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90 Cards in this Set
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As you obtain historical information regarding your patient, you note the patient's presentation & responses are very similar to several patient complaints you have treated in the past. Integrating this information from the past experiences to this current experience is known as:
a. Pattern Recognition b. Active Listening c. Clinical Decision Making d. Clinical Reasoning |
A:
PATTERN RECOGNITION along with the cardinal presentation, history, and physical exam, evaluation of diagnostic findings, and good critical thinking skills all contribute to effective, effecient diagnosis and management of medical patients |
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In which situation has the threat to your personal safety been reduced most significantly?
a. An angry schizophrenic patient has been calmed using verbal diffusing techniques b. A barking dog has been secured in a kennel in the yard c. The perpetrator of a shooting has fled, police are on the scene with you. d. Your partner has taken an angry family member into another room. |
B
HealthCare providers in all environments and situation must remain vigilant in identifying potential safety issues for both the patient and provider. Securing the dog in a kennel away from the patient & providers eliminated that threat. The schizophrenic patient may be temporarily calmed but remains at high risk of outburst. An armed fugitive is a danger, even though they have left the scene. Preshopital providers should never separate themselves or be placed in a situation where communication, patient care or escape is difficult. Assistant should be obtained to deal with the angry family member. |
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You evaluate a patient's environment to assess for:
a. safety concerns b. Room temperature c. Assistive devices d. All of the above |
D.
Pre-hospital and in-hospital areas that involve patients and their families should be continually assessed for environmental concerns such as comfort and temperature, assistive equipment and lifting and moving issues. Assistive devices like walkers, oxygen concentrators, and dentures indicate perfusion and nutrition/dehydration issues. All providers should use their sense of smell, vision, hearing and touch when assessing the environment and patient. |
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An unresponsive patient has a needle in his arm when you arrive. His pupils are pinpoint, and he is breathing 4 times per minute. You are preparing to administer naloxone. At this point opioid overdose is your initial:
a. Differential diagnosis b. Primary diagnosis c. Terminal diagnosis d. Working diagnosis |
A.
This initial diagnosis is based on your global patient assessment and general impression As additional historical, physical exam, and diagnostic findings are obtained. you'll rule out and rule in various possible, differential diagnoses until a working diagnosis is determined. |
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An 18 year old male has a tonic-clonic seizure. Co- workers report no known seizure activity. You can arouse him to voice P118, R 20, BP 102/68. The diagnostic test most likely to arrow your differential diagnosis would be:
a. 23 lead ECG b. Blood glucose analysis c. End tidal CO2 measurement d. Pulse oximetry |
B
While pulse oximetry may be useful, obtaining end-tidal CO2 measurement and a 12 lead ECG are non essential treatment interventions with this critical patient. Seizure activity utilizes significant adenosine triphosphate (ATP) energy and glucose, so obtaining a baseline blood glucose level is essential. |
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A 23 year old female has an acute onset of left flank pain. You should investigate which of the following regarding her pain?
a. Dysuria b. Fever with productive cough c. Increase in appetite d. Syncopal episodes |
A
Dysuria is the most significant associated complaint relative to the left flank pain complaint. Fever, changes in appetite, and syncope would be key symptoms in complaint of dyspnea, abdominal pain, or alterations in mentation. |
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When you use an interpreter to question a 42 year old female about her abdominal pain, what is the best way to ensure information has been conveyed accurately and completely?
a. Ask the interpreter to have the patient repeat back key information about your treatment plan to ensure understanding. b. Have her husband interpret because it will save time, as he will know a significant amount of her history. c. Let the patient write her answers, and have the interpreter restate them so you will have a record of her statements for your report. d. Wait until you arrive at the hospital to find an interpreter to ensure an accurate interpretation of key findings. |
C.
Restarting and summarizing the discussion is essential to clarity and decrease the likelihood of misinterpreting information during verbal communication, especially when a share language is not spoken. Written documentation should include statement made by the patient, noting they were interpreted by a third party. |
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After you ensure scene safety, your highest priority is to:
a. Form a working diagnosis b. Form a differential diagnosis c. Determine the root cause or the patent's problem d Rule out immediate life threats. |
D.
Once your safe to evaluate the patient you must next form a general impression and take a primary survey to determine whether the patients presentation identifies as a life threat, potential life threat, or non-life threat. If a life threat is identified, immediate intervention would be initiated. |
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Which of the following physical findings points to specifically to increased intracranial pressure:
a. BP 200/60 mm Hg b. Both pupils are 5 mm and react sluggishly to light c. Glasgow Coma scale score is 7 d. Respiratory rate is 8 and irregular. |
D.
In the secondary survey, obtaining historical physical exam and diagnostic information and initiating treatment interventions are based on the emergent or non-emergent status of the patient. These assessments components are dynamic and doesn't necessarily follow a rigid format. |
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You are transferring a 65 year old female with renal failure from the nursing home. She has a history of "abnormal lab values" and is drowsy and weak. You note the following lab values: Serum calcium 10.0 mg/dl (0.55 mmol/L), pH 7.28 potassium 6.1 mEq/L. The patient goes into cardiac arrest after you load her into the ambulance. After epinephrine, you should first consider giving her:
a. Calcum Chloride b. Lactated ringers bolus c. Magnesium sulfate d. Sodium bicarbonate |
C.
CLINICAL DECISION MAKING is the ability to integrate diagnostic data and assessment finding with experience and evidence based recommendations to diagnose and treat the patient to improve outcomes. The cardinal presentation is the most significant presenting symptoms or patients complaint. The AMLS pathway is a framework for using an assessment base approach to patient care. |
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Which of the following describe a behavior that represents normal mental status? A person who:
a. Ask you repeatedly what day of the week it is. b. Does not respond when you call her name but pushes your hand away when you perform sternal rub. c. Is drowsy & slow to respond to question after awakening from a nap. d Is oriented to person, place & time and has voices telling her she is evil. |
C.
Answer c is correct because the patient responds after a normal event with appropriate answers, this patient would need to be evaluated for continued drowsiness. Answer A is incorrect because repetitive questions suggest altered mental status and a disruption of short term memory. Answer B is incorrect because deep pain is required to elicit a response of localizing pain; this is indicative of altered mental status. Answer D is incorrect because the patient is demonstrating auditory hallucination a disturbance of perception. Care should be taken with this person as the behavior may be unpredictable and unsafe. |
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Which assessment evaluates at least one aspect of cranial nerve function?
a. Blood glucose analysis b Cincinnati Pre-hospital Stroke Scale c. Glasgow Coma Scale d. Mini-mental status evaluation. |
B.
Only the Cincinnati Preshopital Stroke Scale assesses cranial nerves. Cranial nerve VII is evaluated when the patient is asked to smile or show his teeth. |
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A 72 year old male had a syncopal episode in church. He is now awake but confused. His wife said that he has been complaining of a headache for about a week. He has early Alzheimer's disease Home medicines include Lipitor & Exelon
(Rivastigmine) Which of he following questions may help narrow your differential diagnosis? a. Did he fall and hit his head recently? b. Does he have any allergies? c. Did he take his prescribed medication this morning? d. When was he diagnosed with Alzheimer's disease? |
A.
The best answer is A because it rules in or out trauma as a possible cause. Confirming the presence of allergies is important but not likely a factor that assists with the differential diagnosis in this setting. Although its important to confirm the patient is compliant with his medications, missing one dose of either of these medications is unlikely to cause a syncopal incident. The onset of Alzheimer's is useful information but its not vital in generating an initial differential diagnosis. |
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A 56 year old female experiences a sudden onset of headache and burred vision during yoga class. Her right eyelid is dropping, the pupil on that wide is small compared to the left pupil. You should take her to the hospital with a:
a. A STEMI center b. Ohthalmology surgical capability c. Psychiatric specialist d. Specialized neurologic & vascular capability |
D
The best answer is D because this patient is showing signs and symptoms of a possible stroke. It would be best to transfer the patient to a stroke center or a facility with specialized neurologic and vascular capabilities. |
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A 32 year old complains of headache and dizziness. He vomited one & is walking with a staggering gait. His blood pressure is 148/72, pulse 92, respiration 20. He is a steady stare up toward his right ear. Which sign or symptom makes you consider intracerebral hemorrhage more strongly than migraine headache as a cause of his emergency?
a. Abnormal gaze b. Blood pressure c. His age d. Dizziness and vomiting |
A
The abnormal gaze & pupil size are strong indicators of a intracerebral hemorrhage. Migraines tend to cause disturbances in vision but not changes in gaze or pupil size. The key finding for intracerebral bleeds or hemorrhage are alteration in vital signs, altered LOC, stiff neck or headache, focal neurologic deficits, difficulty with gait and fine motor control nausea, vomiting, dizziness or vertigo, or abnormal eye movements. Migraine headache are severe , recurrent headache accompanied by incapacitating neurologic symptoms such as cognitive or visual disturbances dizziness, nausea, and vomiting. The headache may be either unilateral or bilateral. The eyes usually do not deviate, but the patient may complain of photophobia, flashing lights, phonophobia, or zigzagging lines in the visual field. Migraines tend to occur in younger people, but intracerebral bleeds can occur in any age group. |
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Which is the most reliable indicator that ventilation should be assisted in a patient with altered mental status?
a. Blood glucose is 600 mg/dl b. End tidal CO2 is 60 mm/Hg c. Glashow Coma scale score is 10 d Oxygen saturation is 80% |
B
A patient with an end-tidal co2 should have ventilations assisted to bring EtCO2 readings down to 40 mm Hg. Supplemental oxygen should be applied to return the oxygen saturation to at least 95%. Simply adding oxygen may increase the o2 sats but, if this doesn't improve them, ventilatory assistance may be necessary. If a patient with a Glasgow Coma score of 10 is ventilating and oxygenating adequately assisting ventilation is not required A patient with an elevated blood sugar may be acidotic due to diabetic ketoacidosis and ventilation may be used, but an elevated blood sugar in itself is not a reason for ventilation. |
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A 24 year old male complains of sudden explosive headache. He ask you to lower the lights. He has vomited once. which of the findings would increase your index of suspicion for subarachnoid hemorrhage?
a. Bradycardia b. Hypertension c. Pupil dilation d. Stiff neck |
D.
A stiff neck in the presence of sudden onset of an explosive headache is consistent with a subarachnoid bleed. The stiff neck is associated with irritation of the meninges, from the bleeding. |
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Which of the following findings indicates the need to increases the rate of ventilation in an intubated patient you suspect to have an epidural hematoma?
a. Flexion to painful stimulus b. Hypotension c. Positive Babinski sign d. Unilateral blown pupil |
D.
A pupil that's dilated, fixed or slow to respond on the same side of the injury may indicate herniation due to increased intracranial pressure. The classic symptoms of an increasing herniation are coma, fixed and dilated pupil and decerebrate posturing. |
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A 25 year old helmeted female was thrown from a horse. She is complaining of weakness in her upper extremities. You ask her to close her eyes and identify whether you are moving her thumb up or down. She is unable to do so. This indicates that she does not have normal:
a. Fine motor movement b. Proprioception c. Sense of touch d. Spinal accessory nerve function. |
B.
Proprioception is information that comes to the brain from the body to help determine where the body is in space. She may still be able to feel but can't identify the position of her thumb. |
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A 44 year old male is postictal after a witnessed grand mal seizure. He is arousable to light pain and is presently snoring. His vital signs are BP 142/86, P120, R20, Sa02 98%. You should:
a. Assist ventilations with a bag mask. b. Insert a nasopharyngeal airway c Prepare to intubate his trachea d. Place in supine position. |
B.
Inserting a nasopharyngeal airway is the best answer, since this patient is likely to recover his level of consciousness. The nasal airway will help maintain his airway, but more invasive techniques are indicated at this time He doesn't need intubation at present. Placing him in a supine position puts him at risk for aspiration and potentially increases the difficulty of managing his airways. He's breathing and has adequate oxygen saturation so ventilation is unnecessary at this time. |
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Which of the following is not likely to impair ventilation?
a. Anaphylaxis b. Carbon monoxide poisoning c. Congestive heart failure d. Pneumonia |
A.
Ventilation is movement of air into and out of the lungs. Airway swelling and bronchoconstriction related to anaphylaxis an obstruct airflow and impair ventilation. |
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Which sign or symptom indicates impending respiratory failure in a patient who is having an asthma attack?
a. End tidal C02 32 mm/Hg b. Increased respiratory rate c. S3 heart sounds d. Sleepiness |
D.
Fatigue is an indication of respiratory failure. All other signs may be present during an asthma attack without respiratory failure. |
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A 65 year old female has progressive onset of dyspnea over several days. Her temperature is 102.2 degrees F ( 30 degrees C) Her prescription mediation include Accupril, Spironolatone Lanoxin, Ipratropium, and Salbutamol. Which of the following would be included in your differential diagnosis?
a. Pneumonia b. Pulmonary edema c. Spontaneous pneumothorax d. Status asthmatics |
A.
Pulmonary edema is more likely to present with a sudden onset, no fever, and bilateral lung findings Status asthmaticus is more likely to include generalized wheezes and no fever. Pneumothorax is characterized by sudden onset and abswent breath sounds; fever is unlikely. |
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Which diagnostic test will quickly detect poor ventilation?
a. Capnography b Carbon monoxide sensors c. Chest x-rays d. transcutaneous oxygen saturation |
A.
Capnography assesses carbon dioxide levels, which measure ventilation. Carbon monoxide detectors measuring carbonxyhemoglobin levels in the blood . Chest x-ray assess structural changes in the lung. Oxygen saturation measures oxygen levels in the blood. These levels may decline with a severe decline in ventilation, but this occurs slowly. |
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A patient present with fever, sore throat, and a swollen lower jaw. Which should be included in your differential diagnosis?
a. Foreign body airway obstruction b. Laryngotracheobronchitis c. Ludwig's angina d. tonsillitis |
C.
Fever and swelling do not accompany FBAO The jaw is not swollen in tonsillitis.. Laryngotraheobronchitis (croup) is found in children |
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A 62 year old male has a sudden onset of dyspnea after a bout of coughing Lung sounds are diminished on the right side. which element of his past medical history would help confirm the diagnosis of spontaneous pneumothorax?
a. Heroin abuse b. Pneumonia with 5 years c. Tobacco smoker d. treatment with warfarin |
C
Tobacco use is strong associated with spontaneous pneumothorax |
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Which sign or symptom may develop as a result of pulmonary embolism, OPD, or pulmonary hypertension?
a. Bradycardia b. Jugular venous distention c. Rhonchi d. Right heart strain or right axis deviation |
B
Right heart failure can develop as a consequence of each of these disease processes. |
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You have administered albuterol and parenteral epinephrine to a 21 year old female who is having an asthma attack. Her PC02 is now 55 mm/Hg. What additional treatment is indicated?
a. Apply oxygen, and allow the patients body to reverse the bronchospasm and hypercarbia. b. Coach the patient to slow her respiratory rate. c. No immediate treatment is indicated except to monitor the patient. d. Place the patient on continuous position airway pressure mask. |
A.
This indicates respiratory failure |
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A 24 year old male was diagnosed with Guillain-Barre syndrome 1 week ago. Which complication should you anticipate?
a. Hypertension b. Metabolic acidosis c. Pneumonia d. Spontaneous pneumothorax |
C.
Guillain-Barre syndrome is a respiratory disease caused by a dysfunction of the nervous system. the loss of nerve impulses to the muscles that control respiration diminish the tidal volume. Many patients have compromised immune systems. This results in an opportune condition for bacteria to grow, resulting in respiratory infections. |
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The risk of barotrauma for the asthmatic patient who is receiving mechanical ventilation increases if you decrease the:
a. Expiratory time b. Positive end expiratory pressure c. Respiratory rate d Tidal volume |
A.
The risk of barotrauma increases as PEEP and tidal volume increase . |
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A 25 year old woman was involved in a motor vehicle collision. Her initial vital signs were BP 122/80
P 128, R 20l. Which of the following findings on repeat assessment would indicate that she is developing shock? a. End tidal C02 35 mm/Hg b. Heat rate 118 bpm c. Mean arterial pressure 86 mm/Hg d. Pulse pressure 32 mm/Hg |
D
A pulse pressure deadline from 42 to 32 indicated a decrease in cardiac output. |
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Which gland is responsible for some of the vasoconstriction in shock?
a. Thymus b. Pancreas c. Pituitary d. Thyroid |
C
The anterior pituitary releases antidiuretic hormone (ADH) also known as vasopressin. This is one of the mechanism that causes vasoconstriction. |
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The primary mechanism for septic shock is:
a. Acute loss of intravascular volume b. Direct myocardial depression from endotoxin c. Suppression of normal compensatory mechanisms d. Widespread inflammatory response |
D
The inflammation causes fluid loss. |
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A 24 year old male was injured in a shallow diving accident. Which assessment finding would you anticipate if he is developing neurogenic shock?
a. Blood pressure of 102/88 b. Heart rate 58 c. Oxygen saturation 90% d. Pale, cool extremities |
B
Bradycardia, hypotension, and normal skin color and temperature are anticipated below the level of the injury. Even though his blood pressure is borderline, his pulse pressure is narrow. this is inconsistent with neurogenic shock. |
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Which intervention for a patient in shock presents an increase in myocardial oxygen demand?
a. Administer oxygen by facemask b. Maintain normal body temperature c. Place patient in trendelenburg position d. Start a vasopressor infusion |
B
If the body temperature increases, oxygen demand will increase Likewise, If the patient becomes hypothermic and shivers to compensate, oxygen demand will increase. |
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Which diagnostic test most accurately assesses the presence and magnitude of anaerobic metabolism?
a. Capnography b. Hemoglobin c. Lactic acid d. Serum potassium |
C.
Lactic acid is a by product of anaerobic metabolism. |
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Which patient is at highest risk of non-traumatic obstructive shock?
a. 6 month old with pneumonia b. 22 year old who is 38 weeks pregnant c. 45 year old female with right upper quadrant pain d. 67 year old who has black tarry stools |
B
Patients in the third trimester of pregnancy are at risk for pulmonary embolism, which is a cause of obstructive shock. |
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A 19 year old female is flushed, itchy, and wheezing after eating crab legs. Her vital signs are BP 90/64,
P 128 bpm, R24 breaths per min. Which intervention is indicated first? a. Albuterol updraft b. Diphenhydramine intravenous c. Epinephrine intramuscular d. Normal saline bolus |
C.
All the other interventions are appropriate but epinephrine is the highest priority. |
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a 62 year old male is vomiting coffee ground emesis. Which of his home medicines may make it more difficult to control his bleeding?
a. Acetaminophen b. Furosemide c. Hydrohlorothiazxide d. Plavix |
D
Clopidogrel (Plavix) is an antiplatelet agent |
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Shock related to tension pneumothorax is most directly secondary to:
a. Decreased preload b. Hypovolemia c. Hypoxemia d Pressure on the heart |
A
Blood return to the heart from the inferior and superior venae cavae is obstructed. This leads to decreased preload and consequently decreased cardiac output. |
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the most common sign or symptom found in patients with pulmonary embolism is:
a. Coughing up blood b. Crackles in the affected lung c. Increased respiratory rate d. Pleural friction rub |
C
Clot formation in the vessels causes diminished blood flow through the pulmonary circulation. Blood flow is also redirected, impacting the lungs and causing dyspnea, hypoxia, and an increase in respiratory rate. |
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A 52 year old male with a history of alcoholism complains of pleuritic chest pain. He states the pain increased when he swallows. He appears very ill & has subcutaneous emphysema around his neck. You suspect:
a. Boaerhaave's syndrome b. Choleystitis c. Esophageal varices d. Pleurisy |
A
The chronic alcoholic is at risk for forceful vomiting. This type of vomiting places the patient at risk for acute rupture of the esophagus known as Boerhaaves' syndrome. Mediastinitis, sepsis, and shock are frequent signs of this syndrome. Swallowing often aggravates the pain. Cholecystitis refers to inflammation of the gallbladder and presents with right shoulder pain. Esophageal varice typically present with dull pain and are related to portal hypertension, often associated with cirrhosis. Pleurisy is inflammation of the lining of the lungs and/or chest wall. Typical presentation has sharp pain on inhalation. |
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A 73 year old male awakens suddenly at 0200 complaining of dyspnea. You find him in the tripod position. Crackles are audible around his scapulae. He has a history of hypertension. You suspect his symptoms are related to:
a. Fluid overload b. increased cardiac output c. Let heart failure d. Reactive airway disease |
C
Left ventricular failure leads to congestion in the pulmonary vessels causing crackles. Hypertension is often an underlying etiology. Orthopnea occurs during rest or sleep and results in greater tidal volume and air exchange in a tripod or upright position. Reactive airway disease results from inflammation and constriction of the airways, such as in asthma. This presents with wheezing rather than crackles. |
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A 70 year old male suspected to have a dissecting aorta aneurysm has a blood pressure of 170/102. this sign may indicate:
a. Cardiac tamponade is developing b. Rupture of the aorta is imminent c. The aorta is not dissecting d. The renal arteries are involved. |
D
The renal arteries are off to the side of the abdominal aorta. If these arteries are blocked, this can lead to hypertension. This causes renin to be released and an increase in blood pressure to continue to perfuse the kidneys. |
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Which of the following patients is at highest risk of pericardial tamponade?
a. 55 year old with end stage lung cancer b. 62 year old dialysis patient c. 45 year old with influenza d. 72 your old who takes warfarin |
A
Fluid accumulation caused by cancerous lesions and tissue destruction and fluid leakage due to chest radiation therapy put the 55 year old patient at the highest risk for pericardial tamponde. |
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If you administer nitroglycerin to a patient with ST elevation in leads, II, II and aVF, you should be prepared to:
a. Administer a bolus of normal saline if the blood pressure drops. b. Change to morphine, as nitroglycerin is rarely successful c. Start dopamine drip If the patient becomes hypotensive d. Treat the patient for congestive heart failure |
A
Nitroglycerin will dilate coronary arteries, thus decreasing preload. It may be necessary to increase the fluid volume to increase right ventricular filling pressures. |
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A 45 year old male with a history of hypertension complains of chest "pressure" about a 5 on a scale of 1to 10, for 20 minutes. He "just wanted to be checked out" Vitals sign & 12 lead are normal. You have already administered oxygen and aspirin. You should next:
a. Administer nitroglycerin 0.4 mg sublingual b. Advise him that his ECG is normal & no further care isneeded c. Monitor and tranpsort to the hosptial for further evaluation. d. Perform a right sided ECG |
A
Nitroglycerin is administered to decrease the pain of ischemia. It can be administered if the systolic blood pressure s 90 mm Hg or above . |
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An 82 year old female complains of chest heaviness. She has sinus tachycardia. Her vital sings are BP 108/72 (equal in both arms) P 98, R 20. Her breath sounds are clear in all fields. Aside from myocardial infarction, what should you suspect her chest pain could be related to?
a. Aortic dissection b. Congestive heart failure c. Esophageal rupture d. Pulmonary embolism |
D
Chest discomfort hypotension and clear lung fields are typical presentation of pulmonary embolism. |
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A 40 year old man has chest pain reported as an "elephant sitting on my chest". He confides that he snorted cocaine 5 minutes before his pain began. You should first administer:
a. A fibrinolytic drug b. Lorzepam, 2 mg IV c. Metroprolol, 5 mg IV d. Naloxone, 2 mg IV |
B
Benzodiazepines such as Lorazepam will reduce the anxiety caused by the pain and cocaine. |
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A 65 year old female complains of chest pain that feels like "aching" in her chest. It has become progressively worse over several days. Her temperature is 101 (degrees F). Which finding will help narrow your differential diagnosis to pericarditis?
a. Pleural friction rub is audible b. Pulsus alternans is present c. S3 gallopis auscultated d. ST segment elevation in every lead. |
D
Involvement of more than one coronary vascular area is typical of pericarditis and rarely happens in a myocardial infarction. |
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Your patient complains of discomfort in his hand as you inflate the cuff to assess blood pressure. You not flexion of the wrist and adduction of his fingers. What endocrine disorder do you suspect?
a. Addison's disease b. Cushing's syndrome c. Hypoparathyroidism d. myxedema |
C
Trousseau's sign, a carpal pedal spasm in response to the inflation of he blood pressure cuff, along with hypocalcemia, bradycardia, and malnutrition are seen in hypothyroidism. Congestive heart failure, myxedema, hyponatremia, and hypoglycemia are seen in hypothyroidism. Addison's disease as seen in adrenal insufficiency and lack of cortisol production present with hypoglycemia, Hypotension, hyperkalemia, hyponatremia and emaciation. Cushing's disease which results in an excess of the production of cortisol, results in hyperglycemia, obesity, hypertension, and electrolyte imbalances. |
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A 47 year old female is anxious and complaining of heart palpitation. She reports a recent diagnosis of "thyroid problems". On exam, you notice exophthalmos. Her vital. signs are BP 108/72, P128, R 20. interventions should include administration of:
a. Amiodarone b. Aspirin c. Intravenous fluids d. Methylprednisolone |
C
Exophthalmos ( PROTRUSION OF THE EYEBALL) is a common presentation in hyperthyroidism. In this patient resultant dehydration from excess sweat and diarrhea requires aggressive IV therapy. Amiodarone can cause autoimmune destruction of the thyroid gland. Aspirin is associated with decreased protein binding of thyroid hormones and increased unbinding of T3 and T4. |
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Which assessment find should you anticipate in a patient who has myxedema?
a Chvostek's sign b. Dry, yellow skin c. Exophthalmos d. Hyperactive reflexes |
B.
Dry, yellow skin, hypotension, bradycardia and low blood sugar are typical presentation of myxedema related to hypothyroidism. Chvostek's sign hyperactive reflexes and exophthalmos are symptoms of hyperthyroidism. |
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What treatment should you anticipate in a patient with a history of Addison's disease who has the following vital signs: BP 94/58, P 124, R 20
a. Blood products b. Catecholamines c. Potassium d. Hydrocortisone |
D.
Typical clinical findings of Addison's disease are hyponatremia, hypoglycemia, and hyperkalemia. The adrenal glands are unable to produce sufficient amounts of corticosteroids to meet the body's demand so administration of steroids is necessary. If blood glucose levels are low, it may be appropriate to administer glucose. |
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What finding should you anticipate on the physical examination of a patient with Cushing's syndrome?
a. Blood glucose of 180 mg/dl b. Blood pressure 94/54 c. Heart rate 50 d. A thin face & body profile |
A.
The metabolic alkalosis associated with Cushing's syndrome causes hypernatremia hypokalemia, hypertension, and hyperglycemia. Typical presentation are obesity and facial puffiness often referred to as a moon face. A high blood glucose reading is common. |
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When serum glucose drops below 70 mg/dl, which of the following occurs?
a. Epinephrine secretion increases b. Glucagon secretion decreased c. Growth hormone secretion increases d. Insulin production increases |
A.
central nervous system dysfunction tachycardia confusion and secretion of epinephrine are typical presentations in hypoglycemia. Patients experience hypoglycemia may have a medical history of hypopituitarism and diminished growth hormone secretion. Insulin production decreases. |
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A 22 year old male complains of a 2 day history of abdominal pain. His skin is flushed, and he has a fruity odor on his breath. Assessment reveals BP of 106/50, P 128, R28, glucose 568 mg/dl. Your highest priority intervention would be to:
a. Administer glucagon IM b. Intubate his trachea c. Infuse normal saline rapid IV d. Perform a 12 lead ECG |
C.
Hyperglycemia which results in fluid shifts that causes dehydration, abdominal pain and metabolic acidosis requires fluid replacement with IV therapy. Performing a 12 lead ECG provides important diagnostic information cardiac dysrhythmias may occur. |
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Which patient would be an appropriate candidate for immediate intravenous administration of sodium bicarbonate?
a. A 22 year old who is unresponsive & breathing 8 times per minute following a heroin overdose. b. A 22 year old with anxiety, racing heart rate & tachypnea. c. A 34 year old with 4 days of nausea, vomiting and diarrhea who has shallow respiration & mild confusion. d. A 45 year old who complained of chest pain and now is in cardiac arrest & unresponsive to treatment. |
D.
Acute metabolic acidosis, as seen in prolonged cardiac-arrest resuscitation, may require the administration of sodium bicarbonate. |
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A 72 year old complains of a headache and being depressed . She also has intermittent twitching in the facial muscles and generalized weakness over the past 2 weeks. She has a medical history of Hypoparathyroidism. The ECG reveals a prolongs QT segment. During transport, she has a seizure. Which electrolyte imbalance is most likely?
a. Hypocalcema b. Hyperkalemia c. Hypercalemia d. Hyponatremia |
A.
The patients' cardinal presentation of facial twitching. general weakness, and seizure can signify hypokalemia Hypercalemia can result from thiazide diuretic, hyperthyroidism, adrenal insufficieny and hyperparathyroidism. Hyperkalemia is often seen in Addison's disease, renal failure, Rhabdomyolysis and digitalis toxicities Hyponatremia results from hyperglycemia CHF, excessive sweating and Addison's disease. |
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A 62 year old hunter was lost in a swampy area. When you begin to care for him, he is lethargic, disoriented and has a body temperature of 87.8 degrees F. His ECG shows bradycardia. What should be your treatment priority?
a. Atrophine 0.5 mg IV b. Epinephrine drip at 2 to 10 mcg/min c. Rapid rewarming d. Transcutaneous pacing |
C.
This patient suffers from moderate hypothermia, re-warming is appropriate. Atrophine, epinephrine and TCP would be contraindicated in tachycardic dysrhythmias. |
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A 33 year old male has right lower quadrant abdominal pain and vomiting. Five minutes after you administer a dose of ondansetron, he vomits forcefully. His vital signs are now BP 102/72, P 52 , R20. The alteration in his vital signs is likely related to:
a. Cardiac conduction defect b. Fluid loss c. Medication side effects d. Vagal stimulation |
D.
The vagus nerve plays a role in GI stimulation on the SA Node and AV node in the heart. |
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Your patient is complaining of cramping pain around her umbilical area that "won't let up." This is most suggestive of disease involving the:
a. Appendix b. Gallbladder c. Liver d. Ovary |
A.
Visceral pain in the peri-umbilical area often relates to the appendix, small bowel or cecum |
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A 43 year old male with diffuse abdominal pain and vomiting has yellowish discoloration of his sclera. This indicates he has excess serum:
a. Amylase b. Bilirubin c. Fibinogen d. Proteint |
B.
Jaundice occurs in patients who have excessive bilirubin. This is often seen in advanced hepatitis. |
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A 42 year old male complains of a gnawing, severe pain in the epigastric area that radiates to his back. His vital signs are Temp 102 degrees F, BP 94/68,
P 128, R24. Your highest priority intervention would be to administer: a. Metoclopramide 5mg IV b. Morphine, 2 mg IV c Normal saline 250 ml bolus d. Thiamine 100 mg IV |
C.
The patient has signs of impending shock. Fluid resuscitation has the highest priority |
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A 22 year old patient at a restaurant is complaining of abdominal pain and diarrhea. Her skin is flushed, and she feels faint. Her vital signs are: BP 98/50, P124, R24. which finding in her SAMPLER history is likely to guide your differential diagnosis for this patient?
a. Medical history includes endometriosis b. Home medicines includes Tegretol & Keppra c. Illness began about 10 minutes after eating d. She had a normal menstrual period 3 weeks ago |
C.
The sudden onset of illness may indicate allergic relation. The patient should be carefully questioned about allergies and the food she ate. |
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A 45 year old female complains of right upper quadrant abdominal pain. To help confirm your differential if you suspect cholecystitis you should:
a. Ask her to take a deep breath as you press upward into her right upper quadrant. b. Auscultate her bowel sounds c. Percuss her abdomen d. Tap her heel |
A.
Severe right upper quadrant pain that increases with a deep breath suggests gallbladder or liver disease. |
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An 18 year old, 35 kg female is vomiting copious amounts of bright red blood. The most like diagnosis would be:
a. Crohn's disease b. Esophageal varices c. Mallory-Weiss syndrome d. Peptic ulcer disease |
C.
Esophageal varices are more common in chronic alcoholics. Eating disorder an cause severe vomiting that may precipitate a Mallory-Weiss tear. |
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An 88 year old female complains of nausea, vomiting and constipation. Her abdomen is tender to palpation and appears distended. Her lungs are clear, and her vital signs are: BP 104/76, P 120, R20. An action would be to:
a. Administer sodium bicarbonate 1 mEq/kg IV b. Ask her to contact her personal physician in the morning c. Infuse normal saline at 250 ml/h d. Suggest an enema to relieve the pressure of her stool |
C.
Visual observation and physical exam indicate fluid loss. Immediate treatment would be IV therapy with normal saline. |
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A 45 year old male complains of severe epigastric pain radiating to his back. He has vomited several times. His history is significant for alcohol abuse and hypertension. You suspect an inflammatory condition of a gastric accessory organ. To confirm your differential on physical exam, you should assess for:
a. Blood in the stool b. Psoas sign c. Trey Turner sign d. Pain when the leg is extended. |
B.
Cullen's sign is an indicator of hemorrhagic pancreatitis. |
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When assessing your patient's medication history which would indicate the patent may have a pre-existing ulcer?
a. Atrophine b. Diphenhydramine c. Famotidine d. Tegretol |
C.
Famotidine (Pepcid) is prescribed for stomach and duodenal ulcers to decrease pain and heal inflammation. |
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Which agency oversees the compliance, tracking and reporting, as well as guidelines for preventing transmission of blood borne pathogens in the workplace?
a. Dept of Public health b. Food and drug administration c. The center of disease control & prevention (CDC) d. Department of Labors (OSHA) |
D
The Department of Health ensures the federal regulations are implemented and monitored at the state level. The US Food & Drug Administration (FDA) ensures the safety of prescription medication and over the counter drugs and medical devices. The center for disease control (CDC) monitors epidemiology on the international level and is responsible for tracking and improving outcomes related to infectious diseases. The Occupational Safety & Health Administration (OSHA) specifies personal protective equipment (PPE) for professionals and oversees compliance inspection, tracking of exposure and post-exposure reports of airborne and blood borne pathogens. |
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You are treating a patient who has been diagnosed with Herpes simplex type 1. He exhibits no sign or symptoms at this time. He is in what state of the communicable disease?
a. Latent disease b. Incubation period c. Communicability period d. Disease period |
A
During that latent stages of a disease the infection is inactive but still communicable. The intubation period ranges for hours to years during which the pathogen may be responding but not causing signs or symptoms The communicable period comprises the period when the infection can be spread to another person. The disease period begins with the onset of symptoms or disruption of normal body function. |
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Which of the following is an occupational exposure incident?
a You notice blood spattered on the intact skin on your forearm after a call. b You stick your finger on a contaminated lancet at your brothers house c. Blood spray in your face when a child with face a face laceration sneeze d. A patient you cared for is reported to be HIV positive. |
C
An exposure incident is specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious material that results from the performance of a healthcare workers duties. |
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Antibodies produced by lymphocytes provides what type of immunity?
a. Humoral b. Cell-mediated c. autoimmunity d. Artificial |
A
Cellular immunity is a direct attack on pathogens by lymphocytes and other cells. Autoimmunity is an abnormal immune response again the body's own proteins or tissues. |
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Hepatitis A (HAV) is transmitted by which route?
a. Airborne b Droplet c. Oral-fecal d. Bloodborne |
C
Hepatitis A is typically found in the feces of infected people. It replicates in the liver but doesn't damage the liver. Unlike other hepatitis infection HAV is not transmitted by droplets airborne or blood borne routes. |
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The best measure you an take to reduce your risk of acquiring hepatitis D from an occupational exposure is to:
a. Be vaccinated b. Get immune globulin if you have an exposure c. Take post-exposure drugs as prescribed d. Use standard precautions |
D
There is no immunization or post exposure prophylaxis to protect against hepatitis |
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Which sign or symptom can help diagnose headache from meningococcal meningitis?
a. Fever b. Light sensitivity c. Petechial rash d. Stiff neck |
C
The rash related to viral meningitis is red and flat. |
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A patient infected with which disease should be assessed for pneumonia encephalitis and myocarditis?
a. Infectious parotitis b. Pertussis c. Rubella d. Rubeola |
D
Rubeola is associate with many complications. |
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While treating a trauma patient, you lacerate your hand. Your bleeding hand comes into contact with the blood of the patient. What action is most important to increase your chance of appropriate follow up.
a. Ask the patient if they are infected with HIV, Hepatitis B, or Hepatitis C b. Complete an incident resort, and contact your Chief officer the next business day c. Make an appointment to see occupational health within 1 week d. Notify the receiving facility and your designated infection control officer immediately |
D
Immediate reporting is essential or prompt source- patient testing and prophylaxis administration. Refer to agency and local protocols for direction. |
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Your adolescent patient present with fever, malaise sneezing and paroxysmal spasmodic coughing phase. Which infectious disease would you suspect?
a. Tuberculosis b. Rubella c. Pneumonia d. Pertussis |
D
Pertussis is bacterial infection characterized by a whooping cough or spasmodic, paroxysmal coughing phases. |
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Your patient is agitated and sweaty. Her vital signs are BP 170/108. P 132, R 20. Her pupils are dilated, and her hands are trembling . These signs and symptoms may be associated with:
a. Alcohol withdrawal b. Carbamates c. Diazepam d. Tramadol |
A
This is consistent with the sympathomimetic toxicdrome. |
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Which source provides the most detailed information related to hazardous materials?
a. Location of the emergency b. Material safety data sheets c. pictographs d. Placards |
B
The material safety data sheet (MSDS) is a comprehensive reference or hazardous material. It includes information on routes of entry, health effects, first aid, firefighter measures, handling, storage, exposures, and the chemical and physical properties of hazardous substances. |
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A 2 year old male is found chewing on berries from a lily of the valley plant. Predict his vital signs.
a. BP 130/72, P 128 b. BP 100/60, P 100 c. BP 70/50, P 128 d. BP 70/50, P 70 |
D
The digitalis-like properties of this plant causes bradycardia. |
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A 24 year old female took 24 diphenhydramine tablets. Her vitals signs are BP 86/54, P 110, R 20. What other signs or symptom should you anticipate?
a. Drooling b. Pale skin c. Pinpoint pupils d. Seizures |
D
Benadryl overdose signs and symptoms include dry mouth, fever, ringing in the ears, sleepiness, blurry vision, large pupil and the potential for seizures. |
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The family of a 72 year old male is worried about their father. His blood glucose is 80 mm/hg. His rate and depth of breathing are increased and he is sleepy and weak. He takes metformin. You suspect his sign and symptoms may be related to:
a. Diabetic ketoacidosis b. Hyperosmolar hyperglycemic nonketotic coma c. Lactic acidosis d. Pulmonary embolus |
C
Metabolic acidosis related to metformin is associated with high mortality. |
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A farmer was spraying his barn when he became ill. His heart rate is 60 bpm, and his blood pressure is 88/50. Tears are streaming down his cheeks, and he is vomiting. What toxidrome does this clinical picture fit?
a. Anticholinergic b. Cholinergic c. Opioid d. Sympathomimetic |
B
Anticholinergic drugs causes ataxia, decrease production of mucus, dry mouth and perspiration. Cholinergic medications cause an increase of secretions in the saliva, tears and digestive acids. Sympathomimetic are used in decongestants to decrease histamine responses. |
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Which of the following biological warfare agents causes serious neurologic symptoms that may include paralysis?
a. Botulism b. Plague c. Ricin d. Viral hemorrhagic fever |
A
Clostridium botulinum is a nerve toxin. |
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A 22 year old female is found at a party unresponsive and breathing approximately 8 times per min. Her skin is gray. Which of the following signs or symptoms will confirm your suspicion that the opioid toxidrome is causing her emergency?
a. Blood pressure 170/110 b. Pupils 2 mm & equal c. QRS duration is 0.24 seconds d. Tremors are present |
B
Pinpoint pupils are consistent with opiate toxicdrome Establishing adequate ventilation is the first priority. |
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Your patient is reported to have taken an overdose. She has a history of anxiety disorder and depression. She is unresponsive and vital signs are BP 100/70, P 128, R 20. Her ECG shows right bundle branch block. You suspect she has taken:
a. Amitriptyline b. Lorazepam c. Paroxetine d. Quetiapine |
A
Tricyclic antidepressant overdose causes that characteristic ECG change with tachycardia |
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You respond to a warehouse for "multiple patients with difficulty breathing" From a hallway, you see your patient lying in a room with two other people who don't seem to be breathing. He calls out to you saying he can't breathe. You should first:
a. Administer oxygen by non-rebreather mask b. Drag him out of the room c. Examine the shipping papers d. Stage at a safe distance |
D
Do not enter until appropriate authorities deem it is safe. |
