Medical Review (Chapter 16-19)
Which of the following conditions is more common in women than in men? Cholecystitis Hepatitis Cystitis Pancreatitis
Cystitis
Status epilepticus is characterized by: an absence seizure that is not preceded by an aura. generalized seizures that last less than 5 minutes. profound tachycardia and total muscle flaccidity. prolonged seizures without a return of consciousness.
prolonged seizures without a return of consciousness.
Patients with acute abdominal pain should not be given anything to eat or drink because: digestion prevents accurate auscultation of bowel sounds. it will create referred pain and obscure the diagnosis. food will rapidly travel through the digestive system. substances in the stomach increase the risk of aspiration.
substances in the stomach increase the risk of aspiration.
Albuterol is a generic name for: Atrovent. Alupent. Ventolin. Singulair.
Ventolin.
A patient with a left ventricular assist device (LVAD) tells you that the device's pump flow is continuous. Which of the following should you expect to encounter during your assessment? Absence of a palpable pulse Distention of the jugular veins Low diastolic blood pressure High systolic blood pressure
Absence of a palpable pulse
Which of the following statements regarding anaphylaxis is correct? The signs of anaphylaxis are caused by widespread vasoconstriction. Most anaphylactic reactions occur within 60 minutes of exposure. Anaphylaxis is characterized by airway swelling and hypotension. Patients with asthma are at lower risk of developing anaphylaxis.
Anaphylaxis is characterized by airway swelling and hypotension.
A 58-year-old male presents with confusion, right-sided weakness, and slurred speech. His airway is patent, and his breathing is adequate. His wife is present and is very upset. Which of the following has the MOST immediately priority? Obtaining a complete set of baseline vital signs Asking his wife when she noticed the symptoms Administering glucose to rule out hypoglycemia Documenting all of his current medications
Asking his wife when she noticed the symptoms
While auscultating an elderly woman's breath sounds, you hear low-pitched "rattling" sounds at the bases of both of her lungs. This finding is MOST consistent with which of the following conditions? Acute asthma attack Aspiration pneumonia Early pulmonary edema Widespread atelectasis
Aspiration pneumonia
Which of the following MOST accurately describes the cause of an ischemic stroke? Acute atherosclerotic disease Blockage of a cerebral artery Narrowing of a carotid artery Rupture of a cerebral artery
Blockage of a cerebral artery
A 40-year-old man is in cardiac arrest. Your partner is performing CPR. You are attaching the AED when the patient's wife tells you that he has an automatic implantable cardiac defibrillator (AICD). The AED advises that a shock is indicated. What should you do? Avoid defibrillation because this will damage the patient's AICD. Contact medical control and request permission to defibrillate. Deliver the shock followed by immediate resumption of CPR. Continue CPR and transport the patient to the closest appropriate hospital.
Deliver the shock followed by immediate resumption of CPR.
A 66-year-old woman presents with a stabbing pain in the middle of her chest that radiates to her back. She tells you that the pain suddenly began about 30 minutes ago and has been severe since the onset. She has a history of hypertension, but admits to being noncompliant with her antihypertensive medications. When you assess her, you find that her blood pressure is significantly higher in her left arm than it is in her right arm. What do these signs and symptoms MOST likely indicate? Dissecting aortic aneurysm Acute myocardial infarction Unstable angina Hypertensive emergency
Dissecting aortic aneurysm
A 29-year-old pregnant woman has had severe vomiting for the last 2 days. Today, she is vomiting large amounts of blood. Her skin is cool and pale, and she is tachycardic. The EMT should suspect: Mallory-Weiss tear. esophagitis. esophageal varices. acute pancreatitis.
Mallory-Weiss tear.
A 60-year-old male presents with acute respiratory distress. He is conscious and alert, has pink and dry skin, and has respirations of 22 breaths/min with adequate depth. Which of the following treatments is MOST appropriate for this patient? Oxygen via a nasal cannula, vital signs, and prompt transport to the hospital Positive-pressure ventilations and immediate transport to the closest hospital Oxygen via nonrebreathing mask and a focused secondary assessment Assisted ventilation with a bag-valve mask and a head-to-toe exam
Oxygen via nonrebreathing mask and a focused secondary assessment
Which of the following statements regarding pulse oximetry is correct? The pulse oximeter is a valuable assessment tool that measures the percentage of red blood cells that contain hemoglobin molecules. Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen but does not measure the actual hemoglobin content of the blood. Most otherwise healthy patients can maintain adequate oxygenation and good skin color with oxygen saturation readings as low as 70% to 80%. Caution must be exercised when using the pulse oximeter on a patient with carbon monoxide poisoning because falsely low readings are common.
Pulse oximetry measures the percentage of hemoglobin that is saturated with oxygen but does not measure the actual hemoglobin content of the blood.
Which of the following conditions would be LEAST likely to result in hypoxia? Pulmonary edema Narcotic overdose Pleural effusion Severe anxiety
Severe anxiety
A 59-year-old male with a history of emphysema complains of an acute worsening of his dyspnea and pleuritic chest pain following a forceful cough. Your assessment reveals that he has a barrel-shaped chest, unilaterally diminished breath sounds, and tachycardia. What is the MOST likely cause of this patient's condition? Spontaneous pneumothorax Acute pulmonary embolism Exacerbation of his COPD Rupture of the diaphragm
Spontaneous pneumothorax
Acute coronary syndrome (ACS) is a term used to describe: a group of symptoms that are caused by myocardial ischemia. a severe decrease in perfusion caused by changes in heart rate. the warning signs that occur shortly before a heart attack. the exact moment that a coronary artery is completely occluded.
a group of symptoms that are caused by myocardial ischemia.
A transient ischemic attack (TIA) occurs when: medications are given to dissolve a cerebral blood clot. a small cerebral artery ruptures and causes minimal damage. signs and symptoms resolve spontaneously within 48 hours. a small clot in a cerebral artery causes temporary symptoms.
a small clot in a cerebral artery causes temporary symptoms.
A 35-year-old obese woman is complaining of localized pain in the right upper quadrant with referred pain to the right shoulder. The MOST likely cause of her pain is: acute cholecystitis. acute cystitis. appendicitis. pancreatitis.
acute cholecystitis.
When administering supplemental oxygen to a hypoxemic patient with a chronic lung disease, you should: adjust the flow rate accordingly until you see symptom improvement, but be prepared to assist his or her ventilations. recall that most patients with chronic lung diseases are stimulated to breathe by increased carbon dioxide levels. avoid positive-pressure ventilation because the majority of patients with chronic lung disease are at increased risk for lung trauma. begin with a low oxygen flow rate, even if the patient is unresponsive, because high-flow oxygen may depress his or her breathing.
adjust the flow rate accordingly until you see symptom improvement, but be prepared to assist his or her ventilations.
A 59-year-old male presents with sudden-onset severe lower back pain. He is conscious and alert, but very restless and diaphoretic. Your assessment reveals a pulsating mass to the left of his umbilicus. You should: request a paramedic unit to give the patient pain medication. vigorously palpate the abdomen to establish pain severity. place the patient in a sitting position and transport at once. administer oxygen and prepare for immediate transport.
administer oxygen and prepare for immediate transport.
A 66-year-old female with a history of hypertension and diabetes presents with substernal chest pressure of 2 hours' duration. Her blood pressure is 140/90 mm Hg, her pulse is 100 beats/min and irregular, her respirations are 22 breaths/min, and her oxygen saturation is 92%. The patient does not have prescribed nitroglycerin, but her husband does. You should: obtain a SAMPLE history and contact medical control for advice. administer oxygen, give her 324 mg of aspirin, and assess her further. give her high-flow oxygen, attach the AED, and transport at once. give her one nitroglycerin and reassess her systolic blood pressure.
administer oxygen, give her 324 mg of aspirin, and assess her further.
Older patients with abdominal problems may not exhibit the same pain response as younger patients because of: age-related deterioration of their sensory systems. interactions of the numerous medications they take. chronic dementia, which inhibits communication. progressive deterioration of abdominal organ function.
age-related deterioration of their sensory systems.
An area of swelling or enlargement in a weakened arterial wall is called: an aneurysm. atherosclerosis. a thrombus. an embolism.
an aneurysm.
A 60-year-old female presents with a tearing sensation in her lower back. Her skin is sweaty, and she is tachycardic. The EMT should suspect: kidney stones. strangulated hernia. aortic aneurysm. acute pancreatitis.
aortic aneurysm.
Pain that radiates to the right lower quadrant from the umbilical area, nausea and vomiting, and lack of appetite are MOST indicative of: gastroenteritis. pancreatitis. cholecystitis. appendicitis.
appendicitis.
A 62-year-old man with a history of congestive heart failure presents with severe respiratory distress and with an oxygen saturation of 82%. When you auscultate his lungs, you hear widespread rales. He is conscious and alert, is able to follow simple commands, and can only speak in two- to three-word sentences at a time. You should: place him in a supine position and assist his ventilations with a bag-valve mask and high-flow oxygen. force fluid from his alveoli by hyperventilating him with a bag-valve mask at a rate of at least 20 breaths/min. apply a CPAP device, monitor his blood pressure, and observe him for signs of improvement or deterioration. place him in a position of comfort, deliver oxygen via nasal cannula, and closely monitor his breathing.
apply a CPAP device, monitor his blood pressure, and observe him for signs of improvement or deterioration.
Febrile seizures: are usually benign but should be evaluated. are also referred to as absence seizures. occur when a child's fever rises slowly. often result in permanent brain damage.
are usually benign but should be evaluated.
Components of the Cincinnati Prehospital Stroke Scale include: speech, pupil reaction, and memory. facial droop, speech, and pupil size. arm drift, memory, and grip strength. arm drift, speech, and facial droop.
arm drift, speech, and facial droop.
When assessing for arm drift of a patient with a suspected stroke, you should: ask the patient to hold his or her arms up with the palms down. expect to see one arm slowly drift down to the patient's side. ask the patient to close his or her eyes during the assessment. observe movement of the arms for approximately 2 minutes.
ask the patient to close his or her eyes during the assessment.
A 49-year-old male presents with an acute onset of crushing chest pain and diaphoresis. You should: obtain vital signs and a SAMPLE history. administer up to three doses of nitroglycerin. assess the adequacy of his respirations. administer up to 324 mg of baby aspirin.
assess the adequacy of his respirations.
Law enforcement has summoned you to a nightclub, where a 22-year-old female was found unconscious in an adjacent alley. Your primary assessment reveals that her respirations are rapid and shallow and her pulse is rapid and weak. She is wearing a medical alert bracelet that identifies her as an epileptic. There is an empty bottle of vodka next to the patient. You should: apply oxygen via nonrebreathing mask and transport her for a blood-alcohol test. place a bite block in her mouth in case she has a seizure and transport at once. assist ventilations, perform a rapid exam, and prepare for immediate transport. apply oxygen via a nonrebreathing mask, place her on her left side, and transport.
assist ventilations, perform a rapid exam, and prepare for immediate transport.
A 47-year-old male presents with severe abdominal pain of 3 hours' duration. His abdomen is distended and guarded. Your MOST important consideration for this patient should be to: assess his blood pressure to determine perfusion adequacy. determine the exact location and cause of his pain. transport him in a supine position. be alert for signs and symptoms of shock.
be alert for signs and symptoms of shock.
Alkalosis is a condition that occurs when: blood acidity is reduced by excessive breathing. the level of carbon dioxide in the blood increases. slow, shallow breathing eliminates too much carbon dioxide. dangerous acids accumulate in the bloodstream.
blood acidity is reduced by excessive breathing.
The most basic functions of the body, such as breathing, blood pressure, and swallowing, are controlled by the: cerebrum. cerebral cortex. cerebellum. brain stem.
brain stem.
The respiratory distress that accompanies emphysema is caused by: chronic stretching of the alveolar walls. massive constriction of the bronchioles. repeated exposure to cigarette smoke. acute fluid accumulation in the alveoli.
chronic stretching of the alveolar walls.
You are transporting a 49-year-old male with "tearing" abdominal pain. You are approximately 30 miles away from the closest hospital. During your reassessment, you determine that the patient's condition has deteriorated significantly. You should: consider requesting a rendezvous with an ALS unit. immediately perform a rapid physical examination. assist his ventilations with a bag-valve mask. continue transporting and alert the receiving hospital.
consider requesting a rendezvous with an ALS unit.
Esophageal varices MOST commonly occur in patients who: have a history of esophagitis. have uncontrolled diabetes. consume a lot of alcohol. have weak immune systems.
consume a lot of alcohol.
A conscious and alert 29-year-old female with a history of asthma complains of difficulty breathing that began after her morning jog. The temperature outside is 40°F (5°C). On exam, you hear bilateral expiratory wheezing. After providing supplemental oxygen, you should: determine if she has been prescribed a beta-agonist inhaler. place her in a recumbent position to facilitate breathing. call medical control and ask how to proceed with treatment. contact medical control and administer an antihistamine.
determine if she has been prescribed a beta-agonist inhaler.
Nitroglycerin relieves cardiac-related chest pain by: dilating the coronary arteries and improving cardiac blood flow. contracting the smooth muscle of the coronary and cerebral arteries. increasing the amount of stress that is placed on the myocardium. constricting the coronary arteries and improving cardiac blood flow.
dilating the coronary arteries and improving cardiac blood flow.
A 29-year-old male complains of a severe headache and nausea that has gradually worsened over the past 12 hours. He is conscious, alert, and oriented and tells you that his physician diagnosed him with migraine headaches. He further tells you that he has taken numerous different medications, but none of them seems to help. His blood pressure is 132/74 mm Hg, his pulse is 110 beats/min and strong, and his respirations are 20 breaths/min. Treatment should include: assisting him with his migraine medication and transporting without lights and siren. placing him in a supine position and transporting with lights and siren to a stroke center. applying warm compresses to the back of his neck and transporting with lights and siren. dimming the lights in the back of the ambulance and transporting without lights and siren.
dimming the lights in the back of the ambulance and transporting without lights and siren.
During the primary assessment of a semiconscious 70-year-old female, you should: immediately determine the patient's blood glucose level. ask family members if the patient has a history of stroke. ensure a patent airway and support ventilation as needed. insert a nasopharyngeal airway and assist ventilations.
ensure a patent airway and support ventilation as needed.
A 40-year-old patient without a history of seizures experiences a generalized (tonic-clonic) seizure. The LEAST likely cause of this seizure is: a serious infection. intracranial bleeding. a brain tumor. epilepsy.
epilepsy.
A 30-year-old male presents with acute shortness of breath, widespread hives, and facial swelling. He denies any past medical history and takes no medications. During your assessment, you hear wheezing over all lung fields. His blood pressure is 90/50 mm Hg, and his heart rate is 110 beats/min. In addition to giving him high-flow oxygen, the MOST important treatment for this patient is: an antihistamine. a beta-antagonist. epinephrine. albuterol.
epinephrine
Blood that is ejected from the right ventricle: has a high concentration of oxygen. enters the systemic circulation. flows into the pulmonary arteries. was received directly from the aorta.
flows into the pulmonary arteries.
A patient who is possibly experiencing a stroke is NOT eligible for thrombolytic (fibrinolytic) therapy if he or she: is older than 60 years of age. has a GCS score that is less than 8. has bleeding within the brain. has had a prior heart attack.
has bleeding within the brain.
Common side effects of nitroglycerin include all of the following, EXCEPT: severe headache. bradycardia. hypertension. hypotension.
hypertension.
The MOST significant risk factor for a hemorrhagic stroke is: severe stress. heavy exertion. diabetes mellitus. hypertension.
hypertension.
After the AED has delivered a shock, the EMT should: immediately resume CPR. transport the patient at once. re-analyze the cardiac rhythm. assess for a carotid pulse.
immediately resume CPR.
Asthma is caused by a response of the: respiratory system. cardiovascular system. immune system. endocrine system.
immune system.
You are dispatched to an apartment complex where a 21-year-old female has apparently overdosed on several narcotic medications. She is semiconscious and has slow, shallow respirations. You should: apply oxygen via a nonrebreathing mask and transport at once. insert a nasopharyngeal airway and begin assisted ventilation. place her in the recovery position and monitor for vomiting. insert an oropharyngeal airway and perform oral suctioning.
insert a nasopharyngeal airway and begin assisted ventilation.
You are assisting an asthma patient with his prescribed metered-dose inhaler. After the patient exhales, and before inhaling, the patient should put his or her lips around the inhaler, take a deep breath, and depress the inhale. You should: immediately reapply the oxygen mask and reassess his condition. allow him to breathe room air and assess his oxygen saturation. advise him to exhale forcefully to ensure medication absorption. instruct him to hold his breath for as long as he comfortably can.
instruct him to hold his breath for as long as he comfortably can.
Chronic renal failure is a condition that: is often caused by hypertension or diabetes. occurs from conditions such as dehydration. can be reversed with prompt treatment. causes dehydration from excessive urination.
is often caused by hypertension or diabetes.
Injury to a hollow abdominal organ would MOST likely result in: leakage of contents into the abdominal cavity. pain secondary to blood in the peritoneum. impairment in the blood's clotting abilities. profound shock due to severe internal bleeding.
leakage of contents into the abdominal cavity.
You respond to the residence of a 70-year-old male who complains of weakness and severe shortness of breath. His wife tells you that he is a dialysis patient, but has missed his last two treatments. After applying oxygen, you auscultate his lungs and hear diffuse rhonchi. The patient is conscious, but appears confused. His blood pressure is 98/54 mm Hg, his pulse rate is 120 beats/min and irregular, and his respirations are 24 breaths/min and labored. You should: perform a detailed secondary assessment and then transport him to a dialysis center. treat for shock and request a paramedic unit to respond to the scene and assist you. Correct! leave him in a sitting position, keep him warm, and prepare for immediate transport. place him in a supine position, elevate his lower extremities, and transport at once.
leave him in a sitting position, keep him warm, and prepare for immediate transport.
Most patients with abdominal pain prefer to: lie in a supine position with their knees in a flexed position. sit in a semi-Fowler position with their knees slightly bent. sit fully upright because it helps relax the abdominal muscles. lie on their side with their knees drawn into the abdomen.
lie on their side with their knees drawn into the abdomen.
Individuals with chronic alcoholism are predisposed to intracranial bleeding and hypoglycemia secondary to abnormalities in the: pancreas. kidneys. brain. liver.
liver.
Angina pectoris occurs when: a coronary artery is totally occluded by plaque. one or more coronary arteries suddenly spasm. myocardial oxygen supply exceeds the demand. myocardial oxygen demand exceeds supply.
myocardial oxygen demand exceeds supply.
An acute myocardial infarction (AMI) occurs when: coronary artery dilation decreases blood flow to the heart. the entire left ventricle is damaged and cannot pump blood. the heart muscle progressively weakens and dysfunctions. myocardial tissue dies secondary to an absence of oxygen.
myocardial tissue dies secondary to an absence of oxygen.
In order for efficient pulmonary gas exchange to occur: the percentage of inhaled carbon dioxide must exceed the percentage of inhaled oxygen. the pulmonary capillaries must be completely constricted and the alveoli must be collapsed. there must be low quantities of pulmonary surfactant to allow for full alveolar expansion. oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.
oxygen and carbon dioxide must be able to freely diffuse across the alveolar-capillary membrane.
Common signs and symptoms of AMI include all of the following, EXCEPT: shortness of breath or dyspnea. sudden unexplained sweating. irregular heartbeat. pain exacerbated by breathing.
pain exacerbated by breathing.
When assessing a patient with abdominal pain, you should: visually assess the painful area of the abdomen, but avoid palpation because this could worsen his or her condition. ask the patient to point to the area of pain or tenderness and assess for rebound tenderness over that specific area. observe for abdominal guarding, which is characterized by sudden relaxation of the abdominal muscles when palpated. palpate the abdomen in a clockwise direction, beginning with the quadrant after the one the patient indicates is painful.
palpate the abdomen in a clockwise direction, beginning with the quadrant after the one the patient indicates is painful.
The MOST common and significant complication associated with an acute abdomen is: severe pain. peritonitis. high fever. internal bleeding.
peritonitis.
A 30-year-old woman with a history of alcoholism presents with severe upper abdominal pain and is vomiting large amounts of bright red blood. Her skin is cool, pale, and clammy; her heart rate is 120 beats/min and weak; and her blood pressure is 70/50 mm Hg. Your MOST immediate action should be to: give her high-flow supplemental oxygen. protect her airway from aspiration. rapidly transport her to the hospital. keep her supine and keep her warm.
protect her airway from aspiration.
An important aspect in the treatment of a patient with severe abdominal pain is to: administer analgesic medications to alleviate pain. encourage the patient to remain in a supine position. provide emotional support en route to the hospital. give 100% oxygen only if signs of shock are present.
provide emotional support en route to the hospital.
A 22-year-old female patient is complaining of dyspnea and numbness and tingling in her hands and feet after an argument with her fiancé. Her respirations are 40 breaths/min. You should: provide reassurance and give oxygen as needed. have her breathe into a paper or plastic bag. request a paramedic to give her a sedative. position her on her left side and transport at once.
provide reassurance and give oxygen as needed.
After assisting your patient with prescribed nitroglycerin, you should: reassess his or her blood pressure within 5 minutes to detect hypotension. perform a secondary assessment before administering further doses. place the patient in a recumbent position in case of fainting. avoid further dosing if the patient complains of a severe headache.
reassess his or her blood pressure within 5 minutes to detect hypotension.
Most AEDs are set up to adjust the voltage based on the impedance, which is the: actual amount of energy that the AED will deliver. direction that the electrical flow takes in the body. resistance of the body to the flow of electricity. distance between the two AED pads on the chest.
resistance of the body to the flow of electricity.
Deoxygenated blood from the body returns to the: left ventricle. right ventricle. right atrium. left atrium.
right atrium.
Functions of the liver include: absorption of nutrients and toxins. production of hormones that regulate blood sugar levels. release of amylase, which breaks down starches into sugar. secretion of bile and filtration of toxic substances.
secretion of bile and filtration of toxic substances.
During your treatment of a woman in cardiac arrest, you apply the AED, analyze her cardiac rhythm, and receive a "no shock advised" message. This indicates that: the AED has detected asystole. she has a pulse and does not need CPR. the AED detected patient motion. she is not in ventricular fibrillation.
she is not in ventricular fibrillation.
Dyspnea is MOST accurately defined as: labored breathing with reduced tidal volume. a marked increase in the exhalation phase. a complete cessation of respiratory effort. shortness of breath or difficulty breathing.
shortness of breath or difficulty breathing.
A 67-year-old female with severe chest pain becomes unresponsive, pulseless, and apneic during transport. You should: stop the ambulance, begin CPR, and attach the AED as soon as possible. alert the receiving hospital and perform CPR for the duration of the transport. defibrillate with the AED while continuing transport to the hospital. perform CPR for 1 to 2 minutes and then analyze her rhythm with an AED.
stop the ambulance, begin CPR, and attach the AED as soon as possible.
You are caring for a 70-year-old female with signs and symptoms of an acute stroke. She is conscious, has secretions in her mouth, is breathing at a normal rate with adequate depth, and has an oxygen saturation of 96%. You should: administer one tube of oral glucose and transport. suction her oropharynx and transport immediately. insert an oral airway, apply oxygen, and transport. assist her ventilations with a bag-valve mask.
suction her oropharynx and transport immediately.
A dissecting aortic aneurysm occurs when: the inner layers of the aorta become separated. the aorta ruptures, resulting in profound bleeding. all layers of the aorta suddenly contract. a weakened area develops in the aortic wall.
the inner layers of the aorta become separated.
The left cerebral hemisphere controls: the right side of the body. breathing and blood pressure. heart rate and pupil reaction. the right side of the face.
the right side of the body.
Cardiac output may decrease if the heart beats too rapidly because: a rapid heartbeat causes a decrease in the strength of cardiac contractions. there is not enough time in between contractions for the heart to refill completely. the volume of blood that returns to the heart is not sufficient with fast heart rates. as the heart rate increases, more blood is pumped from the ventricles than the atria
there is not enough time in between contractions for the heart to refill completely.
Acute pulmonary edema would MOST likely develop as the result of: an upper airway infection. severe hyperventilation. right-sided heart failure. toxic chemical inhalation.
toxic chemical inhalation.
A patient who is experiencing aphasia is: experiencing a right hemispheric stroke. usually conscious but has slurred speech. not able to swallow without choking. unable to produce or understand speech.
unable to produce or understand speech.
When you are obtaining medical history from the family of a suspected stroke patient, it is MOST important to determine: if the patient has been hospitalized before. the patient's overall medication compliance. when the patient last appeared normal. if there is a family history of a stroke.
when the patient last appeared normal.