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669 Cards in this Set
- Front
- Back
Kehr's Sign |
referred left shoulder pain--possible splenic injury or ectopic pregnancy |
|
Kernig's Sign |
back, leg pain on knee extension--possible bacterial meningitis |
|
Brudzinski's Sign |
back, leg pain on neck flexion--possible bacterial meningitis or subarachnoid bleed |
|
Hamman's Sign |
crunching sound heard with auscultation over the anterior chest synchronized with heartbeat--trancheobronchial injury |
|
Steeple SIgn |
Possible croup (laryngotracheobronchitis) A/P neck View X-ray |
|
Thumbprint Sign |
Possible epiglottitis lateral neck view x-ray
|
|
ABG Values |
pCO2=35-45 pH=7.35-7.45 HCO3=22-26 |
|
Drugs for AAA |
Nipride and beta blockers |
|
First adjustment on ventilator |
Tidal Volume first than rate |
|
Most common Disslocation |
Hip |
|
Most common spontaneous recurrence |
Anterior Shoulder |
|
Brain natriuretic peptide (BNP) |
Heart failure marker that measures BNP released by an over distention of the heart
below 100=normal above 500-700=heart failure |
|
Rotor-wing pilot required hours |
2000 hours 1000PIC 100 hours at night |
|
"bottle to throttle" time |
at least 8 hours |
|
CVP Measures? Normal Parameter? Which port to use? |
Measures: preload(RA Pressure) Norm: 2-6 Port: proximal port |
|
Spinal Cord Syndromes (ABC) |
Anterior Cord Brown-Sequard Central Cord Syndrome Autonomic dysreflexia |
|
Anterior Cord Syndrome |
complete motor, pain and temperature loss below the lesion |
|
Brown-Sequard Syndrome |
ipsilateral loss of motor, position and vibration sense; contralateral loss of pain and temperature perception |
|
Central Cord Syndrome |
greater motor weakness in UE than LE with varying degrees of sensory loss |
|
Autonomic Dysreflexia |
urinary retention, massive increase in sympathetic tone which can cause HTN, treated by insertion of foley |
|
Normal Urinary Output |
UO: 30-50ml/hr(Adult) UO: 1-2ml/hr(peds) |
|
Normal Blood Volume |
70ml/kg (Adults) 80ml/kg(Peds) |
|
Normal Temperature |
37.6/98.6 |
|
Mild Hypothermia |
32-36degrees decreased HR
|
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Moderate Hypothermia |
29-32 degrees loss of shivering and ALOC |
|
Severe Hypothermia |
20-28 degrees Coma, VF common |
|
2 major causes of heat loss? |
Radiation & evaporation |
|
Thermoregulation ceases at? |
28 degrees |
|
Rules of flight following |
-Sterile cockpit during critical phase of flight -15 minutes maximum between communication center during flight -45 minutes maximum while on the ground |
|
Rotor-wing shut off sequence |
REMEMBER "TFB" Throttle Fuel Battery
Take survival bag and meet at twelve o' clock position |
|
Survival Sequence |
Shelter Fire Water Food |
|
order how to assess the abdomen |
Inspect Auscultation Palpation Percussion |
|
Contraindications for thrombolytics |
History of hemmorrhagic stroke CVA last 12 months Pregnancy or 1 month post pardem |
|
FAR's |
PART 91: no passengers PART 135: passengers(PTs) (14 hours for pilots) |
|
Local Flying area determined by? |
Certificate Holder |
|
Cell phones prohibited when? |
While airborne |
|
PaO2 |
plasma-measured as pressure |
|
SaO2 |
hemoglobin-measured as percentage |
|
Bariobariatrauma |
nitrogen release in obese patients, administer high flow oxygen 15 minutes to lift off to wash out nitrogen |
|
Normal Pediatric SBP?
When does it drop? |
BP LAST TO GO...
SBP: 90+(2xage)
after loss of 25%
DBP: 2/3 SBP |
|
Three killers of ventilator patients during flight |
Pericardial tamponade Tension pneumothorax Hypovelemia |
|
Death from a crush injury is do to? Complication of crush injury? |
renal failure
complications: DIC, compartment syndrome, renal failure and hypercalemia |
|
CAMTS 1. Medical director is not required to? 2. Intubation requirement? 3. Live intubation required during training? 4. Specialty team response time? |
1. live in same state 2.quarterly 3. 5 4. 45 minutes |
|
Pilots area orientation day/night |
5 hours day 2 hours night |
|
helipad required to have |
2 paths, security |
|
Fixed wing twin engine time |
500 hours |
|
ambulance fuel requirement |
175 miles
|
|
ELT set off at |
4Gs |
|
Uniform fit |
1/4 inch space between body and uniform |
|
The bends, decompression, soda can, CO2 in blood |
Henry's Law |
|
Tissue swelling, hypoxic hypoxia, O2 available at altitude |
Dalton's Law |
|
Cellular gas exchange, diffusion |
Graham's Law |
|
Oxygen tank pressure in heat or cold |
Gay-Lussac's Law |
|
BP cuff, ETT cuff, MAST |
Boyle's Law (IABP purges with ascent and decent) |
|
High velocity |
above 2000 FPS |
|
Medium Velocity |
1000-2000 FPS |
|
Low Velocity |
Under 1000 FPS |
|
Tumbling |
rotation on 360 degrees axis |
|
Yaw |
deviation up to 90 degrees from straight path |
|
CVP/RAP |
2-6 |
|
Cardiac Output |
SVxHR 4-8L/MIN |
|
Cardiac Index |
2.5-4.2 |
|
PA Systolic/Diastolic |
15-25/8-12 |
|
PAWP |
8-12 |
|
SVR |
800-1200 |
|
Chest tube location |
Fourth ICS, anterior axillary |
|
Needle Thoracostomy location |
Second ICS midclavicular or the fifth ICS anterior mid axillary line |
|
What do you suspect with a fracture of the first 3 ribs? |
Aortic disruption |
|
Scaphoid abdomen indicates? |
Diaphragmatic Rupture |
|
Abruptio placenta |
dark red, painful |
|
Placenta previa |
red, painless |
|
Terbutaline dose |
0.25 SQ |
|
Define postpartum Hemmorrhage |
Over 500 ml |
|
Uterine Rupture |
Fetal parts can be palpated over abdomen |
|
Effects of altitude worsen with: |
Cold upper latitudes |
|
Gay-Lussac's Law |
Temperature increases and pressure increases
temperature decreases and pressure decreases
EXAMPLE: O2 tank pressure at 2200 in the afternoon, pressure drops to 1800 in the evening(temp decreased in the evening so pressure dropped) |
|
Universal Law |
Combines Boyle's and Charles Law |
|
Graham's Law |
Gas moves from low to high concentration
EXAMPLE: gas through liquid, cellular gas exchange |
|
Henry's Law |
Gas in liquid proportional to gas above liquid
EXAMPLE: the bends, co2 in blood, decompression |
|
Volume of gas in GI expands thrice at what altitude? |
25,000 feet |
|
What law effects GI the most? |
Boyle's Law |
|
Cardiogenic Shock CVP Cardiac Output Cardiac Index PAS/PAD PAWP SVR Heart Rate |
CVP: high CO: low CI: low PAS/PAD: high PCWP: high SVR: high Heart rate initially fast, then slows down |
|
Passive rewarming? |
mild hypothermia only. Up 1degrees Celcius/hr with blankets, heater |
|
Active Rewarming? |
apply heat to body |
|
Warm and dead? |
32 degrees celcius |
|
Heat stroke |
over 42 degrees celcius |
|
Grey Turner's sign |
Flank bruising (retroperitoneal bleeding) |
|
Coopernail's Sign |
Scrotum/labia (abdominal/pelvic bleeding) |
|
Halstead's Sign |
Marbled Abdomen (bleeding) |
|
Cullen's Sign |
Umbilical Discoloration(pancreatitis) |
|
Murphy's Sign |
RUQ pain with inspiration (gallbladder) |
|
Levine's Sign |
Fist to chest "clutching" (cardiac) |
|
Hypoxic Hypoxia |
altitude hypoxia, decreased alveolar oxygen,, tension pnemo (altitude) |
|
Hypemic hypoxia |
decreased O2 carrying capacity in blood |
|
Histotoxic hypoxia |
poisoning (ie. nitrates) |
|
Stagnant hypoxia |
decreased cardiac output, poor circulation(g forces, CHF) |
|
Normal Fetal Heart Rate |
120-160 |
|
Factors fetal well-being |
FHR, fetal movement, variability |
|
most important factor in high risk ob |
variability |
|
TX for fetal distress |
LOCK: left lateral recumbent, O2, correct contributing factors, keep reassessing |
|
CHF Preload |
Many CHF patients are relatively hypovolemic. Careful with diuretics and medications that can decrease preload |
|
CHF Lab test |
BNP=lab test nonspecific >500
|
|
CHF Medications |
No beta-blockers, except for carvidolol(coreg)
Natracor(neseritide)=synthetic version of BNP |
|
Primary douse of death with ventilator dependent patients |
Ventilator acquired pnemonia |
|
Digoxin Class Causes with electrolyte imbalance ECG Changes |
Cardiac glycoside
Hypokalemia
ECG-"dip dip" ST depression |
|
ARDS Treatment CXR |
PEEP
CXR reveals widespread pulmonary infiltrates; glass like appearance |
|
PEEP Effects of PEEP Normal physiologic PEEP |
PEEP
Increased pulmonary vascular resistance Can cause hypotension over 15 CM H2O Normal Range: 3-5 cm H2O |
|
Treat HTN when BP? |
Over 220 systolic MAP over 130 |
|
Dehydration raises serum? |
Sodium Normal sodium: 135-145 |
|
Objective data? |
ABCs, neurological assessment Differential diagnosis for altered mental status:AEIOUTIPS |
|
Bowel sounds in chest cavity? |
Diaphragmatic rupture most common in the left chest |
|
Crunching sound heard over chest with auscultation, may be synchronized with heartbeat? |
Associated with tracheobronchial injury and is called Hamman's sign |
|
Preffered method for moving spinal injured patients |
Scoop stretcher is preferred rather than performing a log roll |
|
Differential diagnosis 1. pulmonary contusion 2. ruptured diaphragm 3. Tracheobronchial injury 4. Esophageal perforation 5. fat embolus
|
1. low sats despite O2, rales 2. chest/abd pain radiated to left shoulder 3. hemoptysis, sub-q air, air leak with chest tube, advance ETT below level of injury into right mainstem 4. fever, hematemesis 5. fever, rash after fracture |
|
Bloss loss of humerous |
750ml
|
|
Blood loss of femur |
1500 ml |
|
PAWP/PCWP Function Normal |
Pulmonary artery wedge pressure/Pulmonary capillary Wedge pressure
looks at the left side of the heart, if high can indicate pulmonary congestion, CHF, and cardiogenic shock
PAWP/PCWP: 8-12 mmHg
|
|
EET Depth |
Adult: 3 x ETT size of average is 19-23CM
PEDS: 10 + age in years
Neonatal: 6 + age weight in KG |
|
Ventilator miscellaneous 1. to change CO2 2. To change Oxygenation |
1. adjust rate, TV
2. adjust PEEP, PAP |
|
Rule of nines for adult and pediatrics |
Know your rule of nines for both adult and pediatric patients |
|
Parkland Formula |
4ml xKG x TBSA. 1/2 over 1st 8hours, rest over 16 hours |
|
Brooke's formula |
2 ml x KG x TBSA. 12 over 1st 8 hours, rest over 16 hours |
|
Consensus formula |
2-4 ml x KG x TBSA. 1/2 over 1st 8 hours, rest over next 16 hours. |
|
ELT Frequency |
121.5 |
|
Confirm ELT working |
Tune it in and listen |
|
Twin engine required offshore |
Raft, vest |
|
Induction agent of choice with bronchospastic patients |
Ketamine(ketalar) |
|
Ativan: indication dose, Max |
Lorazepam, seizures, 1-2mg, Max 4mg |
|
Mannitol dose |
1-2g/kg |
|
Drug choice for cyclic antidepressant OD |
Sodium Bicarbonate |
|
Drug Choice for beta-blocker OD |
Glucagon |
|
Fentanyl dose |
Sublimaze (3ug/kg) |
|
Treatment for malignant hyperthermia |
Dantrium (dantrolene) |
|
Drug for GI Bleed |
Sandostatin (octreotide) |
|
Neurogenic Shock CVP Cardiac Output Cardiac Index PAWP/PCWP SVR Heart Rate |
CVP: down CO: down CI: down PCWP: down SVR: down (distributive shock) HR Can be normal or slow |
|
Arterial Lines Sites Purpose |
Radial, Femoral Monitor pressure, blood draw, ABGs Maintain pressure bag at 300mmHg Underdampening: caused by having air in the system, loose connection, a low pressure bag and altitude changes Overdampening: caused by kinking, increased bag pressure, and tip against the wall |
|
Most common reperfusion dysrhythmia |
AIVR |
|
most common hypothermia dysrhythmia |
VF(osborn wave) |
|
Hypokalemia on ECG |
Peaked P's / Flat Ts |
|
Hyperkalemia on ECG |
Flat P's, peaked T's(treat with calcium) |
|
MAP goal with CHI CPP goal with increased ICP |
MAP: 80-10 CPP: 70-90 |
|
Normal ICP Normal CPP (head) Normal MAP Normal CPP (heart) (Coronary perfusion Pressure) |
ICP: 0-10 CPP:70-90 MAP: 80-100 Heart CPP: 50-60
Remember your head is higher than your heart |
|
GCS Mild Moderate Severe |
Mild: 14-15 Moderate:9-13 Severe: 3-8 |
|
CPP(head) Formula
|
MAP-ICP |
|
MAP Formula |
2 x diastolic + systolic/3 |
|
CPP Heart Formula |
DBP-wedge |
|
Rotor-wing minimums ceiling/visibility Day/local Day/cross-country Night/local Night/cross-country |
Day/local: 500 foot ceiling and 1 mile visibility Day/Cross-country: 1000 foot ceiling and 1 mile visibility Night/local: 500 foot ceiling and 2 mile visibility Night/cross country: 1000 foot ceiling and 3 mile visibility |
|
Number one cause of air medical crashes |
controlled flight into terrain, pushing the weather |
|
Normal Potassium |
3.5-5.5 |
|
Normal sodium |
135-145 |
|
Normal chloride |
95-105 |
|
normal calcium |
8.5-10.5 |
|
Metabolic acidosis elevates? |
potassium |
|
Time of useful consciousness with sudden decompression at: 30,000 feet 41,000 feet |
30,000: 90 seconds 41,000: under 15 seconds
Least amount of time is your answer on exam
|
|
Inferior |
II, III, AVF |
|
Septal |
V1, V2 |
|
Anterior |
V3, V4 |
|
Lateral |
I, aVL, V5, V6 |
|
Posterior |
ST segment depression or reciprocal changes noted in V1-V4, ST elevation V6 |
|
Ischemia |
St depression >1mm in 2 leads |
|
Injury |
ST elevation >1mm in 2 leads |
|
Infarct |
Q wave>25% the height of the R wave |
|
Pediatric age guidelines ETT cuffed versus uncuffed Needle cricothyrotomy Nasal intubations |
"10, 11, 12" Rules
uncuffed tube under 10 Needle Cricothyrotomy only under 11 No nasal intubation under 12 |
|
Primary Cause of PTL(Preterm Labor) |
Infection |
|
Terbutaline contraindications |
IDDM, Maternal HR over 120, vaginal bleeding |
|
PIH(Pregnancy induced HTN) triad signs |
HTN, edema, proteinuria |
|
O2 adjustment calculation to maintain saturation at altitude |
% oxygen patient is already on X pressure at departure (mmHg) pressure at altitude
this equals pressure needed in flight EXAMPLE: Pt on FIO2 of 0.40 Depart: 681mmHg Altitude: 565mmHg patient needs 48% Oxygen |
|
Ventilator Mode CMV(continuous Mandatory Ventilation) |
preset volume of PIP at set rate. Patient can't initiate breath |
|
Ventilator Mode AC(Assist-Control) |
preset volume or PIP with every breath. Can trigger breath, can't control TV |
|
Ventilator Mode IMV(Intermittent Mandatory Ventilation) |
preset breaths, TV, PIP. Patient breaths allowed |
|
Ventilator Mode SIMV(Synchronized Intermittent Mandatory Ventilation) |
allows variation of support |
|
IABP 1. action 2. Deflates 3. Dicrotic Notch |
1. Increase cardiac output, coronary perfusion 2. during ventricular systole 3. aortic valve closing, synchronized with aline or ECG(most common trigger) |
|
IABP Signs/symptoms of ballon leak |
blood specs in tubing, alarm |
|
IABP Clot prevention
|
cycle manually every 30 minutes |
|
IABP increases CO by? |
10-20% |
|
IABP Balloon Rupture |
rusty flakes in line turn the machine off |
|
IABP migration/dislodged |
access Radial pulses and urinary output |
|
Lethal IABP timing cycles |
late deflation and early inflation |
|
Oxyhemoglobin disassociation curve (left shift) |
"L" stands for Alkalosis
Left shift = low Hemoglobin holding O2 alkalosis
Low CO2/Low temp/LOW DPG/Mxydema coma |
|
Oxyhemoglobin disassociation curve (right shift) |
"R" stands for raised
Right=raise/released O2 Acidosis Raised CO2
Raised Temp/Raised DPG/Thyroid storm
|
|
Phlebostatic Axis Where? When? |
Where pressure measurements are made with invasive line
4th intercostal space level of atria |
|
Boyle's Law Ascent |
Barondontalgia (toothache) Barosinutis can occur on ascent Bariobariatrauma(obese)=Nitgrogen in the fat cells can expand causing the "bends" administer high flow O2 for 15 minutes prior to lift off to remove nitrogen |
|
Boyle's Law Decent |
Barotitis media(middle ear) can affect the patient during decent |
|
Mild Hypertension |
140-159/90-99 |
|
Moderate Hypertension |
160-179/100-109 |
|
Severe Hypertension |
over 180/0ver 110 |
|
Volume for RBC |
10ml/kg
|
|
Volume for WBC |
20ml/kg |
|
ABG Rules 1. CO2 and pH 2. Bicarb and pH 3. Bicarb replacement 4. PaO2 at altitude |
1. CO2 up 10=pH down 0.08(inverse) 2. HCO3 up 10=pH up 15 (proportional) 3. KG/4 X base deficit=meq of bicarb needed 4. PaCo2 drops 5 for every 1000 feet elevation |
|
Stages of hypoxia |
Indifferent Compensatory Disturbance Critical |
|
Indifferent Stage |
10,000 feet MSL
increased HR, increased RR, decreased night vision |
|
Compensatory stage |
10,000-15,000 feet MSL
Hypertension, task impairment |
|
Disturbance Stage |
15,000-20,000 feet MSL
dizzy, sleepy, cyanosis |
|
Critical Stage |
20,000-30,000 feet MSL
ALOC, incapacitated |
|
Night Vision lost at: |
5000 MSL |
|
PA Catheter 1. Named? 2. Proximal port is for? 3. S/S of bad placement 4. Procedure for bad placement? 5. Measures? 6. Which port used? 7. Pressure bag set to? |
1. Swan-Ganz 2. CVP, medication 3. VT, ventricular ectopy 4. Float forward to PA or Pull back to RA 5. Right Heart directly, left heart indirectly 6. Distal Port 7. 300 mmHg |
|
Normal Cardiac index |
2.5-4.3 |
|
Stressors of Flight |
1. third spacing 2. fatigue 3. g-forces 4. noise 5. vibration 6. hypoxia 7. dehydration 8. temp changes 9. barometric pressure changes |
|
Personal factors affecting stressors of flight? |
DEATH
Drugs Exhaustion Alcohol Tobacco Hypoglycemia |
|
Dalton's Law |
Sum total of partial pressures equal to total atmospheric pressures(Dalton's Gang)
EXAMPLE: tissue swelling, altitude hypoxia, hypoxic hypoxia
This is why O2 is needed at altitude |
|
Thrombolytics must be administered within? |
three hours of onset of chest pain |
|
Diving Injuries ATM(atmosphere) |
1 ATM for every 33 feet decent
and
add 1 if asking for total ATM versus water pressure |
|
Hypovolemic Shock CVP CO Cardiac Index Wedge SVR Heart Rate |
CVP: down CO: down CI: down PAWP: down SVR: high Heart Rate: fast |
|
Acute Respiratory Failure |
pO2 below 60 pCO2 above 50 |
|
Newton's Law |
First Law: an object in motion tends to stay in motion
Second law: force=mass X acceleration
third Law: every action has=and opposite reaction |
|
Tetralogy of Fallet(TOF) |
Remember PROV
P=pulmonary stenosis R=right ventricular hypertrophy O=overriding aorta V=ventricular septal defect |
|
What is a tet spell? |
blood flow across the right ventricular outflow tract is significantly decreased, resulting in shunting right to left through the VSD out of the aorta, thus bypassing the lungs. Causes include: spasms, sudden decrease in systemic vascular resistance secondary to hypovolemia, dehydration, hot weather, or defecation. Tet spells are usually seen in neonatal period, and peak in incidence between two and four months of life |
|
Atrial Waveforms |
"filling pressures"
Right atrial pressure(CVP)
Left atrial pressure (PAWP/PCWP) |
|
Ventricular Waveforms |
Right ventricular pressure obtained upon insertion of PA catheter or if the catheter has been dislodged backward into the right ventricle resulting in a right ventricular waveform
looks like VT, no dicrotic notch seen on the downslpoe of the right side of the waveform
Left ventricular pressure measured during cardiac catheterization |
|
Arterial Waveforms |
Arterial Lines
Pulmonary artery pressure (PAP)
Dicrotic notch seen on the downslope of the right side of the waveform
|
|
Waves |
A wave= rise in atrial pressure as a result of atrial contraction
C wave=not always visible on the tracing, rise in the atrial pressure which closure of the AV valves (tricuspid and mitral) bulge upward into the atrium following valve closure
V wave=rise in atrial pressure as it refills during ventricular contraction |
|
A wave Correlation to ECG |
A wave generally coincides with the PR interval on the ECG in a right atrial pressure waveform
It will be slightly delayed in a left atrial pressure waveform |
|
C wave Correlation to ECG |
C wave generally coincides with mid to late QRS on the ECG in a right atrial pressure waveform
It will be slightly delayed in a left atrial pressure waveform |
|
V wave Correlation to ECG |
V wave is generally seen immediately after the peak of the T wave on the ECG in a right atrial pressure waveform
It will be slightly delayed in a left atrial pressure waveform |
|
Wave decents |
Decline in right atrial pressure during atrial relaxation (remember "X" in relaXation)
Decline in right atrial pressure resulting from atrial emptying (remember "Y" in emptYing) |
|
Breathing and Waveforms |
RECORD PRESSURE MEASUREMENTS AT THE END OF EXHALATION
In a spontaneously breathing patient, inspiration is the fall in pressure, expiration is the rise in pressure. End-expiration occurs just prior to the respiratory drop in pressure.
Positive pressure mechanical ventilated patients will cause cardiac pressure to rise upon inspiration |
|
Measuring Waveforms |
The end-diastolic pressure can be estimated by identifying the "Z" point
A line is drawn from the end of the QRS to the hemodynamic tracing. The point where the line intersects with the waveform is the "Z" point. The "Z" point on the PAWP tracing will be delayed by 0.08-0.12 seconds from the QRS |
|
Cardiac Output |
Heart Rate X stroke Volume=CO |
|
Dicrotic Notch |
Closure of the Aortic valve |
|
CPK>20,000 |
CPK (muscle enzyme) levels greater than 20,000 is ominous and is an indication of later DIC, acute renal failure and is potentially dangerous hyperkalemia in the heatstroke patient |
|
ANION GAP |
NA-(Cl+bicarb/CO2)=AG Normal 12+/-4 >16 indicates an underlying metabolic acidosis Remember MUDPILES Methanal Uremia DKA Paraldehyde Isoniazide/Iron Lactate Ethhylene glycol Salicylate |
|
2. Which of the following coronary arteries supplies the majority of the circulation to the inferior portion of the heart? |
C. Right coronary |
|
3. V1-V6 chest leads are categorized as |
C. Unipolar leads |
|
4. Which of the following references can be used to determine ST elevation, ST depression, or QRS duration on the ECG tracing? |
B. J point |
|
6. ST elevation seen on the ECG tracing can indicate |
B. Injury |
|
7. Hyperkalemia >7.0 can exhibit which of the following changes on the ECG tracing? |
C. Tented or peaked T waves |
|
11. ST depression can indicate all of the following, except |
C. Acute injury |
|
12. Q waves present with ST elevation can indicate |
B. Acute injury |
|
16. Your patient is exhibiting ST elevation in leads II, III, and AVF. ST depression is noted in V1-V3. Which of the following may prove hazardous? |
D. Nitroglycerin |
|
18. In which sequence does blood flow through the heart valves? |
A. Tricuspid, pulmonic, mitral, aortic |
|
21. The ECG may show peaked P waves, flattened/slurred Ts, and appearance of U waves, which may indicate |
B. Hypokalemia |
|
23. Inferior wall MI is caused by an occlusion of which coronary artery? |
B. RCA |
|
26. On 12-lead ECG, posterior wall MIs manifest as |
C. ST depression in V1-V4 with abnormally tall R waves |
|
30. ST elevation in leads I, aVL, V5, and V6 are indicative of injury to which area of the heart? |
B. Lateral |
|
31. A patient with a history of tricyclic antidepressant overdose can exhibit which of the following on the ECG tracing? |
C. Prolonged QT interval |
|
34. What changes in the ECG would a patient presenting with an inferior wall MI most likely have? |
C. ST elevation in leads II, III, and aVF |
|
35. Normal K+ lab value is |
B. 3.5-4.5 |
|
38. Diagnosis of a right ventricular MI includes |
A. Right-sided 12-lead ECG with ST elevation in V4 |
|
41. Your IABP begins to purge during ascent. The triggering mechanism for this function was initiated as a result of which gas law? |
A. Boyle’s law |
|
42. The balloon has dislodged when treating your IABP patient. Which is the most common site that will be affected? |
B. Left radial |
|
43. During transport you note rust-colored “flakes” in the IABP tubing. This indicates |
D. Balloon rupture |
|
45. The primary trigger used for most IABP operations is the |
C. EKG |
|
46. Inadvertent migration of the IAB may cause which of the following, except |
C. Loss of flow to the carotid vein |
|
47. When timing the IABP, inflation should initiate in synchronization with |
D. Dicrotic notch indicated on the A-line pressure wave |
|
49. Which of the following is the most potentially harmful timing error? |
C. Late deflation |
|
50. During transport you experience a complete IABP failure. You should |
D. Cycle the balloon manually every thirty minutes regardless of timing |
|
1. Normal value for monitoring PA pressures are |
B. 15-25/8-15 mmHg |
|
6. The patient’s PA catheter is exhibiting a large, well defined hemodynamic waveform with an obvious “notch” on the left side of the waveform. The distal tip is most likely located in the |
D. right ventricle |
|
9. A common cause of elevated PA pressures is |
A. mitral valve stenosis B. mitral valve regurgitation C. left ventricular failure D. all of the above |
|
11. The patient’s peripheral A-line is showing a very sharp waveform with readings that appear exaggerated. This may be due to |
B. catheter whip |
|
12. Your fast flush test indicates under-dampening of the system present. Which of the following may be the cause? |
A. Air in the system B. Low-pressure bag pressure C. Altitude change D. All of the above |
|
13. When attempting to “wedge” a PA catheter, you should always |
A. fill the balloon with exactly 1.5 mL, no more B. fill the balloon with exactly 2.5 mL, no more C. fill the balloon with exactly 0.5 mL, no more D. none of the above |
|
14. Your patient’s PA waveform has suddenly changed to resemble a low-amplitude rolling waveform. This is most likely |
D. inadvertent advance to wedge |
|
15. Your patient’s PA waveform is in wedge position. You would |
B. have the patient cough forcefully |
|
16. Your patient presents with the following: CVP 2, CI 6.4, PA S/D 34/16, wedge 7, and SVR 400. What is your diagnosis? |
B. septic shock |
|
17. Your patient presents with following parameters: CVP 20, CI 1.1, PA S/D 8/4, wedge 3, and SVR 1,800. What, is your diagnosis? |
B. right ventricular MI |
|
19. Central venous pressure is a reflection of |
A. right atrial pressure |
|
20. Pulmonary artery pressure reflects |
D. right- and left-sided heart pressures |
|
21. The pulmonary artery wedge pressure evaluates |
C. the left side of the heart |
|
23. Normal range for cardiac output is |
B. 4-8 L/minute |
|
24. Normal range for PAWP is |
B. 8-12 mmHg |
|
25. Normal range for right atrial pressure is |
A. 2-6 mmHg |
|
26. Cardiac output is determined by |
B. heart rate and stroke volume |
|
27. Systemic vascular resistance measures the |
D. afterload for the left side of the heart |
|
28. Pulmonary vascular resistance measures the |
C. afterload for the right side of the heart |
|
29. Stroke volume is |
C. the amount of blood ejected with each heartbeat from the ventricles during systole |
|
30. The dicrotic notch signifies |
C. closure of the aortic valve |
|
31. A decrease in the patient’s CVP can indicate all of the following, except |
D. right-sided heart failure |
|
32. A decrease in the patient’s SVR can indicate all of the following, except |
B. hypovolemic shock |
|
33. An increase in SVR can indicate all of the following, except |
C. septic shock |
|
34. Medications that can decrease preload include all of the following, except |
C. vasopressin |
|
35. Atrial waveforms are described as “filling pressures” and include which of the following? |
B. right atrial and left atrial pressures |
|
36. The PAWP tracing is an indirect measurement of |
C. left atrial pressure |
|
37. Arterial pressure waveforms include all of the following, except |
D. ventricular pressures |
|
38. The “a” wave seen on an atrial waveform indicates |
A. rise in atrial pressure as a result of atrial contraction |
|
39. The “c” wave, when seen (not always visible) on an atrial waveform, indicates |
B. rise in atrial pressure when the AV valves are closed |
|
40. The “v” wave seen on an atrial waveform indicates |
C. rise in atrial pressure as it refills during ventricular contraction |
|
41. The “a” wave, when assessing a right atrial pressure waveform, coincides with which area of the ECG cycle? |
C. in the PR interval |
|
42. In a right atrial waveform, if the “c” wave is present, it generally coincides with which area of the ECG cycle? |
A. mid- to late QRS |
|
43. The “v” waves, when assessing a right atrial pressure waveform, coincides with which area of the ECG cycle? |
B. immediately after the peak of the T wave |
|
44. The downslope on the “v” wave represents atrial emptying, which is called |
D. Y descent |
|
45. The downslope of the “a” wave represents atrial relaxation, which is called |
C. X descent |
|
46. The period following diastole when all the four heart valves are closed is called |
A. isovolumetric contraction |
|
47. Arterial lines have which of the following pressure characteristics as compared to pulmonary artery pressures? |
A. much higher pressures |
|
48. Positive pressure ventilation will cause cardiac pressure to |
A. rise upon inspiration |
|
49. Hemodynamic pressures should be assessed and recorded at the |
A. end of exhalation |
|
50. Which of the following is used as standard for measuring atrial pressures? |
C. identification of the “Z” point from the end of the QRS to the waveform |
|
1 . You are en-flight with a seventy-year-old male cardiac patient on 6 L of oxygen by NC. You are at 5,000 feet and the patient is becoming hypoxic. What is your initial intervention for this patient? |
B. Increase oxygen delivery to the patient |
|
2. Which patient is not affected with altitude temperature changes? |
A. Cardiac patient |
|
4 . Your patient is experiencing left ventricular diastolic failure. Therapy should be focused on |
D. Diuretics and relief of anxiety |
|
5. Your patient is exhibiting ST elevation in leads II, III, and AVF. ST depression is noted in V1-V3. Which of the following may prove hazardous? |
D. Nitroglycerin |
|
7. Electrical alternans may be caused by |
B. Pericardial tamponade/effusion |
|
8. Antidote for Coumadin overdose is |
C. Vitamin K, FFP |
|
9. Your patient has a chief complaint of dyspnea and weakness with the following vitals: BP 72/64, HR 112, RR 28, SpO2 88%, temp. 99.1°F. He is on 6 L/minute of oxygen via NC. The ECG shows ST with frequent PVCs. Physical exam reveals profound vesicular rales and bronchial wheezing. Your most likely diagnosis is |
D. Cardiogenic shock |
|
10. Treatment of cardiac tamponade includes all of the following, except |
D. Needle thoracostomy |
|
11. A patient presenting with Beck’s triad is most likely experiencing |
C. Cardiac tamponade |
|
1 2 . You are transporting a forty-five-year-old man with acute respiratory distress syndrome (ARDS) and MODS secondary to probable organ rejection after a heart transplant. During transport the patient becomes bradycardic with heart rate in the 30s with hypotension. Which of the following therapies will likely prove fruitless? |
D. Atropine 0.5-1 mg IV push |
|
13. Your patient presents with following parameters: CVP 20, CI 1.1, PA S/D 8/4, wedge 3, and SVR 1,800. What is your diagnosis? |
B. RVMI |
|
1 4 . You are transporting a fifty-year-old man from ICU to another facility for further evaluation. The patient has been diagnosed with AMI. He has been complaining of increasing CP, SOB, and dramatic weight loss. He appears very nervous, and you note tremors. His ECG shows AF at 148. The patient may be experiencing |
B. Thyrotoxicosis (grave’s dieases) |
|
15. The formula to calculate MAP is |
B. 2 × DBP + SBP divided by 3 |
|
16. Normal coronary perfusion pressure (CPP) is |
A. 50-60 mmHg |
|
17. When performing a pericardiocentesis, the insertion site is |
C. Just left of the subxyphoid process |
|
1 9 . sixty-year-old man complains of chest pain for three days with a low-grade fever. Patient complains of increased pain when lying in supine position and states that the chest pain decreases when sitting forward. What is the most likely diagnosis? |
C. Pericarditis |
|
21. How is the coronary perfusion pressurecalculated? |
A. DBP − PCWP |
|
22. Inferior wall MI is caused by an occlusion of which coronary artery? |
B. RCA |
|
2 3 . What medications would you expect to administer to a patient presenting with severe chest/abdominal pain, diaphoresis, and is restless? SBP is 170/palp and heart rate in 116. You note a difference in blood pressures when taken on each arm. |
B. Nipride and b-blockers |
|
24. A sign of hyperventilation and hypocalcemia is |
C. Trousseau’s |
|
25. All of the following are signs of cardiac tamponade, except |
B. Pulsus alternans |
|
2 6 . You are transporting a sixty-year-old man complaining of severe chest pain and midscapular pain. He is short of breath and is hypertensive in the upper extremities. You auscultate a harsh systolic murmur. Your diagnosis of this patient is |
B. Aortic rupture |
|
2 7. The MD has ordered a brain natriuretic peptide (BNP), which would evaluate the patient for |
D. CHF |
|
28. Levine’s sign relates to |
C. Cardiac; clenched fist over chest |
|
29. Kussmaul’s sign is a |
A. Rise in venous pressure with inspiration |
|
30. Drug of choice for treating a GI bleed is |
D. Sandostatin |
|
31. You are transporting a fifty-year-old man from a rural facility. Your patient’s ECG is demonstrating ST at 112 with peaked P waves. The ABG indicates pH 7.2, pCO2 18, HCO3 12 and pO2 108. CMP reveals Na 130, K 2.3, Cl 95, HCO3 10, BUN 48, creat 2.2, and glucose of 685. The most appropriate diagnosis would be |
B. DKA |
|
32. Recommended urinary output when caring for an adult patient should be |
B. 30-50 mL/hr |
|
3 3 . Your patient’s EKG is demonstrating ST at 130. ABG indicates pH 7.34, pCO2 35, HCO3 23, pO2 104. The patient’s CMP reveals: Na 132, K 2.5, Cl 97, HCO 3 22, BUN 44, creat 2.0, and glucose 1,185. The most appropriate diagnosis would be |
D. HHNK |
|
34. A patient presenting with meningitis may exhibit which sign on assessment? |
C. Kernig’s |
|
35. Murphy’s sign would indicate which of the following conditions? |
D. Gallbladder |
|
36. A common problem seen with hepatic encephalopathy is |
B. Increased ammonia levels |
|
37. Treatment of pancreatitis would include all of the following, except |
C. Morphine for pain |
|
38. The patient presenting with HHNK has a problem with |
A. Sugar |
|
39. The treatment of diabetes insipidus is |
A. Aggressive fluid replacement and vasopressin |
|
40. Adrenal insufficiency, weight loss, hypotension—the patient may be experiencing |
A. Addison’s disease |
|
41. Myxedema coma is also known as |
C. Hypothyroidism |
|
42. Most common presentation of a patient with hypothyroidism are all of the following, except |
D. Primarily in men |
|
43. Drug of choice for profound hypotension in septic shock is |
B. Levophed |
|
44. You are managing a patient who has been diagnosed with hepatic encephalopathy. His ammonia levels are elevated. Your management in preparing this patient for transport is to inhibit elevated protein level by |
B. Stop GI bleeding and evacuate bowel of blood |
|
45. Grey Turner’s sign may indicate |
C. Pancreatitis |
|
46. Repeated doses of etomidate can cause |
B. Acute adrenal insufficiency |
|
47. A type of angina that can occur at rest, while sleeping, or after exercise is called |
B. Prinzmetal’s |
|
48. A clinical sign that indicates hypocalcemia may be present is |
C. Chvostek’s |
|
49. Your patient presents upper body obesity with thin arms and legs. He has a rounded face “buffalo hump” and is complaining fatigue. He is hypertensive and hyperglycemic. What condition is he most likely presenting? |
D. Cushing’s syndrome |
|
50. Cullen’s sign may indicate |
B. Pancreatitis |
|
1. You are transporting a thirty-year-old man involved in a MCA from a rural area facility. The 70-kg patient is on a ventilator with the following settings: FIO2 1.0, Vt 500, rate 16, PIP 22, and PEEP 5. The ABG results are pH 7.01, pCO2 68, HCO2 12, pO2 280. Interpretation of the blood gas reveals |
A. Metabolic and respiratory acidosis |
|
2. You are transporting a ten-year-old boy weighing 60 kg with diagnosis of status asthmaticus on a ventilator. EtCO 2 is 56 and pulse oximetry reading is 95%. Ventilator settings are at Vt 450, FIO2 1.0, Rate 16, I:E 1:2, PEEP 5, PIP 48. How will you manage this patient? |
B. Reduce I:E ratio |
|
3. When inserting a chest tube, correct insertion site recommended is |
B. 4th-5th ICS anterior axillary line |
|
4. ABG’s reveal pH 7.31, pCO2 58, Bicarb 26, pO2 106. What is your interpretation? |
B. Respiratory acidosis |
|
5. A patient in early shock most probably has which acid-base imbalance? |
D. Respiratory alkalosis |
|
6. Your patient’s ABG’s are: pH 7.43, pCO2 56, HCO3 34. You should correct the pCO2 by |
D. Analyze electrolytes and replace deficiency |
|
8. Electrical alternans may be caused by |
A. Pericardial effusion |
|
9. You are on the scene of a thirty-year-old man involved in a single vehicle rollover accident who was reported to be ejected from the vehicle. The left chest has been decompressed with a needle. The patient is orally intubated and continues to desaturate, and you note an increase in SQ air on the left side of the chest and neck. The next intervention will be to |
C. Advance ET tube below the level of the injury; right main stem intubation |
|
10. Your patient presents with a history of asthma, coronary artery disease, hypertension, and has a chief complaint of dyspnea and weakness with the following vitals: BP 72/64, HR 112, RR 40, SpO2 82%, temp. 99.1°F. He is on 6 L/minute of oxygen via nasal cannula. The ECG shows sinus tachycardia with frequent PVCs. ABG reveals: pH 7.28, pCO2 68, HCO3 24. pO2 58. Physical exam reveals profound vesicular rales and bronchial wheezing. Your most likely diagnosis is |
D. Cardiogenic shock; uncompensated respiratory acidosis, hypoxemia |
|
11. You are transporting a twenty-four-year-old trauma patient from a rural facility who has just been given Anectine in preparation for endotracheal intubation. The patient’s heart rate increases, muscle rigidity is present, and you observe that his end-tidal CO2 has increased to 60 mmHg. Your next intervention would be to administer |
C. Dantrolene |
|
12. When performing a needle thoracostomy, which of the following is generally the preferred site? |
D. 2nd intercostal space, midclavicular line |
|
13. Your patient presents with ABG’s of pH 7.39, pCO 2 68 HCO3 32, pO2 82. He has history of COPD and weighs 65 kg. He presents with a history of SOB for 3 days with a RR 20 and is on 4 L/minute of oxygen by NC. He speaks in four- to five-word sentences. What acid-base disorder is present? |
B. Respiratory acidosis with complete compensation |
|
14. Hamman’s sign may indicate which of the following? |
B. Tracheobronchial injury |
|
15. ABG reveals pH 7.41, pCO2 38, HCO3 22, pO2 56 of a 70-kg patient on a ventilator with the following settings: Vt 700, F 14, FIO2 0.5, I:E 1:2, PIP 46, Pplat 40, and PEEP 5. How will you manage this patient? |
A. Increase FIO2 |
|
16. When managing pO2 of <60, you would |
A. Increase FIO2 and apply/or increase PEEP |
|
17. The patient you are transporting reveals the following ABG: pH 7.51, pCO 2 28, HCO3 24, pO2 110. He is a 60-kg male patient with Vt 650, F14, FIO2 0.21, I:E 1:2, PIP 46, Pplat 42, and PEEP 0. What is your ABG interpretation, and how will you correct it? |
B. Respiratory alkalosis; decrease Vt |
|
18. Minute ventilation is |
D. Vt × RR |
|
19. High-pressure alarms can be caused by all of the following, except |
A. Hypovolemia |
|
20. Low-pressure alarms can be caused by all of the following, except |
C. Pneumothorax |
|
21. Vt is calculated at |
B. 5-8 mL/kg |
|
22. The test most often used to diagnose a pulmonary embolism is |
B. V/Q lung scan |
|
23. Acute respiratory failure is defined as |
A. pO2 <60 mmHg and pCO2 >50 |
|
24. Situations that involve a left shift in the oxygen-hemoglobin dissociation curve are all of the following, except |
D. Increased levels of 2,3-DPG |
|
25. Situations that involve a right shift in the oxygen-hemoglobin dissociation curve are all of the following, except |
A. Alkalosis |
|
26. Repeated doses of etomidate can cause |
B. Acute adrenal insufficiency |
|
27. Interpret the following blood gas: pH 7.39, HCO3 18, pCO2 31. |
D. Metabolic acidosis; completely compensated |
|
28. You are transporting a forty-year-old man from a rural ICU. The CXR reveals a ground glass appearance. The patient is on a ventilator with settings at: Vt 900 mL, rate of 16, FIO2 0.8 with a PEEP of 5. ABG’s reveal: pH 7.34, pO 2 76, pCO2 38 and HCO3 of 24. What pulmonary condition do you suspect? |
C. ARDS |
|
29. You would manage the above patient by |
B. Increasing PEEP |
|
30. The MD has ordered a BNP, which would evaluate the patient for |
D. CHF |
|
31. Which of the following paralytics stimulates motor end plate acetylcholine receptors causing persistent depolarization? |
A. Succinylcholine |
|
32. When administering a defasciculating neuromuscular blockade, the dose recommended is |
B. 10% normal RSI dosage of NMBA |
|
33. You are transporting a twenty-five-year-old woman with a history of suspected overdose. The following ABGs were obtained prior to your arrival at the sending facility: pH 7.52, pCO2 27, HCO3 24, pO2 110. You would most likely suspect |
C. Early salicylate poisoning |
|
34. If the PIP does not change on a ventilator patient with respiratory acidosis, always |
B. Decrease Vt before rate |
|
35. Trouble-shooting high-pressure alarms on the ventilator can be caused by all of the following, except |
D. Leak in ventilator tubing |
|
36. An elevated anion gap can indicate the presence of which of the following? |
C. Metabolic acidosis |
|
37. The average endotracheal tube size that should be utilized in an adult male patient is |
C. 8.0 |
|
38. The administration of Succinylcholine is contraindicated in which of the following? |
B. Hyperkalemia |
|
39. Midazolam is classified as a |
C. Benzodiazepine |
|
40. Ketamine administration is considered the drug of choice for a patient presenting with which of the following? |
C. Asthma |
|
41. Management of an intubated patient presenting with a diagnosis of ARDS would include |
A. Application of positive end-expiratory pressure |
|
42. Excess of mucous secretions and chronic inflammation of the bronchi, leading to obstruction of airflow, hypoxemia, and hypercapnea best describes which of the following conditions? |
B. Chronic bronchitis |
|
43. A chronic obstructive pulmonary disease (COPD) patient would most likely present with which of the following x-ray findings? |
A . Hyperinflation of the lungs, narrow and elongated heart shadow, increased anterior-posterior diameter of the chest |
|
44. The diagnosis of ARDS would most likely present with which of the following x-ray findings? |
B. Widespread pulmonary infiltrates, ground-glassy appearance |
|
45. An ominous sign of impending acute respiratory failure in the asthma patient would most likely be which of the following? |
C. Decreased or absence of bronchoconstriction |
|
46. Signs and symptoms for a patient presenting with a tension pneumothorax would include all of the following, except |
D. Widening pulse pressure |
|
47. The normal range for pCO2 when evaluating an arterial blood gas is |
B. 35-45 mmHg |
|
48. The normal range for pH when evaluating an arterial blood gas is |
C. 7.35-7.45 |
|
49. The normal range for HCO3 when evaluating an arterial blood gas is |
C. 22-26 mEq/L |
|
50. The most likely causes of metabolic alkalosis can include all of the following, except |
C. Diarrhea |
|
1. You are preparing to transport a twenty-year-old man weighing 200 pounds with a history of a self-inflicted gunshot wound to the head. He is intubated with A/C ventilator settings of FIO2 0.5, Vt 600, I/E 1:2, flow 5 L, RR 10, PIP 30. Vital signs are BP 100/60, HR 66, and SaO2 94%. ICP reading of 28. His cerebral perfusion pressure is approximately |
D. <50 mmHg |
|
2. What is the initial clinical presentation that may indicate that ICP may be increasing? |
B. Deteriorating level of consciousness |
|
3. You are transporting an eighteen-year-old female patient with a history of being ejected from a motor vehicle accident. She is currently awake and oriented to person, place, and time; however, she is slow to respond. Vital signs are a BP of 70/42, HR 68, RR 26, SaO2 95%, temp. 98.8°F. Hemodynamic readings are CVP 3, CI 2.0, and SVR 600. ICP reading at 6 with a urine output of 100 mL over the last two hours. Your patient is exhibiting signs and symptoms of |
C. Spinal cord injury |
|
4. You are transporting a forty-year-old male diagnosed with a subarachnoid hemorrhage. Which of the following assessment findings can be associated with his diagnosis? |
C. Positive Brudzinski’s sign |
|
5. You arrive on the scene to manage a fall victim. She presents with a BP 70/palp, HR 62, RR 24, Sats 96%. EMS reports brief LOC but now has a GCS of 14. You note a deformity of the right femur, and she is complaining of neck pain. The clinical presentation is most likely a diagnosis of
|
A. Neurogenic shock |
|
6. Pupillary dilation in response to the oculomotor nerve insult that occurs in uncal herniation is a result of |
A. Loss of parasympathetic stimulation |
|
7. Which formula can be used when calculating a cerebral perfusion pressure (CPP)? |
B. MAP − ICP |
|
8. An early sign of tentorial herniation would be |
D. Ipsilateral pupillary dilation |
|
9. You have been requested to transport a thirty-two-year-old male involved in a twocar motor vehicle collision in which the right side of his head struck the “A-post.” Right middle meningeal artery damage has been noted by CT with right-sided “mass effect” resulting. You would expect which of the following? |
A. Epidural hematoma B. Ventricular collapse C. Cranial midline shift to the left D. All of the above |
|
10. The patient presents with a skull fracture that appears to have a central focal point with multiple fractures outward on radiography. This skull fracture would be described as |
B. Linear stellate |
|
11. A head-injured patient would most likely experience an increased ICP as a result of which action? |
A. Hip flexion B. Gagging on the ETT C. Adduction of the arms D. Rotation of the head E. All of the above |
|
12. You are transporting an awake multisystem trauma patient from a small rural facility with the following vital signs: BP 200/66, HR 56, RR 20-36, SaO2 97%, and temp. 99.9°F. Further assessment reveals a large laceration to the occipital area of the head, with bleeding controlled, and is moving all extremities. Pupils are reactive to light and equal at 4 mm with extraocular movements intact. The patient’s clinical presentation is suggestive of which of the following? |
A. Demonstrating signs/symptoms of cushing’s triad |
|
13. You are transporting a thirty-year-old female who was involved in a single vehicle rollover two hours prior to your arrival. She has a swan catheter in place with the following values: CVP 2, CI 2.0, PA S/D 12/6, wedge 7, SVR 400. Vital signs: BP 80/48, HR 46, RR 24, SaO2 90%. The patient’s clinical presentation is suggestive of which diagnosis? |
D. Neurogenic shock |
|
14. The expected average normal cerebral perfusion pressure range (CPP) is |
C. 70-90 mmHg |
|
15. The average normal ICP range is |
A. 0-10 mmHg |
|
16. The formula to calculate a mean arterial pressure (MAP) is |
B. [(DBP × 2) + SBP] divided by 3 |
|
17. The patient presents with the following hemodynamic parameters: CVP 1, CI 1.7, PA S/D 12/6, wedge 6, and SVR 300. Vital signs are 78/40, HR 60, RR 16, SaO2 98%. The most likely cause is |
B. Neurogenic shock |
|
18. Classic picture of neurogenic shock presents with |
B. Absence of tachycardia |
|
19. You are transporting a patient with a spinal cord injury above T6 level. His baseline vital signs prior to lift off: BP 160/80, HR 62, RR 20. During transport, the patient begins to complain of a throbbing headache with nasal stuffiness. Your assessment reveals that the patient is becoming increasingly agitated. His skin color is flushed and profusely diaphoretic. Repeat vital signs are a BP 206/100, HR 52, RR 26. Your initial management of the patient would be |
A. Insert a foley catheter |
|
20. You have been requested to transport a forty-year-old male fall victim of approximately 25-30 feet, three hours prior to your arrival. Your assessment reveals a greater motor weakness in upper extremities than in lower extremities, with varying degrees of sensory loss. The clinical presentation may suggest which of the following spinal cord syndrome? |
B. Central cord |
|
21. Hypothermia, low levels of 2,3-DPG, and hypocarbia can cause the oxyhemoglobin dissociation curve shift to go |
D. Left |
|
22. In addition to glucose, which electrolyte must be maintained within normal limits when managing a head-injured patient? |
D. Sodium |
|
23. You are transporting a twenty-year-old male, with penetrating head and facial trauma. During transport, the patient complains of a severe headache, nausea, and vertigo. Your assessment reveals nuchal rigidity, aphasia, dysphasia, along with the patient having episodes of vomiting. What is your diagnosis? |
B. Pneumocephalus |
|
24. Calculate the following patient’s cerebral perfusion pressure (CPP): BP 150/75, HR 140, RR 28, SpO2 100%, CVP 2, ICP 25. |
D. 75 |
|
25. You are transporting a normotensive patient, who is presenting with a history of head injury and complaining of extreme thirst. Your assessment reveals he is excreting large amounts of diluted urine, sunken appearance to the eyes, dry mouth, and tachycardia is noted. The initial treatment of the patient would be? |
C. Aggressive fluid replacement and vasopressin |
|
26. Cushing’s triad includes all of the following, except |
B. Narrowing pulse pressure |
|
27. A patient presenting with an initial loss of consciousness with a period of a lucid interval, with return of a normal neurologic status, suddenly complains of a headache, with a deteriorating level of consciousness. The patient is most likely experiencing a |
D. Epidural bleed |
|
28. Brudzinski’s clinical sign may indicate |
A. Subarachnoid bleed or meningitis |
|
29. The presence of a Babinski’s sign in an adult patient would exhibited by |
B. Plantar flexor reflex |
|
30. You have been requested to transport a thirty-two-year-old male intravenous drug user who was brought to the ED without vascular access with a history of having had a witnessed generalized tonic-clonic seizure ten minutes prior to your arrival. The patient arrived post-ictal, but responsive. No other medical history was available. On examining, the blood pressure is 130/80 mmHg, HR 88, respirations 14, and oxygen saturation of 98% on room air. The head is atraumatic, the pupils are 4 mm and reactive, cardiopulmonary exam was normal. Neurologically the patient is oriented to person only; he has no facial asymmetry, moves all four extremities, deep tendon reflexes were + 4 symmetrically, and no Babinski reflexes were present. The blood sugar is 110 mEq/dL. While looking for venous access over the patient’s scarred extremities, the patient began a second generalized tonic-clonic seizure. What is the “best” first line therapy for acute seizure management? |
D. Benzodiazepines |
|
31. Which cranial nerve is affected with a patient presenting with Bell’s Palsy? |
C. VII |
|
32. Cranial nerve III is also known as the |
B. Oculomotor nerve |
|
33. You are transporting a twenty-six-year-old male patient involved in a fall injury. Upon your arrival on the scene, your assessment reveals an awake patient who is not able to shrug his shoulders. Which cranial nerve is most likely affected? |
D. XI |
|
34. A patient diagnosed with Guillan-Barre would most likely present with all of the following, except |
A. Descending paralysis |
|
35. You are transporting a twenty-five-year-old male with a history of acute alcohol intoxication who was involved in a single vehicle roll-over two hours prior to your arrival. The patient is presenting with variable loss of motor function and sensory function from the nipple line down. Which dermatome would most likely be affected and what clinical condition you do suspect? |
C. T4; anterior cord syndrome |
|
36. You have been requested to transport a twenty-year-old male involved in a motor vehicle accident. Your assessment reveals an ethanol-like odor on his breath, GCS 15, with slurred speech, and the patient is able to grossly flex the arms at the elbow but unable to extend his arms at the elbows or wrists or flex or extend the fingers, with no sensation to the medial side of the arm and small finger. The patient was noted to have the capability of extending both lower legs at the knee, but definite weakness was present. He was able to extend and flex his ankles and toes. The clinical findings affect which dermatome and what clinical condition is suspected? |
C. C8, T1; central cord syndrome |
|
37. The presence of a plantar extensor reflex in an adult patient can indicate |
A. Damage to nerve pathways connecting the spinal cord and brain |
|
38. Oculocephalic reflex is also known as |
C. Doll’s eyes |
|
39. The oculovestibular reflex exam is used to assess |
B. Brainstem function |
|
40. Mydriasis is defined as |
C. Dilated pupils |
|
41. The patient presenting with Battle’s and Racoon’s clinical signs is most likely experiencing which of the following? |
B. Basilar skull fracture |
|
42. Which of the following is most likely affected with a patient presenting with an epidural bleed? |
A. Middle meningeal artery |
|
43. Another term used to describe pinpoint pupils is |
B. Miosis |
|
44. You would expect the normal range when measuring a mean arterial pressure (MAP) to be |
C. 80-100 mmHg |
|
45. Which clinical sign/symptom initially would indicate that a ventricular-peritoneal shunt is malfunctioning? |
B. Vomiting |
|
46. You have been requested to transport a thirty-year-old male with a history of being stabbed multiple times in the back. The patient presents with ipsilateral loss of motor function and contralateral loss of pain and temperature. The most likely diagnosis is |
B. Brown-Séquard syndrome |
|
47. You are transporting a patient with a history of diving into shallow water and is presenting with complete loss of motor, pain and temperature below the injured spinal cord lesion. The patient is most likely diagnosed with |
A. Anterior cord syndrome |
|
48. What personal protective equipment (PPE) should be worn when transporting a patient with bacterial meningitis? |
A. Mask, gloves, gown, and eye protection |
|
49. The patient you are transporting is exhibiting decerebrate posturing. What does this term mean? |
A . Increased tone in the extensor muscles with active tonic reflexes, resulting in all four limbs being rigidly extended and rotated internally, opisthotonos, and clenched teeth. |
|
50. On examining, the sixty-year-old female patient that you are preparing for transport appears awake but is unable to speak or follow commands. Vitals are: T 99, BP 168/104, HR 82, RR 18, SaO2 98% on 4 liter of oxygen by nasal cannula. She moves her left side spontaneously but has no movement of the right arm and very little movement of the right leg. The staff reports that she is right handed; radiography revealed no cranial/hip/pelvic fractures and CSF was clear, with no erythrocytes. What blood vessel do you suspect is involved? |
B. Middle cerebral artery in the left hemisphere |
|
1. You are on the scene where a thirty-five-year-old man having gunshot wound to the left chest. The left chest has been decompressed with a needle prior to your arrival. The patient is intubated and continues to desaturate. Your assessment reveals an increase in SQ air to the chest and neck. The next intervention would be to |
B. Advance ET tube below the level of the injury; right main stem intubation |
|
2. You are managing a burn patient who weighs 90 kg with a 65% burn surface area (BSA). How much fluid should this patient receive in the first eight hours when using the Parkland formula? |
B. 11,700 mL |
|
3. What does the clinical presentation of abnormal posturing generally indicate? |
C. Severe injury/damage to the brain and brainstem |
|
4. Using the Consensus formula, calculate how much fluid this 70-kg patient with a 50% BSA would receive in the first 8 hours of care? |
C. 3,500-7,000 mL |
|
5. The most commonly abused organ orsystem is? |
C. Integumentary |
|
6. You are transporting a twenty-year-old man involved in a high-speed motor vehicle accident with a history of being ejected from the vehicle two hours prior to your arrival. The patient has been intubated and remains unconscious, with abnormal posturing noted. Mechanisms of injury associated with acceleration and deceleration that occurs with high-speed motor vehicle accidents or ejection from a vehicle can cause which type of brain injury? |
C. Diffuse axonal injury |
|
7. When inserting a chest tube, correct insertion site recommended is |
B. 5th ICS anterior midaxillary |
|
8. You are transporting a twenty-three-year-old man, with a diagnosis of left-sided hemothorax. Guidelines for tube clamping suggest that the chest tube be clamped after how many milliliters of blood have been removed in the adult patient? |
B. 1,000 mL |
|
9. You arrive on the scene to manage a fall victim. She presents with a BP 80/50, HR 128, RR 36, SaO2 90%. Ground EMS reports that upon their physical examination, the patient revealed decreased bowel-like breath sounds on the left side of the chest. The patient is complaining of difficulty in breathing and severe left shoulder pain. The most likely diagnosis of this patient is |
A. Diaphragmatic rupture and spleen injury |
|
10. You are preparing to transport a seventy-two-kg patient presenting with second and third degree burns to his entire face, anterior torso, and complete left arm. How much fluid should the patient receive in the first eight hours using the Parkland formula? |
A. 4,600 mL |
|
11. A sixty-year-old male patient has been trapped under a tractor for almost six hours. Once extricated, he is most likely to experience |
C. Rhabdomyolysis |
|
12. Your patient was struck from behind while driving. The most common area of injury from a rear-end collision is |
D. T12-L1 injuries |
|
13. The clotting cascade can be triggered through an extrinsic pathway. The triggering mechanism is the release of |
D. Tissue thromboplastin |
|
14. A patient in early shock most probably would present with which of the following acid-base imbalance? |
D. Respiratory alkalosis |
|
15. Which blood component does not require typing and crossmatching before administration? |
D. Albumin |
|
17. Platelets are considered low at |
D. <150 |
|
18. Electrical alternans may be caused by a |
B. Pericardial effusion |
|
19. Normal K+ value is |
B. 3.5-4.5 |
|
20. You are managing a twenty-five-year-old man with burns to the entire face, left forearm, right hand, and anterior portion of the entire left leg. His BSA would be |
B. 19% |
|
21. A twenty-one-year-old patient with history of stab wounds to the chest, presenting with a drop in the systolic blood pressure of 20 mmHg during inspiration, a narrowing pulse pressure, and clear equal breath sounds bilaterally would most likely be managed with all of the following, except |
D. Needle thoracostomy |
|
22. A patient presenting with Beck’s triad is most likely experiencing |
C. Cardiac tamponade |
|
23. Immediate release of intrapleural pressure should be performed where |
D. Second intercostal space, midclavicular line |
|
24. An object in motion will remain in motion and an object at rest will remain at rest unless acted upon by a force; this law is known as |
A. Newton’s first law |
|
25. Your patient was involved in a single car roll-over and is complaining of neck and left shoulder pain. You note bruising to the left chest wall. Vital signs are BP 80/48, HR 130, RR 28, SpO2 96%. The most likely cause is |
C. Splenic injury |
|
26. What is a common problem associated with electrical injuries? |
A. Myoglobinuria |
|
27. When managing a patient with an electrical injury that presents with hematochromagen urine, you should maintain a urine output of |
D. A minimum 100 mL/hr |
|
28. Normal cerebral perfusion pressure is at least? |
C. 70-90 mmHg |
|
29. Your patient presents with following parameters: CVP 0, CI 1, PA S/D 8/4, wedge 3, and SVR 1,800. What is your diagnosis? |
A. Hypovolemic shock |
|
30. Normal ICPis |
A. 0-10 mmHg |
|
31. The formula used to calculate mean arterial pressure is: |
B. [(DBP × 2) + SBP] divided by 3 |
|
32. What is the formula used when calculating cerebral perfusion pressure? |
B. MAP − ICP |
|
33. Grey Turner’s sign may indicate |
C. Retroperitoneal bleed |
|
34. Most commonly seen injuries with side impact or “lay it down” motorcycle crashes include all of the following, except |
B. Pelvic fractures |
|
35. Predictable injuries that can occur with falls can include all of the following, except |
B. C2 fracture |
|
36. Dry chemicals such as lime should be |
A. Brushed off before irrigation |
|
37. Hamman’s sign may indicate the presence of |
B. Tracheobronchial injury |
|
38. Recommended urinary output when managing a burn patient without an electrical injury is |
C. 30-50 mL/hr |
|
39. Hydrofluoric burns can be managed with copious amounts of water and |
A. Calcium gluconate |
|
40. The management approach for a patient experiencing brain herniation can include all of the following, except |
D. Hyperventilation to maintain EtCO2 at 20-30 mmHg |
|
41. Classic picture of neurogenic shock presents with |
B. Absence of tachycardia |
|
42. Your patient presents with motor loss, numbness to touch, vibration on the same side of the spinal injury, loss of pain, and temperature sensation on the opposite side. You suspect that the most likely spinal cord syndrome present is |
A. Brown-Séquard |
|
43. When should escharotomies ideally be performed? |
C. Circumferential burns to the chest decrease chest wall compliance |
|
44. A patient presents with a further drop in MAP of 20% with an increase in fluid loss of over 1,800 mL. Vasoconstriction continues and leads to oxygen deficiency. Physiologically, the body switches to anaerobic metabolism, forming lactic acid as a waste product. The patient would most likely be in which stage of shock? |
C. Intermediate or progressive and decompensated shock |
|
45. Calculate the following patient’s cerebral perfusion pressure (CPP): BP 180/90, HR 120, RR 24, SpO2 98%, CVP 2, ICP 25. |
D. 95 |
|
46. All of the following conditions are considered a form of obstructive shock, except |
B. ICP |
|
47. You are managing a 100-kg burned patient with 70% BSA. How much fluid will the patient receive in the first eight hours using the Consensus formula? |
B. 7,000-14,000 mL |
|
48. Late signs and symptoms of a tension pneumothorax can include all of the following, except |
A. Narrowing pulse pressure |
|
49. The most common cause of pulseless electrical activity in a trauma patient is |
B. Hypovolemia |
|
50. You have responded to a fire in a building with five victims. You notice that a large portion of the synthetic carpet has been burned in the room where you are treating the patients. The patients are exhibiting increasing signs of respiratory distress and coughing after high oxygen has been applied. What may be causing the patients’ signs and symptoms? |
A. Cyanide |
|
1. You are transporting a thirty-eight-year-old man who is presented to the ER with a history of cocaine-induced tachycardia and is complaining of midsternal chest pain. Vital signs are as follows: temperature 101.2°F, BP 200/100, HR 140, RR 28, SaO 2 97% on 2 liters/min of oxygen via nasal cannula. Which of the following medication is contraindicated for management of this patient? |
C. Metoprolol |
|
3. You have been requested to transport a twenty-year-old female with a history of acetylsalicylic acid poisoning two hours prior to your arrival at the sending facility. The patient is complaining of nausea, headache, and tinnitus. When evaluating her ABGs, you would expect which of the following acid-base disturbances to manifest in the early stage of poisoning? |
A. Respiratory alkalosis |
|
4. All of the following muscle enzymes, if elevated, are a diagnostic hallmark in a heatstroke patient, except |
B. Troponin 1 and 2 |
|
5. Defibrillation is usually not effective until the body core temperature is greater than |
C. 30°C |
|
6. Which of the following rewarming techniques can best avoid the dangers of the afterdrop phenomenon when managing a hypothermic patient? |
B. Active internal |
|
7. You are transporting a patient with history of seizures while on a camping trip in July. Her husband drove her to the closest ER for treatment. She has a history of cardiac heart failure and only takes furosemide daily. Labs reveal CK 27,000, LDH 800, BUN 34, CR 1.1, K 3.1, Hgb 15.3, Hct 44, CO2 16, and glucose of 62. The foley bag contains urine that appears dark greenish-brown in color with an output of less than 20 mL in the last hour. She is unresponsive with BP 100/40, HR 144, RR 32, and SaO2 94%. The decrease in urine output and abnormal urine character is most likely the result of which of the following? |
C. Rhabdomyolysis secondary to heatstroke |
|
8. Which of the following blood transfusion reaction can occur within minutes of administration? |
A. Hemolytic |
|
9. You are transporting a forty-year-old mane with history of esophageal varices. The sending physician has ordered a unit of PRBC’s transfusion to be infused during transport. Transport time to the receiving facility is approximately 20-30 minutes. The patient should be monitored for which of the following during transport? |
D. Hemolytic reaction |
|
11. The treatment for acetaminophen poisoning is |
B. N-acetylcysteine (NAC) |
|
12. Antidote for Coumadin overdose is |
C. Vitamin K, FFP |
|
13. Treatment of Digitalis toxicity would include all of the following, except |
D. Beta-blockers |
|
14. When managing a patient with an electrical injury, with the presence of hemochromogen, you should maintain a minimum urine output of |
D. 100 mL/hr |
|
15. The drug of choice for a patient exhibiting signs and symptoms of malignant hyperthermia is |
C. Dantrolene |
|
18. The most critical goal and life-saving measure in heat illness is |
A. Cooling the patient to rapidly decrease body temperature |
|
19. A scuba diver descended to a depth of ninety-nine feet. The scuba diver is under an ambient pressure of how many ATA? |
D. 4 |
|
20. The most common type of decompression sickness typically seen diving emergencies is |
B. Pulmonary |
|
21. Situations that involve a right shift in the oxygen-hemoglobin dissociation curve are all of the following, except |
A. Alkalosis |
|
22. Gases in the lungs of a scuba diver expand as ambient pressure decreases during ascent best describes which gas law? |
D. Boyle’s |
|
23. You are transporting a patient who you note has tea-colored urine in small amount in the foley catheter bag. The nurse reports that his output is only 50 mL in the last twenty-four hours. What treatment would you expect to initiate during the two-hour flight? |
A. Rapid fluid resuscitation, sodium bicarbonate drip, and consider Lasix and mannitol |
|
24. Your head-injured patient is hypothermic. In what direction does the oxyhemoglobin dissociation curve shift to? |
D. Left |
|
25. Poisoning of the cytochrome oxidase enzyme system may cause |
A. Histotoxic hypoxia |
|
26. Two types of drug poisoning that cause hallucinations are |
B. PCP and lysergic acid diethylamide |
|
27. You have been requested to a farming area to transport a forty-year-old man involved in a plane crash. On arrival, the patient is complaining of shortness of breath with increased salivation and blurred vision. Vital signs are BP 100/58, HR 50, RR 36, SaO2 92%. Management of this patient would include all of the following, except |
C. Sodium thiosulfate |
|
28. One of the major organs that must be functional if heat is to be dissipated is the |
A. Skin |
|
29. ARDS and DIC are a result of what in the hyperthermic patient? |
B. Lysosomal enzymes |
|
30. The antidote for ethanol toxicity is |
C. Fomepizole |
|
31. Digitalis toxicity can easily be exacerbated by |
D. Beta-blockers |
|
32. All of the following medications are classified as calcium channel blockers, except |
D. Metoprolol |
|
33. A patient presenting with a complaint of tinnitus and flulike symptoms will most likely have which of the following diagnosis? |
C. Salicylate overdose |
|
34. Which of the following lab test is typically ordered four hours postingestion of acetaminophen overdose? |
B. Liver function |
|
35. Antidote that can be administered for benzodiazepine overdose is |
B. Romazicon |
|
36. Iron poisoning can be managed with |
C. Deferoxamine |
|
37. A patient presenting with ethylene glycol ingestion would present with the following signs and symptoms, except |
D. Metabolic alkalosis |
|
38. What assessment when managing a patient with iron ingestion would indicate that the treatment is effective? |
A. Urine output appears pink in color |
|
39. The administration of Romazicon can cause which of the following adverse reactions? |
B. Seizures |
|
40. Which of the following conditions is commonly associated with ethanol intoxication? |
B. Hypoglycemia |
|
41. Pralidoxime chloride is administered in the management of |
B. Organophosphate exposure |
|
42. Antidote for heparin overdose is |
C. Protamine sulfate |
|
43. Normal BUN is |
D. 35-45 |
|
44. Elevated BUN can indicate all of the following, except |
D. Cerebral vascular accident |
|
45. A patient exposed to organophosphates can present with the following clinical signs/symptoms, except |
C. Mydriasis |
|
46. A patient presenting with tachycardia, pale skin, a change in behavior, and diaphoresis is most likely experiencing which of the following? |
A. Insulin shock |
|
47. Organophosphate exposure causes the overproduction of the neurotransmitter acetylcholine by |
A . Deactivation of the acetylcholinesterase enzyme, which is responsible for the breakdown of acetylcholine |
|
48. Management of cyanide toxicity includes all of the following, except |
C. Protopam chloride |
|
49. Which medication will require the addition of sodium thiosulfate in the infusion bag to prevent thiocyanate toxicity? |
D. Nitroprusside |
|
1. You arrive on the scene of twenty-one-year-old woman involved a single roll-over accident, who is approximately twenty-eight weeks pregnant. Your assessment reveals palpation of fetal parts over the abdomen. What is your diagnosis of the patient? |
B. Uterine rupture |
|
2. The patient is in a breech presentation and delivery appears to be halted upon delivery of the head. The appropriate action would be to |
D. Perform Mauriceau’s maneuver |
|
3. Your patient is experiencing hypertonic uterine contractions. Appropriate therapy would be to |
C. Discontinue any oxytocin administration |
|
4. The patient fetus is exhibiting variable decelerations. This is most likely due to |
B. Cord problems (prolapse, nuchal, short, compression) |
|
5. Late decelerations may indicate |
D. Uterine placental insufficiency |
|
6. The second stage of labor ends with |
D. Delivery of the infant |
|
7. The fetus of a pre-eclamptic mother during labor will commonly experience |
B. Late decelerations |
|
8. Normal magnesium level value is |
C. 1.5-2.5 |
|
9. Preeclampsia is characterized by of the following, except |
D. Seizures |
|
10. The fetus’s variability is |
A. The best indicator of fetal viability B. Normally 10-15 beats per minute C. Expected to increase during active labor D. All of the above |
|
11. Sinusoidal patterns are commonly associated with all of the following, except |
C. Pregnancy-induced hypertension |
|
12. You are transporting a twenty-five year-old G1, PO female who is twenty-eight weeks gestation with a history of presenting to the ER department with headache, hyperreflexia, nausea, vomiting, epigastric pain, and dyspnea. Assessment revealed moist rales on auscultation, wheezing with tachycardia seen on the cardiac monitor. When evaluating her lab results, consumptive thrombocytopenia unaccompanied by any other coagulation factor abnormalities is characteristic of HELLP syndrome, which is defined as a platelet count of less than |
C. 100,000/mm3 |
|
13. After administering fluid resuscitation, performing vigorous fundal massage and giving oxytocin, your patient continues with postpartum hemorrhage. Which drug would be indicated to decrease blood loss? |
B. Methergine |
|
14. When administering magnesium sulfate, the following adverse reactions can occur, except |
C. Increase in FHR variability |
|
15. Hemolytic disease of the newborn can be prevented by the administration of which of the following to a Rhesus negative mother who had a pregnancy with a Rhesus positive infant? |
B. Rho(D) immune globulin |
|
16. Frequency of a contraction is defined as |
D. Beginning of the contraction to the beginning of the next contraction |
|
17. Duration of a contraction is defined as |
C. Beginning of contraction to the end of the contraction |
|
18. Gravida means |
B. Total number of pregnancies |
|
19. You are transporting a twenty-three-year-old female from a small rural hospital with a diagnosis of preterm labor. Her fundal height is measured just slightly above the umbilicus. Your patient is approximately in how many weeks’ gestation? |
B. 20-24 weeks |
|
20. The most common site for an ectopic pregnancy to occur is the |
C. Fallopian tube |
|
21. When managing preterm labor, all of the following medications can decrease or stop uterine activity, except |
A. Apresoline |
|
22. The administration of which of the following medications can help decrease the chance that the fetus will have respiratory distress syndrome when born? |
C. Betamethasone |
|
24. Which of the following terms best describes an intermittent, painless contraction that may occur every ten to twenty minutes after the first trimester of pregnancy? |
D. Braxton Hicks |
|
25. Regular and rhythmic contractions that produce progressive cervical changes after the twentieth week of gestation and before the thirty-seventh week is known as |
C. Preterm labor |
|
26. A small amount of fluid is spread on a slide and allowed to dry completely. A frond crystallization pattern of dried amnionitc fluid (with high concentration of sodium chloride) will be seen under microscopic examination. The test finding is called |
A. Positive ferning |
|
27. Nitrazine paper will turn what color in the presence of amniotic fluid? |
D. Blue |
|
28. Labetalol— |
B . Is a selective mixed alpha-beta adrenergic antagonist agent that decreases systemic vascular resistance without changing cardiac output. |
|
29. A patient exhibiting signs and symptoms of magnesium sulfate toxicity can present with all of the following, except |
C. Depressed deep tendon reflexes |
|
30. You are transporting a twenty-four-year-old female, twentyeight- week gestation, G2, P1, who presents to the ER department complaining of lower abdominal contractions every 5-10 minutes. She has a history of myasthenia gravis and gestational diabetes. Which of the following medications would not be administered to control uterine activity? |
A. Magnesium sulfate |
|
31. A patient presenting with shoulder pain and lower abdominal pain with a history of having her last menses approximately 6-8 weeks, is most likely exhibiting which of the following? |
B. Ectopic pregnancy |
|
32. Which of the following can be a serious complication if, Terbutaline is administered to an insulin-dependent pregnant diabetic patient? |
D. Transient hyperglycemic response |
|
33. Macrosomia refers to |
B . A fetus that is large for gestational age, with increased fat deposition, and an enlarged spleen and liver |
|
34. Inversion of the uterus may occur with any of the following, except |
A. Hypertonic uterus |
|
35. Which of the following has been recognized as a primary cause of preterm labor? |
C. Infection |
|
36. Signs and symptoms of preeclampsia include all of the following, except |
D. Seizures |
|
39. Preeclampsia most commonly occurs during |
B. End of second trimester, beginning of third trimester |
|
40. Placental abruption can be defined as |
D. The premature detachment of a normally implanted placenta from the uterine wall. |
|
41. You are preparing to transport a twenty-year-old female, twenty-four weeks gestation, G3, P1, AB 1. The mother is being placed in lateral recumbent position to prevent which of the following? |
B. Supine hypotensive syndrome |
|
42. The diastolic blood pressure goal when managing pregnancyinduced hypertension is |
C. 90-100 mmHg |
|
43. You are transporting a nineteen-year-old female, thirty weeks gestation, G2, P1, who is presented in a small rural ER department with abdominal pain after receiving a blow to the abdomen two hours prior. The sending staff is concerned that the patient may be exhibiting signs and symptoms of a placental abruption. Which of the following would assist the transport team in recognizing that the presence of concealed bleeding may be increasing? |
C. Marking and determining the fundal height frequently |
|
46. The most common cause of postpartum hemorrhage (PPH) is |
D. Uterine atony |
|
47. Acute fetal tachycardia is defined as |
C. >160 beats per minute |
|
50. Leopold’s maneuver can be used to |
B. Assess fetal position |
|
1. Pediatric dose for Epinephrine is |
D. 0.01 mg/kg IV |
|
2. The pediatric patient may be pretreated with which medication prior to administering Anectine for the purpose of preventing bradycardia? |
B. Atropine |
|
3. You are transporting a thirty-two-week premature neonate with respiratory distress. Which drug may be administered in preparation for transport? |
B. Surfactant |
|
4. A neonate who is experiencing repetitive motions of a bicycling type action with lip smacking is presenting with what type of seizure? |
A. Subtle |
|
5. Your patient is PDA dependent. This would indicate likely require the administration of which of the following drugs? |
D. Synthetic surfactant |
|
6. Which of the following would calculate an appropriate ETT size for a pediatric patient? |
C. (Age + 16)/4 |
|
7. Some pediatric endotracheal tubes are cuffless, which prevents |
D. Subglottic stenosis and ulcerations |
|
8. Persistent Pulmonary Hypertension (PPHN) is a syndrome characterized by persistent elevated pulmonary vascular resistance resulting in |
A. Right-to-left shunt |
|
9. The most common side effect, complicating transport of a newborn with the use of Prostaglandin E1 is |
B. Apnea, hypoventilation |
|
10. A medication utilized in the neonate that accelerates closure of the PDA is |
C. PGE1 |
|
11. A pediatric patient presents to the ED in acute respiratory distress, with increased work of breathing and reduced oxygen saturation. The patient is treated with multiple rounds of nebulized albuterol, ipratropium, oxygen supplementation, and parental steroids, with none to minimal improvement in clinical and objective evidence of respiratory distress. Which of the following medications is recommended for sedation prior to intubation because of the bronchodilatory effect it possesses? |
B. Ketamine |
|
12. You are transporting a nine-year-old man weighing 40 kg with diagnosis of status asthmaticus on a ventilator. EtCO2 is 60. Ventilator settings are at Vt 250, FIO2 1.0, Rate 16, I:E 1:3, PEEP 5, PIP 48. How will you manage this patient? |
B. Increase I:E ratio |
|
13. Recommended urinary output when caring for a pediatric patient should be |
C. 1-2 cc/kg/hr |
|
14. You are transporting a three-year-old boy who was struck by a vehicle two hours prior to your arrival in the ER department. Your assessment reveals BP 60/38, HR 54, RR 36, SaO2 92%, skin condition is cool, with a delayed capillary refill. He is awake but is restless and irritable. Which of the following should always be recognized as ominous signs and should be treated aggressively in the pediatric patient? |
D. Hypotension and bradycardia |
|
15. You are transporting a 20-kg patient presenting with second- and third-degree burns to his entire face, anterior torso, and complete left arm. How much fluid should the patient receive in the first eight hours using the Parkland formula? |
C. 1,440 mL |
|
16. You are transporting a newborn who was delivered vaginally in a small ER about six hours prior to your arrival with a history of bilious vomiting, abdominal distention, feeding intolerance, and lack of stools for the last twenty-four hours. Initial management would include |
C. Decompression of the bowel with intermittent large-bore gastric suction |
|
17. You are managing a four-year-old boy presenting lethargic with nystagmus. You note he has depressed DTRs and has a profound anion-gap. The patient should be managed with which of the following? |
A. IV ethanol drip |
|
18. The fetus was delivered with obvious meconium staining. His one-minute APGAR is 8. Endotracheal suctioning |
D. Should not be performed |
|
19. Which of the following lab test is used to diagnose Reye’s syndrome? |
A. Liver function tests |
|
20. During transport, management of a thirty-seven week newborn diagnosed with persistent pulmonary hypertension (PPHN) may include which of the following to prevent right-to-left shunting? |
B . Continuous monitoring of the blood pressure; support blood pressure with fluid volume replacement, and a vasopressor as needed |
|
21. Pediatric airway anatomy differs from adult anatomy in the following ways, except |
D . In children, younger than six years of age, the narrowest portion of the trachea is at the cricoid process. |
|
22. Primary cause of bradycardia in the neonate and pediatric patient is |
B. Hypoxia |
|
23. Drug of choice for profound hypotension in septic shock is |
B. Levophed |
|
24. You are managing a four-year-old boy who is requiring intubation. The appropriate size ET tube for this patient would be |
D. 5.0 |
|
25. What finding would you expect to see on a chest x-ray for a patient presenting with laryngotracheobronchitis? |
C. Steeple sign |
|
26. Vt is calculated at |
B. 5-8 mL/kg |
|
27. A scaphoid abdomen, unequeal breath sounds, dyspnea, and a shift in the PMI are a classic presentation of which of the following in the neonate patient? |
B. Diaphragmatic hernia |
|
28. Hypoglycemia in the neonate can be treated with |
B. D 10% 2-4 mL/kg |
|
29. You are transporting a ten-year-old boy with a history of being struck by a vehicle while riding his bicycle. Your assessment reveals a deteriorating neurologic status, hypotension, and bradycardia. Your management of the this patient would include all of the following, except |
D. Nasal intubation |
|
30. A full-term newborn weighing 2,800 grams should be intubated with what size endotracheal tube? |
C. 3.5 |
|
31. An eight-year-old child was hit by a car. Your assessment reveals radiation of pain to the left shoulder, ecchymosis, and abrasions to the retroperitoneal area bilaterally and abdominal distention. What injury do you suspect? |
B. Spleen |
|
32. What finding would you expect to see on the lateral neck x-ray to confirm suspicion of epiglottitis? |
D. Thumb print sign |
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33. Fluid resuscitation in a neonate patient should be administered at |
B. 10 mL/kg |
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34. You are transporting a four-year-old boy trauma patient. You are preparing to administer a weight per kg based medication. How many kilograms does patient weigh approximately? |
C. 15 kg |
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35. Expected endotracheal tube centimeter depth for a neonate can best be determined by using which of the following formulas? |
A. 6 + weight in kg |
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36. When identifying vessels on the umbilical stump, the umbilical vein, as compared to the umbilical arteries, is usually located at what position? |
C. 12 o’clock |
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37. The circulating blood volume in a child is |
D. 70-80 mL/kg |
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38. A surgical airway can be placed through the cricothyroid membrane on children over the age of |
C. 11 years |
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39. In an emergency situation, an umbilical vein catheter when placed correctly should only be inserted as far as necessary to obtain blood and should not go beyond which of the following? |
B. Liver |
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40. Noninitiation or discontinuation of newborn resuscitation as recommended by the International Guidelines for Neonatal Resuscitation include all of the following, except? |
C. Gestational age < 28 weeks |
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41. One of the most common causes of new-onset wheezing in children is |
B. Bronchiolitis |
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42. Which of the following is not indicated for the treatment of bronchiolitis? |
C. Corticosteroids |
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43. You are transporting a five-year-old boy with a diagnosis of sepsis secondary, a localized necrotic skin area of unknown etiology. The “bull’s-eye” appearing necrotic area is noted to the left upper thigh area. Which of the following may be the most likely cause? |
B. Brown recluse spider bite |
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44. A ten-year-old boy presents to the emergency department with a history of feeling a “sharp” pinprick, dull numbing pain to the right foot, muscle cramping, with intense abdominal pain that started about thirty minutes prior. Which of the following may be the most likely cause |
A. Black widow spider bite |
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45. You have been called to the scene for a six-year-old girl with a history of snake bite to the left lower extremity while on a camping trip. Management of this patient would include all of the following, except |
D. Application of ice to the affected area |
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46. A newborn who is hypoxic in room air but demonstrates a partial pressure of oxygen greater than 150 in 100% oxygen is more likely to have which of the following? |
B. Pulmonary disease |
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47. Gastroschisis in a newborn is best described as |
D . A defect in the abdominal wall that has otherwise completed its development and allows protrusion of abdominal contents which is not covered by a membrane |
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48. When transporting a neonate suspected of having esophageal atresia, you should immediately |
B. Elevate the head of the bed to prevent gastric reflux |
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49. Which of the following scenarios would be most suspicious for possible child abuse? |
C . Four month old who presents with a nondisplaced femur fracture after reportedly rolling off of the changing table |
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50. You have been requested to transport a five-year-old who was involved in a single rollover accident two hours prior to your arrival at the referring facility. Your exam reveals the following vital signs: Temp. 37.0, P160, RR ventilated via the tracheal tube at 20, BP 100/80, oxygen saturation 97%. He is still unresponsive and being ventilated via the tracheal tube. His pupils are briskly reactive to light. There is excellent chest wall rise and fall via ventilation through the tracheal tube. There are numerous abrasions over his face, chest, abdomen, and lower extremities. The abdomen is distended with decreased bowel sounds. His pelvis is stable, but his right thigh is obviously swollen and tense. Distal perfusion to all four extremities seems adequate. The remainder of his physical examination is unremarkable. The child is clinically presenting with which of the following? |
D. Compensated progressive shock |
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1. Initial intervention for managing a patient presenting with bariobariatrauma is? |
C. Administer high flow oxygen by NRM 15 minutes prior to lift off |
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2. An expanding ETT cuff in flight is an indication of what gas law? |
C. Boyle’s law |
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3. Your oxygen tank pressure reading at 1,200 hours was 1,800 psi. The pilot rechecked the unused oxygen tank in the evening and reported that the gauge reading was 1,500 psi. Which gas law best describes the decrease in pressure? |
A. Gay-Lussac’s law |
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4. How should your flight suit fit to provide space of insulation per CAMTS recommendations? |
D. ¼ in. |
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5. You are beginning to prepare for landing and you have news reporter riding along for the day. You see a high-rise tower at 1,100 high. Sterile cockpit applies how? |
B. Flight crew members are the only one allowed to speak |
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6. You have just crash landed your aircraft and your pilot has asked you to exit the aircraft. What should you take with you? |
C. Survival kit |
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7. You are transporting a non-intubated seventy-year-old man with a history of bilateral pneumonia on 2 L of oxygen by nasal cannula. You are at 10,000 feet and the patient’s vital signs are BP 190/100, HR 102, RR 24, and SaO2 86%. What is the immediate intervention for this patient? |
B. Increase oxygen delivery to the patient |
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8. You are transporting a thirty-year-old man who was involved in a motor vehicle crash. He has a closed femur fracture with a history of alcohol consumption of unknown amount. On the basis of the physiologic effects elicited on the body, which type of hypoxia problems may occur in flight? |
A. Histotoxic and hypemic |
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9. Which one of the following has been determined to be an unreliable sign of hypoxia? |
A. Cyanosis |
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10. An increase in altitude produces? |
B. Low humidity and low temperature |
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11. After a forced aircraft landing, the pilot is incapacitated; your main priority is to? |
C. Turn off throttle, fuel, and then battery |
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12. Your immediate concerns of survival after an aircraft accident include all of the following, except? |
A. Obtain water and go for help |
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13. No pilot may takeoff or land an aircraft under visual flight rules (VFR) when the reported ceiling or visibility is less than which of the following for local day weather minimums? |
B. 500 feet and 1 mile |
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14. The emergency transmit frequency is? |
A. 121.5 |
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15. Average time of useful consciousness (TUC) for a non-pressurized aircraft at 45,000 feet is? |
D. 15 seconds or less |
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16. You are asked to respond to a local scene call with night vision goggles (NVG) capability involving an MVA with multiple injured patients at 2,300. You have been having bad weather off and on. The pilot-in-command (PIC) advises you that weather minimums are currently at 800 and 1. What will you do? |
C. Abort the flight due to weather |
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17. The percentage of oxygen at 25,000 MSL is |
B. 21% |
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18. The altitude at which one begins to lose their night vision is |
D. 5,000 feet |
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19. The pilot made contact upon the aircraft lifting at 1455. The second contact was at 1510 after landing. The communication center has not heard from the transport team since the last flight following transmission. The postaccident incident plan (PAIP) should be initiated at what time? |
C. 1555 |
|
20. Gas that diffuses from an area of higher concentration to an area of lower concentration, best describes which gas law? |
D. Henry’s law |
|
21. Your patient would most likely experience barodontalgia during which phase of flight? |
A. Ascent |
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22. You will be transporting a stable twenty-seven-year-old man with nontraumatic pneumocephalous secondary to gas producing necrotizing bacteria from rural hospital at 8,500 feet elevation to a local hospital at 1,200 feet sea level. What might be the best transport option? What gas law will most affect this patient negatively? |
A. Ground; Boyle’s law |
|
23. You are transporting a sixty-year-old man with a history of nonembolic stroke by rotor-wing aircraft in the middle of a sunny afternoon. When the pilot begins to turn the rotors, the flight team notices that the patient’s eyes are blinking rapidly and he begins to experience a generalized tonic-clonic seizure. The monitor shows what appears to be ventricular fibrillation, but a pulse can be palpated. The seizure activity ceased when the rotor blades stopped and started again with start-up. The seizure activity is most likely due to? |
A. Flicker vertigo |
|
24. You are doing a night flight when you encounter bad weather. The helicopter suddenly impacts the ground and the cockpit is filled with smoke. The best action of the flight team immediately after experiencing the hard landing should be which of the following? |
C . Exit the helicopter after the aircraft has come to a complete stop and meet at a predesignated position a safe distance from the aircraft |
|
25. Your IABP begins to purge during ascent. The triggering mechanism for this function was initiated as a result of which gas law? |
A. Boyle’s law |
|
26. Henry’s law best describes which of the following patient conditions? |
A. Bends |
|
27. On a long fixed wing flight, an option may be to place water on the ET tube cuff to counteract. Which gas law is it? |
D. Boyle’s law |
|
28. Overdue aircraft procedures during flight start after |
C. 45 minutes without contact |
|
29. The absolute minimum hours required by the Federal Aviation Regulation (FAR) Part 135 with regard to a pilot’s “bottle to throttle” rule is |
A. 8 |
|
30. Who has the ultimate authority to initiate or complete a mission? |
C. The PIC |
|
31. The flight team should be prepared that an aircraft will capsize when it hits water because helicopters are top heavy as a result of the weight of the engines and transmission. Once in the water, the flight team can minimize heat loss by using which of the following? |
A. Heat escape-lessening posture (HELP) |
|
32. The total pressure of a gas mixture is the sum of the partial pressures of all gases. Which gas law best describes? |
C. Dalton’s law |
|
33. Malpractice is based on a professional standard of care. The elements that must be proved for a malpractice case include all of the following, except? |
C. Abandonment |
|
34. Air medical programs that frequently fly over large bodies of water need to be familiar with emergency egress procedure in the event of a forced water landing. All of the following are correct regarding the emergency egress, except? |
A . During surface ascent, exhalation should be done rapidly to prevent serious lung injury |
|
35. Administration of the wrong medication to a patient best describes which element of malpractice? |
A. Breach of duty as a result of malfeasance |
|
36. During descent, gas will |
B. Contract |
|
37. The radio signal that follows the curvature of the earth and has the greatest range is? |
C. VHF low-band FM |
|
38. The ELT takes a minimum of ____________ g’s to activate. |
B. 4 |
|
39. A repeater system is a type of which of the following radio systems? |
C. Half duplex |
|
40. In aviation, “You may fly instrument flight rules (IFR) in visual meteorological conditions (VMC), you cannot fly VFR in _________.” |
C. Instrument meteorological conditions (IMC) |
|
41. Decompression illness is mostly attributed to which gas law? |
C. Henry’s law |
|
42. During flight, you notice that the IV drip rate has increased. Which gas law is responsible for this to occur? |
D. Boyle’s law |
|
43. The number one cause of aero-medical crashes is |
A. Pushing the weather (weather-related) |
|
44. Unless it is acted on by a force, a body at rest will remain at rest and a body in motion will move at a constant speed in a straight line best describes which of the following laws? |
B. Newton’s law |
|
45. Four basic variables that affect gas volumetric relationships include all of the following, except? |
B. Altitude |
|
46. CAMTS requires a minimum of _____________ successful live intubations during initial flight training. |
C. 5 |
|
47. During an in-flight emergency procedure, all of the following are correct, except |
A. Place patient in high-fowlers position |
|
48. CAMTS requires that helipads must have all of the following, except |
D. Evidence of adequate security |
|
49. Which of the following is a leading cause of death among scuba divers? |
A. AGE |
|
50. All of the following are considered stressors of flight, except? |
B. Increased partial pressure of oxygen |