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155 Cards in this Set
- Front
- Back
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A seizure that remains confined to a limited portion of the brain, causing localized dysfunction, is a(n) ________ seizure. |
partial |
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Acute exacerbation of Addison's disease can lead to ECG changes and cardiovascular collapse as a result of:
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electrolyte imbalance and low blood volume secondary to potassium retention and sodium excretion. |
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Your patient is a 68-year-old male complaining of difficulty breathing for the past 2 days. He is sitting up, conscious, alert, and oriented and appears to be in mild respiratory distress. Physical examination reveals cool, dry, pink skin; he is thin with well-defined accessory muscles, and you note diffuse wheezing to all lung fields. HR = 102, BP = 136/96, RR = 20, SaO2 = 92%. The patient gives a 20-pack-a-year history of smoking. Based on these clinical exam findings, which of the following is most likely?
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Emphysema
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Your patient is a 45-year-old type I diabetic complaining of a 5-day history of abdominal pain, nausea/vomiting, and increased urination and thirst. His skin and mucus membranes are warm and dry. HR =112 bpm and regular, BP = 94/60, RR = 12 and regular. Your treatment for this patient would most likely include: |
IV of NS 1-2 L. |
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Hypothermia in a near-drowning victim can have protective effects on organs and tissues because: |
hypothermia slows metabolism, decreasing oxygen requirements.
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Which of the following diseases is characterized by a progressive degeneration of he nerve cells that control voluntary movement, weakness, loss of motor control, difficulty speaking, and cramping? |
Amyotrophic lateral sclerosis
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Why is the oxygen-hemoglobin dissociation curve curved and not linear?
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Hemoglobin and oxygen undergo cooperative binding, making it easier for each additional oxygen molecule to bind to hemoglobin. |
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Your patient is a 24-year-old female with a history of asthma . She is in severe respiratory distress. She states that she started having difficulty breathing 6 hours ago that initially responded to her albuterol and Atrovent metered dose inhalers (MDI). However, her breathing has worsened over the past 4 hours and is not responsive to her MDIs. She can speak in 4- to 5-word sentences. Her skin is pale and diaphoretic, and she is using accessory muscles, has expiatory wheezing in all lung fields, and diminished air movement in the bases. HR = 142, BP = 132/78, RR = 30, SaO2 = 88%. In addition to 100% oxygen and an IV of normal saline, which of the following is the best course of prehospital treatment?
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Albuterol and ipratropium via nebulizer, IV corticosteroids
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Prehospital management of an unconscious patient with hypoglycemia should NOT include:
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administration of oral glucose. |
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A 68-year-old female is supine in bed at a rehabilitation hospital. She is unresponsive and has gurgling respirations. Staff reports that the patient is at the facility recovering from right hip replacement surgery performed 14 days prior and has had a worsening infection at the surgery site over the past 7 days. Staff also reports that the patient had a slightly altered mental status yesterday and was found unconscious this morning. Physical exam reveals an accumulation of secretions in her airway, lung sounds clear and equal bilaterally, and skin and mucus membranes warm and dry. You also note erythema and a purulent discharge from a surgical incision on her right hip. HR = 119 and irregular, BP = 86/58, RR = 10 and shallow, blood glucose = 864 mg/dL. Which of the following is the best treatment for this patient? |
Suction the airway, initiate BVM ventilations with 100% oxygen and an oropharyngeal airway, intubate, cardiac monitor, IV of NS 1-2 L, rapid transport.
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All of the following may cause a transient ischemic attack EXCEPT:
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intracranial hemorrhage.
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A patient tells you that she experienced an episode of involuntary "shaking" in her arm. She describes a 1- to 2-minute-long episode of muscular jerking and contracting of her entire left arm. She retained consciousness, lacked an aura, and had no pain associated with the episode. This most indicates a(n) ________ seizure. |
simple partial
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You have intubated a 66-year-old female who was experiencing an acute exacerbation of her emphysema. What special consideration does this patient, with her specific pathology, require? |
While ventilating, you must allow for a prolonged expiratory phase.
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A chemical substance that is released into the blood by a gland and that controls or affects processes in other glands or body systems is a: |
hormone.
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Your patient is a tall, thin, 34-year-old male complaining of shortness of breath. He gives a 3-day history of runny nose, sore throat, and a nonproductive cough. His shortness of breath began after a long bout of hard coughing. His skin is cool, dry, and slightly pale. Lung sounds are clear and equal bilaterally. HR = 102, BP = 136/90, RR = 16, SaO2 = 95%. Which of the following is the most appropriate course of action?
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Oxygen via nasal cannula 4 lpm
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A type II diabetic with a blood glucose of 24 mg/dL would most likely be unconscious due to:
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cerebral hypoglycemia.
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A significantly increased incidence of morbidity and mortality occurs when the body core temperature is less than:
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86°F. |
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If inhaled, which of the following chemicals would NOT form a corrosive acid or alkali in the airway?
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Dihydrogen oxide
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A 19-year-old female with difficulty breathing produces a peak expiratory flow rate of 425, indicating:
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normal ventilatory state.
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A type I diabetic patient who ________ is NOT likely to experience hypoglycemia.
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snacks on a candy bar between meals
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Which of the following should be part of the general management of a patient with altered mental status?
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IV of NS KVO
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A 36-year-old female is conscious and alert, complaining of tachycardia. The patient states that she awoke this morning and "felt my heart racing." She denies chest pain, difficulty breathing, or loss of consciousness but does have dizziness with exertion. Upon further questioning, she states that she has been experiencing frequent episodes of agitation, insomnia, poor heat tolerance, and loss of weight. Physical exam reveals exophthalmos and an enlarged thyroid gland. HR = 142 and regular, BP = 110/70, RR = 14 and regular. Appropriate treatment of this patient would include: |
100% oxygen via nasal cannula 4 lpm, cardiac monitor, IV of NS KVO, propranolol IV, dexamethasone IV.
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All of the following mechanisms compensate for hypothermia EXCEPT:
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decreased muscle tone.
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Which of the following diseases involves inflammation followed by demyelination of the brain and spinal cord nerve fibers? |
Multiple sclerosis
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A male patient with an acute exacerbation of his emphysema presents in severe distress with decreased air movement and diffuse inspiratory wheezes in all fields. HR = 132, BP = 142/88, RR = 30, SaO2 = 88%. Which of the following blood gas values is most likely?
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PCO2 of 70 torr
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A 12-year-old male is pulled from the ocean in cardiopulmonary arrest after drowning. While en route to the hospital, you auscultate lung sounds to verify that your endotracheal tube is still in place and note pulmonary edema. Which of the following BEST explains the pathology of the developing pulmonary edema?
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An increased osmotic gradient is drawing water from the bloodstream into the alveoli.
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Biologically significant quantities of ketone bodies in the blood indicate that:
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glucose is not being used as a primary energy source.
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Which of the following is a collection of genetic diseases characterized by progressive muscle weakness and skeletal muscle degeneration?
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Muscular dystrophy
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Which of the following could be expected to occur in a patient who has suffered a fresh-water drowning or near-drowning?
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Atelectasis secondary to surfactant washout and destruction
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To which of the following medications does the late phase of an asthma attack best respond? |
Cortcosteroids |
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Your patient is a 24-year-old male who has been an in-patient in a rehabilitation hospital following surgical reduction of a fractured pelvis. Staff reports sudden development of hypotension and severe respiratory distress about 30 minutes ago. There is no other significant history. Physical exam findings include cold, diaphoretic skin with peripheral cyanosis; jugular venous distension; clear breath sounds bilaterally; and vitals as follows: HR = 134, BP = 74/50, RR = 28, SaO2 = 84%. Which of the following is most likely? |
Pulmonary embolism
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Your patient is a 45-year-old, insulin-dependent diabetic complaining of weakness. He states a 5-day history of increased thirst, urination, and hunger. You note that he has warm, dry skin and dry mucus membranes. HR is 110, BP is 98/70, and respiratory rate is 20 and deep. Blood glucose is 562 mg/dL. Which of the following statements BEST describes the pathophysiology of this patient's apparent dehydration?
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Glucose is not reabsorbed by the tubule and remains in the urine, resulting in osmotic diuresis and loss of fluid volume. |
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A 61-year-old male with a 24-pack-a-year history of smoking presents with pursed-lipped breathing and shortness of breath. You note that he is thin and has florid skin and a barrel chest. Auscultation of his lungs reveals diffuse expiratory wheezing to all fields. Based on this clinical condition, what additional complication is he most likely to develop?
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Cor pulmonale
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Which of the following laws is demonstrated in decompression illness?
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Henry's
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The type of heat stroke that commonly presents in those with chronic illnesses and is characterized by hot, red, dry skin is:
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classic.
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Patients with ________ experience tremors, periodic muscular rigidity, slowed movement, and impaired balance and coordination.
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Parkinson's disease
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Your patient is a 52-year-old female who is alert, but slightly confused after a syncopal episode lasting about 1 minute. She has no complaints, and your physical exam reveals no abnormalities aside from slight confusion. She has had a stroke and has a history of type II diabetes and hypertension. HR = 100, BP = 132/84, RR = 12, SaO2=99%. Which of the following is LEASTlikely to cause the patient's episode?
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Seizure
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Which of the following statements comparing asthma and emphysema is TRUE?
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Asthma is characterized by reversible airway obstruction, emphysema by irreversible airway obstruction. |
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A patient has a fever of 105°F, irritability, delirium, tachycardia, vomiting, and hypotension. This patient is most likely experiencing problems associated with: |
thyrotoxic crisis.
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Your patient is a 37-year-old male with a history of seizures who is noncompliant with his medications. Friends at his apartment state that he had a seizure, which they describe as being generalized, lasting 3 to 4 minutes. After the seizure, he gradually became alert and oriented. On your arrival, his only complaint is of being tired and wanting to sleep. Physical examination reveals warm, moist skin and an abrasion to his lower lip. HR = 106, BP = 128/88, RR = 20, SaO2 = 98%. The patient does not wish to be transported, though you have clearly explained the risks of refusing transport in light of his noncompliance with his medication. Which of the following is the BEST course of action? |
Empathize with the patient's reluctance to be transported, try again to convince him to go, make sure he understands the risks of refusal, enlist his friends to stay and observe him, and have him sign a release.
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Your patient is a 72-year-old male with a history of emphysema. He is alert and oriented but in severe respiratory distress, able to answer only "yes" or "no" to your questions. He has had progressively more trouble breathing all day and has gotten no relief from his various metered dose inhalers. Physical examination reveals pale, cool, diaphoretic skin; pursed lip breathing; and accessory muscle use. Auscultation of his lungs reveals very little air movement with diffuse expiratory wheezing. HR = 142, BP = 146/100, RR = 30, SaO2 = 86%. As your partner is taking the patient's vital signs, you note that his head is starting to "bob." In addition to an IV of normal saline, nebulized albuterol and Atrovent, which of the following is the best course of prehospital management? |
Endotracheal intubation, ventilation with 100% oxygen, IV corticosteroids |
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A type I diabetic female patient presents with deep, rapid respirations and a fruity odor on her breath. Administration of which of the following medications would best help correct the underlying physiologic disturbance? |
Insulin
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Your patient is a 64-year-old male who is alert and oriented, and visibly upset, sitting on a bench in a shopping mall and complaining of weakness. He describes an acute onset of left-sided weakness in his arm and leg that made it difficult for him to walk. Physical examination reveals noticeable left-side weakness, PEARL, and skin warm and dry. HR = 104, BP = 132/96, RR = 12, SaO2 = 97%. Which of the following is MOST appropriate? |
100% oxygen by nonrebreather mask, blood glucose determination, transport without delay
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Which of the following laws is demonstrated in decompression illness? |
Henry's
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The type of heat stroke that commonly presents in those with chronic illnesses and is characterized by hot, red, dry skin is:
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classic. |
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Patients with ________ experience tremors, periodic muscular rigidity, slowed movement, and impaired balance and coordination. |
Parkinson's disease
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Your patient is a 72-year-old male with a history of emphysema. He is alert and oriented but in severe respiratory distress, able to answer only "yes" or "no" to your questions. He has had progressively more trouble breathing all day and has gotten no relief from his various metered dose inhalers. Physical examination reveals pale, cool, diaphoretic skin; pursed lip breathing; and accessory muscle use. Auscultation of his lungs reveals very little air movement with diffuse expiratory wheezing. HR = 142, BP = 146/100, RR = 30, SaO2 = 86%. As your partner is taking the patient's vital signs, you note that his head is starting to "bob." In addition to an IV of normal saline, nebulized albuterol and Atrovent, which of the following is the best course of prehospital management?
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Endotracheal intubation, ventilation with 100% oxygen, IV corticosteroids |
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A 61-year-old male with a 24-pack-a-year history of smoking presents with pursed-lipped breathing and shortness of breath. You note that he is thin and has florid skin and a barrel chest. Auscultation of his lungs reveals diffuse expiratory wheezing to all fields. Based on this clinical condition, what additional complication is he most likely to develop?
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Cor pulmonale |
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Your patient is a 52-year-old female who is alert, but slightly confused after a syncopal episode lasting about 1 minute. She has no complaints, and your physical exam reveals no abnormalities aside from slight confusion. She has had a stroke and has a history of type II diabetes and hypertension. HR = 100, BP = 132/84, RR = 12, SaO2=99%. Which of the following is LEASTlikely to cause the patient's episode?
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Seizure
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Which of the following is an appropriate medication to administer to a patient experiencing a migraine?
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Prochlorperazine
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Which of the following statements comparing asthma and emphysema is TRUE?
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Asthma is characterized by reversible airway obstruction, emphysema by irreversible airway obstruction. |
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A patient has a fever of 105°F, irritability, delirium, tachycardia, vomiting, and hypotension. This patient is most likely experiencing problems associated with:
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thyrotoxic crisis.
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Your patient is a 37-year-old male with a history of seizures who is noncompliant with his medications. Friends at his apartment state that he had a seizure, which they describe as being generalized, lasting 3 to 4 minutes. After the seizure, he gradually became alert and oriented. On your arrival, his only complaint is of being tired and wanting to sleep. Physical examination reveals warm, moist skin and an abrasion to his lower lip. HR = 106, BP = 128/88, RR = 20, SaO2 = 98%. The patient does not wish to be transported, though you have clearly explained the risks of refusing transport in light of his noncompliance with his medication. Which of the following is the BEST course of action?
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Empathize with the patient's reluctance to be transported, try again to convince him to go, make sure he understands the risks of refusal, enlist his friends to stay and observe him, and have him sign a release.
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A type I diabetic female patient presents with deep, rapid respirations and a fruity odor on her breath. Administration of which of the following medications would best help correct the underlying physiologic disturbance?
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Insulin |
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Which of the following statements about thermoregulation is TRUE?
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The hypothalamus uses negative feedback mechanisms to regulate body temperature.
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Which physiologic response has most likely occurred in a patient who has suffered a dry drowning?
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Laryngospasm
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A saturation diver repairing a deep sea oil platform rapidly ascends from 300 feet to the diving bell at 100 feet. He experienced an acute onset of dizziness and weakness. He has jugular venous distention and muffled heart sounds. HR = 102 and irregular, BP = 100/90, RR = 20. Which of the following is MOST likely?
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Pneumomediastinum
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A 63-year-old female with a medical history of type II diabetes presents with a 4-day history of increased urination and thirst. She called EMS this morning when she experienced a brief period of dizziness while getting out of bed. Your assessment reveals a BP of 108/60, RR of 14/min and regular, and an HR of 122 and regular. You also note that the patient is slightly confused and has warm, dry skin and mucus membranes. Based on this patient presentation, what other finding could you expect?
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Glucosuria
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Your patient is a 16-year-old male who attempted suicide. He is unconscious and apneic, lying supine on a garage floor. The family states they found the patient unconscious in the front seat of a car that was running in an enclosed garage. HR = 70, BP = 100/60, RR = 0. Which of the following is the most appropriate?
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Remove the patient from the garage, initiate BVM ventilations with 100% oxygen, intubate, and transport to a hospital with a hyperbaric chamber. |
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All of the following medications can suppress internal heat-generating mechanisms EXCEPT:
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theophylline. |
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Which of the following statements comparing pulse oximetry and end-tidal CO2 detection is TRUE?
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Pulse oximetry gives the care provider feedback on the effectiveness of oxygenation, while capnography provides feedback on the effectiveness of ventilation.
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Your patient is a 72-year-old female, alert and oriented, sitting up in bed at a nursing home. She is in mild respiratory distress. Staff describe a 4-day history of fever, malaise, and productive cough. The patient also states that she has been experiencing chills and chest pain with deep inspiration. Physical examination reveals rales and rhonchi in the right upper lobe and warm, moist skin. HR = 116, BP = 104/76, RR = 20, SaO2 = 93%. Based on the clinical exam findings, the most appropriate diagnosis would be:
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pneumonia.
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You are transporting a patient from a fire scene to the emergency department. Clinical exam findings are all within normal limits, yet your pulse oximeter is indicating an oxygen saturation of 38 percent. All of the following could contribute to this reading EXCEPT:
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carbon monoxide poisoning.
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Your patient is a 39-year-old type I diabetic male with a history of alcoholism who presents on the floor after taking his insulin and skipping breakfast. You note cool, clammy skin and a weak, rapid pulse of 108. BP = 128/92, RR = 12 and regular, SaO2 = 96%, blood glucose is 21 mg/dL. Your partner assists the patient's respirations with 100% oxygen and a BVM; oxygen saturation rises to 100%. You cannot initiate IV access after two attempts. Further appropriate treatment would include:
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glucagon 1.0 mg IM, thiamine 100 mg IM, cardiac monitor, transport.
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Which of the following explains the profound protein catabolism and gluconeogenesis associated with Cushing's syndrome?
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Cortisol is an antagonist to insulin.
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Which of the following is a risk factor for stroke?
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Atrial fibrillation
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A patient presents with a history of excessive diuresis, signs and symptoms of dehydration, and a blood glucose of 958 mg/dL but has no acetone-like odor on his breath. To which of the following can the absence of an acetone-like odor most likely be attributed?
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Insulin levels sufficient enough to allow some glucose to enter body cells
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Your patient is a 24-year-old male experiencing an acute onset of shortness of breath. Expiratory wheezing is auscultated in all lung fields. HR = 124, BP = 112/68, RR = 42. Your primary goal in managing this patient is to:
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reverse bronchospasm.
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A type of generalized seizure characterized by a rapid loss of consciousness and motor coordination, muscle spasms, and jerking motions is known as a(n):
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tonic-clonic seizure.
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Which of the following statements correctly details the difference between superficial and deep frostbite?
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Frostnip involves the freezing of epidermal tissue, while deep frostbite affects the epidermal and subcutaneous.
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Your patient is a 45-year-old female type I diabetic with a history of a nonhealing foot ulcer. On examination, you find that she lacks sensation in her foot.This is most likely due to:
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peripheral neuropathy.
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Which of the following should be suspected as a potential cause of syncope?
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All of these
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Lung perfusion depends on all of the following EXCEPT:
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an intact alveolar membrane.
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A 32-year-old female presents conscious and alert, sitting at her kitchen table complaining of dizziness and near-syncope with exertion. She describes a 4-day history of fever (104°F orally) nausea , vomiting, and diarrhea unrelieved with over-the-counter medications. Physical examination reveals dry skin and mucus membranes, lung sounds clear and equal bilaterally. HR = 131 and regular, BP = 84/60, RR = 20 and regular, SaO2 = 98%, blood glucose is 48 mg/dL. She states a history of colitis for which she takes prednisone. Further questioning reveals that she has been noncompliant with her prednisone therapy for a week because of financial hardship. The treatment for this patient should include:
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oxygen via nasal cannula at 4 lpm, cardiac monitor, 12-lead ECG, IV of NS with fluid resuscitation, 50% dextrose IV.
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A 72-year-old male is found unconscious in his front yard. His wife states that he has been working in the yard for about 4 hours. He has a bounding pulse of 50; hot, dry skin; and shallow respirations. Management should consist of all the following EXCEPT:
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furosemide IV.
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Your patient is a 59-year-old male who became ill while shopping for antiques with his wife. Your general impression is that the patient is awake but does not respond to your presence, has peripheral cyanosis, and is making weak, rapid respiratory effort but moving very little air. Which of the following should you do next?
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Begin bag-valve-mask ventilations.
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In which of the following events is the primary issue decreased lung perfusion?
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Pulmonary embolism
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A hyperresponsive airway is likely to be in all of the following conditions EXCEPT:
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pulmonary embolism.
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Which of the following statements about pulse oximetry is FALSE?
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Pulse oximetry values can be expected to decrease within seconds in cases of developing hypoxia.
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Your patient is a 32-year-old female who is alert but in significant distress, complaining of a migraine. She has a history of migraines, describes a gradual onset of headache this morning, and is now experiencing nausea and intense throbbing pain behind her temples. She is lying on a couch in a dim room and keeps her eyes closed while talking to you in a low voice. HR = 100, BP = 148/100, RR = 12, SaO2 = 99%. Which of the following is MOST appropriate in the prehospital management of this patient?
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Provide a calm, quiet environment and transport
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A common site of arteriovenous malformation and aneurysm in the brain is the:
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Circle of Willis.
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You are presented with a 72-year-old male patient who is conscious and alert, but a bit lethargic. The patient's daughter called EMS today because she has noticed her father becoming noticeably more lethargic, unemotional, and easily fatigued over the past 2 months. She also states that he has had a decreased appetite and has gained weight over the same period. When asked about any complaints, the patient only says, "I'm constipated and always cold." Which of the following additional signs and/or symptoms would be consistent with this patient presentation?
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A puffy face, an enlarged tongue, and pale, doughy skin
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Improving ________ is a primary treatment goal in a patient with bronchospasm.
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ventilation of the alveoli
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Which of the following does NOT indicate increased intracranial pressure?
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Hallucinations
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All of the following are considered risk factors that predispose individuals to environmental illness EXCEPT:
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gender
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Your patient is a 30-year-old male who is alert and oriented. He does not appear to be in respiratory distress, but after lifting a heavy box he complains of acute onset of shortness of breath associated with sharp, right-sided chest pain. HR = 100, BP = 122/76, RR = 16, SaO2 = 94%. Physical examination reveals cool, slightly pale, and diaphoretic skin. Which of the following is the MOST likely finding upon auscultation of the lungs?
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Decreased lung sounds at the apex on the right side
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Your patient is a 32-year-old male who has been putting a new roof on his garage in unseasonably warm spring temperatures. He complains of weakness, is conscious, is sweating profusely, and has rapid, shallow breathing and a weak, rapid pulse. He is most likely suffering from:
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heat exhaustion.
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Which of the following measures is important in preventing hyperthermia?
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Drinking adequate amounts of plain water
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In a patient who has suffered a near-drowning, you could expect to find all of the following EXCEPT:
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death within 24 hours.
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Which of the following is NOT a modifiable risk factor for Type II diabetes?
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Heredity
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Your patient is a 62-year-old female who is alert and oriented, sitting at her kitchen table. Her husband describes an episode of slurred speech and facial drooping that lasted about 10 minutes and resolved just before your arrival. Physical examination is unremarkable. She has no significant medical history and takes no medications. HR = 78, BP = 134/78, RR = 12, SaO2 = 99%. Which of the following is most likely?
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Transient ischemic attack
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During a domestic disturbance, your patient experienced a sudden onset of violent, bizarre movements of the extremities followed by unresponsiveness to verbal stimuli. On your arrival, the bizarre movements begin again but stop suddenly when you firmly say, "Stop!" This most indicates ________ seizure.
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pseudo
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You are caring for a 62-year-old female patient experiencing a sudden onset of unilateral facial drooping and confusion. Other findings that could be expected in this patient include all of the following EXCEPT: |
polyphagia.
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Your patient has a history of epilepsy and is experiencing loss of consciousness, tonic-clonic muscle activity, and erratic ocular movement. Based on this, you might also expect to find all of the following EXCEPT:
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pinpoint pupils.
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The fundamental thermoregulatory difference between fever and heatstroke is that fever is caused by:
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pyrogens.
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Secretion of glucagon from the pancreas results in hepatic ________ and a subsequent ________ of blood glucose.
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glycogenolysis, increase
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Your patient is a 44-year-old female, alert and oriented, in moderate distress, and complaining of difficulty breathing. She gives a 1-week history of fever and malaise, with shortness of breath developing 3 days ago. She also has left-sided chest pain with deep inspiration and a "phlegmy" cough. Physical examination reveals hot, pale, dry skin and rhonchi and rales throughout the left lung. The right lung sounds are clear. HR = 134, BP = 88/64, RR = 24, SaO2 = 92%. She has a history of two previous mycocardial infarctions and takes nitroglycerin as needed. Which of the following is the best course of prehospital management?
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Oxygen via nonrebreathing mask 15 lpm, IV of NS with fluid challenge |
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A diver was forced to ascend rapidly from 100 feet to the surface when he ran out of air. He now presents lying on the floor of the boat in the fetal position, complaining of pain to his abdomen. He states that he exhaled the entire way to the surface. He is most likely suffering from:
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decompression illness. |
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A saturation diver on a deep sea construction barge rapidly ascends from 300 feet to the diving bell at 100 feet. You might expect all of the following diving emergenciesEXCEPT:
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nitrogen narcosis.
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You are transporting a male patient to the hospital for an evaluation after a possible seizure when you notice the patient's loss of consciousness. His muscles start to contract so that he is arching his back. This best describes the ________ phase of a generalized seizure.
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hypertonic
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Which of the following is LEAST likely to be detrimental when treating a stroke patient?
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IV of lactated Ringer's solution
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With a core temperature of 28°C (82.4°F), a patient will display all of the following signs or symptoms EXCEPT:
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absence of reflexes and response to painful stimuli
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Which of the following best explains why, compared to type I diabetes, untreated type II diabetes typically presents with lower blood glucose levels in hyperglycemia and fewer metabolic disturbances?
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There is adequate insulin production in type II diabetes to allow for glucose use and prevent ketoacidosis.
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A 72-year-old female has a 1-week history of 101°F fever, chills, and dark brown sputum production. She also has rhonchi and rales throughout her right lung. If this condition is left untreated, it could result in:
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septic shock.
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A 24-year-old male is supine on the floor and unconscious with snoring respirations. You note a weak, rapid pulse and cool, diaphoretic skin. HR = 124 and regular, BP = 136/88, RR = 8 and regular. Blood glucose is 24 mg/dL. After manually opening the airway, which of the following is the best sequence of actions?
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Assist ventilations with a bag-valve-mask and supplemental oxygen, IV of normal saline at a keep-open rate, 25 gm dextrose, IV.
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Which of the following statements about pyrexia is TRUE?
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Pyrexia is an increase in metabolism to provide a less hospitable environment for pathogens.
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A 34-year-old female, conscious, alert, and oriented, is complaining of a 3-week history of increased appetite, weight loss, weakness, insomnia, and poor heat tolerance. Her husband states that over the same period she also has frequently been agitated and prone to mood swings. Based on these signs and symptoms, which of the following best describes the additional findings you could expect?
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Exophthalmos and goiter
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Which of the following patients is at risk for the most common cause of upper airway obstruction?
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21-year-old female unconscious and supine on the floor
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An athlete is competing in a marathon on a very hot, humid day and is sweating profusely. To prevent dehydration, he has been drinking 24-30 oz of water an hour as advised by his coach. By doing this, he is increasing his risk of:
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hyponatremia.
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A medical condition caused or exacerbated by the weather, atmospheric pressure, or similar factors is a(n) ________ emergency.
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environmental
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Your patient is a 23-year-old female in moderate respiratory distress, complaining of difficulty breathing. She describes an acute onset of shortness of breath 15 minutes ago that has been getting progressively worse and has not responded to her Atrovent inhaler. Physical examination reveals cool, pale, and diaphoretic skin and clear lung sounds bilaterally. She has a history of asthma, is a smoker, and had breast-reduction surgery yesterday. Medications include Atrovent and albuterol inhalers and birth control pills. HR = 129, BP = 110/60, RR = 26, SaO2 = 91%. In addition to 100% oxygen, which of the following is the most appropriate treatment?
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IV of NS at a keep open rate
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A 44-year-old female is alert and in no apparent distress, complaining of malaise and cramps. The patient has been working in a hot attic all morning without rest or water. She now feels weak, is experiencing dizziness with exertion, and has cramping to her arms and legs. Physical examination reveals warm, moist skin. HR = 98, BP = 114/78, RR = 12. Which of the following best describes her symptoms?
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Mildly dehydrated and hyponatremic
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Your patient is a 48-year-old female who is alert and oriented after a possible seizure. Her friends state they witnessed her slump to the floor and "shake" for about 15 seconds. She awoke in less than 1 minute and was "a bit groggy" for a few minutes. She does not believe she had a seizure, but thinks she may have fainted. Which of the following questions is LEAST important when differentiating seizure and syncope?
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"Are you allergic to any medications?"
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Your patient is a 64-year-old female who is wet and shivering after a fall through the ice on a shallow pond. She is alert, but her speech is slightly slurred. The patient has no signs of injury, but her skin is very cold and wet. Vital signs: HR = 118, BP = 116/78, RR = 16. After removing the patient's wet clothing, placing her supine, using warm packs, and using blankets to prevent further heat loss, which of the following is the appropriate temperature (in degrees F) for IV fluids administered to the patient?
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95°-100°
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Valium would be LEAST likely to impact the cause of ________ seizures.
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pseudo
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An alteration in mental status that comes on abruptly, may have a life-threatening underlying cause, and can be reversed with proper treatment best describes which of the following conditions?
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Delirium
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Which of the following may occur when unacclimatized climbers ascend rapidly to altitudes of 6,600 feet or greater?
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Acute mountain sickness
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Your patient is a 55-year-old male cab driver who was found unresponsive in the driver's seat of his vehicle, which has been parked in front of a hotel for about 45 minutes. The patient is unresponsive to painful stimulus; has snoring respirations at 12 per minute; is cool, pale, and diaphoretic; and has a heart rate of 58 and a blood pressure of 170/104. Which of the following does NOT help when determining the underlying cause of the patient's condition?
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Pulse oximetry
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Your patient is a 23-year-old male in an alcohol treatment facility who is having tonic-clonic motor activity that began 15 minutes ago. The patient has no history of seizures, and one of the counselors cautions you that this patient would probably do anything to get out of rehab and that he might be faking the seizure. Which of the following findings is LEAST reliable when determining the authenticity of the patient's seizure? |
Dropping his hand above his face to see if he avoids letting it hit him
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A 16-year-old female with a history of diabetes is found unconscious in a high school bathroom following volleyball practice. She is tachycardiac; has cool, clammy skin; and is lethargic, slightly combative, and very confused. She is most likely experiencing:
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hypoglycemia.
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Which of the following is NOT a possible precipitating factor of thyrotoxic crisis?
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Cold environment
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Management of a patient who is hyperventilating should include: |
the administration of oxygen and "coaching" the patient to reduce the rate and depth of ventilations.
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A series of two or more generalized motor seizures without an intervening period of consciousness is/are known as:
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status epilepticus.
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You are presented with a 42-year-old male patient who is supine on the floor, responsive to pain only. His wife states that he has been extremely depressed recently and had talked about suicide the night before. PE reveals hot, dry skin; pupils dilated and reactive to light bilaterally; and vomit around his mouth. HR = 138 and regular, BP = 82/52, RR = 16 and shallow. Temperature via tympanic thermometer is 105.5°F. The patient's wife states a medical history of hypothyroidism for which he takes Synthriod. Your partner suctions the airway and initiates BVM ventilations with 100% oxygen and an oropharyngeal airway. Further treatment for this patient should include:
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endotracheal intubation, cardiac monitor, IV of NS, fluid resuscitation, propranolol IV, transport.
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A 63-year-old female with a history of hypothyroidism presents in a stuporous state, responsive only to pain. Physical exam reveals thin hair, a puffy face, an enlarged tongue, and very cold, doughy skin. Her heart rate is 100 and regular, RR is 10 and regular, BP is 90/62, and temperature of 86°F via a tympanic thermometer. Your treatment of this patient should NOT include:
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active rewarming.
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Your patient is a 55-year-old male with a history of seizures who is on the floor, experiencing tonic-clonic motor activity. His jaw is clenched, he has peripheral cyanosis, and there are frothy secretions in his airway. HR = 130, RR = 4 and shallow, SaO2 = 88%. Which of the following is NOT appropriate?
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Suctioning the airway, inserting a nasopharyngeal airway, assisting respirations by bag-valve-mask device with 100% oxygen
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Which of the following statements about capnography is FALSE?
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It can give objective feedback on the efficacy of ventilations being provided to a patient in full cardiac arrest.
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A patient who has suffered prolonged cold exposure and presents no shivering, with dilated pupils, is most likely in:
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mild hypothermia.
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Your patient is a 72-year-old male with a history of coronary artery disease and atrial fibrillation. He complains of a sudden onset of blindness in his right eye. He is noncompliant with both his digitalis and coumadin. He is alert and oriented. HR: 112, irregular; BP: 154/94; RR: 16. Which of the following is LEAST likely?
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Hemorrhagic stroke
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Which three cranial nerves are involved in the cardinal positions of gaze?
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III, IV, and VI
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It is noon, and you are presented with an unconscious 56-year-old male lying on his couch. His daughter states that he is a type I diabetic and confirms that he ate breakfast and took his insulin this morning. She also states that he has had a "chest cold" and a low-grade fever for the past 3 days. His heart rate is 118, BP is 112/84, and respirations are 12 and regular. Blood glucose is 24 mg/dL. What is the most likely cause of this patient's hypoglycemia?
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The patient's recent illness
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Your patient is a 52-year-old male complaining of shortness of breath. He is sitting up, alert, and oriented and appears to be in moderate respiratory distress. He states that he "always gets a chest cold in the winter" and describes a 3-week history of productive cough and increasing shortness of breath. Physical examination reveals coarse rhonchi to the upper lobes bilaterally, air movement is decreased in the bases, and his skin is cool with peripheral cyanosis. You note that he is overweight and describes an 18-pack-a-year smoking history. Based on these clinical exam findings, you might also expect to find:
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JVD, pedal edema, hepatic congestion.
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Which of the following statements about acute respiratory distress syndrome (ARDS) is FALSE?
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The mortality rate is 40 to 50 percent.
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Which of the following best explains the process of osmotic diuresis associated with hyperglycemia?
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Glucose in the urine raises osmotic pressure inside the kidney tubule, drawing water into the tubule from the surrounding tissues.
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Which of the following is NOT an intrinsic risk factor associated with respiratory disease?
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Cigarette smoking
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Which of the following is NOT a situation that is likely to precipitate Addisonian crisis in a patient with Addison's disease?
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The patient ceases long-term steroid treatment.
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Damage resulting in inactivity to ________ pancreatic cells would result in hyperglycemia.
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beta
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Your patient is a 56-year-old male who is conscious and exhibits slurred speech, irritability, and cool, clammy skin. Blood glucose is 54 mg/dL. Proper treatment for this patient could include all of the following EXCEPT: |
5-10 mg of glucagon IM.
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All of the following are characteristic of the second phase reaction of an asthma attack EXCEPT:
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loss of surfactant in the alveoli.
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An 8-year-old male child is alert and oriented after a brief episode of eyelid fluttering and slight loss of muscle tone, which caused him to slump in his chair. His teacher reports that the child was inattentive for about 15-20 seconds during the episode but was fine after. This most indicates a(n) ________ seizure. |
absence
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A seizure that begins as an aberrant electrical discharge in a small area of the brain but spreads to include the entire cerebral cortex is a ________ seizure. |
generalized
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The carpopedal spasms that occur due to hyperventilation syndrome are a result of a relative ________, secondary to ________.
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hypocalcemia, decrease in unbound calcium
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You are called to the scene of a child having a seizure. The child has been sick for several days with an upper respiratory infection and has had a decreased appetite. Core temperature is 106°F, and the skin is flushed. The patient is not actively seizing on your arrival. HR = 110, BP = 102/54, RR = 40 and shallow. The child is 3 years old and weighs 35 pounds. Which of the following medications is appropriate?
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Acetaminophen, 225 mg
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To which of the following can osmotic diuersis, increased excretion, and ketosis be attributed in a diabetic patient with hyperglycemia?
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Increased flow rate through the tubules of the kidney
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Your patient is a 42-year-old female with a history of COPD. She is alert and oriented, in mild respiratory distress, and complaining of shortness of breath. She gives a 3-day history of worsening shortness of breath, sputum production, fever, and malaise. Physical examination findings include warm, dry, pale skin; rhonchi and wheezing auscultated in the upper lung lobes bilaterally; and jugular venous distension. HR = 128, BP = 96/60, RR = 18, SaO2 = 94%. In addition to an IV of normal saline, which of the following is the best course of prehospital treatment for this patient?
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Oxygen via venturi mask 24-35%, nebulized metaproterenol, IV corticosteroids
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Your patient is a 76-year-old female who is lethargic but responds to verbal stimuli. According to family members, the patient experienced a sudden decrease in consciousness level. Physical examination reveals left-sided facial droop, aphasia, a dilated and unreactive right pupil, and a flaccid left arm. Lung sounds are decreased bilaterally. HR = 58, BP = 172/102, RR = 6 and shallow, SaO2 = 88%. Your partner is assisting ventilations with a bag-valve-mask device and oxygen. During your exam, the patient exhibits generalized seizure activity lasting about 30 seconds and is now unresponsive. Which of the following is MOST appropriate?
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Intubation, IV of normal saline at a keep open rate, cardiac monitor, blood glucose determination, transport without delay.
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Your patient is a 19-year-old female who is exhibiting generalized seizure activity. Her roommate states that she had a seizure that lasted about 3 minutes, remained unresponsive, and started having another seizure about 5 minutes after the first. The patient has peripheral cyanosis and copius oral secretions. Which of the following is of HIGHEST priority for this patient?
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Suctioning the airway, assisting ventilations with a bag-valve-mask device
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The body dissipates excessive heat by:
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evaporation.
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Which of the following is LEAST pertinent in the prehospital setting when obtaining the history of a patient with a suspected transient ischemic attack or stroke?
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Allergies
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Your patient is a 23-year-old male in severe respiratory distress. The patient was working in a small, enclosed space when he spilled a 5-gallon drum of ammonia onto the floor and was quickly overcome by the fumes. A coworker pulled him from the room to safety and ensured that no liquid ammonia had splashed onto the patient or his clothing. The patient is complaining of a burning sensation to his throat and lungs, and you note that his voice is becoming progressively more hoarse. Auscultation of lung sounds reveals crackles and wheezes to all lung fields. HR = 144, BP = 150/100, RR = 30, SaO2 = 90%. In addition to an IV of normal saline at a keep open rate, which of the following is the best course of prehospital management?
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Endotracheal intubation, ventilation with 100% oxygen, nebulized albuterol and Atrovent
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Which of the following is characterized by involuntary muscle twitching?
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Myoclonus
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Which of the following statements about carbon monoxide poisoning is TRUE?
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CO binds to iron-containing enzymes inside the cell, contributing to cellular acidosis.
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Which of the following statements about severe acute respiratory syndrome (SARS) is FALSE?
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SARS is caused by the SARS-CoV bacteria.
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Your patient is 24-year-old male Chinese citizen on vacation in the United States. He is in moderate distress complaining of difficulty breathing and gives a 4-day history of runny nose, sore throat, and general malaise with a productive cough. His sputum production was significantly worse when he woke this morning, and he developed difficulty breathing this afternoon. You note cool, pale, and diaphoretic extremities and lung sounds with rhonchi bilaterally. He gives a medical history of asthma treated with an albuterol inhaler as needed. HR = 134, BP = 132/84, RR = 26, SaO2 = 90%. Which of the following is the best course of prehospital treatment for this patient? |
Provider use of PPE, oxygen via nonrebreathing mask 15 lpm, IV of NS KVO, cardiac monitor, notify receiving hospital, transport
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You encounter a patient complaining of polyuria, polyphagia, polydipsia, and abdominal pain. Based on these complaints, which of the following would you also expect to find? |
Kussmaul's respirations and a fruity breath odor |
