skin offers less resistance to electricity, generating more heat. B) Wet skin offers less resistance to electricity, generating more heat. C) Wet skin offers greater resistance to electricity, generating more heat. D) Dry skin offers more resistance to electricity, generating more heat. Dry skin offers more resistance to electricity, generating more heat. Cool-water immersion of a burned part effectively reduces burning only when done within which of the following time frames? A) The first 24 hours B) The first 10 to 15 minutes C) The first 1 to 2 minutes D) The first hour The first 1 to 2 minutes Paralysis of the muscles of respiration may occur when there is body contact with electrical currents as low as ________ mA. A) 50 B) 100 C) 20 D) 5 20 The first step for treating a patient who has been contaminated with dry lime is to: A) Neutralize the lime with a mild acidic solution, such as vinegar and water B) Brush away as much of the powder as possible C) Flush the skin with large amounts of isopropyl alcohol D) Flush with copious amounts of tepid water Brush away as much of the powder as possible Which of the following best describes the pathophysiology of most burns to the human body? A) Heat causes evaporation of water and denatures protein. B) Radiation, including solar radiation and radiant heat, alters cell structures. C) Chemicals cause an endothermic reaction that destroys tissue. D) The skin, and sometimes deeper tissues, are destroyed through combustion. Heat causes evaporation of water and denatures protein. Which of the following represents the modified body surface area percentages in the "Rule of Nines" for pediatric patients? A) Posterior chest is 7 percent. B) Upper extremities are 13.5 percent each. C) External genitalia is 1 percent. D) Lower extremities are 13.5 percent each. Lower extremities are 13.5 percent each. The voltage of a bolt of lightning may be as much as ________ volts, and its temperature may reach ________° Fahrenheit. A) 5,000; 150,000 B) 150,000; 5,000 C) 50,000; 100,000 D) 100,000; 50,000 100,000; 50,000 Most inhalation injuries in burn patients are due to which of the following? A) Toxic inhalation B) Radiation burns of the airway C) Thermal burns of the lower airway D) Thermal burns of the upper airway Toxic inhalation During which phase of a burn injury does extravasation of proteins, water, and electrolytes occur, resulting in edema and potential hypovolemia? A) Emergent B) Hyperemia C) Hypermetabolic D) Fluid shift Fluid shift Your patient is a 23-year-old female who was rescued from a burning house. She was asleep in a back bedroom when the fire started, and there was no smoke alarm. She has a pulse oximetry reading of 99 percent after receiving oxygen by nonrebreathing mask. What is the most appropriate interpretation of this finding? A) Effects of smoke inhalation have been resolved by oxygen administration. B) You cannot rely on this alone to assess oxygenation. C) There was minimal smoke inhalation. D) Carboxyhemoglobin is less than 1 percent. You cannot rely on this alone to assess oxygenation. Which of the following body structures is the best electricity conductor? A) Bones B) Nerves C) Muscle D) Skin Nerves Which of the following burns would be classified as moderate? A) Superficial < 50 percent BSA B) Full-thickness < 2 percent BSA C) Partial-thickness < 30 percent BSA D) Partial-thickness > 30 percent BSA Partial-thickness < 30 percent BSA Patients who survive the first several days of a moderate to critical burn are most likely to die from which of the following complications? A) Hypovolemia B) Organ failure C) Infection D) Hypothermia Infection Flash burns associated with electricity occur because: A) Air is a moderately good conductor of electricity, generating moderate heat B) Air is an excellent conductor of electricity, generating moderate heat C) Air is mildly resistant to the passage of electricity, generating only enough heat to cause superficial burns D) Air is highly resistant to the passage of electricity, generating intense heat Air is highly resistant to the passage of electricity, generating intense heat You are assessing a 37-year-old woman who was rescued from an apartment fire. She has a harsh, stridorous, "brassy"-sounding cough productive of sooty sputum. Her eyebrows and the hair around her face are singed. Respirations = 28, heart rate = 108, and blood pressure = 124/84. You have a 30-minute transport time. Which of the following is the best intervention for this patient? A) One hundred percent oxygen by nonrebreathing mask B) Sedation and cricothyrotomy C) A nebulized albuterol treatment D) RSI and endotracheal intubation RSI and endotracheal intubation The seriousness of burns in the pediatric population is put into perspective by realizing that burns are the ________ leading cause of death in children under age 12 years. A) First B) Second C) Third D) Fourth Second Which of the following chemicals must be brushed off the skin, then covered with oil? A) Phenol B) Sodium metal C) Oleoresin capsicum D) Dry lime Sodium metal CHAPTER 7 Which of the following is NOT part of the axial skeleton? A) Sacrum B) Pubis C) Sternum D) Mandible Pubis Your patient is a 27-year-old male ice skater whose left skate was planted when he was struck and knocked down by another skater. He is agitated and complaining of severe pain in his leg. Your examination reveals an open fracture 6 inches proximal to the ankle joint. Which of the following describes the most appropriate management of this patient? A) Focused exam, oxygen, spinal immobilization, splint from the foot to above the knee, begin transport, start a large-bore IV, and request orders for analgesia B) Focused exam, cover the open wound, apply a lower extremity traction splint, begin transport, start an IV, and request orders for analgesia C) Focused exam, cover the open wound, splint from the foot to above the knee, begin transport, start an IV, and request orders for analgesia D) Rapid trauma exam, high-concentration oxygen, cervical spine immobilization, cover the open wound, use the long backboard for initial splinting, initiate transport, start a large-bore IV, perform a detailed examination, use padded board splints to immobilize from the ankle to above the knee, and reassess the patient every 5 minutes Focused exam, cover the open wound, splint from the foot to above the knee, begin transport, start an IV, and request orders for analgesia Your patient is a football player who had his right foot planted and was tackled from the left rear, causing his body to rotate around the axis of his right lower extremity. This mechanism is most consistent with which of the following types of fractures? A) Oblique B) Spiral C) Impacted D) Comminuted Spiral Which of the following is the highest priority when managing a patient with bilateral closed femur fractures? A) Assessing distal neurovascular function B) Anticipating hypovolemia C) Providing analgesia D) Anticipating pulmonary embolism as a complication Anticipating hypovolemia Upon assessing a patient with a hip injury, you find that his right lower extremity is moved away from the midline of the body. You should describe the right lower extremity as being: A) Abducted B) Externally rotated C) Angulated D) Adducted Abducted Your patient is a 60-year-old female driver of a vehicle involved in a moderate-speed frontal collision. She was unrestrained, but airbags deployed. There is no damage to the windshield, but the bottom of the steering wheel ring is deformed. On your initial approach to the vehicle, you see that an EMT is in the back seat with manual cervical spine stabilization. The patient is anxious and complaining of pain in her legs. She is pale with cool, dry skin. The radial pulse is thready at 116, respirations are 24, and the breath sounds are clear bilaterally and equal. The abdomen is soft and nontender, and there is no pain or instability on assessment of the pelvis. You are 15 minutes from a Level I trauma center. In addition to oxygen, application of a cervical collar, and a large-bore IV of isotonic crystalloids started en route, which of the following is the best management of this patient? A) Seated-spinal immobilization device, extrication onto a long backboard, analgesia B) Rapid extrication onto a long backboard C) Rapid extrication onto a long backboard, bilateral traction splints D) Seated-spinal immobilization device, extrication onto a long backboard, bilateral traction splints, analgesia Rapid extrication onto a long backboard Your patient is a 20-year-old female complaining of ankle pain after stepping off a curb. She states that she is concerned because she had a grade III sprain a year and a half ago that required extensive treatment and rehabilitation. Which of the following most accurately describes the patient's previous injury? A) The ankle ligaments were stretched but not torn. B) The ankle ligaments had a minor tear. C) The ankle ligaments were torn but not all the way. D) The ankle ligaments were completely torn. The ankle ligaments were completely torn. Tendons connect ________ to ________. A) Muscles, bones B) Bones, bones C) Cartilage, bones D) Muscles, fascia Muscles, bones The use of PASG is indicated in the treatment of which of the following musculoskeletal injuries? A) Bilateral tibia/fibula fractures B) Knee dislocation C) Lumbar vertebral compression fracture D) Pelvic fracture Pelvic fracture Which of the following supplies articular cartilage with oxygen and nutrients? A) Bursae B) Capillary beds C) Synovial fluid D) The Haversian system Synovial fluid A partial displacement of a bone end from its position in the joint is called a: A) Sprain B) Dislocation C) Subluxation D) Contracture Subluxation A fracture in which significant energy exchange shatters or splinters bone, creating many fragments, is called a(n) ________ fracture. A) Impacted B) Comminuted C) Oblique D) Spiral Comminuted Your patient is a seven-year-old male with a fracture of the proximal tibia. Which of the following is the most likely and serious complication of this injury? A) Juvenile onset arthritis B) Formation of a bone callus C) Disruption of the epiphyseal plate D) Fat embolism Disruption of the epiphyseal plate Which of the following best describes the function of cancellous bone? A) It produces erythrocytes. B) It acts as a growth plate in long bones. C) Its dense, compact structure is well adapted to weight bearing. D) It contains yellow bone marrow. It produces erythrocytes. A dislocated knee is most likely to damage which of the following vascular structures? A) Femoral vein B) Popliteal artery C) Femoral artery D) Great saphenous vein Popliteal artery

Which of the following types of fractures occurs in pediatric age groups but not in adults? A) Oblique B) Transverse C) Greenstick D) Impacted Greenstick Your patient is a 50-year-old motorcyclist who received a lateral impact from an automobile as he went through an intersection. He has a deformity of the right midthigh and an open right tibia/fibula fracture. He also has a fracture of his left forearm and some abrasions. He was wearing a helmet and suffered no loss of consciousness. He currently has a strong radial pulse of 100, his skin is warm and moist, and he has adequate respirations at 20 per minute. Assuming no significant findings during a rapid trauma exam and intact distal neurovascular status, which of the following is the best way to manage this patient's lower-extremity trauma? A) Use anatomical splinting provided by placing the patient on a long backboard. B) Secure padded long board splints laterally and medially. C) Apply PASG. D) Apply a traction splint. Secure padded long board splints laterally and medially. Not considering other injuries, which of the following musculoskeletal findings warrants immediate transport of your patient? A) Unstable pelvis B) Clavicle fracture C) Posterior shoulder dislocation D) Open fracture of the tibia and fibula Unstable pelvis Your patient is an 80-year-old female who fractured a vertebra while coughing. This type of fracture is best described as a(n) ________ fracture. A) Pathological B) Greenstick C) Epiphyseal D) Comminuted Pathological When assessing a long-bone injury, you should assume you are dealing with a joint injury when the site of injury is within ________ inch(es) of the joint. A) 3 B) 2 C) 1 D) 6 3 One of the earliest indications that compartment syndrome is developing in an injured extremity is: A) Burning pain B) Pallor of the overlying skin C) Loss of distal pulses D) Sensation of pressure in the limb Burning pain A sprain is an injury best defined as which of the following? A) Bone ends are not anatomically aligned B) Muscle fibers are stretched and torn C) Partial or complete tearing of the ligaments of the joint capsule D) A violent muscle spasm that tears away a small piece of bone Partial or complete tearing of the ligaments of the joint capsule Your patient has an abrasion on the bony prominence on the inside of her right ankle. This abrasion should be described as being over which of the following structures? A) Thenar eminence B) Medial malleolus C) Lateral malleolus D) Styloid process Medial malleolus The pain associated with skeletal fractures is transmitted by nerves in the: A) Epiphysis B) Yellow bone marrow C) Osteoclasts D) Periosteum Periosteum Your patient complains of elbow pain and states his doctor told him he had "the bursitis," in his elbow. The patient's condition is characterized by inflammation of the: A) Articular cartilage B) Synovial sacs C) Tendons D) Bone Synovial sacs Your patient is a 21-year-old football player who was struck in the lateral aspect of the left knee by another player's shoulder. The patient is in extreme pain, and the knee is significantly deformed and swollen. The pedal pulse is weak, but present, and capillary refill is less than 2 seconds. The patient is screaming at you to "fix" his knee. You are 10 minutes from the emergency department. You should: A) Splint the knee as found, start an IV, consider narcotic analgesia B) Apply gentle axial traction and realign the limb, splint in alignment C) Flex the knee to a 45-degree angle, splint in position of function D) Start an IV, administer narcotic analgesia, apply firm axial traction until the pulse returns to normal or resistance is met, then splint Splint the knee as found, start an IV, consider narcotic analgesia CHAPTER 8 Which of the following is the correct description of a wound that is below the fifth rib, directly in line with the armpit? A) Sixth intercostal space, midclavicular B) Sixth intercostal space, midaxillary line C) Fifth intercostal space, midclavicular line D) Fifth intercostal space, midaxillary line Fifth intercostal space, midaxillary line The morbidity associated with simple pneumothorax is primarily due to which of the following? A) Occlusion of pulmonary circulation B) Increased intrathoracic pressure C) Loss of chest wall integrity D) Ventilation/perfusion mismatch Ventilation/perfusion mismatch On maximal expiration the diaphragm may be: A) As high as the fourth intercostal space anteriorly B) As high as the second intercostal space anteriorly C) As low as the ninth intercostal space anteriorly D) As low as the eleventh intercostal space anteriorly As high as the fourth intercostal space anteriorly Which of the following occurs during the onset of inspiration? A) Intrathoracic pressure increases and venous return to the heart is impeded. B) Intrathoracic pressure increases and venous return to the heart is facilitated. C) Intrathoracic pressure decreases and venous return to the heart is impeded. D) Intrathoracic pressure decreases and venous return to the heart is facilitated. Intrathoracic pressure decreases and venous return to the heart is facilitated. The trachea divides into the right and left mainstem bronchi at the: A) Carina B) Hilum C) Lingual D) Thoracic inlet Carina Which of the following has the greatest likelihood of resulting in an open pneumothorax? A) Any opening between the pleural cavity and the atmosphere B) Open defects that are two-thirds the size of the trachea or larger C) Open defects that are larger in diameter than the trachea D) Open defects that are one-quarter the size of the trachea or larger Open defects that are two-thirds the size of the trachea or larger Your patient is a 38-year-old male who was pinned beneath the frame of a vehicle when it slipped off the makeshift jacks he was using to elevate it. The patient's brother thinks he may have been trapped for up to 20 minutes. The rescue unit is preparing to use airbags to lift the vehicle off the patient. Which of the following medications could you consider giving this patient? A) Magnesium sulfate B) Calcium chloride C) Sodium bicarbonate D) Potassium chloride Sodium bicarbonate Your patient is a 27-year-old male with one stab wound at the fifth intercostal space posteriorly, on the right. He is ambulatory at the scene but dyspneic and has air movement at the site of the injury. Which of the following should you do first? A) Apply oxygen by nonrebreather. B) Cover the wound with your gloved hand. C) Prepare an occlusive dressing. D) Perform a needle thoracostomy. Prepare an occlusive dressing. Which of the following statements is NOT true of pericardial tamponade? A) It is most often associated with penetrating trauma. B) The systolic blood pressure increases significantly on inspiration. C) As little as 150 ml of blood can cause pericardial tamponade. D) The pathophysiology results in increased venous pressure and decreased cardiac output. The systolic blood pressure increases significantly on inspiration. Which of the following statements concerning blunt thoracic trauma in the pediatric population is most accurate? A) Children are more likely than adults to suffer both rib fracture and organ injury. B) Children are less likely than adults to suffer either rib fractures or organ injury. C) Children are more likely than adults to suffer rib fractures but less likely to suffer significant organ injury. D) Children are less likely than adults to suffer rib fractures but more likely to have significant organ injury. Children are less likely than adults to suffer rib fractures but more likely to have significant organ injury. An individual is struck in the left ventricle with a high-velocity projectile. As compared to low-velocity penetrating trauma, you should have a higher index of suspicion for: A) Ventricular rupture B) Pericardial tamponade C) Simple penetrating injury D) Blunt cardiac injury Pericardial tamponade Your patient received a blow to the left lateral chest at the level of the sixth and seventh ribs. You should suspect fractures at: A) The point of impact of the sixth rib only B) The point of impact and the posterior axillary line of the sixth rib only C) The point of impact on both ribs D) The point of impact and the posterior axillary line of both ribs The point of impact and the posterior axillary line of both ribs You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old female with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient's EMT partner has applied oxygen by nonrebreathing mask and an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient's level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and her abdomen is nonguarded and nontender. Which of the following best explains the presentation of this patient? A) Simple pneumothorax B) Tension pneumothorax C) Pericardial tamponade D) Hemothorax Hemothorax You have arrived on the scene of a paramedic who was shot as she approached a residence on a call. The scene has since been secured. Your patient is a 38-year-old female with one gunshot wound to the left side of the chest at the fifth intercostal space in the midaxillary line. She is pale, cool, and awake but agitated. She is diaphoretic and complaining of pain in her left side and difficulty breathing. The patient's EMT partner has applied oxygen by nonrebreathing mask and an occlusive dressing over the entry wound before your arrival. As you continue your assessment, the patient's level of consciousness decreases. She responds to verbal stimuli. Her airway is clear, her respiratory rate is 38 per minute and shallow, her neck veins are flat, and her breath sounds are absent on the left side. The patient lacks a radial pulse, and the abdomen is nonguarded and nontender. Which of the following should you do first? A) Start a large-bore IV of isotonic crystalloid solution B) Do a rapid trauma assessment C) Assist ventilations with a bag-valve-mask device D) Do an immediate needle chest decompression Assist ventilations with a bag-valve-mask device Which of the following is TRUE of pulmonary contusion? A) Signs and symptoms generally develop gradually. B) Pulmonary contusion is typically an isolated injury. C) The primary pathophysiology is that the alveoli are filled with blood. D) Pulmonary contusion results in paradoxical motion of the chest wall. Signs and symptoms generally develop gradually. Which of the following is the primary prehospital concern with a simple, isolated fracture of the fifth rib in the right posterior-axillary line? A) Hemorrhage B) Pneumonia C) Hypoventilation D) Liver contusion Hypoventilation Which of the following best describes the threat to life associated with traumatic rupture of the esophagus? A) Entry of gastric contents into the mediastinum B) Hypoxia C) Decreased cardiac output D) Massive hemorrhage Entry of gastric contents into the mediastinum Which of the following best describes the epidemiology of sternal fracture? A) Low incidence, low mortality B) High incidence, high mortality C) High incidence, low mortality D) Low incidence, high mortality Low incidence, high mortality Abdominal trauma should be suspected with penetrating thoracic wounds below the ________ rib anteriorly and the ________ rib posteriorly. A) Fourth, ninth B) Second, fifth C) Fourth, sixth D) Second, tenth Fourth, sixth Your patient is an 80-year-old male who was the unrestrained driver of a vehicle without airbags that was involved in a frontal collision with a parked car. Your assessment reveals that he is dyspneic, tachypneic, and tachycardic. He is awake but unable to respond to questions. There are no obvious signs of injury to the head or neck. The patient has paradoxical movement of the sternum with breathing, along with crepitus and subcutaneous air noted on palpation. Chest excursion is limited, and the patient has cyanosis of his lips, ears, and nail beds. Which of the following is MOST needed in this patient? A) Infusion of isotonic crystalloid solution using a large-bore IV B) Application of bulky dressings over the site of paradoxical motion C) Being placed in a prone position to stabilize the chest wall D) Intubation and positive-pressure ventilation Intubation and positive-pressure ventilation Traumatic asphyxia is a(n) ________ type of injury. A) Compression B) Deceleration C) Decompression D) Acceleration Compression Which of the following is a complication of positive-pressure ventilation in the patient with significant chest trauma? A) Pulmonary contusion B) Atelectasis C) Exacerbation of flail chest D) Reduced cardiac output Reduced cardiac output Which of the following most accurately characterizes simple pneumothorax? A) Untreated, it will lead to mediastinal shift and compression of the contralateral lung. B) It is a problem of ventilation/perfusion mismatch. C) It results from air entering the pleural cavity through a defect in the chest wall. D) It results from the creation of a one-way valve that continues to allow air into, but not out of, the pleural cavity. It is a problem of ventilation/perfusion mismatch. Which of the following findings differentiates a simple pneumothorax from a tension pneumothorax? A) Decreased breath sounds on the affected side B) Hemodynamic compromise C) Absent breath sounds on the affected side D) An open defect in the chest wall Hemodynamic compromise Hemothorax is primarily a problem of: A) Blood loss B) Impaired ventilation C) Ventilation/perfusion mismatch D) Increased intrathoracic pressure Blood loss Your patient is a 15-year-old male who was struck in the chest with a baseball. He is unresponsive, pulseless, and apneic. The monitor shows ventricular fibrillation. This condition is most accurately described as: A) Pericardial tamponade B) Blunt cardiac injury C) Commotio cordis D) Traumatic asphyxia Commotio cordis Your patient is a 21-year-old male with a single, small-caliber gunshot wound to the left anterior chest, just lateral to the sternum at the fourth intercostal space. Bleeding from the wound is minimal. The patient is initially anxious, combative, and diaphoretic. Initial vital signs include a heart rate of 100, respirations of 20, and a blood pressure of 110/80. Breath sounds are clear bilaterally and equal. En route the patient becomes quieter but still restless. The heart rate increases to 120, respirations are 24, blood pressure 106/88, and breath sounds remain clear and equal. The patient has also developed significant JVD. You are 15 minutes from a Level I trauma center and 5 minutes away from a large community hospital. You should: A) Immediately decompress the left chest and divert to the community hospital for chest tube insertion. B) Immediately decompress the left chest and continue to the trauma center for chest tube insertion. C) Continue to the Level I trauma center for pericardiocentesis. D) Divert to the community hospital for pericardiocentesis. Divert to the community hospital for pericardiocentesis. Which of the following best describes the mechanism of blunt thoracic trauma associated with blast injuries? A) Deceleration B) Acceleration C) Compression D) Compression and decompression Compression and decompression Thoracic trauma accounts for approximately ________ percent of mortality from trauma? A) 20 to 25 B) 10 to 15 C) 75 to 80 D) 45 to 50 20 to 25 Which of the following is the primary concern in the patient with a hemothorax? A) Hypovolemia B) Increased intrathoracic pressure C) Mediastinal shift D) Atelectasis Hypovolemia Your patient was the unrestrained driver of a motor vehicle without airbags. The vehicle struck a large utility pole at about 45 miles per hour. Your patient has a contusion over his chest and upper abdomen consistent with the shape of the steering wheel. You should suspect which of the following types of injury in this patient? A) Compression B) Compression and acceleration C) Compression and deceleration D) Deceleration Compression and deceleration The location of the neurovascular bundles containing the intercostal arteries is best described as the bundle that runs along the: A) Intercostal space equally distant from both associated ribs B) Posterior surface of the associated rib C) Superior margin of the associated rib D) Inferior margin of the associated rib Inferior margin of the associated rib Your patient is a 24-year-old male who was struck just below the left scapula with a 3-inch-diameter metal pipe. He is awake but having difficulty breathing. His pulse is 112 at the radial artery, and his respiratory rate is 28 per minute and shallow. His breath sounds are present bilaterally but diminished on the left. He has a blood pressure of 108/68. The patient is coughing up some bloody sputum. He has no other complaints, and a rapid trauma survey reveals no additional life-threatening injuries. Which of the following represents the best sequence of intervention for this patient? A) Begin transport immediately, positive pressure ventilation, a large-bore IV of isotonic solution to maintain a systolic blood pressure of 120 mmHg or greater B) High-concentration oxygen by nonrebreathing mask, begin transport, a 16-gauge IV at a keep-open rate C) Positive-pressure ventilation, a large-bore IV of normal saline solution at a keep-open rate, transport D) High-concentration oxygen by nonrebreathing mask, begin transport, two 14-gauge IVs of 50 percent dextrose solution wide open High-concentration oxygen by nonrebreathing mask, begin transport, a 16-gauge IV at a keep-open rate Which of the following best describes the incidence of pericardial tamponade? A) It occurs in 10 to 15 percent of all trauma patients. B) It occurs in less than 2 percent of all patients with serious chest trauma. C) It occurs in 10 to 15 percent of patients with serious chest trauma. D) It occurs in 2 percent of all trauma patients. It occurs in less than 2 percent of all patients with serious chest trauma. The angle of Louis serves as a landmark for performing needle thoracostomy at which of the following locations? A) Second intercostal space anteriorly B) Second intercostal space laterally C) Fourth intercostal space anteriorly D) Fourth intercostal space laterally Second intercostal space anteriorly The central area in the thorax that contains the heart, great vessels, trachea, and esophagus is the: A) Mediastinum B) Pulmonary hilum C) Hemothorax D) Carina Mediastinum You have just inserted a large-bore catheter into the chest of a patient with a tension pneumothorax and received a return of air. Which of the following should NOT be done? A) Insert a second, or even a third, catheter if the patient is symptomatic, despite the release of air. B) Leave the catheter in place, and create a flutter valve. C) Leave the catheter in place and open to air. D) Remove the catheter. Remove the catheter. Another name for an open pneumothorax is: A) Tension pneumothorax B) Sucking chest wound C) Flail chest D) Hemopneumothorax Sucking chest wound Which of the following is LEAST likely to be a sign of an open pneumothorax? A) Large, open thoracic wound. B) Frothy blood around the opening C) Jugular vein distention D) Dyspnea Jugular vein distention Which of the following best describes the finding of tracheal deviation in the trauma patient? A) Its absence rules out tension pneumothorax. B) It is the earliest sign of tension pneumothorax. C) It is not reliably present in patients with tension pneumothorax. D) It is a contraindication to needle thoracostomy in tension pneumothorax. It is not reliably present in patients with tension pneumothorax. The finding of jugular venous distension in the patient with thoracic trauma is LEAST likely to be associated with which of the following? A) Traumatic asphyxia B) Hemothorax C) Tension pneumothorax D) Pericardial tamponade Hemothorax Which of the following may improve breathing in the patient with isolated rib fractures? A) Nitrous oxide B) Taping circumferentially around the chest C) Morphine sulfate D) None of the above Morphine sulfate Which of the following are the most commonly fractured ribs? A) 1 to 3 B) 4 to 8 C) 7 to 12 D) 5 to 10 4 to 8 You are treating a patient whose open chest wound has been sealed by EMTs on the scene before your arrival. During transport the patient becomes more dyspneic, tachycardic, and hypotensive. There are no breath sounds on the affected side, and the patient has JVD. Which of the following is the best action? A) Reinforce the dressing with additional tape, using tincture of benzoin, if necessary, to improve the seal. B) Perform a needle thoracostomy at the second intercostal space in the midclavicular line. C) Perform a needle thoracostomy at the fourth intercostal space in the midaxillary line. D) Remove the dressing, and see if the patient's clinical status improves, then replace the dressing. Remove the dressing, and see if the patient's clinical status improves, then replace the dressing. CHAPTER 9 Which of the following patients may have trauma to abdominal organs? 1. A 30-year-old construction worker who fell from a second-story roof but managed to land on his feet 2. A 17-year-old male with a gunshot wound to the right buttock 3. A 50-year-old male with a stab wound 4 cm inferior to the right scapula 4. A 45-year-old female restrained driver of an SUV with a moderate-speed frontal impact A) 1, 2, 3, 4 B) 3, 4 C) 4 D) 1, 3, 4 1, 2, 3, 4 Which of the following changes is NOT of concern in the pregnant trauma patient? A) Disproportionate increase in vascular volume as compared to red blood cells B) The high likelihood of trauma to the uterus in the first trimester C) Compression of the inferior vena cava D) All of the above The high likelihood of trauma to the uterus in the first trimester Which of the following about the use of PASG in the pregnant patient is NOT true? A) The abdominal section may be inflated in early pregnancy. B) Their use is absolutely contraindicated in pregnancy. C) Their use even in late pregnancy is often indicated. D) None of the above are true. None of the above are true. Which of the following best describes shear injuries to the abdominal organs? A) Sudden compression of gas-containing hollow organs resulting in their rupture B) Sudden decompression of solid or hollow organs C) Tearing of the organ in which the organ is fixed at its point of attachment but free to move otherwise D) Impact of solid organs with the abdominal wall in rapid deceleration Tearing of the organ in which the organ is fixed at its point of attachment but free to move otherwise The liver is injured ________ percent of the time with penetrating abdominal trauma. A) 10 B) 40 C) 25 D) 75 40 Your patient is a 30-year-old pregnant woman at 36 weeks' gestation. She was injured in a fall from a horse and is complaining of painful contractions. Her abdomen is tender to palpation over the uterus, and the uterus becomes firm with contractions, but she denies vaginal bleeding. The patient is anxious, but her skin is warm and dry. Her blood pressure is 112/70, her heart rate is 92, and her respirations are 24. Which of the following statements best describes this situation? A) The mechanism and patient complaints are suspicious for placental abruption. The mother's condition is not life threatening, but fetal demise has most likely already occurred. B) The mechanism and patient complaints are consistent with placenta previa. The mother is stable, but the fetus is in jeopardy. C) The mechanism and patient complaints are consistent with uterine rupture. Both the mother and fetus are in jeopardy. D) The mechanism and patient complaints are suspicious for placental abruption. Both the mother and the fetus are in jeopardy. The mechanism and patient complaints are suspicious for placental abruption. Both the mother and the fetus are in jeopardy. Which of the following can reduce the potential for abdominal injury? A) Proper placement of automobile lap belts in adults B) Side-impact airbags C) Proper placement of automobile lap belts in children D) All of the above All of the above Which of the following is TRUE of abdominal trauma? A) A soft, nontender, nondistended abdomen with intact bowel sounds reliably rules out hollow organ injury. B) Due to the vascular nature of abdominopelvic organs, the onset of signs and symptoms is abrupt and severe. C) A soft, nontender, nondistended abdomen reliably rules out solid organ injury. D) A significant amount of blood can accumulate in the abdominal cavity before signs and symptoms of abdominal injury appear. A significant amount of blood can accumulate in the abdominal cavity before signs and symptoms of abdominal injury appear. Which of the following describes definitive care of the patient with traumatic intraabdominal hemorrhage? A) Admission to the ICU for observation B) Aggressive oxygenation and fluid resuscitation C) Administration of blood or blood products D) Rapid surgical intervention Rapid surgical intervention The suspicion of blunt abdominal trauma should be based primarily on: A) The mechanism of injury B) Distension of the abdomen on palpation C) The patient's complaint of abdominal pain D) The presence of contusions The mechanism of injury Which of the following is a special consideration when managing the pregnant trauma patient? A) She is at increased risk for vomiting and aspiration. B) She may have a 30 percent blood volume loss before experiencing signs and symptoms of shock. C) Placing her supine may decrease cardiac output. D) All of the above are special considerations. All of the above are special considerations. Your patient is a 17-year-old male driver of a vehicle that received a lateral impact at the driver's side door. There are no side-impact airbags, and there is about 8 inches of intrusion into the passenger compartment at the left door. Your patient is complaining of left shoulder pain and pain "in his left side." He has a contusion on the left shoulder and deformity of the left clavicle. He has erythema over the left lateral thorax from ribs 6 through 12 with crepitus on palpation. Which of the following injuries should you suspect? 1. Blunt trauma to the spleen 2. Blunt trauma to the liver 3. Penetrating trauma to the spleen 4. Penetrating trauma to the liver 5. Left pneumothorax 6. Fracture of the left clavicle 7. Soft tissue injury to the left shoulder A) 1, 5, 6 B) 2, 4, 6, 7 C) 1, 3, 5, 6, 7 D) 2, 5, 6 1, 3, 5, 6, 7 Which of the following guidelines applies to prehospital fluid resuscitation of hypotensive patients with intraabdominal hemorrhage? A) In most cases fluid administration should be limited to 3 liters. B) IV access should be obtained using a saline lock, but fluid resuscitation is contraindicated in the prehospital setting. C) Fluid administration rate should be titrated to maintain a systolic blood pressure of 60 mmHg. D) IV access is only necessary if the use of PASG fails to improve the patient's clinical condition. In most cases fluid administration should be limited to 3 liters. Which of the following organs is NOT part of the digestive system? A) Liver B) Spleen C) Stomach D) Pancreas Spleen Damage to which of the following organs is most likely to induce severe infection in the abdominal cavity? A) Urinary bladder B) Colon C) Stomach D) Ureter Colon Your patient is an 18-year-old male who was slashed across the abdomen with a machete. He has a mass of omentum and small bowel protruding from the wound. Which of the following is your primary concern with this patient? A) Immediately covering the wound with an occlusive dressing, using your gloved hand if nothing else is available B) Irrigating the exposed organs with sterile saline to remove debris and gently tucking them back into the opening to keep them warm and moist and to prevent further contamination C) Covering the wound with a sterile, saline-moistened dressing covered by an occlusive dressing D) Ensuring an open airway by anticipating vomiting, providing oxygen, keeping the patient warm, and monitoring for and treating shock Ensuring an open airway by anticipating vomiting, providing oxygen, keeping the patient warm, and monitoring for and treating shock Which of the following may impact the pattern of injury in abdominal trauma? A) Breathing B) A full stomach C) A full bladder D) All of the above All of the above Which of the following is TRUE of the epidemiology of abdominal trauma? A) Morbidity and mortality due to blunt trauma is decreasing, but morbidity and mortality due to penetrating trauma is increasing. B) Morbidity and mortality due to blunt trauma is increasing, but morbidity and mortality due to penetrating is decreasing. C) Morbidity and mortality due to blunt and penetrating trauma are both increasing. D) Mortality and morbidity due to blunt and penetrating trauma are both decreasing. Morbidity and mortality due to blunt trauma is decreasing, but morbidity and mortality due to penetrating trauma is increasing. Which of the following organs is LEAST likely to be injured in penetrating trauma to the abdomen? A) Spleen B) Kidney C) Pancreas D) Small intestine Pancreas The injury in which abdominal organs protrude through a large, deep laceration of the abdominal wall is best described as: A) Disimpaction B) A gutting injury C) Herniation D) Evisceration Evisceration Your patient is a 60-year-old female restrained driver involved in a moderate-speed, frontal-impact collision. When you arrive at the scene, she is sitting up in the driver's seat with a chief complaint of a burning sensation of her face. You note abrasions from deployment of the airbag. After immobilizing the patient on a long backboard, you begin transport. As you perform a detailed examination, the patient complains of developing right shoulder pain. Which of the following should you suspect? A) Myocardial contusion B) Intraabdominal bleeding C) Exacerbation of the patient's arthritis due to immobilization on the backboard D) Shoulder contusion or possible clavical fracture due to restraint by the shoulder harness Intraabdominal bleeding The largest reserve of blood of any body organ is contained in the: A) Liver B) Kidneys C) Spleen D) Pancreas Liver Which of the following is most likely to occur as a result of rapid deceleration without actual contact between the patient's body and the interior of the vehicle? A) Blunt trauma to the pancreas B) Rupture of the colon C) Kidney contusion D) Shearing injury of the liver Shearing injury of the liver Which of the following is TRUE of the patient with a suspected penetrating injury to or rupture of the diaphragm? A) This is the only abdominal injury in which removal of an impaled object is recommended. B) This is one of the primary indications for the use of PASG. C) Pneumothorax may occur even if the thoracic cage is intact. D) Breathing is not impaired unless abdominal organs migrate into the thoracic cavity. Pneumothorax may occur even if the thoracic cage is intact. Which of the following is NOT part of the prehospital examination of the patient with suspected abdominal trauma? A) Asking the patient about abdominal pain first, then palpating the abdomen in all four quadrants B) Auscultating bowel sounds C) Checking for stability of the pelvis D) Assessment of the thorax for injury Auscultating bowel sounds

Which of the following cause(s) injury by inducing liquefaction necrosis? a. Caustics b. Alkalis c. Emulsifiers d. Acids

b.Alkalis

Swimmer's ear is also known as ________. a. Otitis media b. Otitis externa c. Otitis interna d. None of the above

b.Otitis externa

The ________ contain sensors necessary for equilibrium. a. Vestibule b. Semicircular canals c. Incus d. Cochlea

b.Semicircular canals

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When assisting with delivery, which of the following sequences is correct after instructing the mother to stop pushing when the baby's head has delivered? a. As warranted, suction the mouth, direct the baby's head downward to deliver the anterior shoulder, direct the baby's head upward to deliver the posterior shoulder b. Direct the baby's head downward to deliver the anterior shoulder, direct the baby's head upward to deliver the posterior shoulder, suction the mouth first then the nose c. Suction the nose first then the mouth, direct the baby's head downward to deliver the anterior shoulder, direct the baby's head upward to deliver posterior shoulder d. Direct the baby's head downward to deliver the posterior shoulder, direct the baby's head upward to deliver the anterior shoulder, suction the mouth first then the nose a.As warranted, suction the mouth, direct the baby's head downward to deliver the anterior shoulder, direct the baby's head upward to deliver the posterior shoulder

EDC, or estimated date of confinement, refers to the: a. due date. b. date of conception. c. date of the last menstrual period. d. date at which the fetus is viable. a.due date.

Which of the following describes deafness? a. The inability to hear b. A defect in the brain that does not allow sound to be processed c. A congenital defect involving the inner ear d. The inability to understand the spoken word a.The inability to hear

The inability of nerve impulses to reach the auditory center of the brain is called: a. audioneural deafness. b. conductive deafness. c. sensorineural deafness. d. cochlear imbalance. c.sensorineural deafness.

Which of the following most accurately represents the concern in the health care community about avian influenza? a. The causative bacterium is antibiotic resistant. b. The virus is highly infectious, and there is no vaccine currently available. c. The disease has a 100 percent mortality rate. d. It has become endemic in the United States.

b.The virus is highly infectious, and there is no vaccine currently available.

What structures may be affected in a urinary tract infection in a female patient? a. Vagina, bladder, urethra b. Bladder, ureters, vagina c. Urethra, bladder, kidney d. Kidney, bladder, fallopian tubes

c.Urethra, bladder, kidney

Your patient is a 19-year-old male who ingested thirty 500 mg tablets of Tylenol 25 minutes ago. Police officers on the scene are requesting that you "check him out" before they transport him for psychiatric evaluation. The patient denies ingesting other drugs or alcohol and has no complaints. HR = 94, BP = 116/74, RR = 12, SaO2 = 98%. Which of the following would be most appropriate? a. Release the patient to law enforcement custody b. Transport to the emergency department and administer activated charcoal c. Transport to the emergency department and administer sodium bicarbonate d. Transport to the emergency department and start an IV of normal saline

d.Transport to the emergency department and start an IV of normal saline

Your male patient complaining of abdominal pain describes his pain as a dull, crampy sensation that is making him nauseous. The patient is most likely describing ________ pain. a. Visceral b. Referred c. Somatic d. Parietal

d.Two large-bore IVs of normal saline, 20 cc/kg fluid bolus