EMT PASS Section 2 - Test 2

The amount of external pressure that must be applied to a dressing in order to stop bleeding is

1 mmHg greater than the vessel causing the hemorrhage.

A 19 year old was stabbed in the chest and abdomen. You manage the wounds and begin transport. En route his first set of vital signs are BP 94/82, P 122, R 18 and his SpO2 is 96% on a non-rebreather mask at 15 Lpm. What is your estimate of the amount of blood loss he has?

2,000 ml

An infant has a scald burn of half his head, his anterior trunk and the anterior surface of his right leg. What percentage of his body surface is burned?

34%

A 52 year old man rescued one of his children from their burning house. He has blisters, reddened skin and waxy white skin on both lower arms, his anterior thorax and abdomen, and over the upper half of his left lower leg. You should estimate his body surface burned to be

36%. RATIONALE The answer is 36%. Both lower arms are 9% (4.5 x 2), The anterior thorax is 18% and half of the leg is 9%. The other options are wrong. These questions are difficult to answer and thus are rarely seen unless you are passing the test above the standard. Estimating % of body surface burned is difficult from memory and should really be done while en route with a patient where a burn chart is available in your phone or protocol. Audio Player

A 16 year old was shot in the head with a low caliber hand gun. He responds to pain with flexion, demonstrates decorticate posturing and speaks in mumbles. You should record his Glasgow Coma Score as

7.

Which of the following types of fractures will require the longest treatment and rehabilitation in order to restore function?

A comminuted fracture

A 26 year old male has facial burns, a hoarse voice and cough. You are 25 minutes from the nearest hospital. Which of the following would cause you the most concern if present during transport?

A sudden drop of his SpO2 to 86%

Which of the following patients will most likely have complications as a result of hemorrhage loss?

An 82 year old man shot in the leg who has a BP of 94/82

Which of the following patients should you transport to a trauma center if one was available in your area?

An awake person in a car crash where another person died

A 23 year old male was completing a mechanical job on his car when the jack collapsed and pinned him. You find the car resting on his abdomen. He complains of pressure from the car but you see no severe bleeding. What would you be most concerned about?

Bleeding following removal from under the car

Third trimester pregnant females often have mild contractions which mimic early labor. What is the name of these "false" contractions?

Braxton-Hicks

After a small caliber bullet passes through the neck of a patient he is not able to stand up at the scene. Physical examination reveals left sided paralysis and right sided loss of sensation. He has grip strength of the right hand. You should suspect

Brown Sequard Syndrome cord injury. RATIONALE The stem represents signs associated with Brown-Sequard Syndrome. This is a rare injury of the spinal cord where clearing the spine is contraindicated. The distractors don't make sense in this question. The C-6 compression and fracture of both C-5 and C-6 are too narrow choices and likely produce similar signs. Afferent nerve damage affects sensation and not muscle movement, and is very rare.

A 47 year old man fell forward while hiking on a boulder field. He has a distal fracture of the radius that resulted in a

Colles fracture.

Which of the following patients has a Glasgow Coma Score of 8?

Eyes open only to pain, speaks incomprehensible sounds and withdraws with flexion.

Which of the following group of signs and symptoms, if present on a single patient, should lead you to classify the patient as having a critical burn?

Full-thickness burn to the left hand, 30% partial thickness burns to the body trunk, and a fractured left lower arm.

Perforation of which of the following can cause rapid hypovolemia in a patient who suffered an abdominal gunshot wound?

Inferior vena cava

A 22 year old female was stabbed in the right side of her chest just above her breast. She says, "The guy who stabbed me used to be my boyfriend." You have applied oxygen and she is comfortable sitting up. Her vital signs are BP 116/82, P 96 and SpO2 is 99% on 15 Lpm via non-rebreather mask. How should you auscultate her chest for the presence of a pneumothorax?

Listen over the right upper anterior and posterior chest for decreased breath sounds.

What is the primary reason for malnutrition, muscle and weight loss in the geriatric population?

Loss of sense of smell and taste

Which of the following hormones is most helpful in maintaining blood pressure in a patient who has hypovolemic shock?

Norepinephrine

A 12 year old boy fell from his bicycle and does not remember what he was doing when he fell. His parents arrive on scene, and after your physical exam doesn't reveal any injuries they refuse transport. What advice should you give the parents?

Observe the boy, assure he can be easily awakened, and avoid mental stimulation (games) to let his brain rest for a few days.

Which of the following is most important to note regarding assessment of a human bite mark?

Presence of injury under the skin RATIONALE Skin breakage is most important as it opens an avenue for infection. The nature of the bite mark is interesting but all bites have the potential to lead to infection. An intentional bite may occur during child's play or be an indication of some type of abuse. The origin of the bacteria that causes tetanus is found in cow or horse manure.

You have assisted a patient with his epinephrine auto-injector. What should you do with the auto-injector?

Put it in an approved sharps container.

You are assigned triage at a mass casualty event. You should deploy the

START triage system.

Which of the following is the most important factor that affects the amount of injury a patient suffers as a result of a car crash?

Speed at which the vehicles were moving

Under which of the following circumstances is it acceptable to remove a full face shield style helmet worn by a motorcycle victim?

The patient is having a grand mal seizure.

A 52 year old man severs two phalanges immediately distal of the metacarpals. You apply direct pressure which controls the bleeding. What action should you take in regards to the phalanges?

Wrap them in a sterile dressing, place them in a plastic bag and then place the bag on ice.

A closed tension pneumothorax can occur when a rib tears

a bronchus.

When a patient has a tension pneumothorax, the major complication is

a lack of perfusion pressure to the tissues.

A 19 year old male is profoundly hypotensive after a gunshot wound to his abdomen. You are unable to palpate femoral pulses. You should suspect

abdominal aorta trauma.

An allergic 12 year old girl was stung by a bee on a school playground. The principal administered an epinephrine auto-injector "about 5 minutes ago." She has facial swelling, a hoarse voice and is unable to stand. Her vital signs are BP 86/76, P 104 and weak and R 16 and shallow. Her SpO2 is 91% on room air. She tells you she has another epinephrine auto-injector with her in a bag. You should first

administer a second dose of medication.

A 72 year old female is on home oxygen at 4 Lpm by nasal cannula. She calls because her oxygen delivery equipment has failed. When you arrive she is cyanotic around her lips, fingers and lower extremities. Her delivery device shows a liter flow of 4 LPM. Her vital signs are BP 116/82, P 94, and R 22. Her SpO2 is 84%. You should first

administer oxygen via non-rebreather mask.

A 7 year old boy who is allergic to peanuts inadvertently ate cookies that included peanut butter. School officials called when he started wheezing. When you arrive his face and lips are swollen but his wheezing is no longer audible. The school principal hands you an epinephrine auto-injector. You should

administer the epinephrine auto-injector.

When assessing work of breathing in a pediatric patient you should assess

airway sounds, positioning and presence of any retractions or nasal flaring.

An athletic female who is underweight may suffer from

amenorrhea. RATIONALE Amenorrhea (a condition in which normal menstruation ceases) often happens in female athletes who lack adequate body fat. Dysmenorrhea is painful menstruation. Menarche is the first onset of menstruation. Menorrhagia is vaginal bleeding.

A 12 year old boy with a history of diabetes collapsed on the school playground after playing a pick-up game of soccer. You suspect the cause of his hypoglycemia to be

an increase in exercise.

In order to initiate elongation of a humerus bone fracture you should

apply a sling and swathe.

Law enforcement calls you into a scene where a gunshot victim has severe bleeding from a lower leg wound. His skin is pale and he is somnolent. His vitals are BP 98/78, P 114, R 16. You should

apply a tourniquet and rapidly transport.

A 14 year old fell from his bicycle causing a laceration to his penis and scrotal area. You should

apply direct pressure.

A 21 year old has a 10 cm laceration on his left lower leg that occurred when he was cutting tree limbs with a chainsaw. When you inspect the wound you see spurts of blood. His vital signs are BP 112/84, P 94 and R 16. You should first

apply direct pressure.

A 19 year old has a laceration on his outer ear that is venous in nature. When managing this injury you should

apply light pressure to absorb blood.

A 7 year old girl is being cared for at home with technical equipment to assist her breathing. When you arrive the equipment is sounding alarms. She is being cared for by a sitter. Your partner reports her heart rate is 40. You should

assist her ventilations with a BVM hooked to oxygen.

A 78 year old female with a history of two pack a day smoking is on home oxygen. When you arrive she is unable to speak, is cold and clammy and has her head resting on her chest. Her vital signs are BP 96/78, P 94 and R 24 and shallow. Her SpO2 is 78% on 3 Lpm nasal cannula. You should first

assist her ventilations with a BVM.

A 5 year old girl is wheezing and has a history of intrinsic asthma. She tells you, "I've used my inhaler six times today and I am still wheezing." You administer oxygen. Her vital signs are BP 92/78, P 120, R 26 and her SpO2 is 92% on oxygen. You should begin transport and

assist her with another dose of her inhaler.

A mother calls you because her 4 year old son is short of breath. When you arrive he is wheezing and has sternal retractions. She says he has used his inhaler twice in the last 30 minutes without relief. You begin transport and

assist him with another dose from his inhaler.

You are preparing to transfer a quadriplegic patient from his home bed to your ambulance stretcher. Before beginning this transfer you should

assure all "tubes" are accounted for before transfer.

A 6 year old boy is in his backyard holding his lower arm with a bloody cloth. You inspect the wound and classify the bleeding as venous because the

bleeding appears to have stopped.

While driving with lights and sirens on a rainy day you suddenly approach a large pool of standing water. You should

brake slowly and prepare for hydroplaning.

A 29 year old third trimester pregnant female has been feeling contractions for 1 hour. She tells you she is expecting fraternal twins. At her last visit she was informed that both babies were in the head down position. You examine her and she is crowning. You should

call for back-up and prepare for delivery.

A 42 year old unbelted male driver was in a single car crash in a rural area at 3:00 AM. When you arrive at 3:45 he is unconscious and slumped over the steering wheel. After some treatment you determine his vital signs are BP 116/82, P 86 and irregular and R 18. You see a large bruise over his chest. You should suspect

cardiac contusion.

Geriatric patients often have a reduction in cardiac afterload due to

cardiac valve problems.

A 36 year old fell from a horse and landed on his head. On interview he is unable to remember riding a horse. You do not palpate any abnormalities on his skull. You should suspect a/an

cerebral concussion. RATIONALE This stem has classic signs of a cerebral concussion. An epidural hematoma might be a cause but you won't find that upon examination, thus this patient needs transportation because of the mechanism of injury. A cerebral embolism would be in a blood vessel; a poor choice answer. Likewise, basal skull fracture is difficult to assess and would most likely be found via scanning in a hospital. Audio Player

The most complicated situation you may experience with a breech presentation is if the

cervix constricts around the neonate's head.

You are transporting a 42 year old male who suffered paraplegia in a motorcycle crash two years ago. He has a fever from an infection and you have to transport him to a specialty care facility that is two hours away. During transport you should

change his position every hour.

A nuchal cord is present during delivery. When you attempt to correct its presence the cord is not of sufficient length to complete the task. You should

clamp the cord and cut between the clamps. RATIONALE It is not suggested to pull traction on an umbilical cord, so in this instance it is best to clamp the cord in two places and cut between the cord. Most often the cord can be lifted over the neonate's head. Leaving the cord in place is not advisable. You should not attempt to adjust the baby's position during delivery.

After a call your ambulance cot has some of the patient's blood on it. You should

clean it with a 10% bleach solution.

You are called to support a Hazmat Team at a response. As you approach the scene you should park your ambulance in the

cold zone.

Internal bleeding and muscle damage around the site of a long bone fracture can lead to

compartment syndrome.

During your EMS career, your role in participating in research will most frequently be to

complete surveys.

A 3 year old boy ingested an unknown number of phenothiazine tablets. You should

contact the poison control center by phone.

An 86 year old man fell and is unable to get up. When you arrive his caregiver takes you to him. He tells you, "she hits me!" You are unable to find any signs of trauma. The man doesn't know who you are or why you are at his home. You should first

continue to assess his mental status.

A chemical plant supervisor tells you a worker was splashed in the eyes with an alkali solution. He immediately flushed his eyes and continued to do so for 20 minutes prior to your arrival. You should transport and

continue to flush his eyes.

A 28 year old male convenience store clerk was shot during a robbery. When you arrive he is in severe respiratory distress. You find jugular vein distention and absent breath sounds on one side. You should first

cover his wound with a non-porous dressing.

A 46 year old male was shot in the head with a 22 caliber pistol. On arrival he does not respond to painful stimuli. His vital signs are BP 110/74, P 106, R 12. You should

cover the wound and rapidly transport.

A 25 year old male has a gunshot wound in his right chest. Your partner reports a weak, thready pulse. You see irregular, slow breathing. You should first

cover the wound with a gloved hand.

A 14 year old was shot in the right upper chest with a high caliber bullet. When you arrive he is severely short of breath and lying supine on the ground. His vitals are BP 96/78, P 118, R 22 and his SpO2 is 88% on room air. When you log roll him onto a backboard for transport you discover an exit wound. You should

cover the wound with a non-porous dressing taped on 3 sides.

The anterior fontanelle of an infant should be palpated to assess

dehydration or head trauma.

An unconscious 10 year old boy fell from his bicycle striking his head against the pavement. You find a large hematoma over the frontal area of his skull. You should suspect the cause of his unconsciousness to be a/an

depressed skull fracture.

A belted driver is unconscious in the driver's seat. His air bag has not deployed. You should

disconnect the battery cables.

A 26 year old woman who is 2 months postpartum is found at home with a rope around her neck. This type of hanging will produce a/an

distraction injury.

When driving during an emergency response you should

drive with due regard.

While at a scene a foreign object enters your eye causing irritation. You complete the call and the object remains an irritant. You should

flush your eye with water.

On examination of an abdomen immediately following blunt trauma, the abdomen will be soft even if there is bleeding because

fresh blood is not an abdominal wall irritant.

When assessing for abdominal distention you should observe the abdomen

from the side on a line between the symphysis pubis and the xiphoid process.

A 4 year old pedestrian was hit by a car. On arrival he is unconscious, has normal breathing and circulation to the skin. You see an angulated left upper arm and edema on the right side of his head. You suspect the cause of his unconsciousness to be

head trauma.

A 56 year old male driver is apneic and pulseless after being involved in a low speed single car crash into a telephone pole. You begin immediate care. You should suspect the cause of his condition to be

heart attack.

A 21 year old male fell from his motorcycle. He has multiple rib fractures and a stable chest wall. He answers your questions by moaning. His vital signs are BP 96/74, P 108, R 18 and his SpO2 is 92% on room air. You should suspect

hemopneumothorax

Kidney failure secondary to major burns results from

high levels of destructive cell metabolites being in the blood.

A 14 year old boy with a history of diabetes is home with flu-like symptoms. He tells you he's been trying to eat, has been very thirsty and weak. His vital signs are BP 100/78, P 96, R 24. He says he stopped taking his insulin 2 days ago because he was ill. You should suspect

hyperglycemia.

A 26 year old who is having her third child is in active labor. When you examine for crowning you see the neonate's foot protruding from the birth canal. You should

immediately transport her with her pelvis elevated.

In the presence of a significant mechanism of injury, clearing cervical spines protocols indicate you must use immobilization techniques when the patient has

impaired thinking ability.

You treated a 24 year old female who was involved in a high speed car crash. She later had abdominal surgery to control intra-abdominal bleeding. Your prior assessment indicated no abdominal abnormalities. You should suspect her need for surgery was due to

improper placement of a seatbelt.

You arrive for support at a mass casualty event 30 minutes after the incident. You should report to the

incident commander.

You used an AED on a 20 year old male who was shocked while working with electrical wires. After defibrillation he has a pulse and he starts to move his hands and arms. After assuring he is stable, you should

inspect his body for entrance and exit wounds.

The neighbor of an 83 year old frail female called 9-1-1 after she collapsed. When you arrive she is awake and you begin a patient history. The most important finding you should seek is if she

is a reliable historian.

When driving in an emergency response it is important to

limit distractions.

At the scene of a truck crash you see placards on an overturned truck and trailer. Bystanders are standing by the truck. You should first

locate and read the shipping papers.

You are en route to a call where the dispatcher tells you the patient has severe back pain. You should suspect the pain is in the

lumbar spine.

A 2 month old boy has a fever of 103 F and he will not nurse. His mother is holding him; his eyes are open and he is not moving. You see rapid respirations and his heart rate is 170. You should suspect

meningitis.

An 8 month pregnant female was wearing a seatbelt when she was T-boned during a car crash. When you arrive she has a scalp laceration, redness on both pelvic crests, and shortness of breath. You are unable to auscultate fetal heart tones at the scene. Her vital signs are BP 126/88, P 108, R 22 and SpO2 is 97% on room air. You should suspect

minor car crash injuries.

An injury to the occiput area of the skull that causes damage to the underlying brain tissue will likely cause the patient to have difficulty with

muscle coordination.

You are called to a church where an 86 year old female had a syncope episode. When you arrive she is awake, complains of weakness, nausea and some abdominal pain. She says, "I just don't feel well." You should suspect

myocardial infarction.

The most reliable method to determine that a third trimester pregnant female has placenta previa is to

obtain the information via the patient history.

A 22 year old male was stabbed in the abdomen. You find him sitting against a pole beside the street. His puncture wound is in the RUQ. As you prepare to move him to the ambulance, he becomes faint when he stands up. The reason he became faint was due to

orthostatic hypotension.

A bone condition that mostly affects women who are post menopausal is

osteoporosis.

Many patients who are terminally ill and have hospice assistance are receiving

palliative care.

A Colles fracture can best be managed with a

pneumatic splint.

Days after you and your partner managed victims of a multiple car crash he calls you at 1:00 AM after binge drinking. The next day he calls off sick and then misses another shift. He remains at home even when you invite him to a ball game. You should suspect

post-traumatic stress.

Following birth a psychological condition which affects some women and may lead to suicide or suicidal gestures is

postpartum depression.

A fixed and dilated pupil present on a head-injured patient is due to

pressure on a cranial nerve.

During contractions, as the neonate's head causes bulging at the birth canal you should

put slight pressure on the opening to prevent vaginal tearing.

A 7 year old boy with a history of brain trauma is seizing in school. The school nurse says she observed the seizure for five minutes before she called you because the seizure did not stop. She tells you the boy takes Dilantin and Phenobarbital, which she gave him with his lunch. You should

rapidly transport.

You are called to a home where an unconscious obese 51 year old man has CPAP attached over his mouth and nose. You find him cyanotic around the mouth, fingers and in small capillary beds. Your partner reports his SpO2 is 72%. You should

remove the CPAP and ventilate him

A 41 year old female has severe eye irritation and you are able to see a foreign object that appears to be impaled in the eye. She informs you she is wearing contact lenses. You should

remove the contact lenses.

A 17 year old male was shot in the right upper chest with a single shot shotgun. When you remove his hand to inspect his wound it immediately presents with a sucking sound. You manage the wound and begin immediate transport. While en route he becomes increasingly short of breath and his blood pressure begins to drop. You should

remove the dressing, wait until he exhales and re-cover the wound.

Most biological WMDs are designed to enter the victim's blood stream via the

respiratory tract.

A 16 year old pregnant female in her third trimester is screaming in pain when you arrive. She says her contractions are frequent and "very painful." You examine for crowning and it is not present. You should prepare for

routine transport.

A 21 year old female complains of dull aching lower quadrant abdominal pain. Her abdomen is tender. She says she missed her last menstrual period and is sexually active. After your assessment you help her stand up and she becomes faint. Her vital signs are BP 112/84, P 100, R 16. You should suspect

ruptured ectopic pregnancy.

Pelvic inflammatory disease is most often caused by

sexually transmitted bacteria.

A patient with a posterior dislocation of the hip would have a leg that is

short, flexed and internally rotated.

An 11 year old boy fell from his bicycle and has soft tissue injuries to his elbow joint. There is swelling present and his lower arm is not in alignment. You should

splint his arm in the position found.

A conscious 21 year old male was hunting and was struck in the head with an arrow. The arrow entered his forehead, is impaled and exits above his occiput area. Blood is draining down his face into his mouth. You should

stabilize the arrow and transport.

A neonate on delivery has blue colored skin, some facial grimace, little movement, a respiratory rate of 8 and a pulse rate of 56 bpm. You should

start cardiopulmonary resuscitation.

You find a homeless man who is unconscious beside the road. His friends say he has been acting odd for two days, was walking with them and complained of a headache. He collapsed and they called you. You should suspect he suffered a/an

subdural hematoma.

Percussion of the chest is most beneficial in detecting the presence of

tension pneumothorax.

At the scene of an explosion a victim who strikes his head against a large rock from falling down has a

tertiary blast effect.

An 18 year old female calls you because she suffered a "miscarriage." When you arrive she is resting on a sofa. Her vital signs are BP 126/82, P 88, R 14. She gives you a bloody towel containing "what passed out of me." You should

transport her routinely and bring the towel.

A 22 year old female was in a single car crash where she "swiped" her car alongside a pole. She was wearing a seatbelt and is crying. She does not localize any pain. She tells you she is 14 weeks pregnant. You should

transport her routinely without lights and siren.

A blind patient needs routine transport to the hospital. He uses a dog to help guide him. You should

transport the dog with him in the patient compartment.

The most important treatment you can provide to a rape victim is to

treat injuries as you do other patients.

Flushed skin observed in a patient who is in spinal shock occurs because

vasodilation occurs in peripheral blood vessels.