Your patient is a 23 yof in moderate respiratory distress, complaining of difficulty breathing. She describes an acute onset of SOB 15 minutes ago that has been getting progressively worse and has not responded to her Atrovent inhaler. Physical examination reveals cool, pale, and diaphoretic skin and clear lung sounds bilaterally. She has a hx of asthma, is a smoker, and had breast-reduction surgery yesterday. Medications include Atrovent and albuterol inhalers and birth control pills. HR = 129, BP = 100/60, RR = 26, SaO2 = 92%. In addition to 100% oxygen, which of the following is the most appropriate treatment?
A. IV of NS with 250 cc fluid challenge
Your patient is a 70 yom with a hx of emphysema and pulmonary hypertension. His wife called for EMS because the patient has become progressively more dyspneic over the course of the day. Which of the following aspects of the history should concern you the most?
A. the patient was admitted to the ICU last year and required mechanical ventilation
A patient tells you that she experienced an episode of involuntary "shaking" in her arm. She describes a 1-2 minute long episode of muscular jerking and contracting of her entire left arm. She retained consciousness, lacked an aura, and had no pain associated with the episode. This most indicates a(n) _____ seizure.
A. simple partial
Which of the following best explains the cause of the histamine and heparin release in response to exposure to an antigen?
A. humoral cells have initiated a chemical attack on the antigens
All of the following are common complications of renal dialysis EXCEPT:
B. air embolism
A 16 yof with a hx of diabetes is found unconscious in a high school bathroom following volleyball practice. She is tachycardic; has cool, clammy skin; is lethargic; is slightly combative; and is very confused. She is most likely experiencing:
A. hypoglycemia
You are called to a local physician's office where you find a 52 yom patient with a hx of chronic renal failure. He is conscious, but disoriented. The physician reports that the patient's wife brought him in because he has had a "chest cold", missed dialysis yesterday, and is now "acting strangely". Physical examination reveals cool, diaphoretic skin; edema to dependent areas, and lun sounds with rhonchi in the right upper lobe. HR = 118, BP = 142/100, RR = 20 and deep, Sa02 = 97%, BGL = 79 mg/dL. Bloodwork performed by the physician in his office indicates a pH of 7.2. In addition to 15 lpm of oxygen by NRB and an IV of NS KVO, which of the following is most appropriate for this patient in the prehospital setting?
C. IV sodium bicarbonate, 1 mEq/kg
Your patient has a hx of epilepsy and is experiencing loss of consciousness, tonic-clonic muscle activity, and erratic ocular movement. Based on this, you might also expect to find all of the following EXCEPT:
B. pinpoint pupils
The administration of a vaccine results in _____immunity.
A. active induced
Which of the following statements about pulse oximetry is FALSE?
D. pulse oximetry values can be expected to decrease within seconds in cases of developing hypoxia
A 72 yof has a one week history of 101 degree fever, chills, and dark-brown sputum production. She also has rhonchi and rales throughout her right lung. If this condition is left untreated, it could result in:
D. septic shock
You encounter a patient complaining of polyphagia, polydipsia, and abdominal pain. Based on these complaints, which of the following would you also expect to find?
B. Kussmaul's respirations and a fruity breath odor
Your patient is a 44 yof complaining of a 3-day hx of localized abdominal pain in her midepigastric region after eating. The pain tends to subside with antacids. Today she is experiencing nausea, and the pain did not subside with antacids. The patient gives a hx of smoking and moderate alcohol consumption. The patient's skin is warm and dry, and she has a BP of 128/88, a HR of 84, and respirations of 20. Your course of treatment should consist of:
A. transporting the patient in a position of comfort and giving reassurance
Your patient is a 38 yof with a hx of Crohn's disease. She is conscious and alert and complaining of abdominal pain. She describes a one-week hx of increasingly diffuse, crampy abdominal pain. She also states that she has had nausea and comiting, fever, and diarrhea the past two days. Physical exam reveals that her skin is warm and dry and that her abdomen is tender to palpation in all quadrants with no masses or distension noted. HR is 100, BP is 118/78, RR is 14, and Sa02 is 99%. Which of the following treatments is appropriate in the prehospital management of this patient?
D. None of the above
Your patient is a 22 yof in mild distress that is complaining of left lower quadrant abdominal pain and nausea. Which of the following questions would be LEAST helpful when determining the etiology of her abdominal pain?
D. have you ever had a sexually transmitted diease?
The most important factor in determining the respiratory rate is:
D. arterial pC02
Which three mechanisms can produce visceral pain?
D. distension, ischemia, and inflammation
A series of two or more generalized motor seizures without an intervening period of consciousness is known as:
B. status epilepticus
Which of the following findings is most suggestive of cystitis?
C. diffuse, periumbilical abdominal pain
Your patient is complaining of pain secondary to epididymitis. Where should you expect the pain to be located?
C. testes
A patient with speech impairment following a stroke would have involvement in the _____ lobe of the brain.
B. temporal
Your patient is a 60 yom who is conscious and alert and sitting on a toilet. He appears to be in moderate distress and complains of nausea and diarrhea. The patient states that he is allergic to eggs and accidentally ate pancakes made with eggs this morning. He describes a 4 hour hx of severe diarrhea and vomiting. HR is 124, BP is 92/60, RR is 16, nd Sa02 is 98%. The physical exam reveals no urticaria or angioedema; his skin is cool and clammy, and his lung sounds are clear. Based on these findings, what should be your greatest concern?
A. acute dehydration
Which of the following is NOT associated with chronic alcohol ingestion?
A. hyperactivity
An allergen's most common route of entry in an anaphylactic reaction is:
D. injection
What is the innermost layer of meninges that directly overlies the central nervous system?
D. pia mater
Your patient is a 45 year old type I diabetic complaining of a 5 day hx of abdominal pain, nausea, and vomiting, and increased urination and thirst. His skin and mucous membranes are warm and dry. HR is 112 and regular, BP is 12 and regular. Your treatment for this patient would most likely include:
C. IV of NS 1 - 2 L
Your patient is a 72 yom patient who is conscious but slow to respond to questions and commands. He has become increasingly lethargic, unemotional, and easily fatigues over the past two months. He has had a decreased appetite and has gained weight over the same period. The patient further states, "I'm constipated and always cold." Which of the following additional signs or symptoms would be consistent with this patient presentation?
B. A puffy face, an enlarged tongue, and pale, doughy skin
An ER physician tells you that the hyperglycemic diabetic you brought in earlier has a pH of 7.40. What is the likeliest explanation of this statement?
D. the patient is a type II diabetic who was secreting enough insulin to prevent the use of fats for energy
Which of the following is NOT a modifiable risk factor for type II diabetes?
B. heredity
Pain at McBurney's point is associated with:
D. appendicitis
Restoril and Ativan are examples of:
A. benzodiazepines
Epinephrine administration results in all of the following EXCEPT:
A. hypotension
Secretion of glucagon from the pancreas results in _____, which causes a(n) _____ in blood glucose levels.
D. glycogenolysis, increase
McBurney's point, a common site of pain secondary to appendicitis, is located:
A. at the midway point of a line from 1 to 2 inches above the right iliac crest to the umbilicus
Which of the following is commonly indicated in the management of cocaine overdose?
D. Diazepam
Which of the following statements concerning Africanized honeybees is accurate?
A. patients stung by Africanized honeybees tend to have more stings than patients stung by other types of bees.
Which of the following mechanisms is not characteristic for a rectal foreign body?
C. accidental swallowing of something
Which of the following provides evidence that a patient is using accessory muscles to breathe?
D. there is noticeable contraction of the intercostal muscles
Your patient has a hormone-secreting tumor of the adrenal medulla. What hormone is most likely to be secreted by this tumor?
A. Epinephrine
Treatment of a patient in acute renal failure may include all of the following EXCEPT:
A. Potassium
Most carbon dioxide from cellular metabolism reaches the alveoli by being transported:
D. as bicarbonate ion
You patient is a 64 yom who is alert and oriented and visibly upset, sitting on a bench in a shopping mall and complaining of weakness. He describes an acute onset of left-sided weakness in his arm and leg that made it difficult for him to walk. Physical exam reveals noticeable left-sided weakness, PERRL, skin warm and dry. HR is 104, BP is 132/96, RR is 12, Sa02 is 97%. Which of the following is most appropriate?
B. 100% 02 by NRB, BGL, transport without delay
A type II diabetic with a blood glucose of 24 mg/dL would most likely be unconscious due to:
C. cerebral hypoglycemia
Your patient is a 24 yom Chinese citizen on vacation in the US. He is in moderate distress, complaining of difficulty breathing and gives a 4 day hx of runny nose, sore throat, fever, chills, and general malaise with a productive cough. His sputum production was significantly worse when he woke this morning, and he developed difficulty breathing this afternoon. HR is 134, BP is 132/84, RR is 26, and Sa02 is 90%. This presentation is most consistent with:
C. SARS
Which of the following is evaluated in the Los Angeles Prehospital Stroke Screen but is not part of the Cincinnati Prehospital Stroke Scale?
C. Blood glucose level
Your patient has ingested cyanide in a suicide attempt. Which of the following is the primary threat to life you should anticipate?
D. cellular asphyxia
Immediately after virth, an infant is allowed to suckle at the mother's breast. Palpation of the uterus suggests that the uterus is contracting. This finding can be attributed to:
C. secretion of oxytocin
Which of the following is the most reliable way to differentiate between a hyperglycemic emergency and a hypoglycemic emergency?
D. Assess the blood glucose level
Your patient is a conscious and alert 22 yof who as stung by a hornet. She states that she has "allergies to bee stings" and has been told that she could die if stung. Your physical exam reveals a 1 cm diameter, red, edematous area where she was stung on the left forearm. Her skin is warm and dry, and her lung sounds are clear and equal bilaterally. HR is 112 and regular, BP is 122/82, RR is 12 and regular, and Sa02 is 98%. The most appropriate treatment for this patient would include:
D. IV of NS KVO
Your patient is a 15 year old asthmatic who has been having difficulty breathing for 45 minutes but does not have his Xopenex inhaler with him. Capnography shows an ETCO2 of 45 mmHg. The best way to interpret this finding is:
B. the patient's ETCO2 first dropped as he began to hyperventilate but now is rising again and may continue to rise to dangerous levels
