NREMT Practice Questions
You are on-scene with an adult pt exhibiting unusual activity and appears to be intoxicated. He's anxious and hyperactive. His HR and RR are fast, but his BP remains within normal range for his age. The pt denies ETOH or drug consumption but reports he has diabetes. His BCL is found to be 54 mg/dL. How would hypoglycemia cause the pt to present with the above findings? A. The low BGL stimulate the SNS to trigger the release of epinephrine into the bloodstream to promote liver glycogenolysis B. Low BFL mimic ETOH intoxication in the brain because of elevated insulin levels in the bloodstream C. The HR and RR increase in an attempt to promote the natural production and release of glucagon by the alpha cells in the pancreas D. The elevated HR and RR stimulate the adipose tissue to increase glucose and fatty acid uptake in an attempt to correct the BGL
A.
Your adult pt has a confirmed tension pneumothorax that requires pre-hospital decompression to increase his chance of survival. When performing needle decompression, where should the catheter be inserted to be effective? A. Anteriorly in the second intercostal space, just above the third rib, in the mid-clavicular line B. Laterally in the mid-axillary line, inserted just above the fourth rib C. Posteriorly in the second intercostal space below the scapula, just above the rib D. Anteriorly in the middle of the fifth intercostal space, in the mid-clavicular line
A.
Which of the following is responsible for the kidney failure associated with crush injury syndrome? A. Myoglobin released from damaged muscles is filtered by the kidneys, causing renal failure B. Crushed RBCs from damaged blood vessels are filtered through the kidneys, causing renal failure. C. Blood pools in the kidneys due to the crush injury and causes renal necrosis and failure D. Toxic metabolites are rapidly released and filtered through the kidneys, causing acute renal failure
A. Toxic metabolites in the blood after a crush injury is most likely to cause metabolic acidosis, not renal failure. Blood doesn't pool in the kidneys after a crush injury, and RBCs don't do shit.
Your adult trauma pt remains entrapped and may be experiencing the s/s of crush syndrome after having his R leg buried in dirt at a commercial construction site for an extended period. If so, which of the following interventions would be MOST appropriate before the compressive forces are released? A. Ensure the pt is receiving high flow O2 B. Infuse up to 2 L of L/R in the affected limb before releasing the compressive force to dilute the toxins C. Orally intubate the pt using RSI, then hyperventilate to disperse the toxins D. Place a restrictive band made of sheets around the pt's lower abdomen to prevent the spread of toxins
A. Ensure the pt is receiving high flow O2 If the pt is experiencing crush syndrome, he is likely to have a build-up of toxic substances that accumulated due to anaerobic metabolism in the entrapped and compressed body part. Ensure the pt is receiving high flow O2 before the lump is released.
You are called to the scene of a passenger car train derailment with possible injuries and/or fatalities. Once all services are on-scene, who has the ultimate authority for all issues regarding patient care at the scene of the potential mass-casualty incident? A. Medical group officer B. EMS medical director C. Senior or highest ranking paramedic on scene D. Incident commander
A. Medical group officer EMS medical director is ultimately responsible for all treatments but is not available in most cases on the scene. The paramedic would only make treatment decision when he is the recognized treatment officer in the treatment area of the incident; being lead doesn't make it his right or responsibility. The incident commander leads all collaboration of the various divisions of the mass-casualty-incident, however, he does make pt care decision on-scene.
Why is fibrinolytic therapy screening in the pre-hospital environment primarily conduct4ed on ST elevation chest pain patients? A. ST elevation is most likely present before permanent cardiac tissue damage has occurred B. ST elevation indicates a strong cardiac electrical system that is more likely to be salvageable C. ST elevation is the only indicator in the pre-hospital environment that a MI has occurred in the past D. Acute MI is the only cause of ST elevation
A. ST elevation is most likely present before permanent cardiac tissue damage has occurred. ST elevation is the most reliable indicator in an infarction in the first few hours of the event. The presence of ST elevation indicates permanent tissue damage hasn't occurred. Fibrinolytic therapy is indicated for patients with ST elevation. ST elevation isn't only caused by acute MI; other causes include LBBB, some ventricular rhythms, left ventricular hypertrophy, pericarditis, and ventricular aneurysm.
You are called to assist a mother who found her 2 y/o playing with insecticide that contains organophosphates. The child is showing s/s of poisoning with excessive salivation and diaphoresis apparent. Medical command recommends the administration of atropine to help dry the secretions and increase the child's cardiac output. Which of the following dosages of atropine would be considered appropriate for this pt? A. 4 mg given IM B. 0.05 mg/kg IV (max of 3 mg) C. 0.01 mg/kg IV D. 0.5 mg given SC
B. 0.05 mg/kg IV (max of 3 mg)
Your newborn pt is in need of a fluid bolus to return his circulating blood volume to a near normal level after a bleeding injury has occurred, but the bleeding is now controlled. What is an acceptable fluid bolus amount for the newborn patient? A. 25 mL/kg of body weight/1 hour B. 10 mL/kg of body weight/5-10 minutes C. 100 mL/1-3 minutes and can be repeated twice D. 40 mL of normal saline/1 minute
B. 10 mL/kg of body weight/5-10 minutes
Your adult pt was involved in a baseball accident in which a ball struck him in the face around the mandible. He is conscious and alert, denies LOC, but isn't able to close his mouth. It appears as if he is yawning widely and isn't able to return his face to a normal position. What is the MOST LIKELY cause of this finding? A. Temporomandibular joint fracture B. Anterior mandibular dislocation C. Mandibular spasm D. LeFort II fracture
B. Anterior mandibular dislocation A muscle spasm that affects the mandible is most likely to cause the pt to clench his teeth and complain of pain associated with the forceful mouth closer. LeFort II fractures run across the face above the bridge of the nose and end bilaterally at the TMJ; it doesn't cause the classic wide open mouth. TMJ fracture is likely to cause intense pain and misaligned lower jaw. It isn't likely to cause the mouth to be wide open.
Which of the following prefixes would a paramedic use when describing any condition within a pt's musculoskeletal joints? A. Algia- B. Arthro- C. Arter- D. Angio-
B. Arthro-
What is the medication type of choice for relieving bronchospasm associated with COPD in the pre-hospital setting? A. Steroids B. Beta-agonists C. Anticholinergics D. Sympathomimetics
B. Beta-agonists
Your adult pt called for help after developing a blistering lesion on his left thigh a few days after returning home from vacation. The blistered area is encircled by a red ring that gives it the appearance of a "bull's eye." Which of the following should you suspect? A. Black widow spider bite B. Brown recluse spider bite C. Scorpion bite D. Bee sting
B. Brown recluse spider bite Scorpion sting and bee stings are painful and don't go undetected by the victim. These bites tend to go away within a day or two, not worsen into a blistering lesion. Black widow spider bites are normally painless initially, but quickly develop into muscle cramps and spasms with intense pain within an hour or so.az
Which of the following medical conditions is MOST likely to cause enlarged airspace beyond the terminal bronchioles with collapse and destruction of the alveoli? A. Pneumonia B. Emphysema C. Asthma D. Bronchitis
B. Emphysema
Your medical command physician has ordered you to place an NG tube in the stomach of your 60 y/o pt with abdominal pain. It's suspected he is bleeding from peptic ulcers due to his past medical history and a large amount of blood in his emesis. What would be the MOST appropriate way to measure the proper length of the NG tube? A. From the pt's nose around the shape of his jaw and ending at the sternal notch B. From the pt's nose to his ear to his xiphoid process C. From the pt's nose to his manubrium then add two hand widths to the length D. From the pt's nose straight to his umbilicus
B. From the pt's nose to his ear to his xiphoid process
Injury to Cranial nerve X (vagus) following a closed head injury will result in what loss of function? A. Spontaneous breathing B. Gag reflex C. Temperature control D. All the above
B. Gag reflex
You are called to assist a 55-year-old male who possibly sustained a snake bite. On arrival, your pt is calm but concerned that a poisonous snake envenomation may have occurred. He states the bite took place less than 15 minutes prior to your arrival. He has two fang makes on his R lower leg, posteriorly. His vitals remain SNL while his skin tone/color is unchanged. Which of the following interventions would be MOST appropriate after ensuring ABCs and initiating oxygen therapy? A. Apply a tourniquet above the bite marks with enough pressure to stop circulation past the tourniquet B. Immobilize the extremity in the neutral position with a pressure immobilization bandage C. Apply a pressure dressing on top of the bite marks with an ice pack applied D. Immobilize the pt using full body spinal immobilization technique
B. Immobilize the extremity in the neutral position with a pressure immobilization bandage There is no need to apply full spinal immobilization unless the pt has sustained an injury to his spine or neck; it son't help slow or stop the flow of venom. It isn't recommended to apply a tourniquet that completely stops blood circulation to and from an extremity as this would likely cause tissue and muscle necrosis. Never apply ice to a suspected snake bite in an attempt to slow the spread of venom (may block flow of blood circulation).
Your adult trauma pt sustained a large laceration to her L thigh that was bleeding profusely on your arrival, but now the bleeding is controlled with a bulky pressure dressing. The pt is confused, pale, and found to have a BP of 90 systolic just after the injury was treated. After medical intervention and treatment for shock, the pt's BP continues to fall. Which of the following MOST LIKELY caused this to occur? A. In internal hemorrhage that hasn't been found B. Increasing hypoxemia and lactic acidosis C. Increased O2 availability and metabolic alkalosis D. An increase in the hydrostatic pressure in the capillaries allowing fluids to be reabsorbed
B. Increasing hypoxemia and lactic acidosis
All traditional means of clearing and obstructed airway have been exhausted, and your adult pt is quickly approaching cardiopulmonary arrest. As a last-resort effort to save your pt's life, you decide to attempt ventilation through a needle cricothyrotomy. Where do you want to insert the catheter in order to ventilate the patient? A. Downward through the tracheal ring just above the cricothyroid membrane B. Into the midline of the cricothyroid membrane at a 45-degree angle towards the feet. C. At a 90-degree angle n the sternal notch just below the cricothyroid membrane D. Upward at the bottom edge of the first tracheal ring below the cricothyroid membrane
B. Into the midline of the cricothyroid membrane at a 45-degree angle towards the feet
You are called to assist PD with an adult mental health patient who has minor abrasions after a scuffle with the officers. On scene, the patient refuses EMS care for his injuries. Officers on scene give you permission to treat the patient. Which of the following forms of consent would allow you to treat the patient without fear of violating his right to refuse care? A. Implied consent B. Involuntary consent C. Expressed consent D. Informed consent
B. Involuntary consent
You are called to assist law enforcement with an adult mental health patient who has minor abrasions after a scuffle with PD officers. On the scene, the pt refuses EMS care for his injuries. Officers on the scene give you permission to treat the pt. Which of the following forms of consent would allow the paramedic to treat the pt without fear of violating his right to refuse care? A. Implied consent B. Involuntary consent C. Expressed consent D. Informed consent
B. Involuntary consent Involuntary consent refers to treatment rendered under the order of law. An exampled would be caring for a pt that PD is holding on a mental health watch, under protective custody, or under arrest, who requires emergency medical treatment. PD can't grant EMS the authority to treat a competent adult who is not being held by PD.
Which classification of personal protective equipment offers the highest respiratory system production but a lower level of skin protection? A. Level A B. Level B C. Level C D. Level D
B. Level B Level A offers the highest protection for skin, respiratory, and eyes; offers full containment of all body surfaces. Level C is a step down from B and is usually initiated when transporting possibly contaminated patients when the toxic exposure is known to be a respiratory irritant. It offers limited respiratory and skin protection without eye protection. Level D is no respiratory protection and limited skin protection.
Your adult pt may be experiencing a GI bleeding event causing N/V and cool, clammy skin. While obtaining IV access, which blood sample tube would give the hospital staff the MOST information about the possibility of a GI bleed? A. Lavender top blood sample tube with EDTA B. Light blue top with sodium citrate C. Red top with no additive/preservative D. Green top with heparin
B. Light blue top with sodium citrate. Lt blue top is used primarily for blood coagulation studies like prothrombin time, activated partial thrombin time, fibrinogen levels, and D-dimer. Lavender top contains the anticoagulant EDTA; it's used for whole blood hematology testing. Red top tubes don't contain ANY preservatives or additives. They're used primarily for serum electrolytes, liver enzymes, therapeutic drug levels, and blood bank procedures. Green top tubes contain heparin and used to test electrolytes, glucose, and cardiac enzymes. *Bonus* When you collect tube samples, to them in this order: - Red, blue, green, purple. IF you fill blue first = has to be completely full, so if you use it first it'll suck some air in and not get you as much blood as you need.
Your adult pt was located within the primary blast zone of a natural gas explosion at a local residence. If the pt was in close proximity to the source of the explosion, which of the following injuries would be referred to as primary blast injuries? A. Impaled debris and shrapnel from objects being exploded in the primary blast B. Lung injuries such as pneumothorax due to sudden pressure changes C. Radiation exposure that causes chronic illness such as respiratory carcinoma D. Broken bones from striking secondary objects while being hurled away from the blast
B. Lung injuries such as pneumothorax due to sudden pressure changes. Primary blast injuries occur from the sudden changes in the environmental pressure. This often ruptures the hollow organs such as lungs, stomach, and intestines. Secondary blast injuries are caused by the displaced flying debris that was caused BY the primary blast - so your impaled debris injuries. Tertiary injuries occur from being tossed about during an explosion, like a broken bone. Quaternary blast injuries occur after the disaster and are classified as lung diseases, brain injuries, etc. They don't occur due to the explosion itself; they're caused by the effect of the blast on the body such as inhaled poison gases, etc.
The pre-hospital administration of medications to reduce ICP is controversial. However, medications that may be ordered by MCP to reduce cerebral edema and/or circulating blood volume includes which of the following? A. Lidocaine B. Mannitol C. NTG D. Lasix
B. Mannitol Mannitol is an osmotic diuretic helpful in reducing the fluid associated with cerebral edema and effectively lowering BP. NTG maybe used fo lower BP, but it's not indicated for reduction of cerebral edema or reducing circulating blood volume. Lidocaine helps with increased ICP by controlling any FURTHER increase; doesn't actually lower ICP. Lasix helps with BP, but it's not indicated for increased ICP.
Which of the following is responsible for the kidney failure associated with crush injury syndrome? A. Crushed RBCs from damaged blood vessels are filtered through the kidneys, causing renal failure B. Myoglobin released from damaged muscles is filtered by the kidneys, causing renal failure C. Blood pools in the kidneys due to the crush injury and causes renal necrosis and failure D. Toxic metabolites are rapidly released and filtered through the kidneys, causing acute renal failure
B. Myoglobin released from damaged muscles is filtered by the kidneys, causing renal failure Myoglobin is responsible for renal failure, not crushed RBCs. Toxic metabolites in the blood after a crush injury is most likely to cause metabolic acidosis, not renal failure. Blood doesn't pool in the kidneys after a crush injury.
which of the following medications works by relaxing smooth muscles to provide vasodilation, as well as reduce HR and stroke volume of the heart? A. Cardura B. Verapamil C. Lidocaine D. Metoprolol
B. Verapamil Calcium channel blockers work by relaxing smooth muscles to provide vasodilation as well as reduce HR and stroke volume of the heart. Examples include diltiazem (or Cardizem), verapamil, and nicardipine. Metoprolol is a beta-blocker used to decrease the workload of the heart by blocking sympathetic stimulation of the beta receptors on the SA node and myocardial cells, thus decreasing the force of the contractions and causing a reduction in heart rate; it doesn't work on smooth muscle. Cardura is an alpha-adrenergic blocker used to lower BP by dilating peripheral blood vessels causing a decrease in peripheral vascular resistance; it doesn't affect cardiac or vascular smooth muscle. Lidocaine is a sodium channel blocker that works by impairing conduction of sodium ions through sodium channels and is primarily used in the treatment of cardiac dysrhythmias of ventricular origin; it doesn't affect cardiac or vascular smooth muscle to decrease BP.
You are assisting a full-term pregnant pt in the delivery of her newborn at home. However, once the baby's head delivers and turns to accommodate the shoulders, the next few contractions fail to produce the newborn's shoulder. In this case, what should you do next? A. Using gentle pressure on the infant's head the the palm of your gloved hand, expedite transport because delivery will require cesarean section at the hospital. B. Using gentle pressure, guide the infant's head back into the birth canal and rotate the infant's head in the opposite direction and see if the next contraction allows the shoulder passage. C. Using gentle pressure, guide the infant's head downward to facilitate the anterior shoulder and then upward to release the posterior shoulder. D. Using gentle pressure, guide the infant's head upward to facilitate the anterior shoulder, and then downward to release the posterior shoulder.
C.
Your adult anaphylaxis pt is suffering from hypotension that isn't responding to epinephrine. Which of the following medications is capable of combating HoTN associated with anaphylaxis when epinephrine fails to improve blood pressure? A. Ipratropium B. Hydrocortisone C. Cimetidine D. Albuterol
C. Cimetidine Cimetidine is an H2 antagonist that may help improve a pt's BP during anaphylaxis when epi fails to improve the pressure by blocking the histamine that is partly responsible for the vasodilation. Albuterol is a beta-agonist that is helpful during an anaphylactic reaction to help relieve the associated bronchospasm; it may help raise BP slightly, but this is not likely if epi fails to increase the pressure. Hydrocortisone is a corticosteroid given during an allergic reaction or anaphylaxis in an attempt to reduce some of the inflammation associated with the reaction it's not capable of increasing BP. Ipratropium is an anticholinergic capable of relieving the bronchospasm associated with anaphylaxis. However, it is not especially effective in increase in BP.
Which of the following medications may be effective in reversing the signs and symptoms of dystonia? A. Morphine sulfate B. Lidociane C. Diphenhydramine D. Promethazine
C. Diphenhydramine Diphenhydramine is an antihistamine that functions as an anticholinergic agent. It helps to reverse the painful muscle spasms associated with dystonia by helping return the normal muscle cell stimulation. Morphine may be indicated for the *pain* accompanying dystonia, but won't reverse what's causing the spasms. Promethazine is an antiemetic and literally has nothing to do with muscle spasms. Lidocaine is an antidysrhythmic and is effective in slowing some very fast heart rates, but also won't help reverse the effects of dystonia.
Which of the following findings would a paramedic expect to see in a pt with a chronic adrenal dysfunction such as Addison's disease? A. Reddened and dry skin, hyperglycemia, N/V, and electrolyte abnormalities B. Cool and clammy skin, hypoglycemia, and potassium insufficiency C. Pale dry skin, weakness, hyperglycemia, dehydration, and electrolyte abnormalities D. Darkened skin, anorexia, hypoglycemia, N/V
D.
While evaluating the pupils of your unresponsive trauma pt, you note his pupils have a dysconjugate gaze. What type of injury does this finding normally represent? A. Injury or damage at the level of the Pons B. Cerebral damage or increased ICP C. Brain lesion or damaged tissues within the brain D. Brainstem damage or herniation has occurred
D. Deviation of the pupils to opposite sides it known as dysconjugate gaze. Cerebral damage is likely to place undue pressure on cranial nerve III and cause unilateral, fixed, and dilated pupils. Pt's with lesions or damage at the cellular level within the brain tissue are more likely to present with pupils that unilaterally point to either side known as conjugate gaze. Injury or damage at the level of the Pons is most likely to be evident by the presence of pinpoint nonreactive pupils.
Thyroid storm is caused by the acute hyperfunction of the thyroid gland and is a true medical emergency that requires emergent hospital intervention. Which of the following s/s would a paramedic expect a pt experiencing a thyroid storm to exhibit? A. Bradycardia, tachypnea, hypothermia, palpitations, and lethargy B. Bradycardia, bradypnea, hyperthermia, confusion, and delirium C. Tachycardia, bradypnea, hypothermia, GI upset, and listlessness D. Tachycardia, tachypnea, hyperthermia, palpitations, and delirium
D. Pts with thyroid storm present with symptoms related to adrenergic hyperactivity as seen in other conditions that overstimulate the SNS such as cocaine ingestion or hypoglycemia. Therefore, the pt wouldn't likely present with bradycardia, bradypnea, hypothermia, or lethargy. They often present with paranoia, delirium, and restlessness; it is not likely they would present with listlessness.
If a pt is suffering from pulmonary edema, which of the following will be helpful in increasing the pt's lung volume and vital capacity while reducing venous return to the heart and helping to diminish the overall work of breathing without affecting blood pressure? A. Administering 0.04 mg of NTG sublingually B. Administering 2 mg of morphine sulfate IV C. Placing the pt in the Trendelenburg position with legs elevated to 30 degrees D. Placing the pt in a sitting position with his legs dependent
D. NTG maybe a powerful vasodilator, but it doesn't increase lung volume or capacity. Morphine is effective in reducing venous return and reducing work of breathing, but doesn't increase lung volume or vital capacity. NEVER place a pt in the Trendelenburg position - that's literally the opposite of what you want,
You are treating a 48 year old patient who presented with symptomatic narrow-complex supra-ventricular tachycardia that has not responded to vagal maneuvers or adenosine. The patient remains hemodynamically stable and shows no signs of congestive heart failure. He is conscious and denies any other past medical history. The patient refuses to allow electrical cardioversion to convert the rhythm. What secondary pharmacology agent may be effective in converting the rhythm in this situation? A. Lidocaine B. Atropine C. Amiodarone D. A beta-blocker or calcium channel blocker
D. A beta-blocker or calcium channel blocker. A calcium channel blocker may effectively convert the patient in SVT, as long as the patient remains hemodynamically stable and there are no signs of acute pulmonary edema associated with congestive heart failure. A beta-blocker or calcium channel blocker is often reserved for in-hospital setting for patients with persistent SVT. However, medical command physicians may recommend the administration of beta-blockers or calcium channel blockers. Amiodarone is not an effective medication for patients suffering from SVT; it is indicated for pulseless V-tach and/or V-fib. Atropine is not indicated for SVT; it is indicated for sinus bradycardia. Lidocaine is an effective antidysrhythmic that effectively suppresses V-tach.
After intimating your apneic patient, what tube placement confirmation means should be assessed FIRST? A. Attach ETCO detector B. Auscultation each lung field for the presence of breath sounds C. Attach capnography to determine presence of ventilatory waveform D. Auscultate over epigastric region for presence/absence of breath sounds
D. Auscultate over epigastric region for presence/absence of breath sounds
You are transporting a 20 y/o pregnant female from a local hospital to a medical facility that specializes in high-risk pregnancies when you note the pt is experiencing unexplained hypotension and bradycardia. The pt has a patent IV and is being administered magnesium that was initiated by the hospital staff. On the cardiac monitor, the pt presents with a lengthening PR interval and signs of an impending high-degree nodal block. Which of the following interventions would be MOST appropriate in this case? A. Stop the mag sulfate infusion immediately, and administer the appropriate dose of calcium chloride to correct the adverse effects of magnesium toxicity. B. Continue the infusion, but administer potassium chloride to counteract the adverse effects of the magnesium chloride administration. C. Increase the magnesium sulfate infusion rate, and administer a 1,000 mL normal saline bolus to support the pt's blood pressure. D. Reduce the infusion by half, and administer dextrose 50% to counteract the adverse cardiac effects caused by eh magnesium chloride infusion.
A. Mag sulfate toxicity in pregnant pt's may result in prolonged PR intervals, QRS complexes, and QT intervals. It may also cause high-degree infra-nodal blocks, bradycardia, frank HoTN, and if not corrected, cardiac arrest. The continued infusion could result in all of the above risks and it's not acceptable OR helpful to give potassium or D50W. Calcium chloride is the appropriate med to combat mag toxicity.
Which of the following frequency bands used by EMS for radio communication, uses a repeater system and is best suited for urban areas? A. 800 MHz B. Ultra High Frequency (UHF), 450-470 MHz C. Vey High Frequency high band, 150-174 MHz D. Very High Frequency low band, 32-50 MHz
A. 800 MHz These signals generally have limited range due to their straight line of travel, therefore repeaters were introduced to make the signals travel "longer"; ideal for large urban areas.
Which of the following patients BEST fits the criteria for a critical burn? A. A 60 y/o pt with partial-thickness burns across 25% of the body, not involving the hands, feet, face, or genitals B. A 20 y/o pt with partial-thickness burns on 25% of the body, not including the hands, feet, face, or genitals C. A 10 y/o pt with superficial burns over 60% of the body D. A 15 y/o pt with full-thickness burns on the left upper/lower arm, non-circumferential
A. A 60 y/o pt with partial-thickness burns across 25% of the body, not involving the hands, feet, face, or genitals Criteria for a "critical" burn areL 1. Critical burns: - Burns involving hands, feet, face, or genitals - Circumferential burns of torso, arms, or legs - >10% BSA 2. Partial-thickness burns: - >30% BSA 3. Any thickness burns: - Airway of respiratory involvement - Other trauma such as fractures - Patients <5 or >55 y/o with a "moderate" rated burn
Which of the following is a potentially life-threatening emergency that most often occurs with injuries above T4-T6 and results from the loss of parasympathetic stimulation? A. Autonomic dysreflexia B. Spondylolysis C. Spinal stenosis D. Osteomyelitis
A. Autonomic dysreflexia Autonomic dysreflexia is a late sign of spinal cord injury. 85% of pts with an injury above T6 will develop this condition. Pts with the condition develop HTN. Osteomyelitis is inflammation of the bone and muscles secondary to infection. Spondylolysis is a structural defect of the spine, which is congenital and chronic. Spinal stenosis is a narrowing of the spinal column.
Your adult trauma pt is not breathing effectively due to his injury. He is exhibiting the s/s associated with hypoperfusion including suspected acidosis. At this point, which of the following will attempt to correct the imbalance? A. Chemoreceptors B. Neurotransmitters C. Catecholamine production D. Metabolite accumulation
A. Chemoreceptors Chemoreceptors respond to the body's decreased perfusion and increased acidosis by stimulating an increase in the rate and depth of spontaneous ventilations. This helps correct the acidosis by decreasing PCO2. Catecholamine production maintains cardiac output and blood pressure during shock; they aren't effective for correcting hypoxia and acidosis. Neurotransmitters aren't responsible for nor capable of helping the body correct hypoxia and acidosis. Metabolite accumulation isn't a condition associated with shock or any of the body's responses to hypoperfusion.
Fractures and dislocations are normally splinted in the position found. However, if circulation is impaired distally, if allowed by medical control, an attempt may be made to realign the fracture/dislocation in hopes of regaining circulation. What is the one EXCEPTION to this rule indicating re-alignment should never by attempted in the pre-hospital setting? A. Elbows B. Fingers C. Shoulders D. Knees
A. Elbows
You are on-scene with a 40 y/o male complaining of a severe headache and palpitations. The pt reports he was recently diagnosed with autonomic hyperreflexia syndrome and prescribed sublingual nifedipine as needed (PRN) to manage his conditions. Which of the following BEST describes autonomic hyperreflexia syndrome (AHS)? A. Hypotension secondary to spinal shock, caused by losing sympathetic tone of the blood vessels B. A spinal condition characterized by abnormal flexion responsible for stiffness or fixation of a vertebral joint C. Overactivity of the autonomic nervous system that causes an abrupt onset of extremely high blood pressure D. Injury caused by excessive pressure on the anterior aspect of the spinal cord
C. Autonomic hyperreflexia is an abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation. It's often caused by an old spinal cord injury. This reaction may include changes in HR, excessive sweating, HTN, muscle spasms, and altered skin color. AHS stimulates the ANS causing a major vasoconstriction effect on all blood vessels and sudden onset extreme HTN, not HoTN. Autonomic hyperreflexia doesn't place pressure on the anterior aspect of the spinal cord, that's what anterior cord syndrome is and it's caused by a displaced/fractured intervertebral disk. Spondylosis is characterized by stiffness/fixation of a vertebral joint.
Your closed head injury pt is suspected of suffering brainstem herniation. If so, which of the following indicators will MOST likely present? A. Hemiplegia and unequal pupils that are sluggish to respond B. Abnormal posturing with decorticate posturing and an increased pulse rate C. Abnormal extension with decerebrate posturing or no motor response to painful stimuli D. Decreased systolic BP and non-reactive, dilated pupils
C. Pt's with brainstem herniation will likely present with abnormal extension including decerebrate posturing and no motor response to painful stimuli. They may also have bilateral, dilated, unresponsive pupils or asymmetrical pupils greater than 1 mm. Brainstem herniation pt's will not present with decreased BP; they will likely have increased BP and wide pulse pressure. Pts with abnormal posturing and decorticate posturing will likely have a decreased pulse rate, not an increased one. Pts with hemiplegia have injuries that have reached the cortex of the brain and have not yet suffered brainstem herniation.
You are treating an adult closed-head injury pt whose respirations are irregular, shallow, and very fast at 40 times per minute. What does this usually indicate in a patient with a closed-head injury? A. He's not hyperventilating; his body is promoting CO2 retention to naturally combat the brain swelling B. Metabolic acidosis due to the CO2 retention C. Respiratory alkalosis and an increase in ICP D. Respiratory acidosis and brain-stem injury
C. The rapid, irregular RR is due to the increase in ICP and is the body's attempt to correct the alkalinity associated with the injury and hypoxia. This patient should be considered to be experiencing low to normal CO2 blood levels.
If a myocardial infarction patient presents with bradycardia and hypotension, with of the following is the MOST likely cause? A. Sympathetic nervous system response to an anterior MI. B. The inability of the ischemic sympathetic nervous system to maintain an adequate heart rate and blood pressure. C. Parasympathetic nervous system response to an inferior wall MI. D. The vasodilation of peripheral blood vessels caused by the sympathetic nervous stimulation.
C. V/S response to an MI is dependent on the area and type of ANS involvement. Inferior MIs often show a mainly parasympatholytic response while anterior MIs present with a mainly sympatholytic response (which would cause tachycardia and HTN, not the other way around). The bradycardia and HoTN associated with an MI are not caused by an ischemic sympathetic nervous system.
Croup, bronchiolitis, epiglottitis, and asthma are all examples of pediatric respiratory problems that may require EMS intervention. Which of the following BEST describes or defines bronchiolitis? A. An inflammatory disease causing restrictive airway compromise in infants 3-6 months old B. A bacterial infection that afflicts children over 3 y/o from an unknown cause C. A viral infection caused by RSV that affects children between 6-18 months old D. A viral infection of the upper airway caused by influenza affecting children between 1-2 years old
C. A viral infection caused by RSV that affects children between 6-18 months old Bronchiolitis is a viral infection of the lower airways that occurs primarily in infants under the age of 18 months. It is characterized by expiratory wheezing, respiratory distress, inflammation, and obstruction at the level of the bronchioles.
Sighing is a slow, deep inspiration followed by a prolonged expiration and is thought to be a protective reflex. Which of the following is it thought to prevent? A. Carbon dioxide retention B. Aspiration C. Atelectasis D. Subcutaneous emphysema
C. Atelectasis Atelectasis is the collapse of lung tissue preventing the exchange of gases. Pt's with the potential for this to occur, such as emphysema and rib fracture pts, may sigh to help keep the alveoli open at the end of exhalation. Sighing doesn't prevent aspiration, that's the epiglottis. Sighing isn't considered a preventive measure for CO retention; its primary purpose is to allow a little air to remain in the lower air sacs to prevent alveolar collapse. Subq emphysema is an abnormal finding in pneumothorax; that's when air escapes the injured lung and accumulates in the tissue (you'll hear "rice crispy" sounds and feelings when you palpate the injury).
Which of the following hazardous materials is described as a yellow-green poisonous substance that may smell like a mixture of pineapple and pepper? A. Phosgene B. Soman C. Chlorine D. Sarin
C. Chlorine Soman is a clear, colorless, and tasteless liquid with a slight camphor odor (used as a nerve agent). Phosgene is a poisonous gas that has a gray-white cloud and smells like freshly mowed hay. Sarin is a clear, colorless, and tasteless poisonous liquid that's odorless (sometimes seen in nerve agents).
You are on scene at a MVC and your 20 y/o pt is entrapped. He is unconscious, unresponsive, and has a palpable carotid pulse that is weak and thready. His breathing is slow ad shallow at 4x a minutes with equal chest wall expansion. There are no obvious deformity injuries or hemorrhage noted. FD on-scene has stabilized the vehicle and provided you and your partner a relatively safe environment to manage the entrapped pt. However, access is limited to the seated pt, and extrication is expected to take another 20 minutes. After having your partner maintain c-spine stabilization, which of the following would be the BEST choice for securing the pt's airway? A. Intubate the pt using the blind orotracheal intubation technique to maintain in-line mobilization of the spine, then assist ventilation B. Use nasotracheal intubation techniques to gain complete control of the pt's airway and assist ventilation C. Insert a King LTD and begin assisting ventilations with a BVM D. Insert a nasal airway and administer high-flow oxygen therapy
C. Insert a King LTD and begin assisting ventilations with a BVM King LTD is a good choice when cervical spine manipulation must be kept to a minimum. It wouldn't be the best choice to insert a nasal airway in the nares of an unconscious trauma pt due to the high possibility of a skull fracture, especially when better options are available. Blind orotracheal intubation should be withheld until all else has failed to intubate a dying pt, and them many local protocols prohibit its use. It wouldn't be indicated in a trauma situation when a pt is breathing on his own.
Your adult pt is found unconscious with decreased respirations. Which of the following medical conditions is MOST likely to cause a diret decrease in a pt's respiratory effort and/or breathing rate? A. Metabolic acidosis B. ASA poisoning C. Metabolic alkalosis D. CNS lesion involving the Pons
C. Metabolic alkalosis
This organization, which was instituted in 2011, is responsible for alerting responders to the potential for a terrorist attack and also provides specifics of the current threat. A. Homeland Security Advisory System (HSAS) B. Terrorism Alert and Advisory System (TAAS) C. National Terrorism Advisory System (HTAS) D. National Security Alert System (NSAS)
C. National Terrorism Advisory System (NTAS)
When a patient is deceased, who MUST give the final consent for organ tissue donation? A. The ER physician B. The pt's non-family medical power of attorney C. The pt's next of kin D. The pt's physician
C. The pt's next of kin When a deceased pt is a potential organ tissue donor, consent must be granted by the pt's next of kin. The legal, accepted order of next of kin is: - spouse (together or separated but not yet divorced) - adult son or daughter - parents - siblings - legal guardian A non-family member POA would have the right to give permission for organ donation if non of the above exist. The pt's physician or medical common physician would never have the right to give consent.
Your conscious, alert, and oriented adult pt was involved in a motor vehicle accident involving major rear-end impact. He was the restrained driver and is now complaining of the inability to move either of his arms. There are no obvious injuries noted. The pt is able to move both lower extremities but report weakness and decreased sensation to the interior aspects of both thighs. The pt has diminished but present distal pulses. He only has some touch sensation, and no grips or hand/arm movement, leading you to determine upper extremity paralysis exists. Which of the spinal injury syndromes is MOST LIKELY to cause the s/s described above? A. Failed back syndrome B. Anterior cord syndrome C. Brown-Sequard syndrome D. Central cord syndrome
D. Central cord syndrome Central cord syndrome is characterized by a hyperextension injury that leaves the pt unable to move his arms but retains some movement and sensation in the lower extremities. Anterior cord syndrome is typically a flexion injury characterized by decreased sensation of pain and temperature. Light touch sensation remains intact, but the pt is unable to move ANY of his extremities. Brown-Sequard syndrome is a hemitransection of the of the spinal cord. Pressure on half of the spinal cord results in decreased sensation and movement contralaterally (opposite side) and does not cause arm paralysis. Failed back syndrome results from an injury received during surgery to correct an intervertebral disk and does not relate to an acute injury.
In compensated shock states, the body attempts to maintain a viable blood pressure when a decrease in circulating blood volume is detected. How does the body initially respond to the decreased volume? A. ADH and aldosterone secretion is halted to cause water and sodium retention B. Shunting blood away from the peripheral circulation to allow more blood to be delivered to the vital organs C. Decreasing catecholamine production in attempt to reduce the peripheral vascular resistance D. Increasing catecholamine production in an attempt to increase the BP
D. Increasing catecholamine production in an attempt to increase the blood pressure The body does shunt blood away from the muscles, skin, kidneys, and liver. This doesn't occur, however, until after the sympathetic and hormonal responses. It occurs late in the adrenal response to the lost volume.
Your unconscious closed head injury pt presents with a widened pulse pressure and bradycardia. Her pupils are sluggish to react, and she is exhibiting abnormal extension posturing. Her s/s lead you to believe she is experiencing increased ICP from the injury. What area of the brain is MOST likely impacted by the increase in pressure? A. Medulla B. Pons C. Cortex D. Midbrain
D. Midbrain Pts with increased ICP at the level of the cortex and upper brainstem often present with an increase in BP while the pulse rate falls, and Cheyne-Stokes respirations may be present. The pt will likely withdraw from pain at this point. Pts who have an increased ICP at the medulla will likely present with blown pupils, ataxic respirations, irregular pulse, and fluctuating BP; they aren't likely to survive.
Your unconscious closed head injury pt presents with a widened pulse pressure and bradycardia. Her pupils are sluggish to react, and she is exhibiting abnormal extension posturing. Her s/s lead you to believe she is experiencing increased intracranial pressure from the injury. Which area of the brain is MOST likely impacted by the increase in pressure? A. Pons B. Cortex C. Medulla D. Midbrain
D. Midbrain. Cortex and upper brainstorm present with inc BP while pulse rate falls, and Cheyenne-Stokes resp may be present. Medulla will have blown pupils, ataxic resp, irregular pulse, and fluctuating BP.
You arrive on-scene of a seizure call to fin an adult pt postictal. He is conscious, and his level of consciousness is improving. He reports that he has an epilepsy history and suffers from grand mal seizures. He says he was recently prescribed medication for the condition, but he doesn't like to take it. Which of the following medications is he MOST likely prescribed for epileptic seizures? A. Lithium B. Diltiazem C. Clinidine D. Phenytoin
D. Phenytoin Common epileptic seizure medication prescribed today is mainly in the form of phenytoin. Phenobarbital was once the common medication and is still sometimes seen. However, phenytoin is prescribed most often due to its effectiveness and minor side effects. Lithium is a medication for the treatment of bipolar disorder and is not an intended epileptic medication. Clonidine and Diltiazem are prescribed for the long-term treatment of chronic HTN.
ST-segment elevation is one of the first ECG characteristics assessed when trying to determine if an acute MI is occurring. However, there are situations when assessing a patient's ST-segment elevation is not used to determine the presence of a STEMI. In which of the following situations would assessing ST-segment elevation be contraindicated when trying to determine the presence of a STEMI? A. When the patient has experienced any kind of MI in the past. B. When the patient has taken NTG in the last 2 hours. C. When the patient may have a higher than normal potassium level. D. When the patient also exhibits a left bundle branch block (LBBB) on the ECG.
D. When the patient also exhibits a left bundle branch block (LBBB) on the ECG. A patient who has a new or existing LBBB is likely to experience repolarization issues that will make the ST-segment measurements invalid when trying to assess for a STEMI. Hyperkalemia may alter the T waves (tall and tented) however, it is not likely it will interfere with the associated S-wave, so ST-elevation measurement stay relevant. Patients who have had an MI in the past will likely have evidence of the infarct on an ECG tracing. However, it is still appropriate to evaluate the patient for a STEMI. Taking NTG will not affect the ST-segments.
