Test 2.2

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. Albuterol and Atrovent via nebulizer, epinephrine 1:1000 SQ, IV of NS with 250 cc fluid challenge
B. IV of NS at a keep-open rate
C. IV of NS with 250 cc fluid challenge
D. Albuterol and Atrovent via nebulizer, IV of NS KVO

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 still smokes half a pack of cigarettes a day
B. the patient was admitted to the ICU last year and required mechanical ventilation
C. the patient has a fever and productive cough
D. the patient is using 2 lpm of oxygen at home

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
B. psychosomatic
C. absence
D. petit mal

Which of the following best explains the cause of the histamine and heparin release in response to exposure to an antigen?

A. humoral cells have initiated a chemical attack on the antigens
B. IgE antibodies have activated the membranes of B and T cells, resulting in release of histamine and heparin
C. IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation
D. IgG and IgM antibodies have activated basophils and mast cells, resulting in degranulation

All of the following are common complications of renal dialysis EXCEPT:

A. air embolism
B. dysfunction of the fistula
C. localized infection at the needle puncture site
D. bleeding from the needle puncture site

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. diabetic coma
B. diabetic ketoacidosis
C. hyperglycemia
D. 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?

A. IV furosemide, 120 mg
B. IV dextrose, 25 gm
C. IV sodium bicarbonate, 1 mEq/kg
D. IV magnesium sulfate, 10 gm

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:

A. pinpoint pupils
B. impaired respiration
C. urinary incontinence
D. increased oral secretions

The administration of a vaccine results in _____immunity.

A. active induced
B. natural induced
C. natural passive
D. passive induced

Which of the following statements about pulse oximetry is FALSE?

A. oxygen saturation is the percentage of hemoglobin that is bound with some molecular structure
B. pulse oximetry has the ability to noninvasively measure total hemoglobin (SpHb) in addition to Sp02 and other parameters
C. pulse oximetry values can be expected to decrease within seconds in cases of developing hypoxia
D. pulse oximetry should be used on all patients with respiratory complaints

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:

A. cardiogenic shock
B. pnenumonia
C. septic shock
D. chronic bronchitis

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?

A. BGL between 80 and 120 mg/dL
B. complaint of chest pain and SOB
C. Kussmaul's respirations and a fruity breath odor
D. BGL of less than 70 mg/dL

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. sodium bicarbonate IV
B. transporting the patient in a position of comfort and giving reassurance
C. high-concentration oxygen by NRB
D. IV of NS with 250 cc fluid bolus

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?

a. diphenydramine
b. ketorolac (Toradol)
c. Methylprednisolone
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?

A. when did the pain start?
B. when did you last menstrual period start?
C. are you having an vomiting or diarrhea?
D. have you ever had a sexually transmitted diease?

The most important factor in determining the respiratory rate is:

A. alveolar p02
B. arterial p02
C. arterial pC02
D. alveolar pC02

Which three mechanisms can produce visceral pain?

A. somatic, referred, and peritonitis
B. distension, ischemia, and inflammation
C. peritonitis, cholecystitis, and a ruptured abdominal aorta
D. blunt trauma, penetrating trauma, and medical illness

A series of two or more generalized motor seizures without an intervening period of consciousness is known as:

A. a petit mal seizure
B. a complex partial seizure
C. hypertonic seizures
D. status epilepticus

Which of the following findings is most suggestive of cystitis?

A. flank pain radiating to the groin
B. diffuse, periumbilical abdominal pain
C. suprapubic tenderness to palpation
D. abdominal distension

Your patient is complaining of pain secondary to epididymitis.  Where should you expect the pain to be located?

A. testes
B. flank
C. suprapubic region
D. lower left or right quadrant, depending on which side is affected

A patient with speech impairment following a stroke would have involvement in the _____ lobe of the brain.

A. parietal
B. frontal
C. occipital
D. 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. the patient's discomfort
B. acute dehydration
C. respiratory failure
D. ventricular dysrhythmia

Which of the following is NOT associated with chronic alcohol ingestion?

A. Thiamine deficiency
B. hyperactivity
C. esophageal varices
D. decreased sensation in hands and feet

An allergen's most common route of entry in an anaphylactic reaction is:

A. inhalation
B. ingestion
C. absorption
D. injection

What is the innermost layer of meninges that directly overlies the central nervous system?

A. dura mater
B. arachnoid membrane
C. pia mater
D. cerebrospinal membrane

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:

A. IV of NS KVO, nitroglycerin 0.4 mg SL, every 3 - 5 minutes
B. IV of NS 1 - 2 L
C. IV of NS KVO, 50 percent dextrose IVP
D. IV of D5W KVO, 50 percent dextrose IVP

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?

A. A puffy face, an enlarged tongue, and pale, doughy skin
B. A "moon-faced" appearance and hyperpigmentation of the skin
C. Hypothermia, tachycardia, and hypertension
D. Goiter, atrial fibrillation, nausea, and vomiting

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?

A. The patient is a type I diabetic who di not take his insulin and is therefore unable to use glucose for energy
B. the patient is a type II diabetic who was secreting enough insulin to prevent the use of fats for energy
C. the patient is a type I diabetic who took his insulin and did not eat, resulting in the breakdown of proteins for energy
D. the patient is a type II diabetic who was no longer 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?

A. lack of excercise
B. obesity
C. poor diet
D. heredity

Pain at McBurney's point is associated with:

A. cholecystitis
B. kidney stones
C. appendicitis
D. pancreatitis

Restoril and Ativan are examples of:

A. sedatives
B. narcotics
C. benzodiazepines
D. barbiturates

Epinephrine administration results in all of the following EXCEPT:

A. tachycardia
B. hypotension
C. increased cardiac contractile force
D. increased peripheral vasoconstriction

Secretion of glucagon from the pancreas results in _____, which causes a(n) _____ in blood glucose levels.

A. glucogenesis, decrease
B. glucogenesis, increase
C. glycogenolysis, decrease
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
b. 2 inches above the umbilicus in the midline
c. 1 to 2 inches above the iliac crest in the right midaxillary line
d. at the midway point of a line from the symphysis pubis to the right anterior, superior iliac crest

Which of the following is commonly indicated in the management of cocaine overdose?

A. Narcan
B. Thiamine
C. Flumazenil
D. Diazepam

Which of the following statements concerning Africanized honeybees is accurate?

A. the venom of Africanized honeybees causes acute renal failure
B. the venom of Africanized honeybees is more toxic than that of other types of bees
C. patients stung by Africanized honeybees tend to have more stings than patients stung by other types of bees.
D. Envenomation by Africanized honeybees requires treatment with specific antivenin

Which of the following mechanisms is not characteristic for a rectal foreign body?

A. accidental swallowing of something
B. sexual gratification
C. accidental trauma
D. psychosis on the part of the patient

Which of the following provides evidence that a patient is using accessory muscles to breathe?

A. there is noticeable contraction of the intercostal muscles
B. the patient is using his diaphragm with inspiration
C. the patient is sitting up, leaning forward to breathe
D. the patient's lips are pursed

Your patient has a hormone-secreting tumor of the adrenal medulla.  What hormone is most likely to be secreted by this tumor?

A. Cortisol
B. Dopamine
C. ACTH
D. Epinephrine

Treatment of a patient in acute renal failure may include all of the following EXCEPT:

A. IV normal saline
B. Furosemide
C. Dialysis
D. Potassium

Most carbon dioxide from cellular metabolism reaches the alveoli by being transported:

A. as bicarbonate ion
B. as carbonic anhydrase
C. bound to hemoglobin
D. dissolved in plasma

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?

A. 100% 02 by NRB, transport without delay, IV or NS KVO and 25 gm of dextrose, IV while en route
B. 02 4 lpm via nasal cannula, BLS transport
C. 100% 02 by NRB, BGL, transport without delay
D. reassurance, BLS transport

A type II diabetic with a blood glucose of 24 mg/dL would most likely be unconscious due to:

A. gluconeogenesis
B. diabetic ketoacidosis
C. cerebral hypoglycemia
D. insulin shock

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:

A. Hantavirus pulmonary syndrome
B. Tuberculosis
C. SARS
D. Pneumonia

Which of the following is evaluated in the Los Angeles Prehospital Stroke Screen but is not part of the Cincinnati Prehospital Stroke Scale?

A. Arm drift
B. Speech
C. Facial droop
D. 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?

A. liver failure
B. pulmonary edema
C. hypotension
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:

A. inhibition of estrogen and progesterone
B. secretion of oxytocin
C. inhibition of oxytocin
D. secretion of estrogen and progesterone

Which of the following is the most reliable way to differentiate between a hyperglycemic emergency and a hypoglycemic emergency?

A. follow the conventional wisdom, "Pale, cool, wet: low; red, hot, dry: high"
B. determine whether or not the patient took his insulin or oral antihyperglycemic medication
C. determine whether the patient is a type I or type II diabetic
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:

A. 100% 02 via NRB at 15 lpm, IV of NS 1 - 2 L, epinephrine 1:1000 0.3 mg SQ, diphenhydramine 25 mg IV
B. IV of NS KVO
C. transport only
D. 15 lpm oxygen via NRB, epinephrine 1:1000 0.3 mg SQ, diphenhydramine 25 mg IV, transport

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:

A. this is a low ETCO2 indicating that the patient is hyperventilating and thus in the early stages of an asthma attack
B. this is a normal ETCO2, indicating this this is a mild asthma attack
C. this is a high ETCO2, and the patient requires immediate ventilator assistance to prevent respiratory arrest
D. the patient's ETCO2 first dropped as he began to hyperventilate but now is rising again and may continue to rise to dangerous levels