Description

All Quizes Combined

All Quizes Combined
Block 1
Volume 1 Quiz 8
1. Adequate perfusion depends on:
a. The presence of oxygen in blood
b. Adequate production of carbon dioxide
c. Blood pressure and the presence of oxygen in the blood
d. Blood pressure
2. The type of blood that may be administered to all people in an emergency,
regardless of their blood type is,
a. AB positive
b. O positive
c. O negative
d. AB negative
3. Which of the following is a response to histamine release?
a. Release of leukotrienes
b. Suppression of lysosomal enzymes
c. Decrease in vascular wall permeability
d. Increase blood flow to the site of injury
4. Which of the following is NOT one of the body’s three chief lines of defense
against infection and injury?
a. Immune response
b. Homeopathic secretions
c. Inflammatory response
d. Anatomic barriers
5. The excess elimination of hydrogen ions, as many occur in vomiting, can result
in:
a. Respiratory alkalosis
b. Respiratory acidosis
c. Metabolic alkalosis
d. Metabolic acidosis
6. You are presented with a pt displaying Urticaria, dyspnea, hypotension, nausea,
vomiting, and dizziness. This pt is MOST likely suffering from which type of
hypersensitivity reaction?
a. Type 1
b. Type 2
c. Type 3
d. Type 4
7. The spleen is a part of which organ system
a. Digestive
b. Lymphatic
c. Endocrine
d. Cardiovascular
8. Which of the following processes is used when glucose enters a cell?
a. Osmosis
b. Facilitated diffusion
c. Diffusion
d. Active Transport
9. The general term for the storing and creating energy in the body is?
a. Homeostasis
b. Negative Feedback
c. Granulation
d. Metabolism
10. The process that produces an increase in cell size as a result of increasing
workload is?
a. Hypertrophy
b. Atrophy
c. Hyperplasia
d. Metaplasia
11. B lymphocytes are primarily responsible for:
a. Neutralizing antibodies
b. Producing antigens
c. Producing antibodies
d. Directly attacking antigens
12. A pt was shot in the abdomen and has a resultant massive hemorrhage and
hypoperfusion, IV therapy would help treat hypoperfusion by?
a. Slowing the rate of hemorrhage
b. Increasing the heart rate
c. Replacing blood constituents
d. Increasing preload
13. Which of the following terms can be defined as the activities of the body that
allow the maintenance of physiological stability
a. Homeostasis
b. Metabolism
c. Dysplasia
d. Natural stability
14. The amount of blood that returns to the heart during diastole
a. Cardiac output
b. Preload
c. Afterload
d. Myocardial capacity
15. Most of the formed elements of the blood are
a. Erythrocytes
b. Stem cells
c. Leukocytes
d. Thrombocytes
16. The sagittal plane separates right and left portions of the body True or Flase?
a. True
b. False
17. The largest percentage of water in body is located in the?
a. Interstitial fluid
b. Extracellular fluid
c. Extrastitial fluid
d. Intracellular fluid
18. Blood pressure is represented by
a. Preload – afterload
b. Cardiac output x peripheral vascular resistance
c. Stroke volume x heart rate
d. Cardiac contractile force – peripheral vascular resistance
19. Septic shock is precipitated by
a. An overwhelming infection
b. Exposure to an antigen
c. Poisoning
d. MODS
20. Solution having a comparatively higher concentration of solutes is said to be
a. Osmotic
b. Hypotonic
c. Hypertonic
d. Isotonic
21. Positively charged atom
a. Anion
b. Cation
c. Bicarbinate
22. Tissue that lines the external body surface
a. Epithelial
b. Smooth
c. Cardiac
d. Skeletal
23. The term pH is a measure of
a. Sodium hydroxide concentration
b. Carbonic acid concentration
c. Hydrogen ion concentration
d. Sodium bicarbonate concentration
24. On average human body is what percent of water
a. 60%
b. 70%
c. 50%
d. 80%
25. Which of the following terms describes a substance moving from higher
concentration to lower concentration?
a. Diffusion
b. Osmosis
c. Active transport
d. Facilitated diffusion
26. Primary constituent of plasma is
a. Clotting factors
b. Proteins
c. Electrolytes
d. Water
27. Substance that separate into electrically charged particles in water
a. Electrolytes
b. Anions
c. Elements
d. Atomic particals
28. The process in which the size of the cell decreases from decreasing workload is
a. Metaplasia
b. Atrophy
c. Hyperplasia
d. Hypertrophy
29. Pulmonary edema is characteristic of what classification of hypoperfusion?
a. Neurogenic
b. Hypovolemic
c. Cardiogenic
d. Septic
30. The level of structural organization that consists of groups of tissues working
together is an
a. Organ systems
b. Organelle
c. Organism
d. Organ
31. T lymphocytes are primarily responsible for
a. Directly attacking antigens
b. Producing antigens
c. Producing antibodies
d. Neutralizing antigens
32. The preferred resuscitation fluid for a pt with an ongoing gi bleed is?
a. PCRB’s
b. Whole blood
c. Normal saline
d. Plasma
33. The most abundant cation in intracellular fluid is
a. Potassium
b. Sodium
c. Chloride
d. Sodium Bicarb
34. Shock can be best described as
a. Hypotension
b. Decreased cardiac output
c. A state inadequate tissue perfusion
d. A decrease in myocardial contraction
35. The shift of intravascular fluid to interstitial space is called
a. Third space fluid loss
b. Diuresis
c. Insensible water loss
d. Turgor
36. Which of the following ph values indicates acidosis in the body
a. 7.4
b. 7.35
c. 7.3
d. 7.45
37. The most abundant cation in extracellular fluid is
a. Chloride
b. Sodium
c. Potassium
d. Magnesium
38. A change in cell size shape and appearance caused by an external stressor is?
a. Dysplasia
b. Metaplasia
c. Hyperplasia
d. Hypertrophy
Quiz 1-9
1. You are caring for an elderly female w/suspected vertebral fx and a known hx of
spontaneous fx secondary to osteoporosis, She freq takes a hydrocodone
containing preparation (vicoprofen) for pain. W/ her current injury you find it
necessary to administer a greater than expected dosage of morphine. To what is
this need for a higher dosage due
a. Synergism
b. Cross tolerance
c. Psych dependency
d. Potentiation
2. Which of the following is not typically assoc w/type I diabetes
a. Insulin dependency
b. Obesity
c. Juvenile onest
d. Inadequate insulin release from the beta cells of pancreatic islets
3. In a patient experiencing an MI admin a med that reduces Afterload is beneficial
because
a. Prolong the q-t interval, thereby allowing time for complete atrial
contribution to the ventricle
b. Improves the stroke volume of blood ejected from the heart by also
reducing preload
c. Reduces the blood flow to unnecessary areas, redirecting blood to the
heart
d. Reduces the workload of the heart redirecting myocardial oxygen
consumption
4. Tricyclic antidepressants achieve the therapeutic effect by
a. Prolonging the duration of norepinephrine and serotonin at the receptor
sites
b. Blocking the release of norepinephrine and serotonin at the synapse
c. Blocking the release of acetylcholine at the synapse
d. Enhancing degradation of norepinephrine and serotonin at the synapse
5. The chief physiological effect of nerve gases such as VX and sarin are to
a. Produce an adrenergic blockade throughout the body
b. Competitively block the muscarininc receptor sites at the target organs
c. Competitively block the nicotinic receptor sites at the neuromuscular
junction
d. Irreversibly block the enzyme cholinesterase
6. Which of the following statements about antibiotics is NOT true?
a. Viruses are not susceptible to antibiotics
b. An individual who has developed a resistance to one type of antibiotics
will typically respond well to other antibiotics in a similar class
c. Because antibiotics are generally so safe, they are prescribed
indiscriminately, even for unknown viral infections.
d. Antibiotics typically achieve their therapeutic action by destroying the
bacterial cell wall
7. You are caring for a young mother that jnust gave birth to her first child. Despite
taking appropriate measures, she continues to exhibit postpartum hemorrhage. In
addition to crystalloid intravenous infusions what medication might you consider
to manage this patient?
a. Oxytocin (pitocin)
b. Terb
c. Dopamine
d. Epi solution
8. Which of the following statements about warfarin (coumadin) is NOT true?
a. It was originally used as rat poison
b. It prevents coagulation by antagonizing the effects of vitamin K
c. It actively breaks down the fibrin network, thereby dissolving formed
thrombi
d. It helps treat chronic atrial fibrillation
9. What term best describes the effects a drug has on its target organs
a. bioavalability
b. pharmacokinetics
c. pharmacodynamics
d. biotransformation
10. The paramedics chief concern with patients taking Viagra is
a. acute renal failure
b. cardiac dysthrhymias
c. agitation and combative behavior
d. hypotension
11. An important distinction between analgesics and anesthesia is
a. analgesics are reversible, whereas anesthesia are not
b. anesthesia can only be administered intravenously
c. anesthesia block all sensations
d. analgesics produce unconsciousness in high doses
12. All laxatives are similar in that they
a. Increase peristalsis via direct stimulation
b. Reduce the molecular bonds of colon contents
c. Reduce surface surfactant, thereby improving passage
d. Increase the water content in the colon
e. Decrease surface surfactant, thereby improving passage
f. Increase bulk in the intestine
13. Sympathetic nervous system stimulation that results in vasoconstriction and some
bronchoconstriction is most likely affecting
a. beta2 receptor sites
b. beta1 receptor sites
c. alpha2 receptor sites
d. alpha1 receptor sites
14. According to Frank Starling’s law, the administration of nitrogen will result in
a. increased preload, increased stroke volume, and decreased myocardial
oxygen demand
b. decreased preload, increased stroke volume, and decreased myocardial
oxygen demand
c. decreased preload, decreased stroke volume, and increased myocardial
oxygen demand
d. decreased preload, decreased stroke volume, and decreased myocardial
oxygen demand
15. An important physiological distinction between the sympathetic and
parasympathetic divisions of the autonomic nervous system is
a. the sympathetic ganglia are close to the spinal cord
b. only the sympathetic division innervates the target organs or tissue directly
c. the sympathetic division does not use acetylcholine as a neurotransmitter
d. The parasympathetic nervous system contains no ganglionic fibers.
16. A drug with a wax like base that melts at body temperature allowing absorption
into body tissue is called a
a. suppository
b. capsule
c. suspension
d. elixir
17. Glucagon will affect blood glucose levels by
a. enhancing the absorption of glucose from the gastrointestional tract
thereby increasing blood glucose levels
b. inducing glycogenolysis and gluconeogenesis, thereby increasing blood
glucose levels
c. inducing the storage of glucose into the liver and skeletal muscle through
glycogenesis, thereby decreasing blood glucose levels
d. enabling the rapid absorption of glucose into the cells thereby decreasing
blood glucose levels.
18. Which of the following drug names are the same
a. chemical and genetic
b. chemical and trade
c. brand and trade
d. proprietary and official
19. If a drug were to block the nicotinic receptors at the neuromuscular junction, what
symptomatic effect might this have on the patient?
a. Increase gastric motility
b. Inability to move voluntary and involuntary muscles
c. Papillary constriction
d. Decrease in heart rate
20. Which of the following is a generic name of a drug
a. Tylenol
b. Acetaminophen
c. Excedrin
d. Motrin
21. A beta 2 specific agonist causes which of the following physiologic responses
a. Bronchoconstriction
b. Increased heart rate
c. Bronchodilation
d. Decreased heart rate
22. Which of the following medications will have the greatest impact on reducing
stroke volume?
a. Dobutamine
b. Furosemide
c. Digoxin
d. Dopamine
23. You are seeing a 69 year old female patient complaining of fatigue and nausea.
She has a history of heart failure, and two previous MI’s. She reports having
blurred vision with halos around objects. Her vitals are blood pressure of 144
over 88, her pulse is 110 and irregular, her respirations are 16. What should you
suspect is causing her symptoms.
a. Toxic blood levels of digoxin
b. New onset heart failure with impaired cerebral perfusion
c. Acute closed angle glaucoma
d. Cerebral embolus secondary to atrial fibrillation
24. You have been instructed to administer a protein binding medication to a 10
month old patient. With this in mind, which of the following statements is true.
a. Children under 1 year of age have less plasma proteins than older children,
thus the drug will have a diminished effect.
b. Children under 1 year of age have more plasma proteins than older
children, thus the drug will have a diminished effect.
c. Children under 1 year of age have less plasma proteins than older children,
thus the drug will have a greater effect.
d. Children under 1 year of age have more plasma proteins than older
children, thus the drug with have a diminished effect.
25. Viagra achieves its therapeutic action in the treatment of erectile dysfunction by.
a. Enhancing neuronal stimulation of the amygdale in the brain
b. Relaxing vascular smooth muscle, which increases blood flow to the
corpus cavernosum
c. Stimulating sympathetic receptors in the nerve fibers leading to the sexual
organs
d. Stimulating parasympathetic receptors in the nerve fibers leading to the
sexual organs.
26. Which of the following in NOT associated with the sympathetic nervous system?
a. Vagus nerve
b. Thoracolumbar
c. Flight or fight
d. Adrenergic
27. Oxytocin is frequently used in the prehospital setting to.
a. Stop preterm labor contractions
b. Control seizures from eclampsia of pregnancy
c. Help control postpartum hemorrhage
d. Facilitate labor and induce delivery
28. An antimetic phenothiazine (compazine, phenergan) have which of the following
undesirable side effects
a. Euphoria
b. Hallucinations
c. Diarrhea
d. Extrapyramidal effects
29. You respond to the aid of a 19 year old who is reported to have taken an overdose
of a prescribed medication. She exhibits combativeness and sever tremors. Her
blood pressure is 160 over 100, and her pulse is 132. Sinus tach appears of her
ECG. Which of the following classifications of drugs is more likely to cause
these symptoms?
a. Barbiturates
b. Benzos
c. Amphetamines
d. Opiates
30. Which of the following pharmacokinetic processes would be least affected by the
hypotensive state of a patient in Cardiogenic shock
a. Absorption
b. Distribution
c. Elimination
d. Biotransformation
31. When administering glucagons to a patient, it is important to remember that.
a. Glycogen stores must be available in the liver and muscle for glucagons to
be effective.
b. It is only effective in patients with elevated blood glucose levels.
c. Glucagons can only be administered intravenously
d. Glucagons will stimulate glycogenesis in a hypoglycemic patient
32. Shortly after treating your patient for a cardiac dysrhythmia, your patient
complains of dry mouth, blurred vision, palpitations, and sensitivity to light.
Which drug might you have administered too much of?
a. Adenosine
b. Atropine
c. Lidocaine
d. Amiodarone
e. Aspirin
33. Which of the following is not associated with the parasympathetic division of the
autonomic nervous system?
a. Feed and breed
b. Craniosacral
c. Cholinergic
d. Short preganglionic neurons
34. A college student in an effort to improve test scores, takes a drug, intelliboost,
which enhances cortical function by increasing dopamine release in the brain. It
just so happens that he also is taking a cold remedy, sneezeless, which inhibits the
chemical breakdown of dopamine at all receptor sites. Which of the following
best describes the drug interactions..
a. Sneezeless and itelliboost have an additive effect
b. Sneezeless has a cumulative effect
c. Sneezeless potentiations the effects of intelliboost
d. Sneezeless and intelliboost have a synergistic effect.
35. Medications best suited for treating bronchoconstriction generally stimulate?
a. Beta 2 receptor sties
b. Beta 1 receptor sites
c. Alpha 1 receptor sites
d. Alpha 2 receptor sites
36. methylpheridate (Ritalin), a drug used to treat attention deficit hyperactivity
disorder (ADHD), achieves its therapeutic action by
a. inhibiting the CNS and a concomitant state, allowing for less distraction
and greater focus
b. stimulating the CNS, which in ADHD has a idiosyncratic sedation effect,
allowing greater concentration.
c. Inhibiting the CNS, which in ADHD has a profound sedation effect,
allowing greater concentration.
d. Stimulating the CNS and causing a heightened awareness and arousal,
allowing for greater focus.
37. Which of the following statements about bronchial asthma is true?
a. Prednisone and methyprednisone should be reserved for only the most
sever asthma attacks.
b. Ipratopium (Atrovent) is often added to beta agonists to treat
bronchospasm, because it works through a different mechanism that relax
bronchial smooth muscle.
c. The nonselective sympathomimetics continue to be the most popular
treatments for mild to moderate asthma attacks.
d. People with bronchial asthma maintain symptom free lifestyles with daily
treatments of propranolol.
38. If a patient were exhibiting pupilary constriction, hypersalivation, bronchial
wheezing, and Bradycardia. Which division of the ANS should you suspect is
affected?
a. Blockade of the cholinergic nervous system
b. Stimulation of the sympathetic nervous system
c. Stimulation of the parasympathetic nervous system
d. Blockade of the voluntary nervous system
39. Which of the following is NOT a side effect of oral contraceptives?
a. Hypertenstion
b. Early onset osteoporosis
c. Unintended pregnancy
d. Thromboembolism
40. Drugs with high abuse potential and no accepted medical benefits are classified as
schedule
a. 2
b. 1
c. 3
d. 4
41. You are carring for a 48 year old patient with acute onset pulmonary edema
secondary to an acute MI. He has crackles in both lung fields and wheezes in the
bronchial regions. His blood pressure is 160/90, his pulse is 112, and his
respirations are 32. Which of the following meds is indicated first and why?
a. NTG to vasodilate the coronary vessels to maximize myocardial oxygen
supply
b. Morphine sulfate to decrease anxiety and reduce Afterload
c. Lasix to achieve a diuresis and remove a portion of fluids from the
intravascular space.
d. NTG to reduce preload and Afterload to redistribute fluids to the
periphery.
e. Morphine sulfate to remove fluids from the intracellular space.
42. One important reason meds are given via IV is such drugs
a. Do not affect the kidneys
b. Can be more easily reversed if an untoward affect occurs
c. Bypass the liver initially
d. Have a delayed onset of action compared to the oral route
43. All of the following result from elevated insulin levels in the blood EXCEPT.
a. Gluconeogenesis and glycogenolysis
b. Conversion of glucose to glycogen from storage in the liver and skeletal
muscle
c. Increased cellular transport of glucose, potassium, and amino acids
d. Promotion of cell growth and division
e. Promotes proteins, carbohydrates, lipid, and nucleic acid synthesis.
44. Which of the following is most likely to affect elimination of a medication
a. Burns on more than 30% of your body
b. Renal disease
c. Metabolic alkalosis
d. Hemorrhage
45. If a newly developed drug is undergoing a double blind study in a large pt
population, it is most likely in phase ___ of human studies.
a. Phase 4
b. Phase 2
c. Phase 1
d. Phase 3
46. At the cellular level, the treatment of seizures is generally accomplished by:
a. Inhibiting the influx of sodium and calcium ions into the neural cells
b. Enhancing the influx of potassium ions into the neural cells
c. Enchancing the influx of sodium and calcium ions into the nerual cells
d. Inhibiting the influx of potassium ions into the neural cells
47. A prolonged deficiency of vitamin C may result in:
a. Kwashoirkor
b. Pemidous anemia
c. Scurvy
d. Increased bleeding
48. The narcotic nalbuphine (Nubain) not only binds to opiate receptor sites to
provide analgesia, it prevents other opiods, such as morphine sulfate, from
binding to these sites, lessening repiratory depression. These characterisistics
make the drug an:
a. Agonist
b. Competitive agonist
c. Competitive antagonist
d. Agonist antagonist
49. Pts experiencing the onset of signs and symptoms indicative of myocardial
ischemia are sometimes encouraged to chew ASA. ASA is beneficial because it:
a. Inhibits the clotting cascade, thereby preventing thrombus formation
b. Decreases the formation of platelet plugs and potential thrombi
c. Reduces the pain of an AMI through its analgestic actions
d. Blocks the converstion of fibrinogen to fribrin
50. The study of the basic processes that determine the duration and intensity of a
drug’s effect and how those drugs are absorbed, distributed, biotransformed, and
elimated is called:
a. Polypharmacy
b. Phamacodyamics
c. Drug profiling
d. Pharmacokinetics
51. Which of the following meds is appropriate for the routine treatment of type 2
diabetes: (unknown answer)
a. Ultralente insulin
b. Glucagons
c. Chlorpropamide
d. NPH insulin
52. You are caring for a 45 yr old male pt who was tending to his fruit orchard when
he suddenly developed headache, dizziness, blurred vision, and tremors. You
note that he was inconteinent of urine, has papillary constriction, and is salivating
excessively. Which of the following medications would be most appropriate to
manage this pt?
a. Ipratropium bromide
b. Diazepam
c. Physostigmine
d. Atropine sulfate
53. When treating pts with suspected hypoglycemia, which of the following should be
of greatest concern?
a. Infiltration of the IV during the admin of 50% dextrose in water
b. The admin of O2 before any other therapies
c. Confirming that the pts have histories of diabetes before continuing
treatment
d. Ensuing that a blood glucose specimen is obtained before initiating any
hypoglycemic therapies in an unconscious pt.
54. Which of the the following is NOT one of the main sources of drugs?
a. Animals
b. Plants
c. Synthetic materials
d. Herbs
55. The acronym SLUDGE helps identify ________ affects on the ANS.
a. Parasympathomimetic
b. Sympathomimetic
c. Parasympatholytic
d. Sympatholytic
56. Which of the following statements about insulin is NOT true?
a. Insulin is classified as natural or modified
b. Insulin must be given subcutaneously
c. Insulin is now produced through recombinant DNA tech
d. Insulin is available as short, intermediate, or long acting
57. Naloxone is an opiod:
a. Agonist
b. Agonist antagonist
c. Antagonist
d. Analgesic
58. Fibrionolytics achieve their therapeutication by:
a. Interfering with the clotting cascade
b. Decreasing platelet aggresgation
c. Blocking the converstion of plasminogen to plasmin
d. Breaking up a thrombus that has formed
59. Which of the following statements about NTG is NOT true?
a. NTG achieves its therapeutic effects by blocking the entry of calcium into
the cells of smooth muscle.
b. NTG commonly causes headache and orthostatic hypotenson
c. NTG primarily dilated veins and coronary vessles.
d. NTG is poorly lipid soluble, which prevents it from passing through cell
membranes, thereby pronlonging its effects
60. While caring for a 60 yr old male with a suspected femur fx, your partner
accidently administers the full vial of morphine sulfate (15mg) when only 4mg
was ordered. What adverse effects are likely to occur in this pt?
a. Widended QRS and respiratory depression
b. Hypotension and respiratory depression
c. Hypotension and tachypnea
d. Sedation and hypertension
61. A drug or other substance that blocks the actions of the sympathetic nervous
system is called
a. Adrenergic
b. Sympatholytic
c. Sympathomimetic
d. Anticholinergic
62. ________ is the preferred antihypertensive for the management of pregnancy
induced hypertension.
a. Coreg
b. Apresoline
c. Captopril
d. Nifedipine
63. Because they can thicken bronchial secretions, you should not use ______ in
patients with asthma.
a. Mucolytics
b. Antitussives
c. Antihistamines
d. Antidysrhythmics
64. An example of an anticholingeric drug used in the treatment of asthma is
a. Atropine
b. Ephedrine
c. Proventil
d. Beclovent
65. The drug name that is derived from its chemical composition is referred to as its
a. Official name
b. Chemical name
c. Generic name
d. Trade name
66. Drug legislation was instituted in 1906 by the
a. Narcotics act
b. Cosmetics act
c. Pure food and drug act
d. Pharmacology act
67. The six rights of medication administration include the right:
a. Dose
b. Time
c. Route
d. All of the above
68. Which of the following routes is the least appropriate for medication
administration in the prehospital setting?
a. Oral
b. Sublingual
c. Subcutaneous
d. Intravenous
69. Drugs manufactured in gelatin containers are called
a. Pills
b. Tablets
c. Capsules
d. Extracts
70. A drugs pharmacodynamics involve its ability to cause the expected response, or:
a. Affinity
b. Efficacy
c. Side effect
d. Contraindication
71. A type of anesthesia that combines decreased sensation of pain with amnesia,
while the patient remains conscious, is a (an)
a. Opioid
b. Nonopioid
c. Anesthetic
d. Neuroleptanesthesia
72. ________ agents oppose the parasympathetic nervous system
a. Cholinergic
b. Adrenergic
c. Antiadrenergic
d. Anticholinergic
73. In antidysrhythmic classification, class 1A drugs include all of the following
except:
a. Quinidine
b. Lidocaine
c. Procainamide
d. Disopyramide
74. Loop diuretics achieve their therapeutic effects by:
a. Enhancing reabsorption throughout the loop of henle
b. Decreasing the reabsorption of sodium at the ascending loop of henle
c. Decreasing the absorption of sodium at the glomerlus
d. Increasing the reabsorption of sodium at the ascending loop of henle
75. ______ are medications released from mast cells upon contact with allergens.
a. Histamines
b. Leukotrienes
c. Glucocorticoids
d. Methyixanthines
V1 C10
1. Having a pt swallow a tablet with a drink of water is an example of?
a. Subligual
b. Oral administration
c. Buccal
d. Topical administration
2. Which of the following routes will medication have the quickest onset of action?
a. Intramuscular
b. Oral
c. Intradermal
d. Subcutaneous
3. Administration of a medication to the right eye would be documented medically
as administration to which of the following?
a. O.g.
b. O.u.
c. O.d.
d. O.s.
4. Which of the following is a disadvantage of pulmonary drug administration via
nebulizer or metered dose inhaler?
a. Side effects are more likely with pulmonary drug administration
b. Pulmonary absorption is a slow route for drug administration
c. It requires that the pt have adequate ventilation
d. It is necessary to use a larger dose for inhaled medications than if the drug
was administered by another route
5. Into which of the following containers would it be necessary to inject a volume
of air equal to the intended volume of medication before withdrawing the
medication with a needle and syringe?
a. IV fluid bag
b. Vial
c. Ampule
d. All of the above
6. Administration of medication into the dorsal gluteal must be injected into which
quadrant of the muscle?
a. Lower, inner
b. Lower, outer
c. Upper, inner
d. Upper, outer
7. When preparing for venipuncture, a constricting band should be placed tight
enough to restrict ________ flow and not left in place for more than ________
minutes.
a. Venous but not arterial ; 5
b. Venous but not arterial ; 2
c. Both venous and arterial ; 5
d. Both venous and arterial ; 2
8. Which of the following is a disadvantage to intravascular volume replacement
with isotonic crystalloid solutions?
a. 2/3 of the volume enters the extravascular space within one hour of
administration
b. There is an immediate shift of vascular volume to the interstitial space
c. Sodium shifts into cells and potassium shifts out of cells
d. Intracellular fluid shifts to the vascular space
9. Using microdrip tubing, how many drops of fluid equals 1ml?
a. 10
b. 15
c. 20
d. 60
10. Which of the following pts, assuming each is in critical need of an IV and that
you have made multiple unsuccessful attempts to start an IV, would be a
candidate for IO therapy?
a. An 81 yr old male
b. A 9 month old male
c. A 35 yr old female
d. All of the above
11. Which of the following is an advantage of sublingual drug administration?
a. Slow rate of drug absorption
b. Rapid absorption due to sublingual vasculature
c. Uniform absorption through the conjunctival mucosa
d. Rapid dissolution of tablets so that the medication can be swallowed
12. Which of the following solutions is appropriate for the pt needing vascular
volume replacement in the prehospital setting?
a. 0.9% sodium chloride solution
b. 0.45% sodium chloride and 5% dextrose in water
c. 5% dextrose in water
d. Dextran 40
13. A plastic or glass container with a self-sealing rubber top is known as a(n):
a. Ampule
b. Blister pak
c. Prefilled syringe
d. Vial
14. Which of the following is considered a site of central venous access?
a. Saphenous vein
b. External jugular vein
c. Femoral vein
d. Median cephalic vein
15. Just as you are arriving at the emergency department bay, your pt on whom you
started an IV at the scene, complains of sudden chills, back pain, and nausea.
The pt appears flushed, and his skin is hot and moist to the touch. Which of the
following most likely accounts for your pt’s presentation?
a. Pulmonary thromboembolism
b. Circulatory overload
c. Anaphylaxis
d. Pyrogenic reaction
16. Which of the following veins is NOT a site of peripheral venous access?
a. Subclavian
b. Median basilic
c. Saphenous
d. External jugular
17. Which of the following is the appropriate method for preparing a site for
venipuncture or injection?
a. Use of a disinfectant
b. Use of an antiseptic
c. Cleaning
d. Chemical sterilization
18. Which of the following is NOT a Percutaneous route of medication
administration?
a. Sublingual
b. Inhalation
c. Buccal
d. Transdermal
19. Which of the following is NOT a pulmonary route of medication administration?
a. Nasal drops and sprays
b. Inhalation of aerosolized medications
c. Instillation of liquid medications into an endotracheal tube
d. Nebulization of liquid medications by pressurized air.
20. You have 2mg of Naloxone in 10ml solution. What is the mg/ml concentration
of the drug?
a. 0.002mg/ml
b. 1mg/ml
c. 2mg/ml
d. 0.2mg/ml
21. Which of the following is appropriate for a subcutaneous injection of
medication?
a. Insertion of the needle at a 90 degree angle
b. Up to 2ml of medication
c. An 18 gauge, ¾” needle
d. Volume of medication of 1ml or less
22. Which of the following is a parenteral route of drug administration?
a. Intramuscular
b. Rectal
c. Gastric tube
d. Oral
23. Which of the following intravenous solutions would remain in the vascular
system the longest?
a. 5% dextrose in water
b. Plasmanate
c. Lactated ringers solution
d. 0.9% sodium chloride
24. Shortly after starting an IV on your pt, you note that the IV is not dripping. You
have removed the constricting band, and all the clamps on the tubing are open.
You note that there is minor swelling around the venipuncture site. There is no
discoloration of the site, but it is firm and cool to the touch. Which of the
following most likely accounts for your findings?
a. The site has become infected
b. The tip of the catheter is occluded by a valve in the vein
c. Fluids extravasated into the tissue surrounding the IV site.
d. The tip of the catheter is occluded by a blood clot.
25. The maximum volume of medication to be delivered into the deltoid muscle is
_____ml.
a. 1
b. 2
c. 3
d. 5
V1 C13
1. The tip of a curved laryngoscope blade is placed correctly:
a. Under the epiglottis
b. In the vallecula
c. At the junction of the hard and soft palates
d. At the glottic opening
2. A musical squeaking, or whistling sound that may be heard on inspiration or
expiration while auscultating lung fields is known as:
a. Rhonchi
b. Crackles
c. Wheezing
d. Stridor
3. The respiratory rate may be greater than normal in:
a. Beverage alcohol ingestion
b. Sleep
c. Acidosis due to ASA overdose
d. The use of medications such as diazepam or morphine
4. When intubating an adult pt, the onset of bradycardia is most likely due to:
a. Hypoxia
b. Stimulation of the vagus nerve
c. Hypercarbia
d. Increased ICP
5. A high pitched inspiratory noise caused by a partial upper airway obstruction is
called:
a. Stridor
b. Rhonchi
c. Wheezing
d. Dysphonia
6. An adult pt who has been intubated due to respiratory arrest should be ventilated
_____ times per minute?
a. 30
b. 24
c. 15(on quiz)
d. 10
7. The hypoxic drive is stimulated by:
a. Low PaO2
b. Low PaCO2
c. High PaCO2
d. High PaO2
8. Of the normal tidal volume for the average 70 kg adult, what amount of air (in ml)
is not available for gas exchange?
a. 50
b. 100
c. 150
d. 250
9. At the end of exhalation, the intrathoracic pressure is:
a. Significantly less than atmospheric pressure
b. Slightly less than atmospheric pressure
c. Equal to atmospheric pressure
d. Greater than atmospheric pressure
10. With which of the following conditions should you NOT attempt endotracheal
intubation of the pt unless airway failure is imminent
a. Respiratory syncyctial virus (RSV) infections
b. Epiglottitis
c. Pulmonary embolism
d. COPD
11. Which of the following is the correct order of events after an ET tube has been
properly inserted?
a. Secure the tube, listen for breath sounds over the epigastrium, listen for
equal breath sounds bilaterally, inflate the cuff with 5 – 10 cc of air.
b. Inflate the cuff with 5 – 10cc of air, listen for breath sounds over the
epigastrium, listen for bilateral lung sounds, secure the tube.
c. Inflate the cuff with 5 – 10cc of air, listen for equal breath sounds
bilaterally, listen for breath sounds over the epigastrium, secure the tube.
12. Moderate hypoxia is indicated with a pulse ox reading of?
a. 86-91
b. 81-85
c. 90-94
d. 95-100
13. A fine, bubbling sound heard on inspiration and associated with fluid in the
alveoli and terminal bronchioles is called:
a. Pleural friction
b. Bronchovesicular sounds
c. Crackles
d. Rhonchi
14. Which of the following increases the risk of a FBAO?
a. Alcohol consumption
b. Age
c. Dentures
d. All of the above
15. The normal partial pressure of O2 is _____ mmHg.
a. 35 to 45
b. 50 to 75
c. 80 to 100
d. 100 to 150
16. Physiologically the term respiration refers to the:
a. Exchange of all gases, nutrients, and wastes at the cellular level
b. Exchange of gases at the alveolar capillary interface
c. Exchange of gases at the cellular level
d. Mechanical process that moves air into and out of the lungs
17. Which of the following interferes with ventilation in the presence of a flail
segment?
a. The ability to generate negative intrathoracic pressure is impaired
b. The ability to generate positive intrathoracic pressure is impaired
c. Intrathoracic pressure decreases on the affected side
d. Intrathoracic pressure increases on the affected side
18. Which of the following is a disadvantage of pulse oximetry?
a. Pulse oximetry gives no information about the amount of carbon dioxide
in the blood.
b. Tissue hypoxia may be present even with a normal SaO2 reading
c. Pulse oximetry cannot differentiate between hemoglobin bound to oxygen
and hemoglobin bound to carbon monoxide
d. All of the above are disadvantages
19. The bifurcation of the trachea is called the:
a. Carina
b. Hilum
c. Cricoid cartilage
d. Glottic opening
20. When using the end tidal carbon dioxide detector, the absence of carbon dioxide
in exhaled air after six breaths indicates the endotracheal tube has been placed:
a. Correctly
b. In the esophagus
c. In the left mainstem bronchus
d. In the right mainstem bronchus
21. When a portion of the lung is unavailable for gas exchange, yet pulmonary
circulation continues in that area of the lung, a condition known as ________
results.
a. Eupnea
b. Atelectasis
c. Ventilation perfusion mismatch
d. Pulses pardoxus
22. You should be prepared to immediately intubate any pt with respiratory distress
who is exhibiting:
a. Altered mentation
b. Wheezing
c. A pulse ox reading of 90 or less
d. A heart rate over 100
23. Which of the following is not a structure of the upper airway
a. Hypopharynx
b. Larynx
c. Trachea
d. Nasopharynx
24. In which of the following situation would you expect end tidal carbon dioxide
levels to be very low despite a patient airway?
a. The pt is being ventilated with room air
b. Hypoventilation
c. The pt is in cardiac arrest
d. Hyperthermia
25. Which of the following mechanisms is responsible for hypoxemia in the pt with a
pulmonary embolism?
a. Pulses paradoxus
b. Atelectasis
c. Lower airway obstruction
d. Pulmonary shunting
26. Without adequate airway maintenance and ventilation, the pt can succumb to
brain injury or death in how many minutes?
a. 6-10
b. 2-4
c. 4-6
d. 10-12
27. When swallowing, the structure that occludes the tracheal opening to prevent
aspiration of foods and liquids is the:
a. Uvula
b. Cricoid cartilage
c. Epiglottis
d. Pyriform fossa
28. Aspiration of vomit into the lungs may result in:
a. Tissue damage
b. Pulmonary edema
c. Pneumonia
d. All of the above
29. During a respiratory assessment, the absence of breath sounds may indicate a:
a. Pulmonary embolism
b. Bronchitis
c. Pneumothorax
d. Flail chest
30. The tip of the ET tube for the pediatric pt should be inserted _____ cm below the
vocal cords
a. 4-5
b. 2-3
c. 1-2
d. 3-4
31. Which of the following statements about manual airways in true:
a. They require specialized equipment
b. The are often neglected by EMT’s and paramedics
c. They are difficult to learn
d. They are contraindicated in trauma pt’s
32. Progressively deeper, faster breathing alternating gradually with shallow, slower
breathing is called:
a. Cheyne-stokes respirations
b. Biot’s respirations
c. Agonal respirations
d. Kussmaul’s respirations
33. In which of the following situations should you suspect pulmonary shunting?
a. A foreign body in the right mainstem bronchus
b. Pneumonia
c. Pulmonary embolism
d. All of the above
34. The reading obtained by the use of a pulse oximeter reflects the:
a. Amount of saturated hemoglobin per deciliter of blood
b. Ratio of unsaturated hemoglobin to saturated hemoglobin**
c. Partial pressure of oxygen in capillary blood
d. Amount of oxygen dissolved in the blood
Block 2
Volume 2 Chapter 1 Quiz
1. All of the following encourage patient communication except.
a. Listening closely to everything the patient says
b. Maintaining eye contact through the interview
c. Using sophisticated medical terminology
d. Asking the patient for clarification
2. Which of the following actions can you take to establish rapport early in the
interview with your patient?
a. Ask as many questions as possible to get her attention
b. Be as stiff and emotionless as possible
c. Respond to her condition with empathy
d. Do not allow her to discuss her chief complaint freely
3. Which of the following in NOT part of the preliminary patient data.
a. Date and time of physical exam
b. Patient age and occupation
c. Source of information about the patient
d. Chief complaint
4. Which of the following body positions best communicate that you care about your
patients problems
a. Standing close to the patient so you are above him
b. Standing far from the patient as to practice good hygiene
c. Sitting as the patients level across the room
d. Sitting beside the patient addressing him at eye level
5. When speaking with your patient you should
a. Speak very softly as to not frighten the patient
b. Speak in a calm reassuring voice
c. Speak loudly so that everyone in the room can hear you
d. Demand out loud that you have the patients full attention
6. Which words or terms would you use while addressing your patient
a. Enduring terms such as “sweetie, honey, or pops”
b. No terms, because they can make her nervous
c. Terms of the patients choice
d. Formal titles like “Mr. Smith”
7. Which of the following nonverbal cues demonstrates your sincerity to the patient
a. Averting your gaze most of the time as to not embarrass your patient
b. Crossing your arms across your chest and tapping your foot.
c. Offering a comforting touch or shaking the patients hand
d. Continuing to touch the patient even after he withdraws
8. When questioning a female patient about abdominal pain about a possible
pregnancy, you should
a. Question her in front of her parents so she will be more truthful
b. Question her in private without her parents nearby so she will be more
truthful
c. Question the parents directly because the patient will not be truthful
d. Ask no questions because she wont be truthful anyway
9. Which of the following is an example of an open ended question
a. “Does your pain radiate to the shoulder?”
b. “Do you take high blood pressure meds?”
c. “Where do you hurt?”
d. “Do you have any allergies to medicine?”
10. Which of the following is an example of a closed ended question
a. “Do you have any medical history?”
b. “What is your medical history?”
c. “Where is your discomfort?”
d. “What were you doing when the pain began?”
11. Which of the following statements is true?
a. Always use closed ended questions when gathering history because they
save time
b. Always use open ended questions because they give a more complete
picture of the chief complaint
c. Use a combination of open and closed ended question to gather a history
of the chief complaint
d. Only ask a few questions as to not embarrass the patient
12. Which of the following statements about patient communication is true
a. Use sophisticated medical terminology to sound professional
b. Use language appropriate to the patients level of understanding
c. Cultural differences make no difference in the professional world of
medicine.
d. Avoid using interpreters because they only confuse the patient
13. When you repeat your patients words to encourage him to give more details, you
should use the technique called
a. Facilitation
b. Clarification
c. Reflection
d. Interpretation
14. When you ask questions to refine a patients initially vague answer, you are using
a technique called
a. Facilitation
b. Interpretation
c. Confrontation
d. Clarification
15. When you detect an inconsistency in a patients story, which technique should you
use to keep the patient from hiding is feelings
a. Facilitation
b. Interpretation
c. Confrontation
d. Clarification
16. Which of the following statements can show your empathy towards the patient
a. “That must have been very difficult”
b. “What is your name”
c. “Are you saying that take a diuretic”
d. “You say that your chest doesn’t hurt, but you keep rubbing it”
17. All of the following actions can help make taking a history on a sensitive subject
easier EXCEPT:
a. Observing experienced clinicians ask these type of questions
b. Attending a lecture or seminar on these sensitive subjects to learn more
about them
c. Asking some open ended questions to these subjects as practice.
d. Using euphemisms and metaphors to ask embarrassing questions
18. Elements of patient history include all of the following except:
a. Preliminary data
b. Current health status
c. Physical examination
d. Present illness
19. Which of the following statements is true regarding a comprehensive patient
history
a. Use all components every time you interview a patient
b. Use the components that apply to the patients situation and status
c. Use the components the patient chooses
d. Use only one component as not to confuse the patient
20. Which of the following pieces of information should you record as preliminary
data
a. The chief complaint
b. The patients age
c. Aspects of the present illness
d. Elements of past history
21. Which of the following statements is an example of a chief complaint
a. The patient is complaining of a tibia fracture
b. The patient is complaining of a MI
c. The patient is complaining of dyspnia
d. The patient is complaining of chest pain
22. An example of a primary problem is
a. Leg pain
b. Shortness of breath
c. MI
d. Nausea
23. A practical template for exploring various aspects of a chief complaint is
a. ABCDE
b. OPQRST-ASPN
c. AEIOU-TIPS
d. MOUSE
24. Which of the following questions is designed to find out about palliation
a. “What were you doing when this pain begain”
b. “What makes the pain feel better”
c. “What does the pain feel like”
d. “How long have you been having this pain”
25. What is an example of referred pain
a. Chest pain located under the sternum assiosiated with a cardiac condition
b. Abdominal pain related to pancreatitis
c. Epigastric pain associated with a cardiac disorder
d. Flank pain associated with a kidney stone
26. Questions to ask about a patients past medical history include all of the following
areas except:
a. General state of health
b. Adult diseases
c. Surgeries or injuries
d. Duration of the pain
27. Which of the following questions gathers information about a patients current
health status
a. “Where does the pain go”
b. “When did you have your appendix removed”
c. “How many cigarettes do you smoke a day”
d. “Do you also feel nauseous”
28. What does the “C” in CAGE alcohol screening tool stand for
a. Are you concerned about your drinking
b. Have you ever felt the need to cut down on your drinking
c. Are you constipated after drinking
d. What causes your drinking
29. Areas in the patients current health status include all of the following except:
a. Environmental hazards
b. Home situation
c. Past medical history
d. Sleep patterns
30. Which of the following actions would you take if confronted with a patient who is
silent
a. Stay silent yourself as to show empathy
b. Encourage the patient to speak by confronting him with your perception of
what is happening
c. Assume that the patient is noncopperate and to call the police
d. Assume that the reason is emotional and ignore it
31. Which of the following is a challenge to your ability to solicit patient information
a. Patients level of cognitive functioning
b. Complaints of multiple systems
c. Intoxication
d. All of these
32. The active listening technique of reflection involves
a. Repeating the patients words exactly
b. Making eye contact with the patient
c. Asking for clarification of the patients complaint
d. Confronting the patient if you detect inconsistencies
33. The history begins with an open ended question about your patients
a. Primary problem
b. Severity of symptoms
c. General status of health
d. Chief complaint
34. A mnemonic for remembering the questions for determining the present illness is
a. ABCDE-CHART
b. OPQRST-ABCD
c. HEENT
d. OPQRST-ASPN
35. Part of active listening includes maintaining eye contact and using appropriate
gestures in a process known as
a. Formulation
b. Facilitation
c. Fulmination
d. Faculation
36. Which of the following establishes the foundation for good patient care
a. Asking open ended questions
b. Eliciting a good history
c. Using active listening
d. Using common sense
37. A sign or symptom that causes a patient or bystander to request medical help is
known as the
a. Primary problem
b. Associated symptom
c. Chief complaint
d. Present illness
38. When asking about a patients health status, you or your partner should ask about
all of the following except:
a. Surgeries or hospitalizations
b. Use of tobacco
c. Immunizations
d. Religious beliefs
39. Which of the following statements does NOT accurately describe depression
a. It is a common medical problem
b. It often present with insomnia and physical complaints
c. It is commonly misdiagnosed or ignored
d. It is seldom letha
Volume 2 Chapter 2 Quiz
1. Physical exam techniques include all of the following EXCEPT:
a. Inspection
b. Palpation
c. Auscultation
d. Association
2. What technique does a Paramedic use to effectively evaluate for tenderness,
rigidiy or crepitus?
a. Palpation
b. Auscultation
c. Percussion
d. Inspection
3. A stethoscope is usually needed to hear all of the following sounds EXCEPT
a. Stridor
b. Bowel sounds
c. Crackles
d. Wheezing
4. When evaluating a patient’s skin condition, a paramedic should check for which
of the following?
1. color
2. temperature
3. pigmentation
4. moisture
a. 1,2
b. 1,2,3
c. 2,3,4
d. 1,2,4
5. You are sent to the home of an insulin dependant diabetic female. You ask her to
state her name, the month, and her address. This would be an example of
a. Assessing memory and attention
b. Interrogation
c. Assessing mood
d. Assessing judgment
6. The physical exam begins when the Paramedic first
a. Talks to the patient
b. Sees the patient
c. Touches the patient
d. Asks the patient about past medical history
7. Skin color is best evaluated at the
a. Cheeks and nose
b. Wrists and neck
c. Nail beds and conjuntiva
d. Mouth and limbs
8. Cyanosis is caused by increased
a. Carboxyhemoglobin
b. Deoxyhemoglovin
c. Methemoglobin
d. Oxyhemoglobin
9. Examination of the eyes include checking the symmetry of:
1. pupil size
2. lens color
3. shape
4. contour
a. 1,2
b. 1,2,3
c. 2,3,4
d. 1,3,4
10. Your patient was in a mvc (motor vehicle crash) but was not discovered until 3
hours later. When you examine him, you discover bilateral discolored skin over
the mastoid process. You should suspect
a. Ethmoid bone fracture
b. Sinusitis
c. Basilar skull fracture
d. Opthalmoscope
11. Aterial occlusions, retinal hemorrhages, and cataracts can be visualized with a(an)
a. Otoscope
b. Naked eye
c. Corneal lens
d. Opthalmoscope
12. Using an otoscope you can examine a patient for _________ and ________.
a. tinnitus, eustachian tube blockage
b. cranial nerve VII function, basilar skull fx
c. otitis, mastoiditis
d. tympanic membrane rupture, tympanic color changes
13. You are examining a 50 yom, complaining of ear pain and a fever. You inspect
the tympanic membrane and note it is a pearly grey/translucent color. You
conclude the patient has
a. A buildup of fluid behind the eardrum
b. A normal eardrum
c. Otitis media
d. Hemotmpanum
14. Nasal flaring in an indication of
a. Epistaxis
b. Cocaine abuse
c. Respiratory distress
d. Rhinitis
15. Lesions found on the lips maydicate
a. Dehydration
b. Allergic reaction
c. Anemia
d. Cancer
16. If an abnormal finding is noted in the patient’s respiratory rate or pattern during
the chest examination you should:
a. Record the findings and continue the exam
b. Take immediate steps to intervene the condition
c. Spend as much time as necessary to determine the cause
d. Palpate the abdomen to see if there is referred pain
17. You are examing a 70 yof patient with an altered mental status. She is awake and
can speak. You detect an odor of acetone and suspect that the patient is suffering
from
a. DKA
b. Cyanide poisoning
c. A bowel obstruction
d. Alcohol poisoning
18. A tear in the tracheo-bronchial tree or a pneumothorax can be characterized by
________ in the neck
a. subcutaneous emphysema
b. swollen lymph nodes
c. mediastinal deviation
d. jugular vein distention
19. The standard sequence for the physical exam is
a. Inspect, palpate, auscultate, percussion
b. Inspect, auscultate, percussion, palpate
c. Palpate, percussion, auscultate, inspect
d. Inspect, auscultate, palpate, percussion
20. A light, popping, nonmusical sound heard upon auscultation of the lungs is best
describes as
a. Stridor
b. Wheezing
c. Rhonci
d. Rales
21. A large harsh sound over the traches on ausculation with a stethescope suggests
a. Normal air sounds
b. Foreign body obstruction
c. Bronchoconstriction
d. Pneumothroax
22. When auscultating the breath sounds of a patient with pleurisy, you might expect
to hear which of the following sounds
a. Wheezes
b. Rhonci
c. Crackles
d. A friction rub
23. When auscultating the posterior chest, you should listen
a. Down one side first, then the other
b. From side to side as you proceed down the chest
c. Only at the bases
d. Only at the apices
24. Pulse quality refers to
a. Rate
b. Rhythm
c. Strength
d. Location
25. You are assessing a 34 yof who appears in hypovolemic shock. You except her
pulse to be
a. tachycardiac and bounding
b. bradycardiac and strong
c. bradycardiac and irregular
d. tachycardiac and weak
26. Which of the following is inlcuded in an examination of the cardiovascular
system
a. palpating for the atrial impulse
b. palpating both carotid arteries simultaneously
c. auscultating breath sounds
d. auscultating for carotid bruits
27. During ventricular systole the ventricles contract while the
a. tricuspid and mitral valves close
b. the pulmonic and aortic semilunar valves close
c. atria simultaneously contract
d. tricupspid and mitral valves open
28. The technique of ________ involves careful, noninvasive, informed observation
a. Auscultation
b. Palpation
c. Inspection
d. Percussion
29. The sounds of turbulent blood flow around a partial obstruction in the carotid
sinuses are known as:
a. Thrills
b. Bruits
c. Vibrations
d. Stridor
30. Which of the following body systems would not be evaluated during an
abdominal exam
a. Musculoskeletal
b. Digestive
c. Cardiovascular
d. Reproductive
31. How should a patient by positioned for an abdominal exam
a. Standing
b. Sitting
c. Lying on their left side
d. Supine with the head and knees supported
32. Dicoloration over the umbilicus, known as _______sign, ia
a(an)__________indicator of intra-abdominal bleeding
a. Grey-turners, late
b. Cullen’s, late
c. Cullen’s, early
d. Grey-turners, early
33. Ausculation for bowel tones should be done
a. In all four quadrents
b. Over the umbilical cord
c. Over the epigastrium
d. In all nine regions
34. When evaluating a female’s patient genitalia, a paramedic must always provide
for _______ as well as a ____________
a. A sedative, pillow
b. Confidentiality, scribe
c. Privacy, witness
d. Pain medication, sheet
35. To inspect and examine the anus, a Paramedic shoud place the patient
a. Supine with legs spread
b. Prone with legs spread
c. Kneeling
d. Left or right lateral recumbent with privacy
36. An elderly male is complaing of sob. You discover pitting edema that is 1/2″
deep. This is ______ pitting edema
a. +1
b. +2
c. +3
d. +4
37. You are examing a patient’s peripheral vasculature when you note he has no radial
pulse. Your next step would be to
a. Palpate a carotid or femoral pulse
b. Palpate for the ulnar pulse
c. Start CPR
d. Defib at 200J
38. The crunching sounds of unlubricated skeletal parts rubbing agaisnt each other is
best described as
a. Bursal friction
b. Arthritis
c. Asynovial rub
d. Crepitation
39. Which of the following best describes the technique of evaluating plantar reflexes
including Babinksi’s
a. Tap the patellar tendon just below the knee
b. Strike the triceps along the posterior aspect of the distal humerus
c. Have the patient dorsiflex the foot, then strike the Achilles tendon
d. Stroke the lateral aspect of the sole of the foot from heel to ball, curving
medially
40. Your patient is complaing of numbness and hand pain that wakes him. One
explanation could be
a. Bursitis
b. Chondromalcia
c. Carpal tunnel syndrome
d. Plantar fascitis
41. Your patient has a swollen, painful leg. You flex the knee and palpate the calf,
causing more pain. This might suggest
a. Osteopyllitis
b. deep vein thrombosis (dvt)
c. internal claudication
d. hypokalemia
42. The loss of muscle tone that causes a limb or other part of the body to lay loosley
is best described as
a. Spasticity
b. Rigidity
c. Paresthesia
d. Flaccidity
43. During a neurologic exam, you ask your patient to stick out his tongue. It deviates
to the right. This may indicate a lesion to the patient’s _________ nerve
a. Facial
b. Hypoglossal
c. Vagus
d. Glossopharyngeal
44. Your patient is a 3 yom who presents with a fever. His parents state that he has
had diarrhea and vomiting for 2 days. The patient has not eaten in 24 hours. To
best evaluate the patient’s peripheral perfusion status, you should examine his
a. Cap refill
b. Blood pressure
c. Respiratory rate
d. Fingertip sensation
45. Areas of a neuro exam include all of the following EXCEPT
a. Cranium
b. Crainial nerves
c. Mental status and speech
d. Reflexes
46. The term stuporous best describes which of the following patient conditions
a. the patient awakens when shaken and answers questions appropriately, but
left alone falls back to sleep
b. The patient awakens when shaken and provides confused answers to
questions
c. The patient is arousable for short periods of time and is unaware of his/her
surroundings
d. The patient is unarousable to physical stimuli
47. While speaking, your patient shifts from topic to topic, without realizing that his
thoughts are not connected. This might be a sign of any of the following
conditions EXCEPT
a. Depression
b. Schizophrenia
c. Manic episodes
d. Psychosis
48. A patient who loses his balance while standing with his eyes closed and feet
together for 20-30 seconds is exhibiting
a. A positive tilt test
b. A positive Babinski reflex
c. Shy-Drager syndrome
d. A positive Romberg test
49. Which of the following is INCORRECT regarding the physical exam of older
infants and young children
a. Try to keep the child as close to the parents as the situation permits
b. The more invasive the procedure, the later in the exam you should perform
it
c. Avoid letting the child handle your basic equipment so he does not get so
upset during the exam
d. Use a soft voice and a smile during the exam
50. when evaluating a patient with an altered mental status, which of the following
tools would be of greatest benefit to your assessment of the condition
a. opthalmoscope
b. stethoscope
c. thermometer
d. glucometer
Volume 2 Chapter 3
1. In an infant the heart rate is best detected by palpating the brachial artery and?
a. Auscultate the apical pulse
b. Palpating the femoral pulse
c. Palpating the carotid pulse
d. Auscultate the carotid pulse
2. A Pt. with skin described as “clammy” has
a. Warm and dry
b. Cool and moist skin.
c. Warm and moist
d. Cool and dry
3. When assessing the chest any open wounds you locate should be?
a. Covered with a gauze bandage
b. Probed for depth
c. Treated with an ointment
d. Sealed with an occlusive dressing.
4. Which of the following best describes why a focused history is important in
responsive pt.?
a. It suggests diagnostic impression
b. It allows treatment to be initiated immediately
c. It helps formulate a field diagnosis.
5. Special emphasis should be placed on which of the following during your detailed
physical exam?
a. Area suggested by the chief complaint.
b. Mental status
c. Cardiovascular and respiratory systems
d. Cranial nerve function
6. You are en route to a hospital with a patient who appears stable following a MVC.
To detect changes in the patient’s condition witch of the following should be
repeated during transport?
a. Detailed physical exam
b. Initial Assessment.
c. Reflex tests
d. HEENT exam
7. Which of the following should be searched for during the physical examination to
determine if the patient has any specific pre-existing health conditions?
a. A hospital identification band from pt’s last visit
b. Personal physician contact numbers
c. Insurance information cards
d. Medical alert tags
8. At the scene of a multiple vehicle collision, which of the following actions should
you take first?
a. Withdraw and wait for additional resources to arrive
b. Quickly scan the scene
c. Go directly to the first pt you see
d. Go directly to the pt who appears most seriously injured
9. During the initial assessment your patient groons tries to turn away when you
apply a sternal rub. Otherwise there is no other response. The Patients medical
status can be described as?
a. Reponds to verbal stimuli
b. Alert
c. Paranoid
d. Responds to painful stimuli
10. Your patient presents with audible stridor in the upper airway. Which of the
following statements is true?
a. Stridor is not a sign of a serious problem
b. You must evaluate the history of the condition causing the stridor and the
associated clinical signs.
c. Stridor is a sound that is referred from the lower airway
11. Which of the following choices is the sequence of steps when assessing a major
trauma patient?
a. Initial Ax, Reconsider Mech. Of injury, rapid trauma assessment, vital
signs, and history.
12. Your patient is unresponsive to painful stimulus and has snoring resp. What is
your next action?
a. Suction
b. Check for a pulse
c. Perform a head tilt chin lift.
d. Administer O2 at 15 lpm
13. You respond to a scene where a gunshot has been heard and there is a report of a
man down you should enter the scene when?
a. You observe the gunman fleeing the scene
b. Bystandards inform you the scene is safe
c. Police officers arrive and secure the scene
d. You arrive on scene
14. Forming a general impression as part of your initial assessment helps you to?
a. Determine general clinical status and priority.
b. Make a determination about cervical spine
c. Determine baseline mental status
15. All of the following are signs of inadequate breathing in an infant except?
a. A respiratory rate of 32 per minute
b. Cynosis
c. Use of accessory muscles
d. Altered mental status
16. You are assessing an adult patient. When you palpate her wrist to locate a pulse,
you don’t feel one. You should immediately palpate?
a. For an ulnar pulse
b. Opposite radial pulse
c. For a carotid pulse.
d. For a poplateal pulse
17. The purpose of manual stabilization of the C-spine during the initial assessment of
a trauma patient is to?
a. Help you avoid litigation
b. Allow you to control the pt
c. Secure the pt so he can’t escape the ambulance
d. Prevent the patient from moving his neck
18. All of the following mechanisms of injury yield a high level suspicion for life
threatening injury except?
a. A stab wound distal to the knee.
b. A collision between a motorcycle and a pedestrian
c. Falling off the top of a 30 ft extention ladder
d. A pt ejection from a motor vehicle after a collison
19. You are treating a 27 year old asthmatic patient outside a bar when a groaning
crowd becomes hostile and unruly. To protect yourself, crew, and your patient
you should?
a. Exit the scene leaving the pt behind
b. Use your vehicle to disperse the crowd
c. Move the pt into the bar
d. Remove yourself and the patient from the scene.
20. Which of the following may indicate either cardiac tamponade or tension
pneumothorax?
a. Distended neck veins
21. Your patient remains unresponsive after a painful stimulus is applied. The family
reports that the patient was found unconscious in bed, after complaining of a
terrible headache. Which of the following represents the correct sequence of
action?
a. Initial assessment, rapid medical assessment, detailed exam, and brief
history from family.
22. Which of the following best describes when you should perform a scene size up?
a. Simply don’t get out of the ambulance
b. Throughout the event because safe scenes may change suddenly
c. Only at the end of the event to be sure you caught everything
d. Only at the pt’s side
23. Which of the following best describes the differences in approach when assessing
responsive and unresponsive patients?
a. You should elicit chief complaint, histories of present illnesses, and past
medical history from responsive medical patients before conducting a
physical exam.
24. A critical patients vital signs should be reassessed every
a. 15 minutes.
b. 20 minutes.
c. 10 minutes.
d. 5 minutes.
25. An important aspect of the ongoing assessment is to monitor and evaluate all of
the following except the?
a. Vital signs
b. Transport priority
c. Effectiveness of interventions
d. Estimated length of the wait in triage.
26. Rebound tenderness in the abdomen is a sign of potential?
a. Peritoneal irritation.
b. Full urinary bladder
c. Kidney stones
d. Food poisoning
27. When responding to a domestic dispute you should?
a. Have dispatch tell pt to come outside
b. Wait for law enforcement to arrive.
28. Which of the following patient conditions requires immediate transport?
a. Unresponsive to painful stimuli after ALS interventions.
b. Narcotic OD
c. Wrist fx
d. Neck and back pain secondary to a MVC
29. You locate a 55 year old female lying supine on the side of the road. There are no
bystandards. You determine the patient is unresponsive. What should you do
next?
a. Provide high flow O2
b. Intubate airway
c. Apply cervical collar
d. Manually stabilize her C-spine.
30. While performing an initial assessment on a trauma patient. Who has fallen from
a roof, you discover absent lung sounds on the right side. Which of the following
actions should you take next?
a. Search for other signs of tension pneumothorax.
b. Intubate the pt
c. Decompress the pt chest
d. Move to the abdomen and continue rapid trauma assessment
31. You are evaluating a patient who was a restrained driver of a motor vehicle that
crashed into the median barrier at 40 mph. Now he is awake, alert, and oriented
complaining of neck and back pain. There is a bruise across his upper abdomen
in the shape of a seat belt. Based on this, you should assume he his?
a. Major trauma patient, transport him to the nearest hospital
b. Major trauma patient, transport him to a trauma center.
c. Minor trauma patient, transport him to the nearest hospital
d. Minor trauma patient, transport him to the hospital of patients choice.
32. Which of the following is not a consideration when evaluating the forces of the
mechanism of injury?
a. Whether it was a rural or urban setting.
b. Direction of impact
c. Whether the mechanism was blunt or penetrating
d. Mass and velocity of weapon involved
33. Your patient is not alert, but is responsive to painful stimulus. His airway is
patent. He is breathing at 8 times per minute. Your next action should be to
administer?
a. O2 6 LPM NC
b. O2 15 LPM NRB
c. PPV with a BVM and O2 15 LPM.
34. Orthostatic changes are present when which of the following occurs in response to
the patients moving from a supine to a seated position?
a. BP remains the same, HR increases 40-50 BPM
b. BP decreasing in 10-20mmhg, HR increasing 10-20 BPM.
35. When assessing a major trauma patient, which of the following statements is
TRUE of the pt’s history?
a. Take no history because there is no time to do so on trauma pt’s
b. Complete a history of assessing a chief complaint, and current health
status
c. Complete a rapid history by using SAMPLE.
36. Your 3 year old patient opens her eyes when you speak to her and can respond.
Her mental status is?
a. Lathargic
b. Stuperous
c. Responsive to tactile stimuli
d. Responsive to verbal stimuli.
37. Which of the following problems is not critical to find during the initial
assessment?
a. Scalp hematoma
b. FBAO
38. After determining that a person does not respond to verbal stimuli, your next
action is to?
a. Elicit painful stimuli.
b. Apply manual C-spine stabilization
c. Place him in the recovery position
d. Insert an OPA
39. When responding to calls involving two vehicle collisions you must always
suspect?
a. Severe lower extremity injuries
b. Multiple patients.
c. Pt’s with altered mental status
d. Pt’s with fail chest
40. Your patient appears awake but barely looks at you when you call his name. His
airway is open, and he is breathing at 34 times per minute. He appears cyanotic.
What is your next action?
a. Insert a NPA
b. Administer PPV with a BVM and O2 15 LPM
c. Administer O2 6 LPM via NC
d. Administer O2 15lpm via NRB mask
Volume 2 Chapter 4 Quiz
1. With your field diagnosis in mind, you develop a treatment plan for your patient.
This part of the critical decision-making process is called:
a. applying principles
b. evaluating the results
c. interpreting the data
d. forming a concept
2. Your patient is in cardiac arrest. You are focused on initiating CPR, managing the
airway, and, if necessary, defibrillating as soon as possible. Your step-by-step
approach of data in this situation is best called:
a. convergent
b. divergent
c. reflective
d. reactive
3. Ways to remain clam under pressure include all of the following EXCEPT:
a. using mental checklists
b. raising your technical skills to a pseudo instinctive level
c. learning to multitask
d. breathing quickly and deeply
4. As you manage your patients condition, you mentally visualize a flow chart that
describes a pathway for your treatment, based on the patients signs and symptoms.
This format is known as:
a. Sop
b. Algorithm
c. Standing order
d. protocol
5. After determining that your patient is in cardiac arrest, you and your crew begin
resuscitation. CPR in begun, the airway is managed with a BVM and oral airway,
and an IV is initiated. Several medications are delivered, and the results are
evaluated. You determine that the patient needs an intervention that requires base
contact. Until now, you have been operating under:
a. Protocols
b. Algorithms
c. Intuition
d. Standing Orders
6. The six “Rs” of putting together the critical decision making process include all of the
following except:
a. Reading the patient
b. Reinforcing good practices
c. Revising the management plan
d. Reviewing your performance
7. The portion of critical thinking dedicated to assessing initial response to treatment
and locating less than obvious problems is:
a. Revising
b. Reviewing
c. Reevaluating
d. reacting
8. Paramedics can treat patients with the same techniques as other clinicians except
they:
a. Perform these procedures in uncontrollable and unpredictable
environments.
b. Are not allowed to make clinincal decisions
c. Treat life threating emergencies only
d. Are far less trained than other practitioners
9. The term acuity refers to:
a. The severity of the patients condition
b. The use of standing orders for care
c. Critical thinking and decision making skills
d. The use of an algorythm
10. Treatments that can be performed before contacting the medical direction physician
are known as:
a. Standing orders
b. Algorithms
c. Protocols
d. Management plans
11. After a call, you discuss the patient with the emergency department physician,
comparing diagnoses and care plans. This is an example of:
a. Putting it off all together
b. Evaluating
c. Reflecting
d. Applying principles
12. The ability to critically evaluate a patients condition and formulate a treatment plan
rests on all of the following fundamental knowledge and abilities except:
a. Excellent working knowledge of anatomy and physiology
b. Focusing on large amounts of data
c. Identifying and dealing with medical ambiguity
d. Strictly following protocols
13. While people think under pressure, hormones can diminish their:
a. Muscle strength
b. Sensory acuity
c. Ability to concentrate
d. Natural reflexes
14. You arrive at a location and begin to read the scene by:
a. Observing the immediate surroundings
b. Appoching the patient
c. Addressing life threats
d. Conducting a focused exam
15. In critical decision making, addressing life threats as they are found is an example of:
a. Reading
b. Reacting
c. Reviewing
d. reevaluating
16. The first step in critical thinking is to:
a. Conduct a focused exam
b. Ascertain the chief complaint
c. Form a concept
d. Determine strategically significant conditions
17. Changing or stopping interventions that are not working is an example of:
a. Re-evaluating
b. Reading the patient
c. Reviewing your performance
d. Revising the management plan
18. You are evaluating a patient who was in a motor vehicle collision. You determine
that the patient is responsive to pain only. He has a partially amputated arm at the
elbow, a possible pelvic fracture, and a flail chest. You classify this patients
condition as:
a. Critically life threatening
b. Expectant
c. Non-life threatening
d. Potentially life threatening
19. Your 23 year old patient presents with relatively normal vital signs and is fully alert
and oriented. Her only complaint is lower abdominal pain. If you assume she is
pregnant, you are:
a. Interpreting the data
b. Evaluating
c. Overgeneralizing
d. Applying principles
20. Critical thinking is a thought process used to:
a. Focus on a situations most important aspect
b. Defend one’s actions in a CQI process
c. Establish credibility with an emergency physician
d. Analyze and evaluate
21. Your patient is emotionally distraught with a long, complicated medical history and
presents with multiple problems. You consider the physical, emotional, and
psychological aspects of her condition. This type of data processing is called:
a. Reflective
b. Reactive
c. Convergent
d. Divergent
22. Which of the following choices is the correct sequence of steps in critical decision
making?
a. Forming a concept, Interpreting the data, Applying the principles,
Evaluating results, and Reflecting on the incident.
23. Using knowledge and experience to diagnose patients and plan their treatment is
called clinical:
a. Practice
b. Intuition
c. Judgement
d. reflection
24. After considering the information you have collected, you determine the most likely
cause of your patients condition. This step in the critical decision making process is
called:
a. Reflecting on the incident
b. Interpreting the data
c. Forming a concept
d. Applying the principles
25. During the ongoing assessment of a stable patient, you should recheck vital signs
every 15 minutes. This is an example of:
a. Reflecting
b. Reviewing
c. Evaluating
d. Applying principles
Volume 2 Chapter 5
1. Specialized terms for radio use enhance communications by:
a. Shortening airtime and transmitting thoughts quickly
b. Lengthening airtime and transmitting thoughts quickly
c. Shortening airtime and transmitting thoughts reasonably accurately
d. Rationing airtime and transmitting thoughts quickly
2. Without formal transfer of care to the receiving hospital, paramedics could be
charged with:
a. Neglect
b. Abuse
c. Malpractice
d. Abandonment
3. Systems that transmit and receive on the same frequency are:
a. Trunked
b. Duplex
c. Multiplex
d. Simplex
4. In most systems 911 called are first routed to the ______ who then sends the call
to:
a. PSAP, base station
b. EMS-C, PSAP
c. EMD, PAAP
d. PSAP, EMD
5. The main duties of the dispatcher after sending the responders and providing
prehospital instructions include:
a. Discussing medical direction
b. Directing the crew to an appropriate receiving facility
c. Supporting and coordinating
d. Transferring communications
6. A(n) _______ system uses a computer to route transmissions to the first available
frequency,
a. Digital
b. Repeater
c. Encrypted
d. Trunked
7. In addition to gathering the incident location, the dispatcher should also obtain the
____ from the caller.
a. Pt’s insurance information
b. Call back number
c. Medical history
d. Callers past 911 use
8. The dispatcher’s directions to the caller for appropriate emergency measures are
known as:
a. Enchaned 911 services
b. Call coordination
c. Prearrival instructions
d. Priority dispatching
9. Which of the following is the key link in the chain that results in the best possible
pt outcome?
a. Confrontation
b. Coordination
c. Communication
d. Conceptualization
10. The acronym PSAP stands for:
a. Paramedic system answering point
b. Public safety agency paramedics
c. Prehospital safety and prevention
d. Public safety access point
11. Which of the following best describes why it is important to use terminology that
is widely accepted by the medical and emergency services communities?
a. Unfamiliar terms may be meaningless or misleading
b. It is required by regulations
c. To increase professional recognition and status
d. To prevent anyone in the general public listening in from understanding
what is going on
12. _____ communications are condensed and require a decoder to translate.
a. Analog
b. Digital
c. Cellular
d. Telephone
13. The type of communication system that works like a telephone is
a. Multiplex
b. Duplex
c. Ultra-simplex
d. Simplex
14. Cellular telephone systems use _____ to transmit communications
a. Satellite technology
b. Regional radio base stations
c. Short wave technology
d. Underground cables
15. Using terminology widely accepted by the emergency services and medical
community when giving a report to emergency department personnel is important
because:
a. “10-codes” are meaningless to physicians
b. Semantics enhance effective communication
c. The receiver must be able to decode the message
d. Verbal communication is the preferred medium
Volume 2 Chapter 6
1. The subjective narrative includes information that is elicited:
a. By observing the pt’s actions only
b. From dispatch information
c. During history taking
d. Through palpation
2. Writing false or malicious words to damage a persons character is called:
a. Character assassination
b. Libel
c. Bad faith
d. Slander
3. Seeking and recording pertinent negatives demonstrates which of the following:
a. Thoroughness of your examination
b. Charting by exception
c. Use of the pert-neg format
d. Thoughtfulness of your care
4. The paramedics general impression is documented in the:
a. Subjective narrative
b. Objective narrative
c. Diagnosis section
d. Assessment/management plan
5. The prehospital care report should document all the following except:
a. Treatments provided
b. Subjective opinions
c. Objective observations
d. Pertinent negatives
6. You are completing your PCR and cannot remember the correct spelling of a
medical term. You should:
a. Make up an abbreviation for the word
b. Cross out the sentence an indicate an error
c. Try to spell the word even if you are wrong
d. Use plain English instead
7. Which of the following best describes why abbreviations and acronyms can cause
interpretation problems and confusion:
a. Nursing uses a different set of abbreviations and acronyms
b. They are not universally excepted by all EMS agencies
c. Physicians use a different set of abbreviations and acronyms
d. Some abbreviations and acronyms can have multiple meanings
8. Which of the following would be most useful for paramedics to carry with them
as an aid to proper documentation?
a. Copy of previous charts
b. Pocket sized medical dictionary
c. Quality assurance policy
d. Pocket sized thesaurus
9. Why is it important for billing companies to have a complete PCR
a. It is required by law
b. These companies need a lot of information to generate bills
c. These companies also perform quality assurance on the charts
d. These companies can then decide whether to bill for services
10. Seeking and recording pertinent negatives demonstrates which of the following:
a. Charting by exception
b. Use of the PERT-NEG format
c. Thoughtfulness of your care
d. Thoroughness of your examination
11. Which of the following statements is inappropriate for a PCR
a. The pt was intoxicated
b. The pt had trouble walking
c. The pt’s appearance indicated a lack of self care
d. The pt stated “I feel fine”
Block 3.1
Volume 3 Chapter 1 Quiz
1. Your patient is a 68 year old male complaining of diff. breathing for 2 days. He is
sitting up, conscious, alert, and oriented and appears to be in mild resp. distress.
Phys. Exam reveals cool, dry, pink skin, he is thin with well defined accessory
muscles, and you note diffuse wheezing in all lung fields. The patient gives a 20
pack a year smoking history. Based on the exam what is it?
a. Diverticulitis
b. Asthma
c. Pulmonary embolism
d. Emphysema
2. Which of the following statements about pulse Ox is false?
a. Pulse Ox values could be expected to decrease within seconds in cases of
developing hypoxia.
b. Pulse Ox should be used on all pts with respiratory compromise
c. It may be difficult to obtain a reading in pts with peripheral
vasoconstriction
3. The functional unit of the respiratory tree is?
a. Pharynx
b. Lamina propria
c. Alveoli
d. bronchiole
4. The mechanical process by which air is moved in and out of the lungs is?
a. Ventilation
b. Diffusion
c. Perfusion
d. respiration
5. The amount of air moved in and out of the lungs during a normal, quiet
respiration is?
a. Function reserve capacity
b. Tidal Volume
c. Inspiratory capacity
d. Dead space volume
6. Which of the following is not an intrinsic risk factor associated with respiratory
disease?
a. Cigarette smoking
b. History of lung cancer in father
c. Mother died during delivery
7. The most superior portion of the pharynx is the?
a. Oralpharynx
b. Larynogopharynx
c. Nasopharynx
d. trachea
8. The structure that occludes the trachea to prevent aspiration during swallowing is
the?
a. uvula
b. Carina
c. Vallecula
d. Epiglottis
9. Lung perfusion depends on all of he following except:
a. Intact pulmonary capillaries
b. Adequate blood volume
c. Efficient pumping of the heart
d. An intact alveolar membrane
10. Diffusion is defined as:
a. Movement of molecules across a membrane from an area of greater
concentration to an area of lower concentration
b. Movement of molecules across a membrane from an area of lower
concentration to an area of greater concentration
c. Movement of molecules across a membrane with the assistance of ATP
d. Ability of hemoglobin to accept and bind with oxygen
11. Your patient is a 24 year old male experiencing an acute onset of SOB.
Expiratory wheezes are auscultated in all lung fields. Your primary goal in
managing this patient is to?
a. Improve alveolar perfusion
b. Reduce inflammation
c. Reverse bronchospasm
d. Evaluate peak expiratory flow rate
12. Your patient is a 72 year old female, alert and oriented, sitting up in bed at a
nursing home. She is in mild resp. distress. Staff describes 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 exam. Reveals
rhales and rhonchi in the right upper lobes and warm, moist skin. Based on the
clinical exam findings, the most appropriate diagnosis would be?
a. CHF
b. Chronic bronchitis
c. Pneumonia
d. COPD
13. Which of the following best defines perfusion?
a. Ability of hemoglobin to accept and bind with oxygen
b. Circulation of blood through the capillaries
c. Movement of molecules across a membrane from an area of greater
concentration to an area of lower concentration
14. All of the following are acceptable methods of clearing a FBAO in an
unconscious supine adult except:
a. Alternating back blows and abdominal thrusts.
b. Abdominal thrusts
c. Using magil forcepts to pull the obstruction out
d. Encouraging patient to continue coughing
15. A hyperresponsive airway is likely to be in all the following conditions except:
a. ARDS
b. Emphysema
c. Pulmonary embolism
d. Asthma
16. Improving ______ is a primary treatment goal in a pt with bronchospasm.
a. Lung compliance
b. Ventilation of the alveoli
c. Lung perfusion
d. Diffusion across the alveolar membrane
17. Which of the following would result in an increased respiratory rate?
a. A decrease in cerebrospinal fluid PO2
b. Stimulation of chemoreceptors by an increase of PCO2
c. Stimulation of baroreceptors by an increase of PCO2
d. An increase of cerebrospinal fluid PH
18. Normal inspiration involuves all the following except
a. Relaxation of the intercostals muscles
b. Flattening of the diaphragm
c. An increase of intrathorasic volume
19. The carpopedal spasm that occur due to the hyperventilation syndrome are a result
of realitive _______, secondary to _________.
a. Hypocalcemia, increase in bound calcium
b. Hypercalcemia, respiratory alkalosis
c. Hypocalcemia, decrease in unbound calcium
d. Hyponatremia, respiratory alkalosis
20. Which of the following statements comparing asthma and emphysema is TRUE:
a. Both diseases are common in children
b. Asthma is characterized by reversible airway obstruction, emphysema by
irreversible airway obstruction
c. Both diseases are caused by smoking
21. Management of a pt who is hyperventilating should include:
a. Breathing into a paper bag to correct respiratory alkalosis
b. Coaching the pt to hold their breath
c. Withholding O2
d. The administration of O2 and coaching the pt to reduce the rate and depth
of ventilations
22. An example of diffusion in the respiratory system is
a. Movement of O2 from the alveoli into the pulmonary capillaries across the
alveolar membrane
b. Movement of CO2 from the alveoli into the pulmonary capillaries across
the alveolar membrane
c. Perfusion of the pulmonary capillaries with O2 from the alveoli across the
alveolar membrane
23. Which of the following statements about capnography is false
a. It is a useful tool to verify proper ET placement
b. It can be useful when diagnosing specific pulmonary pathologies
c. It can give objective feedback on the efficacy of ventilations being
provided to a pt in full cardiac arrest
d. Normal end tidal CO2 values are between 35 – 45 torr
24. A 61 yr old male with a 24 pack a year history of cigarette smoking presents with
pursed lips, SOB. You note that he is thin and has florid skin and a barrel chest.
Auscultation of his lungs reveals diffuse expiratory wheezing in all fields. Based
on this clinical condition, what additional complication is most likely to develop.
a. Pulmonary embolism
b. Asthma
c. Cor pulmonale
d. Left heart failure
25. Your pt is a 16 yr old male who attempted suicide. He is unconscious and apneic,
lying supine on his garage floor. The pt was found in the front seat of a running
car. HR 70, BP 100/60, RR 0, in addition to IV with NS, which of the following
is most approp
a. Remove from garage, place ET, and transport to nearest hospital
b. Place ET, remove from garage, and transport to hospital with hyperbaric
chamber
c. Remove from garage, start BVM with O2, place ET, transport to hospital
with hyperbaric chamber
d. Remove from garage, start BVM with O2, place ET, transport to nearest
hospital
26. Which of the following is the purpose of surfactant in the lungs
a. Aid in the facilitated diffusion of carbon dioxide and oxygen across the
alveolar membrane
b. Destroy and remove foreign material from the alveoli
c. Aid in the facilitated diffusion of O2 across the alveolar membrane
d. Decrease the surface tension of water in the alveoli
27. Your pt is a 68 yr old male complaining of difficulty breathing for 2 days. He is
sitting up alert, and orientated and appears to be in mild respiratory distress.
Skins are cool, dry, and pink and he appears thin with well defined accessory
muscle use. You hear wheezing in all lung fields. HR 102, BP 136/96, RR 20,
SaO2 92%. The pt gives a 20 pack a year history of smoking. Based on these
findings, which of the following is most likely.
a. Emphysema
b. Asthma
c. Chronic bronchitis
d. CHF
28. During inspiration the air pressure in the chest cavity is _____ than atmospheric
pressure.
a. Higher
b. Positive
c. Lower
d. The same
29. Which of the following is not a role of the upper respiratory system
a. Warm inspired air
b. Carry out gas exchange with inspired air
c. Filter inspired air
d. Humidify inspired air
30. Your pt is a 23 yr old male in severe respiratory distress. The pt was working in a
small enclosed space when he split a 5 gallon drum of ammonia onto the floor and
was quickly overcame by fumes. A coworker has pulled him from the room to
safety and assured no ammonia has spilled onto his clothing. The pt is
complaining of burning sensation to his throat and lungs, and you note his voice is
becoming progressively more horse. Lung sounds revel crackling and wheezing
in all lung fields. HR 144, BP 150/100, RR 30, SaO2 90%. In addition to IV
with NS at TKO rate, which of the following is the best course of action
a. ET placement, ventilation with O2, nebulized albuterol and atrovent,
corticosteroids via IV
b. O2 via NRB, nebulized albuterol and atrovent, corticosteroids via IV
c. ET placement, ventilation with O2, nebulized albuterol and atrovent
d. ET placement, ventilation with O2
31. Your pt is a 34 yr old male complaining of SOB. He gives a 3 day history of
runny nose, sore throat, and nonproductive cough. His SOB 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, SaO2 95%. Which of the
following is the best course of action?
a. O2 via NRB, albuterol via nebulizer, IV of NS TKO
b. O2 via NRB, IV of NS TKO
c. O2 via NC at 4lpm
d. BLS transport only
32. The _______ plura lines the thoracic cavity and contains nerve fibers
a. Alveolar
b. Innervated
c. Parietal
d. Visceral
33. An increased hydrogen ion concentration in the cerebrospinal fluid results in a(n)
_______ respiratory rate
a. Unchanged
b. Increased
c. Erratic
d. Decreased
34. Normal exhalation requires all the following except:
a. Passive lung recoil
b. A decrease in intrathoracic volume
c. Nervous stimulation from the phrenic nerve
d. Relaxation and upward movement of the diaphragm
35. Impulses from the ______ nerve(s), which originate in the ________, stimulate
the diaphragm to contract
a. Intercostals, thorasic spinal cord
b. Phrenic, cervical spinal cord
c. Intercostals, brain stem
d. Phrenic, thorasic spinal cord
36. An increase in arterial PCO2 results in a(n)_______ in cerebrospinal fluid pH and
a(n)_________ in ventilation
a. Increase; decrease
b. Decrease; decrease
c. Increase; increase
d. Decrease; increase
37. You have intubated a 66yr old female pt who was experiencing an acute
exacerbation of her emphysema. What special consideration does this pt, with her
specific pathology require
a. O2 should be limited to 4lpm because of the hypoxic drive common in
COPD pts
b. She requires frequent, deep suctioning
c. While ventilating, your must allow for a prolonged expiratory phase
d. She requires hyperventilation to blow off excessive CO2
38. Which of the following is the most important determination of ventiatory rate
a. Arterial PCO2
b. Venous PCO2
c. Arterial PO2
d. Venous PO2
39. Which of the following correctly lists the divisions of the bronchial tree in
descending order:
a. Main stem bronchi, secondary bronchi, tertiary bronchi, bronchioles,
terminal bronchioles, respiratory bronchioles, alveolar ducts, alveolar sacs,
alveoli
b. Main stem bronchi, secondary bronchi, bronchioles, tertiary bronchi,
respiratory bronchioles, terminal bronchioles, alveolar ducts, alveolar sacs,
alveoli
c. Main stem bronchi, bronchioles, secondary bronchi, tertiary bronchi,
bronchioles, terminal bronchioles, respiratory bronchioles, alveolar ducts,
alveolar sacs, alveoli
40. ______ risk factors are those that are influenced by or are from within the patient.
a. Intrinsic
b. Inherent
c. Extrinsic
d. Generic
41. The anatomical difference between the two mainstem bronchi helps to explain
why:
a. Gastric contents tend to pass down the right mainstem bronchus into the
lungs
b. Pneumonia that results from aspiration occurs more commonly in the right
lung.
c. Endotracheal tubes advanced too far into the trachea will pass into the
right mainstem bronchus.
d. All of the above
42. The alveoli are moistened and kept open because of the presence of an important
chemical called _______ that is secreted by type II cells found on the alveolar
surface.
a. Tryptosin
b. Histamine
c. Surfactant
d. Macrophage
43. Nerve impulses from the ________ nerve, which begins in the region of the
cervical portion of the spinal cord and travels through the chest cavity, stimulate
the diaphragm to contract.
a. Vagal
b. Cranial
c. Phrenic
d. Hypoglossal
44. The total volume of air in the lungs, called the _______ measures approximately
6K in an adult male.
a. Total lung capacity
b. Minute alveolar volume
c. Minute respiratory volume
d. Forced expiratory volume.
45. The most important determinant of the ventilatory rate is the arterial _____
a. PO2
b. pH
c. PCO2
d. Hg
46. The oxygen dissociation curve can be altered by changes in the:
a. PCO2
b. Blood pH
c. Body temperature
d. All of the above
47. Cellular respiration occurs in the peripheral:
a. Veins
b. Arteries
c. Capillaries
d. Arterioles
48. ________ is (are) characterized by long, deep breaths that are stopped during the
inspiratory phase and separated by periods of apnea; this pattern is a result of
stroke or sever central nervous system disease.
a. Kussmaul’s repirations
b. Apneustic respirations
c. Ataxic (Biot’s) respirations
d. Central Neurogenic hyperventilation
49. Common medications used by patients with COPD include all of the following
except:
a. Diabinese
b. Theophylline
c. Cromolyn sodium
d. Antibiotic agents
50. A whistling sound due to narrowing of the airways by edema,
bronchoconstriction, or foreign materials describes:
a. Stridor
b. Snoring
c. Rhonchi
d. Wheezing
51. The preferred abbreviation to describe oxygen saturation measurement is
________.
a. O2
b. SpO2
c. PaO2
d. SaO2
52. _________ is a graphic recording or display of the capnometry reading over time.
a. Capnogram
b. Capnograph
c. Capnography
d. Capnometry
53. _______ describes an excess of red blood cells resulting in an abnormally high
hematocrit.
a. Anemia
b. Hypoxemia
c. Plycythemia
d. Thrombocytopenia
54. The paramedic should measure _________ to determine the severity of an asthma
attack and the degree of response to treatment
a. CO2
b. PCO2
c. PEFR
d. ETCO
55. Your pt is a 30 year old male who has been in pt in a rehabilitation hospital
following surgical reduction of a fractured pelvis. Staff reports sudden
development of hypotension and severe respiratory distress about thirty minutes
ago. There is no other significant history. Physical exam findings include cold,
diaphoretic skin with peripheral cyanosis; jugular venous distention; clear breath
sounds bilaterally; and vitals as follows: HR 134, BP 74/50, RR 28, SaO2 84%.
Which of the following is most likey?
a. Myocardial infarction
b. Spontaneous tension pneumo
c. Pulomary embolism
d. Idophatic CHF
56. Your pt is a tall, thin, 34 yr old male complaining of shortness of breath. He gives
a three 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?
a. Oxygen via NRB 15 lpm, IV of NS KVO
b. BLS transport
c. O2 via NRB 15 lpm, albuterol via neb, IV of NS KVO
d. O2 via NC 4 lpm
Volume 3 Chapter 2a Test
1. The presence of inverted T waves on an ECG indicates:
a. Myocardial ischemia
b. Hypoglycemic
c. Angina
d. Hyperkalemia
2. Pharmacological interventions initiated by prehospital care providers in the
treatment of CHF include all of the following except:
a. Lasix
b. NTG
c. Dopamine
d. Albuterol
3. Which of the following best characterizes successful defibrillation?
a. Uniform mass depolarization of myocardial cells, repolarization, intrinsic
pacemaker function resumes.
b. Uniform mass repolarization of myocardial cells, depolarization, intrinsic
pacemaker function resumes.
c. Uniform mass depolarization of myocardial cells, intrinsic pacemaker
function resumes.
d. Uniform mass repolarization of myocardial cells, intrinsic pacemaker
function resumes.
4. An elevation of the ST segment is associated with:
a. Myocardial injury
b. Hyperkalemia
c. Myocardial ischemia
d. Left ventricle hypertrophy
5. Management for a patient experiencing angina may include all of the following
except:
a. NTG SL
b. 100% oxygen
c. Epi 1:1000 SQ
d. NTG topical
6. Which of the following is not a likely immediate cause of acute myocardial
infarction:
a. Hypolipidemia
b. Hyperlipidemia
c. Coronary artery occlusion
d. Coronary artery spasm
7. Which of the following ECG findings may occur with unstable angina:
a. U wave
b. Q wave formation
c. T wave elevation
d. ST segment depression
8. The most common cause of death resulting from MI is:
a. Hypercalcemia
b. Occlusion of airway
c. Dysrhythmia
d. Stroke
9. Your patient is a 38 year old male who was involved in a motor vehicle accident
in which he sustained blunt force trauma to his chest. Physical exam reveals JVD,
difficulty breathing, equal lung sounds bilaterally, and a narrowing pulse pressure.
Which of the following is most likely:
a. Cardiac contusion
b. Cardiac tamponade
c. Tension pnemothorax
d. Traumatic asphyxia
10. A 42 yo female is alert and oriented, complaining of chest pain. Which of the
following questions would be the least productive with regard to performing a
focused history:
a. Are you having trouble breathing
b. What were you doing when the pain started
c. When did the pain start
d. When did you last see your doctor
11. Which of the following is most characteristic of right heart failure:
a. JVD, peripheral edema, and pulmonary edema.
b. Rales cough with pink tenged sputum
c. JVD, peripheral edema, and hepatic engorgement
d. Ascities, peripheral edema, and cynosis
12. The heart sound produced by closure of the AV valve is:
a. S1
b. S2
c. S3
d. S4
13. Which of the following is not indicated for a 44 year old male who is supine on
the floor, pulseless, and apneic after experiencing chest pain and shortness of
breath:
a. Epi
b. Intubation
c. Cardioversion
d. IV access
14. A 63 year old male is alert and oriented, complaining of dizziness. He describes
an acute onset of dizziness and near syncope that has lasted for 15 minutes. He is
also experiencing substernal chest pain radiating to his jaw, as well as nausea, and
weakness. Physical exam reveals cool, diaphoretic skin, delayed cap refill and
mild rales to the bases bilaterally. He has no significant med. History, but he
takes 325 mg of aspirin a day. Hr=220, BP=88/52, RR=16, SaO2=95%. The
patient is receiving O2 by NRB. Which of the following should be done first:
a. Give additional 162mg ASA and NTG spray SL
b. Give pt a breathing treatment of Albuterol and Advent via nebulizer
c. Give lasix 40mg IVP
d. Attach the cardiac monitor.
15. Which of the following is least likely to be associated with an AMI:
a. Chest pain with inspiration
b. Nausea and vomiting
c. Anxiety and restlessness
d. Cool, pale, diaphertic skin
16. ________ is a drop in systolic B/P of more than 10mmHg with inspiration.
a. Pulsus paradoxus
b. Pulsus alternans
c. Electrical alternans
d. Pulse defict
17. Paramedics use all of the following interventions to treat CHF Except:
a. Place IV with microdrip at TKO rate
b. Use NTG in pt with cardiac wheezing
c. Place pt on monitor
d. Administering fluid bolus to treat hypotension
18. Your pt’s ECG shows a braid S wave in lead 1, and an R-S-R prime complex in
lead V1. this indicates a:
a. Chamber enlargement
b. Hemiblock
c. Right bundle branch block
d. Third – degree AV block
19. The predominant effect of a drug with primarily alpha properties would result in
which of the following:
a. Increased HR
b. Vasodilation
c. Decreased HR
d. Vasoconstriction
20. Cardioversion is used to treat all of the following rhythms except:
a. SVT
b. V-Fib
c. V-Tach with pulse
d. A-Fib
21. Signs and symptoms of decreased tissue perfusion secondary to cardiogenic shock
include all of the following except:
a. Constricted pupils
b. Tachnypea
c. Cool diaphertic skin
d. ALOC
22. A 67 year old male is unconscious, sitting in a chair, and has agonal respirations.
His wife states that he was up all night with difficulty breathing and chest
discomfort but would not go to the hospital. Physical exam reveals pink, frothy
sputum in the airway; cold, diaphoretic skin; and rales audible without a steth.
HR=108, BP-=74/P, RR=4, SaO2=82%. The monitor shows sinus tach. Which
of the following is the highest priority when treating this patient?
a. Lasix
b. NTG
c. Dophamine
d. Intubation
23. The heart sound produced by the closing of the aortic and pulmonary valves is:
a. S1
b. S2
c. S3
d. S4
24. A 48 year old male is sitting upright in bed in resp. distress. He describes an
acute onset of difficulty breathing and C/P during the night that has been
worsening for the past 3 hours. He also complains of nausea. Pain is described as
a substernal pressure radiating to his left shoulder. Physical exam reveals cool,
diaphoretic skin; and rales on auscultation bilaterally. Med. History includes two
prior MI. Meds. Include Zestril and metaprolol. HR=132, BP=140/100, RR=25,
SaO2=92%. Which of the following is not indicated:
a. NTG
b. Lasix
c. Adenosine
d. MS
25. A 66 year old male is supine on the waiting room floor in a dentist office. He is
pulseless and apneic. Bystanders state he seemed excessively anxious and then
collapsed about 5 minutes ago. The monitor shows asystole in the three leads.
Which of the following is the most appropriate first action:
a. Start IV, give epi and atropine
b. Defib up to three times
c. Begin BVM ventilations and chest compressions
d. Do not start CPR
26. A 45 year old male is alert and oriented, complaining of chest pain. He describes
a 2 day history of worsening pain described as a burning sensation below his left
breast that radiates across his chest. He states that the pain seems to get better
right after eating, but then worsens again. Medical history includes MI,
hypertension, and type two diabetes. His meds include Inderal, Vasotech,
glucotrol, and lopid. Physical exam reveals cool, dry skin; clear lungs, and no
JVD or peripheral edema. HR=102, BP=132/86, RR=12, SaO2=98%. The
patient is on O2 by cannula at 4 lpm. Which of the following should be done
next?
a. .4 NTG SL
b. 81 mg ASA
c. 12 lead ECG
d. Precautionary IV and transport
27. Which of the following is not a likely immediate cause of AMI?
a. Hyperlipidemia
b. Cardiogenic shock
c. Coronary occlusion
28. A decrease in preload results in a:
a. Decrease in afterload
b. Increase in stroke volume
c. Decrease in perhipheral vascular resistance
d. Decrease in cardiac output
29. Which of the following best differentiates cardioversion from defibrillation:
a. Cardioversion is timed to be synchronous with the patients R wave.
b. Cardioversion requires less than 100J
c. Cardioversion is a mass depolarization of the entire heart
30. A 48 yr old male complaining of chest pain that he describes as dull, located
substernally, but radiating to his neck. He rates the pain as six and complains of
nausea and lightheadedness. His skin is cool and diaphoretic. HR=96,
BP=124/82, RR=14, SaO2=97% The 12 lead is nondiagnostic, In addition to O2,
NS at TKO, and transport, which of the following would be most appropriate
a. Ressasurance his condition isn’t cardiac related
b. NTG
c. ASA, NTG, and MS
d. NTG, MS, and lasix
31. Your pt is a 54 yr old male who is unresponsive and cyanotic with aganol
respirations. A quick look down shows V-tach. Which of the following is most
important when determining the immediate treatment of this pt?
a. How long has be been “down”
b. Does he have a pulse
c. Does he have an implanted cardio defiberlator
d. Is he allergic to lidocane
32. Parasympathetic innervation of the heart occurs with the ______
a. Spinal accessory nerve
b. Vagus nerve
c. Phrenic nerve
d. Cardioaccelerator nerves
33. A 56 yr old male is alert and orientated and complaining of severe, tearing, pain
in his abdomen that radiates to his back, as well as numbness in his legs. He has a
hx of hypertension, and type II diabetes. His skins are cool and diaphoretic.
HR=110, BP=108/82, RR=20, SaO2=98%, which of the following does the pt
need most right now
a. Two large bore IV’s
b. Determination of the presence or absence of a pulsating abdominal mass
c. Transport
d. Focused exam
34. Which of the following best describes the physiology of anastomosis:
a. Allow right to left shunt
b. Provide collateral circulation of the myocardium
c. Provide alternative routes of myocardial conduction
35. The appearance of a pathological Q wave on a ECG indicates the presence of
______ tissue.
a. Injured
b. Ischemic
c. Reperfused
d. Infacted
36. Measures to treat Cardiogenic shock include all of the following except:
a. Reducing peripheral resistance
b. Reducing stroke volume
c. Increasing the contractile force
d. Improving preload
37. Which of the following would you expect NOT to find while assessing a pt with
cardiac tamponade
a. Orthopnea
b. Diminished lung sounds
c. Rapid and weak pulse
d. Pulses paradoxus
38. The hearts normal electrical axis has a range of ____ to ____
a. -30 degrees to +105 degrees
b. +29 degrees to +105 degrees
c. +30 degrees to -105 degrees
d. -29 degrees to +105 degrees
39. Two examples of a fibrinolytic are
a. Diltiazem and Activase
b. Aspirin and Retavase
c. Retavase and Activase
d. Activase and Aspirin
40. The muscle in a typical artery falls in between what layers
a. Lumen and tunica intima
b. Elastic membrane and tunica adventitia
c. Tunica intima and elastic membrane
d. Lumen and elastic membrane
Volume 3 Chapter 2b
1. The hearts electrical axis is 59 degrees. In normal tracing which lead will have
the most positive deflection?
a. Lead 1
b. Lead 2
c. Lead 3
d. AvR Lead
2. The thick middle tissue layer of the heart is the?
a. Endocardium
b. Epicardium
c. Myocardium
d. Pericardium
3. An elevation of the ST segment is associated with?
a. Left ventricular hypertrophy
b. Hyperkalemia
c. Myocardial injury
d. Slowed conduction through the AV node
4. The passage of the electrical current away from the positive will cause
_______deflection on the recorder?
a. Positive
b. Negative
5. Any time the axis equals or exceeds +105 degrees the patient is said to have?
a. Left axis deviation
b. Normal axis deviation
c. Right axis deviation
d. Irregular axis deviation
6. Two electrodes of opposite polarity are utilized they are called?
a. Tripolar
b. Unipolar
c. Augmented
d. Bipolar
7. Leads 1, 2, 3 are?
a. Tripolar
b. Unipolar
c. Augmented
d. Bipolar
8. The very outmost layer of a typical artery is called the what
a. Lumen
b. Tunica intima
c. Tunica membrane
d. Tunica adventitia
9. Myocardial ischemia results in?
a. St segment depression with or with out T wave inversion
b. Inverted P wave with no PRI increase
c. An irregular QRS with no visible P wave
d. Inverted P wave with a PRI increase
10. This coronary artery provides oxygen to the cardiac cells at the SA node
a. Circumflex
b. Right coronary artery
c. Great cardiac vein
d. Left coronary artery
11. The precardial leads provide a view of the?
a. Horizontal plane of the heart, including left ventricle and septum
b. Horizontal plane of the heart, including right ventricle and right atrium
c. Inferior portion of the heart, including entire right ventricle
d. Lateral plane of the heart, including part of the right ventricle
12. Your pt has a hx of progressively worsening angina that comes on at rest. This
most indicates ______ angina
a. Unstable
b. Ludwigs
c. Prinzmetal’s
d. Decubitus
13. The pressure in the left ventricle at the end of diastole is called
a. Stroke volume
b. After
c. Preload
d. Ejection fraction
14. The amount of resistance that must be overcome by the left ventricle during
systole is called ______.
a. Cardiac output
b. Afterload
c. Stroke volume
d. Preload
15. Cardioversion is used to treat all the following rhythms except:
a. SVT
b. A-Fib
c. V-Fib
d. VT with pulse
16. Action potential begins in a myocardial cell when:
a. Na+ enters cell giving it a positive charge
b. Na+ enters cell giving it a negative charge
c. K+ enters cell giving it a positive charge
d. Mg++ enters cell giving it a negative charge
17. The relative refractory period of the myocardium is represented by the ______.
a. Beginning of the QRS complex
b. Isoelectric line
c. ST segment
d. Down slope of the T wave
18. Signs and or symptoms of a dissecting aortic aneurysm include all of the
following except:
a. Headache
b. Chest pain
c. Difficulty breathing
d. Hypotension
19. The lead to the left of the sternum at the forth intercostal space is the
a. MCL
b. V1
c. AVF
d. V2
20. Your pt’s ECG shows a braid S wave in lead 1, and a R-S-R complex in lead V1,
This indicates a:
a. Chamber enlargement
b. Third degree AV block
c. Hemiblock
d. Right bundle branch block
21. Which of the following ECG findings is LEAST anticipated in a pt experiencing
an acute myocardial infarction?
a. ST elevation
b. Osborn wave
c. ST depression
d. QRS greater than 0.12s
22. An infarction that affects only the deeper levels of the myocardium is a(n):
a. Subendocardial
b. Endocardial
c. Transmural
d. Subepicardium
23. Myocardial ischemia results in:
a. Appearance of Q waves
b. ST segment depression with or without T wave inversion
c. ST segment elevation
d. Inverted T waves
24. Parasympathetic innervation of the heart occurs via the _______?
a. Spinal accessory nerve
b. Phrenic nerve
c. Cardioaccelerator nerves
d. Vagus nerve
25. Your pt is in a-fib, has a heart rate of 108 on the monitor, but her radial pulse is
88. The pt is experiencing.
a. Paradoxical pulse
b. Pulsus alternans
c. Pulse deficit
d. Pulses obliterans
26. Increased _______ does NOT occur due to increased venus return to the heart
a. Myocardial stretch
b. Afterload
c. Stroke volume
d. Myocardial contraction
27. The left coronary artery supplies blood to all these areas except:
a. The interventricular septum
b. Part of the right ventricle
c. Part of the right atrium
d. The left ventricle
28. _______ is a first line antidysrhythmic used to treat and prevent life threatening
ventricular dysrhythmias.
a. Dobutamine
b. Bretylium
c. Lidocaine
d. Procainamide
29. ______ ______ states that the more the myocardial muscle is stretched, the
greater its force of contraction will be
a. Cushing’s reflex
b. Starling’s law
c. Poiseuille’s law
d. End-diastolic volume
30. The period of time when the myocardium is relaxed and cardiac filling and
coronary perfusion occur is called:
a. Ejection fraction
b. Diastole
c. Anastomoses
d. Systole
31. A positive dromotropic agent will
a. Increase heart rate
b. Increase contractility
c. Speed impulse conduction
d. Cause vasoconstriction to occur in coronary arteries
32. A pt with stable atrial tachycardia would be given which drug
a. Verapamil
b. Amiodarone
c. Vasopressin
d. Nitronox
33. Certain chemicals that are released by the heart when myocardial cells are
damaged are called.
a. PTCA’s
b. Creatine phosphorus
c. Cardiac enzymes
Volume 3 Chapter 2-C
1) The hearts electrical axis is 59 degrees. In normal trasing which lead will have
the most positive deflection?
a. AVF
b. Lead 1
c. Lead 2
d. Lead 3
2) The thick middle tissue layer of the heart is the?
a. Myocardium
b. Endocardium
c. Pericardium
d. Epicardium
3) An elevation of the ST segment is associated with?
a. Myocardial injury
b. Myocardial ischemia
c. Hyperkalemia
d. Left ventricle hypertrophy
4) Passage of the electrical current away from the positive will cause deflection on
the recorder?
a. No
b. An upward
c. A negative
d. A positive
5) The dysrhythmia characterized by each impulse arriving at the AV junction being
progressively delayed until, eventually, AV conduction is completely blocked is
called ______ AV block (Mobitz 1)
a. Third-degree
b. First-degree
c. Second-degree
d. Complete
6) Any time the axis equals or exceeds +105 degrees the patient is said to have?
a. Right axis deviation
b. Normal electrical axis
c. Left axis deviation
d. Intermediate axis
7) Two electrodes of opposite polarity are utilized they are called?
a. Pericardial
b. Precordial
c. Unipolar
d. Bipolar
8) Leads 1, 2, 3 are?
a. Unipolar
b. Precordial
c. pericardial
d. Bipolar
9) Myocardial ischemia results in?
a. Inverted T waves
b. St segment elevation
c. Appearance of Q waves
d. St segment depression with or with out T wave inversion
10) In lead 2, the negative electrode is placed on the?
a. Right arm and the positive electrode is placed on left leg
b. Left arm and the positive electrode is placed on the left leg
c. Right arm and the positive is placed on the left arm
d. Right leg and the positive electrode is placed on the right arm
11)Which of the following ECG findings is LEAST anticipated in a patient
experiencing a MI?
a. Osborne wave
b. QRS greater than .12
c. ST depression
d. ST elevation
12)Which of the following statements are false about axis deviation?
a. A left axis deviation exists if the hearts axis is greater than or equal to -30
degrees
b. A right axis deviation indicates COPD and/or pulmonary hypertension
c. The hearts normal axis is between +29 and -105 degrees
d. Left axis deviation is associated with valvulvar heart disease and
hypertension.
13)A 12-lead ECG that reveals slight ST segment elevation , Q wave in leads 2, 3,
and aVF, and ST elevation in V1 and V2 most indicate which of the following?
a. The patient has had a myocardial infartion in her inferior wall and is
experiencing ischemia extending into the right ventricle.
b. The patient is experiencing myocardial injury in her lateral wall
c. The patient is experiencing ischemia and injury in her left ventricle and
septum
d. The patient is experiencing myocardial ischemia in her inferior wall that is
extending into the septum
14) The precordial leads provide a view of the?
a. Inferior portion of the heart, including the entire right ventricle
b. Horizontal plane of the heart, including right ventricle and right atrium
c. Horizontal plane of the heart, including left ventricle and septum
d. Lateral plane of the heart, including part of the right ventricle, most of the
left ventricle, and the sputum.
15)Your patients ECG shows a broad S wave in lead 1 and a R-S prime complex in
lead V1. This indicates?
a. Chamber enlargement
b. Third degree AV block
c. Hemiblock
d. Right bundle branch block
16) True posteriors infarct s can be recognized by looking?
a. At leads V5 and V6
b. For reciprocal changes in V1 and V2
c. At leads II, III, and AVF
d. None of the above
17) Purpose of the precordial leads is to evaluate the?
a. Left ventricle and the septum
b. Right atrium and septum
c. Left ventricle and apex
d. Left atrium and septum
18) The presence of inverted T waves on an ECG indicates?
a. Myocardial infarction
b. Myocardial injury
c. Myocardial necrosis
d. Myocardial ischemia
19)An infection that effects only the deeper levels of the myocardium is?
a. Transmural
b. Subendocardial
c. Endocardial
d. Subepicardium
20) The precardial leads provide a look at the____ plane of the heart.
a. Horizontal
b. Diagonal
c. Parallel
d. verticle
21) St segment elevation, T wave inversion and the development of significant Q
waves in the ______ leads indicate myocardial infarct involving anterior surface
of the heart
a. II, III, and AVF
b. V5 and V6
c. I, V2, V3, and V4
d. I and AVL
22) The lead to the left of the sternum at the fourth intercostal space is?
a. V1
b. AVF
c. V2
d. MCL
23)A 12-lead ECG that reveals ST elevation in all of the precordial leads most
indicates myocardial?
a. Injury to the right ventricle, left ventricle and septum
b. Injury to the right ventricle and septum
c. Infarction to the right and left ventricles
d. Ischemia to the left ventricle and septum
24) The appearance of a pathological Q wave on an ECG indicates the presence of
______ tissue.
A. Reperfused
B. Infracted
C. Injured
D. Ischemic
Block 3.2
Quiz 3-3
1. Your patient is a 32 year old male who is alert and oriented, complaining of
severe pain. He states he has a history of disk herniation. Today, he experienced
an acute onset of lower back pain while lifting a heavy box. Physical exam.
Reveals a palpable muscle spasm and pain with palpation at the level of L4 and
L5. He is lying on his right side and states that the pain is too severe for him to
move. Which of the following would not be appropriate?
a. MS via IV
b. Use a “scoop” stretcher to move the pt to the gurney
c. C-spine, supine immobilization on a long backboard
d. Right lateral recumbent position on a long backboard for transport
2. During a domestic disturbance, your patient experienced a sudden onset of
violent, bizarre movements of the extremeties 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
a. Simple partial
b. Absence
c. Pseudo
d. Complex partial
3. A series of two or more generalized motor seizures without an intervening period
of consciousness is/are known as a _______ seizure
a. Complex partial
b. Petit mal
c. Hypertonic
d. Status epilepticus
4. Which of the following diseases is characterized by a progressive degeneration of
the nerve cells that control volutary movement, weakness, loss of motor control,
difficulty speaking, and cramping?
a. Amytrophic lateral sclerosis
b. Multiple sclerosis
c. Bell’s palsy
d. Muscular dystrophy
5. Which of the following is a collection of genetic diseases characterized by
progressive muscle weakness and skeletal muscle degeneration?
a. Multiple sclerosis
b. Muscle dystrophy
c. Amyotrophic lateral sclerosis
d. Myasthenia gravis
6. 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.
Which of the following is LEAST likely?
a. Hemorrhagic stroke
b. Embolic stroke
c. Thrombotic stroke
d. Retinal artery occlusion
7. A patient with aphasia following a stroke would have involvement in the _______
love of the brain.
a. Frontal
b. Occipital
c. Temporal
d. Parietal
8. Your patient states that he often experiences a painful cramping and freezing up
of his hands and feet while handwriting or walking, respectively. This best
describes:
a. Myoclonus
b. Palsy
c. Torticollis
d. Dystonia
9. 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 patients seizure?
a. A current history of sudden alcohol abstinence
b. Unresponsive to painful stimuli
c. Incontinent of urine and tongue biting
d. Dropping his hand above his face to see if he avoids letting it hit him.
10. 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 syould you
do next?
a. Begin BVM ventilations.
b. Apply monitor and de-fib pads
c. Check for radial pulse
d. Check the pt’s pulse ox reading
11. Your patient is a 64 year old male who is alert and oriented, and visibly upset,
sitting on a bench in a shopping mall, complaining of weakness. He describes an
acute onset of left sided weakness in his arm and leg that made it difficult for him
to walk. Physical exam reveals noticeable left sided weakness, PEARL, skin
warm and dry. Which of the following is most appropriate?
a. 100% O2 by NRB mask, blood glucose determination, transport without
delay.
b. Reassurance and BLS transport
c. Oxygen 4lmp NC, BLS transport
d. 100% O2 by NRB mask, transport without delay, IV NS at TKO, 25Gm
dextrose while in route
12. Your patient, a 56 year old female, is alert but disoriented after a seizure her sister
witnessed. Her sister describes a 2 minute generalized seizure that ended a few
minutes before you arrived. The patient has a history of seizures treated with
clonazepam, and type 2 diabetes treated with glucophage. The patient is slightly
uncooperative and does not seem to understand why you are there. Physical exam
is unremarkable, except for persistent disorientation to time, place, and event.
Which of the following is most appropriate at this point?
a. Call for law enforcement
b. Assess the patients blood glucose level
c. Restrain the patient for transport
d. Apply cardiac monitor, IV of NS at TKO, check blood glucose level,
restrain the pt as necessary to carry out
13. A seizure that remains confined to a limited portion of the brain, causing localized
dysfunction is a ______ seizure.
a. Tonic
b. Absence
c. Partial
d. Petitmal
14. You are transporting a male patient to the hospital for an evaluation after a
possible seizure when you notice the patients LOC. His muscles start to contract
so that he is arching his back. This best describes the ________ phase of a
generalized seizure.
a. Postictal
b. Clonic
c. Hypertonic
d. Tonic
15. 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?
a. Organic brain syndrome
b. Dementia
c. Alzheimer’s disease
d. Delerium
16. 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 an _______ seizure
a. Pseudo
b. Absence
c. Simple partial
d. Generalized
17. A seizure that begins an an aberrant electrical discharge in a small area of the
brain but spreadsto include the entire cerebral cortex is a
a. Complex
b. Partial
c. Clonic
d. Generalized seizure
18. 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 and aura,
and had no pain associated with the episode. This most indicates a _______
seizure.
a. Simple partial
b. Absence
c. Petit mal
d. Psychosomatic
19. Which of the following is characterized by involuntary muscle twitching?
a. Trismus
b. Ataxia
c. Myoclonus
d. Dystonia
20. Your patient is a 52 year old female who is alert, but slightly confused after a
syncopal episode lasting abou 1 min. 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 2 diabetes and hypertension. Which of the following is
least likely to cause the patients episode?
a. Seizure
b. Orthostatic hypotension
c. Hypoglycemia
d. Transient cardiac dysrhythmia
21. 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?
a. History of diabetes
b. Allergies
c. Medications
d. History of cardiovascular disease
22. Patients with ________ disease experiences tremors, periodic muscular rigidity,
slowed movement, and impaired balance and coordination.
a. Autonomic dysreflexia
b. Parkinsons disease
c. Amyotrophic lateral sclerosis
d. Peripheral neuralgia
23. 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 exam reveals left sided facial droop, aphasia, a
dilated and unreactive right pupil, and a flaccid left arm. Lung sounds are
decreased bilaterally. Your partner is assisting ventilations with BVM with O2.
During your exam, the patient exhibits generalized seizure activity lasting about
30 seconds and is now unresponsive. Which of the following is most appropriate?
a. Hyperventilate by bag valve mask, IV NS at keep open rate, diazepam
5mg IV, intubate if no improvement, transport without delay
b. Intubation, IV of NS at a keep open rate, cardiac monitor, blood glucose
determination, transport without delay.
c. Hyperventilate by bag valve mask, IV NS at keep open rate, check blood
glucose level, administer 25Gm of dextrose if needed, administer thiamine
and Naloxone, intubate if no improvement, transport without delay
24. Which of the following diseases involves inflammation followed by
demyelination of the brain and spinal cord nerve fibers?
a. Alzheimer’s disease
b. Multiple sclerosis
c. Muscular dystrophy
d. Multiple sclerosis
25. Which of the following does NOT indicate ICP?
a. Hallucination
26. 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?
a. Polyphagia
b. Diplopia
c. Dysarthria
d. Hemiparesis
27. Your patient is a 19 yo 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?
a. Start IV and administer 5mg of diazepam
b. Suctioning the airway, applying 15lpm of oxygen by NRB
c. Suctioning the airway, assisting ventilations with a BVM
28. All of the following may cause a transient ischemic attack EXCEPT:
a. Hypotension
b. Cerebrovascular spasm
c. Intracranial hemorrhage
d. A small embolus
29. 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 secreations in his airway. Hr-130 RR-4 and shallow
sao2-88 Which of the following is not appropriate?
a. Immediate nasal intabation and hyperventilation with a 100 o2
b. An IV of NS at a TKO rate, check blood glucose level, administer 5mg of
diazepam, IV
c. Suctioning the airway, inserting a nasopharyngeal airway, assisting
respirations by bag-valve-mask device with 100% oxygen
30. A type of generalized seizure characterized by a rapid LOC and motor
coordination, muscle spasms, and jerking motions is known as:
a. Complex partial seizure
b. Absence
c. Simple partial seizure
d. Tonic-clonic seizure
31. Which of the following is a risk factor for stroke:
a. Sinus arrhythmia
b. First degree heart block
c. PAC’s
d. A-Fib
32. Your patient is a 62 yo 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 PTA. Physical exam is
unremarkable. She has no significant med history and takes no meds. Which of
the following is most likely?
a. Absence seizure
b. Stroke
c. Transient ischemic attack
d. Meniere’s diease
33. Which of the following is caused by unilateral paralysis of cranial nerve VII?
a. Dystonia
b. Bells palsy
c. Myoclonus
d. Autonomic dysreflexia
34. Your patient is a 55 yo male cab driver who was found unresponsive in the
drivers 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 resp. at 12
per minute, is cool, pale, and diaphoretic; and has a HR of 58 and a B/P of
170/104. Which of the following does not help when determining the underlying
cause of the patients condition?
a. Checking the pupils
b. Blood glucose level
c. Pulse Ox
d. Scene survey
35. Your patient is a 45 year old female type I diabetic with a history of a nonhealing
foot ulcer. On exam, you find that she lacks sensation in her foot. This is most
likely due to:
a. Peripheral neuropathy
b. Raynaud’s disease
c. Claudication
d. Brown-Sequard syndrome
36. Which of the following should be part of the general management of a patient
with altered mental status?
a. IV of NS KVO
b. 50% dextrose
c. Hyperventilation with 100% oxygen
d. thiamine
37. The most common cause of dementia in the elderly is:
a. Parkinson’s disease
b. Alzheimers disease
c. Cerebrovascular disease
d. Multi-infarct demintia
38. your patient is a 24 yo male who is alert and oriented, complaining of severe
dizziness and a earache for 2 days. He states that any movement of his head
causes him to become very dizzy and nauseated. The patients skin is warm and
dry, his pupils are equal and reactive, and there is no gross neurological deficit.
Which of the following is most likely?
a. Occult subdural hematoma
b. Transient cerebral ischemia
c. Hypersensitivity of the carotid sinus, aggravated by head movement
d. Vertigo
39. Your patient is a 37 yo male with a history of seizures who is noncompliant with
his meds. Friends at his apartment state that he had a seizure, which they describe
as being generalized, lasting 3-4 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 exam reveals warm, moist skin and an abrasion to his
lower lip. 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
meds. Which of the following is the BEST course of action?
a. Empathize with the patients 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.
b. Call for law enforcements assistance with an immediate detention order,
restrain the pt if necessary, administer oxygen by NRB, start an IV of
normal saline at a keep open rate, and administer diazepam if the pt
experiences another seizure en route to ED
c. Have the friends help you secure the pt to the gourny, restrain the pt if
necessary, start an IV of NS at keep open rate, administer 5mg of
diazepam if the pt becomes agitated, and trasport
40. Your patient is a 57 yo male who is alert and oriented, complaining of a slight
headache. His coworkers state the patient fainted. The patient describes feeling
weak and lightheaded before the incident, and came to lying on the floor.
Medical history includes cardiovascular disease with a history of angina and
hypertension. Meds include clopidogrel (plavix), nitro, and metoprolol. Which
of the following is LEAST helpful when formulating a field impression for this
patient?
a. Orthostatic vital signs
b. Cardiac monitoring
c. Pulse Oximetry
d. Neurological exam
41. Which of the following infectious childhood diseases would most likely result in
paralysis?
a. Spinal bifida
b. Rubella
c. Poliomyelitis
d. German measles
42. Your patient is a 32 yo female who is alert but in significant distress, complaining
of a migrane. 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. Which of the following is MOST
appropriate in pre hospital management of this patient?
a. Provide a calm, quiet environment and transport.
b. Lorazepam 2mg
c. NTG SL to treat her hypertension
d. MS, IV in 2mg increments, up to 10mg
43. The neurotransmitter found in the synaptic terminals of the sympathetic nerves is?
a. Adrenalin
b. Dopamine
c. Acetycholine
d. Norepinepherine
44. Which of the following should be suspected as a potential cause of syncope?
a. Vagal stimulation
b. Hypovolemia
c. Cardiac dysrhythmia
d. All of the above
45. Your pt has a history of epilepsy and is experiencing loss of consciousness, tonicclonic
muscle activity, and erratic ocular movement. Based on this you might
also except to find all of the following EXCEPT:
a. Pinpoint pupils
b. Impaired respirations
c. Increased oral secretions
d. Urinary incontinence
46. Which of the following does NOT indicate increased intracranial pressure?
a. Bradycardia
b. Hallucinations
c. Fever
d. Stroke
Quiz 3-4
1. Secretion of glucagons from the pancreas results in hepatic _________ and a
subsequent ______ of blood glucose.
a. Glycogenolysis; increase
b. Glucogenesis; decrease
c. Glycogenolysis; decrease
d. Glucogenesis; increase
2. Which of the following is NOT a modifiable risk factor for type 2 diabetes?
a. Obesity
b. Poor diet
c. Lack of exercise
d. Heredity
3. Your patient is a 56 yo 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:
a. IV of NS
b. Consideration of D50 IV if the patient cannot follow simple commands
c. Administration of oral glucose if the patient is able to swallow
d. 5-10 mg of glucagon IM
4. Which of the following is NOT a possible precipitating factor of thyrotoxic crisis?
a. Trauma
b. Infection
c. Cold environment
d. Overdose of thyroid hormone
5. Immediately after birth, an infant is allowed to suckle at the mothers breast. Milk
flows from the nipple, and palpation of the uterus suggests that the uterus is
contracting. These findings suggest that the:
a. Ovaries are secreting estrogen
b. Posterior pituitary is not secreting Oxytocin
c. Posterior pituitary is secreting Oxytocin
d. Ovaries are secreting estrogen and progesterone
6. A 63 yo female with a medical history of type 2 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. 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?
a. Fruity breath odor
b. Atrial flutter
c. A blood glucose of 68 mg/dL
d. Glucosuria
7. You are presented with a 42 yo 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. Temp
via tympanic thermometer is 105.5F. The patients wife states a med. History of
hypothyroidism for which he takes synthriod. Your partner suctions the airway
and intitiates BVM ventilations with 100% O2 and an OPA. Further treatment for
this patient should include:
a. ET intubation, cardiac monitor, IV of NS, fluid resuscitation, propranolol
IV, transport.
b. Cardiac monitor, synchronized cardioversion, IV of NS KVO, transport
c. Cardiac monitor, IV with NS 1-2L, cardizem IV, transport
d. Cardiac monitor, IV of NS, cardizem IV, transport
8. Which of the following would you expect to see immediately after the ingestion
of a large meal?
a. Increase of blood glucagon and blood glucose levels
b. Increase of blood glucose and blood insulin levels.
c. Decrease of blood glucose levels followed by an increase of blood insulin
levels
d. Increase of blood glucagon levels and a decrease of blood glucose levels
9. A type 1 diabetic female patient presents with deep, rapid respirations and a fruity
odor on her breath. Administration of which of the following meds. Would best
help correct the underlying physiologic disturbance?
a. D50
b. Glucagon
c. Insulin
d. 100% oxygen
10. Which of the following pathologies would necessitate the careful preparation of
an IV site due to skin fragility and increased risk of infection?
a. Addison’s disease
b. Cushings syndrome
c. Grave’s disease
d. Myxedema
11. Your patient is a 39 year old type 1 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, blood glucose is 21mg/dl. Your
partner assists the patient’s resp. with 100% O2 and a BVM; O2 saturation rises
to 100%. You cannot initiate IV access after two attempts. Further appropriate
treatment would include:
a. Glucagons 1.0mg IM, thiamine 100mg IM, cardiac monitor, transport.
b. Cardiac monitor, transport, re-attempt IV while en-route.
c. 50% dextrose IM, thiamine 100mg IM, cardiac monitor, transport
d. 125-25g oral glucose, thiamine 100mg IM, cardiac monitor, transport
12. Your patient is a 45 yo type 1 diabetic complaining of a 5 day history of abd.
Pain, N/V, and increased urination and thirst. His skin and mucus membranes are
warm and dry. Your treatment for this patient would most likely include:
a. IV of NS KVO, 50% dextrose IVP
b. IV of NS 1-2L
c. IV of NS KVO, NTG 0.4mg SL , every 3-5 min
d. IV of D5W KVO, 50% dextrose IVP
13. Which of the following is associated with a greater predisposition for
hypoglycemia due to decreased gluconeogenisis?
a. Pancreatits
b. Cardiac failure
c. Choleocyctits
d. Renal failure
14. To which of the following can osmotic diuresis, increased excretion, and ketosis
be attributed in a diabetic patient with hyperglycemia?
a. Increased glucose reabsorption in the tubules of the kidney
b. Increased insulin excretion in the tubules of the kidney
c. Decreased potassium concentration in the urine
d. Increased flow rate through the tubules of the kidney
15. A type 1 diabetic patient who _________is NOT likely to experience
hypoglycemia.
a. administers too much insulin
b. snacks on a candy bar between meals
c. skips a meal and administers insulin as normal
d. starts and exercise program, exerting more than usual
16. Which of the following best explains why, compared to type 1 diabetes, untreated
type 11 typically presents with lower blood glucose levels in hyperglycemia and
fewer metabolic disturbances?
a. Patients with type II diabetes can take oral hypoglycemics
b. Patients with type I diabetes must use insulin to maintain adequate blood
glucose levels
c. There is a adequate insulin production in type 2 diabetes to allow for
glucose use and prevent ketoacidosis.
d. It is easier to comply with the oral hypoglycemic medications used to
manage type II diabetes than the insulin used to manage type II diabetes.
17. Prehospital management of an unconscious patient with hypoglycemia should not
include:
a. Administration of glucagon IM
b. Administration of D50 IV
c. Administration of oral glucose
d. BVM ventilations with 100% O2 and an OPA
18. A 24 yo male is supine on the floor and unconscious with snoring resp. You note
a weak, rapid pulse and cool, diaphoretic skin. BG is 24 mg/dl. After manually
opening the airway, which of the following is the best sequence of actions?
a. Insert an OPA, assist ventilations with a BVM and supplemental oxygen,
IV of D5W, 1mg glucagon, IV
b. Insert an OPA, assist ventilations with a BVM and supplemental oxygen,
1mg glucagon IM
c. Assist vent. With a BVM and supp. O2. IV of NS at a keep open rate,
25gm dextrose, IV.
19. A patient presents with a history of excessive diuresis, signs and symptoms of
dehydration, and a BS of 958mg/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?
a. Insulin levels insufficient to allow any glucose to enter body cells
b. Insulin levels sufficient enough to allow some glucose to enter the body
cells.
c. Elimination of acetone by buffers in the blood
d. The elevated blood glucose
20. You encounter a patient complaining of polyuria, polyphagia, polydipsia, and abd.
Pain. Based on these complaints, which of the following would you also expect
to find?
a. Blood glucose between 80-120 mg/dL
b. Complaint of chest pain and shortness of breath
c. Kussmauls respirations and a fruity breath odor.
d. Blood glucose of less than 70 mg/dL
21. It is noon, and you are presented with an unconscious 56 yo male lying on his
couch. His daughter states that he is a type 1 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. BG is 24mg/dl. What is the most
likely cause of this patients hypoglycemia?
a. Too little insulin
b. A myocardial infarction
c. The patients excessive breakfast
d. The patients recent illness
22. Damage resulting in inactivity to _____pancreatic cells would result in
hyperglycemia.
a. Beta
b. Delta
c. Islet
d. Alpha
23. A 22 yo male, unconscious after a MVC, is being cared for by a BLS crew. He is
fully immobilized, and ventilations are being provided by BVM with an OPA in
place. Witnesses report that the patients vehicle was traveling on the highway at
about 55 miles per hour, then swerved for no apparent reason and drove off the
shoulder, rolling over once before coming to rest on its wheels. The patient was
initially found in the drivers seat with his seat belt on. Physical exam reveals
some minor abrasions to the patients face and shoulders; the airway is clear, the
chest, abd., extremeties, and pelvis are fine; bilateral breath sounds are clear and
equal. BG is 42mg/dl. Which of the following is the most appropriate initial
treatment of this patient:
a. Continue BLS ventilations, glucagon 0.5mg IM, reassess
b. Intubate, initiate transport, cardiac monitor and IV access while in route to
trauma center
c. Intubate, cardiac monitor, IV of NS KVO, 50% dextrose IV, reassess
d. Continue BLS ventilations, cardiac monitor, IV of NS KVO, 50%
dextrose IV, reassess.
24. Which of the following explains the profound protein catabolism and
gluconeogenesis associated with Cushings syndrome?
a. Increased epi and norepi release result in hypermetabolism
b. Cushing’s syndrome effects normal fat deposition
c. Glucocorticoids cause sodium retension and increased blood volume
d. Cortisol is an antagonist to insulin
25. Your patient is a 45 yo insulin dependent diabetic complaining of weakness. He
states a 5 day history of increased thirst, urination, and hunger. You note that he
has warm and dry skin and dry mucus membranes. BG is 562mg/dl. Which of
the following statements BEST describes the Pathophysiology of this patients
apparent dehydration?
a. Glucose is not reabdorbed by the tubule and remains in the urine, resulting
in osmotic diuresis and loss of fluid volume.
b. Polydipsia results in increased flow in the kidney and increased urination
c. Elevated glucose levels result in hypermetabolism and reduces fluid
volume.
d. Osmotic
26. Your patient is a 72 yo male who presents conscious but lethargic, sitting in a
chair. His son states that the patient has been a bit slow lately, has been gaining
weight, and would like him checked out at the emergency department. Med. Hx
includes hypothyroidism and MI. The patient has been compliant with his
synthroid and has nitro for use as needed. Phys exam reveals that the patient
responds to verbal stimuli though is noticeably confused, has a large tongue, and
has skin that is pale, cold and doughy. He is constipated. Temp. 88F, BG 180mg/
dl. Your treatment of this patient is:
a. 100% O2 via NRB at 10lpm, cardiac monitor, IV of NS KVO, transport.
b. 100% O2 via NRB at 10lpm, IV warm NS 1-2L, transport
c. 100% O2 via NRB at 10lpm, cardiac monitor, IV of NS KVO, rewarm
with heat blanket and/or heat packs, transport
27. A 16 yo female with a history of diabetes is found unconscious in a high school
bathroom following volleyball practice. She is tachycardiac; has cool, clammy
skin; is lethargic; slightly combative; and very confused. She is most likely
experiencing?
a. Hyperglycemia
b. Diabetic coma
c. Hypoglycemia
d. Diabetic ketoacidosis
28. A 68 yo female is supine in bed at a rehabilitation hospital. She is unresponsive
and has gurgling resp. Staff reports that the patient is at the facility recovering
from right hip replacement surgery performed 14 days prior and has had
worsening infection at the surgery site over the past 7 days. Staff also reports that
the patient had a slight altered mental status yesterday and was found unconscious
this moring. Pysical exam reveals an accumulation of secretions in her airway,
lung sounds CBL, and skin and mucus membranes warm and dry. You also note
erythema and a purulent discharge from surgical incision. Which of the following
is the best treatment of this patient?
a. Suction the airway, initiate BVM with 100% O2, OPA, intubate, cardiac
monitor, IV of NS 1-2l, 50% dextrose IV, rapid transport
b. Suction the airway, initiate BVM with 100% O2, OPA, intubate, cardiac
monitor, IV of NS 1-2l, rapid transport.
c. Suction the airway, initiate BVM with 100% O2, OPA, cardiac monitor,
IV of NS KVO, rapid transport
d. Suction the airway, oxygen 15 lpm NRB, cardiac monitor, IV of NS 1-2l,
rapid transport
29. 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:
a. Medication
b. Hormone
c. Secretion
d. neurotransmitter
30. Which of the following best explains the process of osmotic diuresis associated
with hyperglycemia?
a. Glucose in the urine lowers osmotic pressure inside the kidney tubule,
drawing water into the tubule from the surrounding tissues.
b. Elevated blood glucose levels result in increased ADH secretion
c. Decreased insulin levels result in decreased ADH secretion
d. Glucose in the urine raises osmotic pressure inside the kidney tubule,
drawing water into the tubule from the surrounding tissues.
31. A type 2 diabetic with a blood glucose of 24mg/dl would most likely be
unconscious due to:
a. Cerebral hypoglycemia
b. Insulin shock
c. Diabetic ketoacidosis
d. gluconeogenesis
32. Acute exacerbation of Addisons disease can lead to ECG changes and
cardiovascular collapse as a result of:
a. Electrolyte imbalance and low blood volume secondary to potassium
retention and sodium excretion.
b. Electrolyte imbalance secondary to fluid retention, potassium excretion,
and sodium retention
c. Electrolyte imbalance secondary to increased mineralcorticoid secretion
from the adrenal glands
d. Decreased mineralcorticoid secretion resulting from increased sodium and
potassium excretion
33. Biologically significant quantities of ketone bodies in the blood indicate that:
a. Ketone bodies are being used as a primary energy source
b. Glucose metabolism has increased relative to normal hemodynamic states
c. Glucose is not being used as a primary energy source.
d. The lungs are using free fatty acids, resulting in acetone-like smell on the
breath
Quiz 3-5
1. You are called to the home of a 28 yo male who is complaining of hoarseness, a
scratchy sensation in the back of his throat, and palpitations. The symptoms
began about 30 minutes ago and have grown steadily worse ever since the patient
prescribed penicillin 1 hour ago. Patient management should include all of the
following EXCEPT:
a. IV of NS TKO
b. Epi 1:1000 0.3mg SC
c. O2 via NRB 15lpm
d. Administration of an IV beta blocker
2. Your patient is experiencing dyspnea and urticaria after ingesting penicillin.
Auscultation of his lung fields reveals diffuse expiratory wheezes throughout.
Which of the following meds will best help correct your patients bronchospasm?
a. Solu-Medrol 125mg IV
b. 100% oxygen via NRB 15lpm
c. Epinephrine 1:1000 SQ
d. Ranitidine 50mg IV
3. Which of the following is the best route for administering epinephrine to patients
in severe anaphylactic shock?
a. IV
b. SC
c. IM
d. ET
4. Diphenhydramine is administered in anaphylaxis because it:
a. All of the above.
b. Blocks histamine receptors
c. Reduces histamine release from mast cells and basophils
d. Possibly reduces peripheral vasodilation
5. Which of the following signs indicates aggressive airway maintenance in a patient
experiencing an anaphylactic reaction?
a. Generalized rash
b. Urticaria
c. Expiratory wheezing
d. Stridor
6. Which of the following treatment regimens for anaphylaxis lists the meds in the
correct order of administration following O2?
a. Epi, dexamethasone, diphenhydramine
b. Epi, diphenhydramine, dexamethasone
c. Diphenhydramine, Epi, dexamethasone
d. Diphenhydramine, dexamethasone, Epi
7. Your patient is a 46 yo male who is unconscious on his front lawn after being
stung by a bee. You note Angioneurotic edema. HR=132, BP=76/40, RR=24 and
shallow. You should?
a. Assist ventilations with 100% O2 via a BVM
b. Intubate the patient
c. Administer Epi 1:10000 SQ
d. Start IV of NS wide open and administer epi 1:10000 SQ
8. Your patient is a 31 yo female complaining of dizziness and difficulty breathing
after being stung by a bee. You note that she is extremely anxious, and your
physical exam reveals a rapidly developing urticaria to her shoulders, neck, and
face. While you are performing your PE and interview, your partner has
administered O2 via a NRB, initiated IV access, placed the patient on the cardiac
monitor, and administered epi SQ and diphenhydramine IV. Despite this, you
also note that her voice is quickly becoming more hoarse, and that she has
developed expiratory wheezes in all lung fields. What should be your major
concern at this point, and what is the most appropriate treatment?
a. Laryngeal edema leading to total airway occlusion, intubate.
9. Immunity resulting from a direct attack on a foreign substance by specialized cells
in the immune system is:
a. Primary immunity
b. Cellular immunity
c. Secondary response
d. Humoral immunity
10. Following exposure to an allergen, a patient experiences a release of histamine
and heparin into the surrounding tissues. Which of the following best explains the
cause of the histamine and heparin release?
a. IgE antibodies have attached themselves to the membranes of basophils
and mast cells, resulting in degranulation.
11. An allergens most common route of entry in an anaphylactic reaction is:
a. Inhalation
b. Absorption
c. Injection
d. ingestion
12. Which of the following statements about antihistamine use in anaphylaxis
treatment is TRUE?
a. Antihistamines displace histamine and then block histamine receptors
b. Antihistamines block histamine receptors and reduce histamine release
from mast cells and basophils
13. Which of the following statements about codicosteroid use in anaphylaxis
treatement is TRUE?
a. Corticosteroids can reduce the inflammation associated with anaphylaxis.
b. Corticosteroids can help reverse broncoconstriction assosicated with
anaphylaxis.
14. Your patient is experiencing profuse hives, itching, dyspnea, coughing,
tachycardia, and dizziness after eating seafood 5 minutes ago. You might also
expect to see all of the following signs EXCEPT:
a. Broncospasm
b. Cyanosis
c. Hypertension
d. Laryngeal edema
15. Epinephrine administration results in all of the following EXCEPT:
a. Tachycardia
b. Increased contractile force
c. Increased peripheral vasoconstriction
d. Hypotension
16. The first medication administered to a patient experiencing an anaphylactic
reaction should be?
a. High flow O2.
b. Epi 1:1000 SC
c. Epi 1:10000 IV
17. A 58 yo male with significant cardiac history is unconscious after taking a dose of
penicillin. His skin is pale with peripheral cyanosis. Your partner initiates BVM
ventilations with 100% O2 while you place the patient on the cardiac monitor and
start an IV. Of the following, the most appropriate next course of action is to:
a. Administer epinephrine 1:10000 IV
b. Administer epinephrine 1:1000 SC
c. Run NS wide open and gain additional IV access
18. Your patient is a conscious and alert 22 yo female who was stung by a hornet.
She states that she has allergies to bee stings and has been told that she could die
if stung. Your physical exam reveals a 1-cm in diameter, red, edematous area
where she was stung on the left forearm. Her skin is warm and dry, and her lung
sounds are clear and equal bilaterally. The most appropriate threatment for this
patient would include:
a. 100% o2 via NRB mask, cardiac monitor, IV of NS KVO, transport.
19. Which sign associated with an allergic reaction should concern a caregiver the
most?
a. Warm, flushed skin
b. Wheezing
c. Urticaria
d. GI distress
20. _______ is a potentially life threatening condition involving the head, neck, face,
and upper airway.
a. Hives
b. Wheals
c. Urticaria
d. Angioedema
21. Which of the following medications for treating allergic reactions and anaphylaxis
also relieves the abdominal cramping associated with both?
a. Dopamine
b. Epinephrine
c. Ranitidine
d. Diphenhydramine
22. Which medication would be the best choice for reducing the bronchospasm and
laryngeal edema associated with anaphylaxis?
a. Oxygen
b. Solu-Medrol
c. Albuterol
d. Dexamethasone
23. Which medication is best for improving hypotension secondary to anaphylactic
shock?
a. Hydrocortisone
b. Epinephrine
c. Oxygen
d. Diphenhydramine
24. The two most common causes of fatal anaphylaxis are _______ and _______.
a. Hymenoptera stings, injected penicillin
b. Shellfish, sulfa drugs
c. Shellfish, tree nuts
d. Hymenoptera stings, tree nuts
25. Which from the following best describes why the secondary response to an
antigen is faster than the primary response?
a. The secondary response uses memory cells, which immediately release
antigens specific to the antibodies
b. The secondary response uses memory cells, which immediately release
antibodies specific to the antigen.
26. Approximately______ deaths are attributed annually to anaphylaxis in the US.
a. 100-500
b. 400-800
c. 800-1000
d. 25-40
27. _______ is considered an ominous sign late in anaphylaxis.
a. Hypotension
b. Tachycardia
c. Hypertension
d. Bradycardia
28. Which treatment would best halt the urticaria associated with an allergic reaction?
a. Epinephrine SQ and diphenlydramine IM
b. Oxygen NRB at 15lpm
c. Solu-Medrol IV
d. Dopamine IV infusion and albuterol via nebulizer
29. Upon identifying an antigen in the bloodstream, B cells launch a chemical attack
by producing antigens specific to the antibody. This is an example of _____
immunity?
a. Cellular
b. Antibody
c. Humoral
d. Secondary
30. Your patient is a 43- year old female with a history of peanut allergy. She is
complaining of dizziness after eating a casserole that she later discovered
contained peanuts. Your PE reveals warm, diaphoretic skin; a blotchy, red tash
covering her chest and arms; and lung sounds that are clear and equal bilaterally.
In addition to providing oxygen, appropriate treatment for this patient includes:
a. IV of NS KVO, epinephrine 1:1000 SQ, diphenhydramine IV
b. IV of NS KVO
Quiz 3-6
1. Murphy’s sign is:
a. Pain produced by pressing under the right costal margin in the presence of
an inflamed gallbladder.
2. Your patient is a 22- year old female in mild distress who is complaining of left
lower quadrant abdominal pain and nausea. Which of the following questions
would be LEAST helpful when determining the etiology of her abdominal pain?
a. “have you ever had a sexually transmitted disease?”
3. All of the following contribute to the pathogenesis of diverticulosis EXCEPT:
a. Decreased colon motility
4. Your patient, who has a history of Cholecystitis, is experiencing pain in her right
shoulder. She is most likely experiencing _____ pain.
a. Somatic
b. Referred
c. Visceral
d. Cardiac
5. While palpating the lower abdomen of a 63- year old male complaining of back
pain, you note a pulsating mass. You should:
a. Ask your partner to confirm
b. Determine if the mass is fixed or freely mobile in the abdomen
c. Ask the patient to take a deep breath, then palpate while patient exhales
d. Stop palpating
6. Which of the following correctly lists the organs and regions of the
gastrointestinal tract in sequence after the stomach?
a. Duodenum, jejunum, ascending colon, transverse colon, descending colon,
ileum, colon, rectum, anus
b. Duodenum, ileum, jejunum, ascending colon, transverse colon, descending
colon, rectum, anus
c. Duodenum, jejunum, ileum, ascending colon, transverse colon, descending
colon, rectum, anus
7. Your patient is a 24- year old male complaining of a 1 week history of abdominal
pain. He describes the pain as in the upper-right quadrant, dull and reproducible
with movement and palpation. He also describes a decreased appetite, weight
loss, and clay-colored stool over the same period. Of the following, which is the
most likely cause of his clinical condition?
a. Acute hepatitis
b. Ruptured spleen
8. Your patient is a 66- year old female who is conscious and alert, complaining of a
1- week history of progressive “lightheadedness” with exertion. She also
complain of mild nausea; dark, sticky stools, and pain in her lower abdomen.
Which of the following is the most likely cause of this patients condition?
a. Diverticulitis
b. Acute cholecystitis
c. Ingestion of an iron or bismuth containing medication
d. Gastroinestinal bleeding
9. A 52 yo male is in moderate distress, complaining of nausea and vomiting. He
describes a 3 day history of upper left quadrant abdominal pain described as sharp
and radiating to his back. You note a slightly distended abdomen. He called
EMS today when he developed nausea and vomiting. He denies any change of
bowel habits and states he has a history of alcoholism. Of the following, which is
most likely the cause of his clinical condition?
a. Pancreatitis.
10. All of the following are considered part of the lower gastrointestinal tract
EXCEPT the:
a. Large intestine
b. Duodenum
c. Ileum
d. Jejunum
11. The mortality rate of ruptured esophageal varices is over ____ percent.
a. 60
b. 50
c. 30
d. 20
12. Your patient is a 44 yo female complaining of a 3 day history of localized abd
pain in her midepigrastric region after eating. The pain tends to subside with
antacids. Today she is experiencing nausea and the pain did not subside with
antacids. The patient gives a history of smoking and moderate alcohol
consumption. The patients skin is warm and dry, and she has a blood pressure of
128/88, a HR of 84, and resp of 20. Your course of treatment would be:
a. Transport the patient in a position of comfort and giving reassurance.
b. Sodium bicarbonate IV
c. IV on NS with 250cc bolus
d. High flow oxygen by NRB
13. Which of the three mechanisms can produce visceral pain?
a. Somatic, refered, and peritonitis
b. Blunt trauma, penetrating trauma, and medical illness
c. Peritonitis, cholecystitis, and ruptured abdominal aorta
d. Distension, ischemia, and inflammation
14. A 46 yo female alcoholic is hypotensive, in severe distress, complaining of
dysphagia, and vomiting bright red blood. Of the following, which is the most
likely cause of this patients clinical condition?
a. Acute gastroenteritis
b. Esophageal varices
c. Acute gastric ulcer perforation
d. Hemorrhagic pancreatits
15. Bleeding in the gastrointestinal tract proximal of the ligament of Treitz is
considered to be in the:
a. Upper GI Tract
b. Colon
c. Lower GI Tract
d. Small intestine
16. Your patient is a 19 yo male complaining of a 2 day history of abd pain described
as diffuse and colicky, located around his umbilical area. He also states a loss of
apetite and a low grade fever over the same period. Palpation of his abdomen
reveals tenderness and guarding to the periumbilical area. Of the following,
which is the most likely cause of his clinical condition?
a. Peptic ulcer disease
b. Bowel obstruction
c. Appendicitis.
d. Cholecystitis
17. A 56 yo female is conscious and alert, complaining of diarrhea and nausea. The
patient describes a 2 day history of her symptoms and states that the pain is all
over her abdomen. All four quadrants are tender to palpation. She also describes
hematochezia. PMH includes CAD, and she recently began taking 324mg of
ASA once a day. Of the following, which is the most likely cause of his clinical
condition?
a. Acute gastroenteritis
18. Your patient is a 46 yo male truck driver who is sitting on a toilet complaining of
bleeding with defecation. He states that he had to strain significantly to produce a
bowel movement, then noted blood on his stool afterwards. He claims no
significant medical history, has had no recent illness, and takes no medication.
You note the presence of bright red blood on the surface of his stool. Of the
following, which is the most likely cause of his clinical condition?
a. Crohn’s Disease
b. Upper GI bleed
c. Hemorrhoids
d. Colitsis
19. Increased hepatic resistance to blood flow, as happens in cirrhosis, results in:
a. Hepatic vein hypertension and hepatic vein aneurysm
b. Hepatic arterial hypertension and obstruction of the common bile duct
c. Portal artery hypertension and ascites
d. Portal vein hypertension and esophageal varices
20. Your 43 yo male patient is alert and oriented, complaining of abd pain. He states
that he is experiencing nausea and has vomited twice. Which of the following is
the most appropriate follow up question?
a. What did the material you vomited look like?
b. Did you become dizzy or faint while you were vomiting
c. What were you doing when the vomiting started
d. Do you drink more than three alcoholic beverages a day
21. Which of the following questions would best help you determine if the pathology
of a patient complaint has been progressing?
a. On a scale of 1-10 being the worst pain possible, how would you have
rated the pain when it started? How would you rate the pain now?
22. Your patient is 44 yo female with a history of hiatal hernia. She is complaining of
diffuse abd pain. All four quadrants are tender to palpitation. She also states that
she has vomited numerous times and describes the presence of bile. You note that
her abdomen is slightly distende, and auscultation o her abd reveals absent bowel
sounds. Of the following which is the most likely cause of her clinical condition?
a. Pancreatits
b. Diverticulitis
c. Bowel obstruction
d. Cholecyitits
23. Another name for gallstones is
a. Cholecystits
b. Peptic Ulcer
c. GERD
d. Cholelithiasis
24. All of the following are located in the upper right quadrant except:
a. Gallbladder
b. Spleen
c. Liver
d. Portion of large intestine
25. _____ pain allows an examiner to pinpoint the area of irritation
a. Somatic
b. Visceral
c. Parietal
d. Referred
26. The order to properly access the abdomen is
a. Palpate, auscultate, inspect
b. Inspect, auscultate, palpate
c. Auscultate, palpate, inspect
d. None of the above
27. A 52 year old male is in moderate distress, complaining of nausea and vomiting.
He describes a 3 day history of upper left quadrant abdominal pain described as
sharp and radiating to his back. You note a slighty distended abdomen. He called
EMS today when he developed nausea and vomiting. He denies any change of
bowel habits and states he has a history of alcoholism. Of the following, which is
the most likely cause of his clinical condition?
a. Hepatitis
b. Pancreatitis
c. Peptic ulcer disease
d. Gastroenteritis
Quiz 3-7
1. Which of the following is LEAST likely to lead to acute renal failure?
a. Interstical nephritis
b. Heart failure with hypotension
c. Pneumonia
d. Urethral obstruction
2. Your patient is a 30-year old male complaining of pain radiating from the left
flank into the groin. He states that it began as a vague pain in his flank, then
became very sharp and radiating. Based on his description of his pain, you would
also expect him to complain of?
a. Dysuria
b. Fever
c. Inability to urinate
d. Purulent urethral discharge
3. The structure in the kidney that forms urine is the?
a. Nepheron
b. Renal cortex
c. Renal tubule
d. Renal medulla
4. All of the following are major functions of the kidney except:
a. erythrocyte development regulation
b. toxic waste removal
c. water, electrolyte, and pH balance maintenance
d. glucose elimination
5. A 76-year old patient with acute interstitial nephritis presents with oliguria,
altered mental status, and edema to his face, hands, and feet. Of the following,
which best describes the pathophysiology behind these clinical findings?
a. Increased GFR results in water, electrolyte, and metabolic waste retention
b. Decreased GFR results in water, electrolyte, and metabolic waste retention
c. Na+ and K+ excretion results in metabolic acidosis and fluid imbalance
d. Na+ and K+ retention results in metabolic acidosis and fluid imbalance
6. All of the following are common complications of renal dialysis EXCEPT:
a. narrowing of the fistula
b. local infection
c. air embolism
d. bleeding from the needle puncture site
7. All of the following symptoms are consistent with urinary tract infections
EXCEPT:
a. dysuria
b. passing hard, granular material in the urine
c. frequent urge to urinate
d. difficulty beginning and continuing to void
8. Your 42-year old patient with no medical history presents with a 2-day history of
distended abdomen; edema to the face, hands, and feet; and oliguria. Of the
following, which is the likely clinical diagnosis?
a. Acute renal failure
b. Shock
c. Chronic renal failure
d. Congestive heart failure
9. The structure that filters blood into a nephron is the:
a. flanks
b. glomerulus
c. loop of henle
d. bowmans’s capsule
10. Your patient is a 22-year old male who is a alert and in mild discomfort,
complaining of left flank pain. The paitnet describes the pain as diffuse, located
at the left flank, and states that it has been getting increasingly more “crampy”
over the past 30 min. he describes the pain as a 3/10 on the pain scale. He denies
dysuria and hematuria. Based on your clinical findings, which of the following is
the best treatment for this patient?
a. Position of comfort, IV with fluid administration.
b. BLS transport only
c. Oxygen via nasal cannula 4lpm, cardiac monitor, IV of NS KVO,
morphine, IV, transport
11. Your patient is a 68-year-old female who is conscious but confused, lying supine
in bed without complaint. Her daughter states that the patient was recently
diagnosed with a bladder infection and has been taking antibiotics. She
also states that her mother has not produced urine for 2 days, during which
she has become increasingly confused. Physical examination revels
swelling to the face, hands, and feet; cool and moist skin; and lung sounds
that are clear and equal bilaterally. HR=104, BP = 142/88, RR = 14, SaO2
= 96%. In additions to administering oxygen, which of the following
course of action is most appropriate?
a. IV of NS with 250 cc fluid challenge
b. IV of NS KVO
c. IV of NS KVO, furosemide
d. Cardiac monitor, 12-Lead ECG, IV of NS KVO
12. Hemodialysis and peritoneal dialysis differ in all the following ways EXCEPT:
a. Hemodialysis commonly occurs via the internal fistula, while peritoneal
dialysis commonly occurs via an indwelling catheter.
b. Hemodialysis involves removing blood volume from the patient, while
peritoneal dialysis does not
c. Hemodialysis complications include hypotension, chest pains, and
seizures. Peritoneal dialysis does not have these complications because no
blood volume is removed from the patient during the produce.
d. Peritoneal dialysis can occur at a patients home, while hemodialysis must
be administered and supervised by medical professionals.
13. The leading cause of end stage renal failure is
a. acute renal failure
b. uncontrolled diabetes and hypertension
c. kidney infection
d. renal calculi and kidney infection
14. Two sugar solutions of unknown concentrations are placed in a container on
separate sides of a semipermeable membrane. After some time, you note that
there is a net movement of water across the membrane from side A to side B of
the container. Which of the following statements about the two solutions is true?
a. The sugar solution on side B is hypo-osmolar to the sugar solution on side
A
b. The sugar solution on side A is hyperosmolar compared to the sugar
solution on side B
c. There is no difference in osmolarity between the two sugar solutions
d. The sugar solution on side B is hyperosmolar compared to the sugar
solution on side A
15. Which of the following about chronic renal failure is TRUE?
a. The renin-angiotensin loop is disrupted, resulting in severe hypotension
with the release of renin
b. Chronic anemia can develop as a result of decreased erythropoietin
production
c. GFR decreases, resulting in overexcretion of K+ and Na+
d. The retention of phosphate ions results in hypercalcemia
16. All of the following may be associated with urinary tract infection EXCEPT:
a. Prostatitis
b. Cystitis
c. Cholecystitis
d. Pyleonephritis
17. A patient experiencing restlessness, agitation, dysuria, and flank pain radiating
into the groin. Appropriate treatment for this patient would consist of all the
following EXCEPT:
a. Morphine
b. IV fluid therapy
c. Phenergan
d. Lasix IV
18. Of the following which is true of the changes in blood chemistry in a patient with
chronic renal failure?
a. H+ excretion leads to alkalosis
b. Blood glucose decreases
c. H+, K+, and Na+ retention leads to isothenuria
and creatinine levels increase
d. Uremia and creatine levels increase
19. Your patient is a 32 yr old female, alert and complaining of dysuria. She
describes a three day history of urinary pain, urgency, and difficulty. She
describes her dysuria as a 5 on a scale of 1 to 10. Physical examination reveals
tenderness on palpation of the lower abdomen, bilaterally, and warm, dry skin.
HR = 88, BP = 126/78, RR = 12. The most appropriate action is
a. Cardiac monitor, BLS transport in position of comfort
b. Oxygen via NC at 4lpm, cardiac monitor, IV of NS KVO, Morphine IV,
transport
c. Oxygen via NC at 4lpm, cardiac monitor, IV of NS with 250ml fluid
bolus, Morphine IV, transport in position of comfort
20. 68 year old male conscious but confused, laying supine on his kitchen floor. The
patient had no complaint other than wishing to be helped up from the floor. The
patient can tell you that he slipped a few days ago and has been on the floor since
then. Phsical exam reveals dry, cool skin, dry mucu=ous membranes, clear lung
sounds bilaterally and no indications of trauma. HR = 112, BP = 98/70, RR = 14,
SaO2 = 96%. Your partnet finda an appointment card indicating that the patienr
missed a dialysis appt. 2 days ago. Which of the following is the best course of
action for managing this patient?
a. Oxygen via non re breather mask at 15lpm, IV of NS with a 250ml cc fluid
challenge, blood glucose determination
Quiz 3-8
1. Your patient is a 48-year old female who is unconscious with snoring respirations
after ingesting an unknown substance. You note cold, peripherally cyanotic skin
and a weak, rapid pulse. Her pupils are equal and reactive but constricted. She
has no unusual odors, and her blood glucose levels is 80 mg/dl. Which of the
following is appropriate?
a. Intubate, ventilate using supplemental oxygen, IV, 1mEq/kg sodium
bicarb
b. Assist ventilations using supplemental oxygen, IV, 2mg Naloxone, 100mg
thiamine, 25gm dextrose
c. Assist ventilations using supplemental oxygen, IV 2mg Naloxone
2. Which of the following correctly pairs a toxin with its antidote?
a. Opiates: Naloxone
3. When a substance enters the body through the gastrointestinal tract, it has
accessed the body by ______.
a. Ingestion
b. Absorption
c. Injection
d. Inhalation
4. The need to progressively increase the dose of a drug to reproduce the effect
originally achieved at smaller doses is:
a. Habituation
b. Addiction
c. Tolerance
d. Substance abuse
5. A compulsive and overwhelming dependence on a chemical substance is:
a. Addiction
6. The pathophysiology of toxic inhalation involves:
a. Irritation, edema, and destruction of alveolar tissue
7. LSD, STP, and PCP are examples of :
a. Sedatives
b. Hallucinogens
c. Narcotics
d. Amphetamines
8. “Rock” and “crack” are street names for:
a. Aspirin with codeine
b. Morphine
c. Cocaine
d. Heroin
9. Which of the following is a narcotic?
a. Mescaline
b. Heroin
c. Cocaine
d. Crack
e. Spank
10. Alcohol is classified as a:
a. Depressant
b. Stimulant
11. Restoril and ativan are examples of:
a. Sedatives
b. Benzodiazepines
c. Narcotics
d. Barbiturates
12. A 19-year old male has ingested fifty 325 mg aspirin tablets 20 min. before your
arrival. He is alert and complaining of burning abdominal pain. Which of the
following is appropriate in the prehospital management of this patient?
a. Syrup of ipecac
b. Manually induced vomiting
c. Po administration of sodium bicarb
d. Activated charcoal
13. Your patient is a 16-year old female who has taken an overdose of Phenobarbital.
She is unresponsive. Her skin is cool and pale, and she has a BP of 92/60, HR 60,
RR 6. You have intubated the patient and started an IV. Which of the following
is appropriate?
a. Sodium bicarb 100mEq, Naloxone 2mg, 25gm dextrose, transport
b. Transport
c. Naloxone 2mg, 25gm dextrose, transport
14. Your patient is a 44-year old male has been in jail for 3 days after being arrested
for driving while intoxicated. He now presents with diaphoresis, anxiety,
hallucinations, insomnia, and tremors, blood glucose of 85 mg/dl. Which of the
following is appropriate?
a. IV of NS KVO
15. A patient is experiencing severe abdominal cramping, vomiting, diarrhea, and
facial flushing after eating undercooked chicken. Management of this patient
should include all of the following EXCEPT:
a. Placing patient in position of comfort on gourny
b. Administering oxygen if pt has a low SaO2
c. Activated charcoal
16. Which of the following is a highly toxic, odorless, tasteless gas that is a byproduct
of incomplete combustion?
a. Carbon monoxide
17. Prozac, paxil, and Zoloft are all examples of:
a. Tricyclic antidepressant
b. Selective serotonin reuptake inhibitors
c. Monoamine oxidase inhibitors
d. Sympathetic nervous system stimulants
18. Naproxen, ibuprofen, and ketorolac are all examples of :
a. TCAs
b. SSRIs
c. NSAIDs
d. MAOIs
19. Your patient is a 29- year old male who is conscious, alert, and extremely
hyperactive after using cocaine. Physical examination reveals warm, diaphoretic
skin and dilated pupils bilaterally. Which of the following medications should be
considered to manage this patient?
a. Propanolol
b. Diazepam
c. Naloxone
d. Metaprolol
20. Your patient is a 2 yo male who is alert and crying after ingesting bathroom
cleaner. Physical exam reveals no obvious burns or irritations to his oropharynx,
and his skin is cool and dry. Which of the following is most appropriate?
a. Transport
21. Narcan as an antagonist to all of the following medications EXCEPT:
a. Codeine
b. Cocaine
c. Methadone
d. Heroin
22. The primary goal with a patient who has been bitten by a pit viper is to:
a. Administer oxygen
b. Administer antivenom
c. Slow absorption of the venom
d. Remove the venom from the surrounding tissue
23. A 54 yo female presents conscious and alert in significant pain after a rattlesnake
biter to her hand. You note two small puncture wounds surrounded by a swollen,
red area. She states that she is nauseous and has chills. Your management of this
patient should include:
a. Full immobilization of the patient
b. Immobilization of the affected arm in a neutral position, apply a
constricting band
c. Immobilization of the affected arm in a neutral position
d. Immobilization of the affected arm in a neutral position, apply cold packs
24. A 32 yo male presents conscious and in mild distress, complaining of nausea and
sweating. He states that his symptoms started 2 days ago when he stopped
drinking cold turkey. Physical exam reveals cool, diaphoretic skin; slightly
dilated pupils bilaterally; and a general weakness to all extremeties. Which of the
following findings would also be likely?
a. Delirium tremens, hallucinations, and anxiety.
b. Hypertension, bradycardia, and hyperglycemia
c. Depression, hypotension, and polyuria
d. Insomnia, hyperglycemia, and difficulty breathing
Quiz 3-9
1. Which of the following statements about immunity is true?
a. Lymphocytes are the primary cells involved in the immune response.
2. Which of the following situations would not result in anemia?
a. Iron deficiency
b. Blood loss
c. Destruction of red blood cells
d. Increased production of erythropoietin
3. Your patient is a 26 yo afro American male who is alert and in severe distress,
complaining of pain in his hands and feet, as well as abdominal pain. The pain
began this morning but has progressed from an initial rating of 5/10 to a 9/10 at
the present time. The patient has a history of sickle anemia and denies any
trauma. Physical exam reveals cool, diaphoretic, skin, pain with palpation to all
of abdomen, splenomegaly and Priapism. Select the most appropriate diagnosis
and treatment?
a. Sickle cell trait. Administer oxygen according to pulse oximetry readings,
and give a 500 ml bolus of a isotonic crystalloid solution.
b. Sickle cell occlusion crisis. O2 by NRB, isotonic crystalloids and
morphine.
c. Sickle cell disease, administer oxygen according to SaO2 reading, start IV
of NS, and administer kertorolac for pain
d. Sickle cell occlusion crisis. O2 by NRB, isotonic crystalloids and aspirin.
4. Which of the following situations would result in erythropoietin secretions?
a. Hypoxia
5. A smoker who also takes supplemental vitaming K would be expected to?
a. Have enhanced clotting ability
6. Which of the following statements about leukocytes is false?
a. Leukocytes travel through blood vessel walls into the surrounding tissues.
b. Leukocytes protect against foreign invaders
c. Leukocytes engulf and destroy foreign invaders via leucopoiesis
d. Leukocytes follow chemical signals to an infection site
7. In the presence of calcium, thrombin will encourage ______
a. Conversion of fibrin to fibrinogen
b. Platelets to form clots
c. Prothrombin activation
d. Plasminogen release
8. You are pruning a rose bush and puncture the skin of your thumb with a thorn.
The next day, you note that the area is swollen. Which of the following best
explains the swelling that has just occurred?
a. Cell-mediated immunity activation results in chemotaxis and increased
capillary permeability
b. Localized vasodilation and increased capillary permeability results in
plasma leakage into the tissue surrounding the injury site.
c. There is an infection resulting in edema to the surrounding tissue.
d. Humoral immunity activating results in localized tissue damage and
edema of the surrounding tissue surrounding the injury site.
9. When patients experience lacerations on their hands, the clotting process that
occurs is mediated by the _____ pathway.
a. Platelet
b. Intrinsic
c. Common
d. Extrinsic
10. Which of the following situations would result in a more rapid response by the
immune system to an infection?
a. First time exposure to an antigen with memory B cell activation
b. Second exposure to an antigen with memory B cell activation
c. First time exposure to an antigen with memory T cell activation
d. Fist time exposure to an antigen
11. Prehospital treatment for a hemophiliac patient who is bleeding is to
a. Administer pain management
b. Control bleeding with direct pressure
c. Contact online medical control for factor VIII infusion
d. Administer IV colloid solutions
12. In a pt with hematological disease resulting in high production of abnormal red
blood cells, which of the following would you be most likely to find
a. Pale skins
b. Fever
c. Hepatomegaly
d. Splenomegaly
13. Which of the following statements about DIC is true
a. Obstetric complications is not a risk factor for DIC
b. DIC most commonly results from hemophilia, hypertension, and severe
tissue injury.
c. Activated thrombin converts fibrinogen to fibrin in the circulating blood
flow
d. The bleeding typical of DIC is a result of an increased fibrinogen level
14. Humoral and cell meditated immunity differ in that cell mediated immunity uses
a. B cells which generate effector cells to combat such invaders as
intracellular organisms, while humoral immunity uses T cells that reside in
lymph tissue and produce antibodies to combat foreign invaders.
b. T cells which generate effector cells to combat such invaders as
intracellular organisms, while humoral immunity uses B cells that reside
in lymph tissue and produce antibodies to combat foreign invaders.
c. T cells which reside in lymph tissues and produce antibodies to combat
foreign invaders, while humoral immunity uses B cells that generate
effector cells to combat such invaders as intracellular organisms.
15. Which of the following is not a process in NOT a goal of the inflammatory
process
a. Chemotaxis
b. Production of antibodies to combat pathogens
c. Attraction of white blood cells
d. Localize the damages and facilitate repairs
16. All are true about polycythemia EXCEPT:
a. Can occur secondary to dehydration
b. Patients are NOT at risk for thrombis
c. Can result in bleeding abnormalities
d. Abnormally high hematocrit
17. The more acidic the blood, the more readily the hemoglobin
a. Releases oxygen
b. Binds oxygen
c. Releases carbon dioxide
d. Binds carbon dioxide
18. All of the following are components of the inflammatory process EXCEPT:
a. Increased blood flow
b. Decreased chemotaxis
c. Vasodilation
d. Increased capillary permeability
19. A cat scratches a patient on the arm. Twenty four hours later, the area is swollen
and red. What additional signs and symptoms is she most likely to exhibit
a. Fever and hypotension
b. Loss of appetite
c. Urticaria
d. Pain and warmth at injury site
Quiz 3-10
1. Which of the following may occur when unaclimated climbers ascend rapidly to
altitudes of 6600 feet or greater.
a. Decompression illness
b. High-altitude gas embolism
c. Acute mountain sickness
d. Nitrogen narcosis
2. Which of the following statements correctly details the difference between
superficial and deep frostbite
a. Frostnip involves the freezing of epidermal tissue, while deep frostbite
affects the epidermal and subcutaneous
b. Superficial frostbite involves the epidermal and subcutaneous layers only,
while deep frostbite extends into the muscle layers.
c. Superficial frostbite results in no tissue freezing, while deep frostbite does
d. Frostnip does not cause pain, while deep frostbite can cause significant
pain.
3. The signs and symptoms of progressive altitude illness include all the following
EXCEPT:
a. Malaise
b. Anorexia
c. Dyspnea with exertion
d. Hypothermia
4. Which of the following disorders is characterized by painful muscle contractions
and weakness?
a. Hypocalcemia
b. Thermal intolerance
c. Heat cramps
d. Pyrospasms
5. Your pt is a 32 year old female mountain climber who lost her glove in frigid
conditions. The fingers of her right hand are hard, white, cold, and noncompliant.
You are based in a warm cabin, but, due to weather conditions, you cannot
evacuate your patient for 24 to 36 hours. In addition to administering analgesia,
which of the following is the most appropriate treatment?
a. Thaw the hand by immersion in 120-140 degree F water, using passive
range of motion during the process. Cover the thawed hand with lose, dry,
sterile dressing.
b. Use sterile, bulky dressing material to cover the hand, elevate the hand on
pillows, and allow passive thawing of the hand at ambient room air
temperature.
c. Cover the hand with waterproof dressing or plastic bag, and place it in a
basin filled with snow to prevent thawing. Provide liberal amounts of
warm drinks such as coffee, hot tea, and cocoa.
d. Thaw the hand by immersion in 102-104 degree F water, leave any blisters
in tact, and cover the thawed hand with loose, dry, sterile dressing.
6. 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.
a. Pulmonary overpressure
b. Decompression illness
c. Aterial gas embolism
d. Pneumomediastinum
7. An athlete is competing in a marathon on a very hot, humid day and is sweating
profusely. To prevent dehydration he has been drinking 30oz of water as advised
by his coach. By doing this he is increasing the risk for
a. Hyponatremia
b. Hyperkalemia
c. Hypernatermia
d. Hypocalcemia
8. Your patient is a 32 year old male who has been putting a new roof on his garage
in unseasonably warm spring temperatures. He complained of weakness; is
conscious; is sweating profusely; and has rapid, shallow breathing and a weak,
rapid pulse. He is most likely suffering from
a. Heat stroke
b. Heat cramps
c. Heat exhaustion
d. Heat syncope
9. Which of the following statements about thermoregulation is TRUE?
a. The hypothalamus uses negative feedback mechanisms to regulate body
temperature
b. The posterior pituitary gland uses negative feedback mechanisms to
regulate body temperature
c. The hypothalamus uses positive feedback mechanisms to regulate body
temperature
d. The posterior pituitary gland uses positive feedback mechanisms to
regulate body temperature
10. The body dissipates excessive heat by
a. Vasoconstriction
b. Shivering
c. Evaporation
d. Inhibiting diuresis
11. Which physiologic response has most likely occurred in a patient who has
suffered a dry drowning
a. Hemodilution
b. Laryngospasm
c. Pulmonary edema
d. Mammalian dive reflex
12. Which of the following measures in important in preventing hyperthermia
a. Drinking adequate amounts of plain water
b. Use of stimulate and electrolyte containing sport drinks
c. Ingesting 2 to 3 grams of Na per day, using salt tablets if necessary
d. Use of over the counter diuretics to help dissipate heat via the kidneys
13. A female patient is complaining of numbness in her fingers and toes that started
while she was skiing. Upon examination, her extremities appear soft and
blanched. Patient management should consist of.
a. Massaging the blanched areas to promote blood flow
b. Puncturing blisters to reduce swelling
c. Administering an analgesic to reduce pain while the areas are thawing
d. Rewarming in a 98.6 degree F water bath
14. All of the following are considered risk factors that predispose individuals to
environmental illness except
a. Diabetes
b. Fatigue
c. Young age
d. Male sex
15. A 72 year old male is found unconscious in his font 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
a. IV of NS with fluid administration
b. Furosemide IV
c. Rapid, active cooling
d. Oxygen via NRB 15lpm
16. All of the following compensate for hypothermia except:
a. Vasoconstriction
b. Piloerection
c. Shivering
d. Decreased muscle tone
17. A 12 year old male is pulled from the ocean in cardiopulmonary arrest after
drowning. When en route to the hospital, you auscultate lung sounds to verify
that your ET tube is still in place and note pulmonary edema. Which of the
following best explains the pathology of the developing pulmonary edema
a. Heart failure secondary to cardiac arrest has produced in pulmonary
congestion
b. An increased osmotic gradient is drawing water from the bloodstream into
the alveoli
c. There is an acute inflammatory response to pollutants in the seawater
d. There is aspiration pneumonia
Quiz 3- 11
1. Mushrooms and yeast are examples of:
a. Fungi
b. Helminths
c. Parasites
d. protoza
2. You have just started an IV in the back of a moving ambulance. Which of the
following is the best way to dispose of your contaminated sharp?
a. Recap it with a one handed technique and dispose of it when the
ambulance stops
b. Place it directly in a puncture-resistant sharps container
c. Drop it on the floor so it can easily be seen during cleanup after the call
d. Insert it into the bench seat cushion until the ambulance stops
3. A 44 yo male staying in a homeless shelter is alert and complaining of shortness
of breath. He has a 2-week history of cough with hemoptysis, fever, chills, and
night sweats. Physical exam reveals skin to be wam and moist and lung sound
decreased in the right upper lobe with rhonchi. You should assume this patient
has a high likelihood of having?
a. Pneumonia
b. Tuberculosis
c. Pulmonary anthrax
d. pneumoconiasis
4. Which of the following is best described as a charge from the abscnce of
antibodies to detectable levels of antibodies in the blood after exposure to an
infectious disease?
a. Clinical horizons
b. Chemotaxis
c. Seroconversion
d. Virulence
5. Epidemiology is best described as the study of:
a. The body’s immunity to infectious disease
b. The patterns of disease in communities
c. The pathophysiology of infectious disease
d. Vaccines and disease treatment
6. Which of the following measures most effectively protects EMS providers from
infectious disease?
a. Hand washing after all patient contact
b. TB Vaccinaton
c. Through disinfection of the ambulance after every call
d. Glove use for all patient contact
7. Which of the following is a mobile, single-celled, parasitic organism?
a. Protozoan
b. Virus
c. Bacterium
d. Fungus
8. Mononucleosis presents with all the following signs and symptoms EXCEPT?
a. Sore throat
b. Hepatomegaly
c. Fatigue
d. Enlarged and tender lymph nodes
9. Which of the following agencies monitors national disease data and provides
disease information to health care provider?
a. OSHA
b. CDC
c. NFPA
d. FEMA
10. Which of the following techniques destroys some, but not all, microorganisms?
a. Sterilization
b. Cleaning
c. Disinfection
d. Decontamination
11. Hepatitis E is often associated with?
a. HBV infection
b. TB infection
c. Contaminated drinking water
d. HIV infection
12. For which of the following diseases is there no vaccine?
a. Croup
b. Meningitis
c. Encephalitis
d. All of the above
13. Which of the following types of agents acts specifically by inhibiting bacterial
growth or reproduction?
a. Antiseptic
b. Aseptic
c. Pathological
d. Bacteriostatic
14. Which hepatitis often presents with hepatitis D?
a. A
b. B
c. C
d. D
15. While working in the emergency department, you accidentally stick yourself with
the stylette of an IV needle you just used to start an IV. What do should you do
immediately?
a. Stop the bleeding with a sterile gauze pad
b. Wipe the area with an alcohol prep
c. Wipe the area with a povidine-iodine swab
d. Wash the area thoroughly with soap and running water
16. Which of the following is NOT a known transmission route for hepatitis B?
a. Blood transfusion
b. Tattooing
c. Dialysis
d. Insect bites
17. Which of the following organisms causes mononucleosis?
a. Herpes zoster
b. Treponema
c. Pediculus humanus capitus
d. Epstein Barr virus
18. Which of the following statements about influenza and the influenza virus is
false?
a. Receiving a flu shoot prevents influenza infection
b. High risk individuals include the pediatric and geriatric populations
c. Influenza is the leading cause of respiratory disease worldwide
d. The disease is characterized by acute onset of fever, chills, malaise, cough,
and muscle aches
19. Which of the following is NOT a common pediatric viral disease
a. RSV
b. Pertussis
c. Measles
d. Mumps
20. Which of the following about mumps is true?
a. Mumps are of no concern to the adult patient
b. Mumps are characterized by enlargement of the salivary glands
c. Mumps are not highly communicable
d. There is no vaccine for the mumps virus
21. Your patient is a 20 year old female college student who lives in a dormitory. She
complains of weakness, fever, chills, nausea, a rash on her chest, and neck pain.
Physical examination revels warm, moist skin; pain with flexion of her neck; and
a petechial rash on her chest. HR=92, BP=106/68, RR=14, SaO2=99%. Which
of the following is most appropriate?
a. Place a N-95 respirator on the patient, transport BLS, notify the hospital
before arrival, and seek follow-up care for you and your partner
b. Administer O2 via NRB, cardiac monitor, IV of NS and transport
c. Place a face mask on your patient and yourself, transport BLS, notify the
hospital before arrival, and seek follow up care for you and your partner
d. Administer O2 via NRB, BLS, and transport
22. Your patient is a 64 year old male who is in a rehabilitation facility. He is 5 days
postoperative for repair of a hip fracture. He is complaining of SOB, which has
been progressing for the past two days. He has a fever and a cough productive of
purulent sputum. Physical examination reveals hot, moist skin, and bilateral
lower lobe rhonchi. HR=122, BP=126/88, RR=28, SaO2=92%. Which of the
following is most appropriate?
a. Oxygen by NRB, BLS transport
b. Oxygen by NRB, IV of NS, 40mg furosemide
c. Oxygen by NRB, IV of NS
d. Albuterol nebulized with oxygen, IV of NS
23. Which of the following statements about sinusitis is FALSE?
a. Pain and pressure are usually alleviated when the patients lean forward
and lower their heads.
b. Nasal drainage my be purulent and/or blood tinged
c. Decongestants may be of some value in treating sinusitis
d. A heat pack placed directly over the affected sinus can help relieve pain
and facilitate drainage
24. Your patient is a 21 year old male who is alert and orientated, complaining of a
rash that started about 36 hours ago, first appearing on his truck. The rash has
now spread to his face and extremities. You notice multiple small fluid filled
vesicles on the patients body. The patient is concered that he will miss work as a
second grade student teacher. He has no medical history, including childhood
diseases. The patient is most likely suffering from
a. Rubella
b. Herpes simplex
c. Varicella
d. Brucellosis
25. The destructive substances released from some bacteria when they die are known
as
a. Endotoxins
b. Exotoxins
c. Syncytia
d. Prions
26. Which of the following statements about herpes simplex type 2 (HSV-2) is false?
a. HSV-2 is responsible for 70-90% percent of all genital herpes cases.
b. There is a low risk of disease transmission via casual contact
c. Treatment with Acyclovir can eradicate the virus
d. In addition to painful lesions to the infected area, fever and enlarged
lymph nodes can be present during the initial presentation of the infection
Quiz 3 -13
1. Ovulation occurs:
a. As a result of an LH surge around day 14 of the menstrual cycle.
b. When the corpus albicans ruptures
c. Secondary to an decrease in FSH and estrogen
d. When the corpus luteum ruptures
2. Your 28 yr old female pt was sexually assaulted with a foreign object and is
bleeding heavily from the vagina. Which of the following is appropriate?
a. Performing a manual pelvic exam
b. Speculum examination
c. IV access and fluid replacement
d. Packing dressings in the vagina to stop bleeding
3. Which of the following is a potential complication of untreated PID (pelvic
inflammatory disease)?
a. Sepsis
b. Primary amenorrhea
c. Cystitis
d. Renal failure
4. You are called to the scene of a sexual assault. You are presented with a 19-yr
old female who is withdrawn and sitting in a corner in her bedroom. Which of the
following questions is appropriate to ask?
a. “Do you know if you were penetrated?”
b. “Why did you bring him home with you from the nightclub?”
c. “Are you injured anywhere?”
d. “What type of clothing were you wearing?”
5. If fertilization of and egg occurs, which phases of the menstrual cycle in progress
does not occur?
a. Secretory and menstrual
b. Ischemic and menstrual
c. Proliferative and menstrual
d. Secretory and ischemic
6. The term used to describe how many times a women has been pregnant is
a. Gravida
b. Parity
c. Para
d. Menarche
7. A 24 yr old female presents complaining of severe lower quadrant abdominal pain
and bloody, purulent vaginal discharge 3 days after having a dilation and
curettage. Of the following, which is the most likely clinical condition of this
patient?
a. Mittelshmerz
b. Abruptio placentae
c. Endometriosis
d. Endometritis
8. A 45 yr old female presents complaining of abdominal pain just superior to the
symphysis pubis, urinary frequency, dysuria, and a fever of 99 degrees F. Based
on her complaints her best diagnosis would be?
a. Endometriosis
b. Ruptured ovarian cyst
c. Cystits
d. Endometritis
9. 9Endometritis is a complication associated with all the following except:
a. Elective abortion
b. Ectopic pregnancy
c. Childbirth
d. Spontoaneous abortion
10. A 35 yr old female presents complaining of a one year history of a dull, crampy
pain in her pelvis that comes with her menstrual cycle, yet is very different from
normal menstrual discomfort. She also describes dysparenunia and frequent
spotting. Of the following, which is the most likely clinical condition of this pt?
a. Endometriosis
b. Mittelschmerz
c. Uterine fibrosis
d. Endometritis
11. The muscular organ that contains the fetus, placenta, amniotic fluid, and
associated structures during pregnancy is the:
a. Oviduct
b. Pouch of Douglas
c. Endometrium
d. Uterus
12. The most common form of gynecological trauma is:
a. Self-induced abortion
b. Foreign body insertion
c. Abdominal trauma
d. Straddle injury
13. Your patient is a 35 yr old female who is complaining of severe abdominal pain in
both lower quadrants. She states that she had tubal ligation 2 years ago and
“knows she can’t be pregnant.” Which of the following questions is appropriate
to ask?
a. “Have you ever had a sexually transmitted disease?”
b. “Are you married or in a monogamous relationship?”
c. “When was the last time you had sexual intercourse?”
d. “When was your last menstrual period?”
14. Which of the following in not appropriate in the care of a victim of a sexual
assault?
a. Touch the pt’s shoulder or tap her on the leg to assure her
b. Explain all procedures and ask for permission before starting them
c. Approach the patient in a calm professional manner
d. Be especially attentive to the pt’s modesty
15. Signs of an ectopic pregnancy include all of the following except:
a. Syncope
b. Missed, late, or unusually light menstrual period
c. Fundal height at the level of the umbilicus
d. Unilateral abdominal pain
16. Menorrhagia is:
a. Excessive menstrual flow
b. Painful menstruation
c. Insignificant menstruation
d. Irregular cycles of menstruation
17. Which of the following is true of mittelschmerz?
a. It is usually accompanied by heavy menstrual bleeding
b. It is a sign of ectopic pregnancy
c. It is typically located unilaterally in one of the upper abdominal quadrants
d. It is associated with ovulation
18. Your pt is a 44 yr old female who is alert and in mild distress. She states that she
had an acute onset of sharp, right lower quadrant abdominal pain last evening
while having intercourse and that the pain has not subsided. She states the pain
radiates to her lower back and rates it as a five on a scale of one to ten. Physical
examination revels tenderness with palpation to the lower right abdominal
quadrant, and her skin is warm and dry. HR=100, RR=12, BP=116/78, Her last
menstrual period was three weeks ago, she had a tubal ligation ten years ago, and
she states she has several small fibroid tumors. Which of the following is the
most likely diagnosis for this pt?
a. Ectopic pregnancy
b. Ruptured ovarian cyst
c. Mittelschmerz
d. PID
19. A 20 yr old sexually active female presents in severe distress, hypotensive. She
describes an acute onset of sever lower R quadrant abdominal pain and states that
she has not had her period in the last three months. The most likely clinical
diagnosis would be:
a. Ruptured ovarian cyst
b. Spontaneous abortion
c. Ruptured ectopic pregnancy
d. Torsion of an ovarian cyst
20. The period of time from ovulation to menstruation is approximately _____ days.
a. 21
b. 14
c. 28
d. 7
21. Your pt is a 34 yr old female in no apparent distress, complaining of dysuria.
She describes a 4 day history of dysuria, urinary frequency, and hematuria. She is
sexually active with one partner, last menstrual period ten days ago and G3P3.
Physical examination revels warm, dry skin and pain with palpitation above the
pubis. HR=96, BP=124/68, RR=12, temp=99.9 F. Which of the following is the
most likely diagnosis for this pt?
a. Cystitis
b. Pyelonephritis
c. PID
d. Endometriosis
22. Which of the following is true of the fallopian tubes?
a. This is the normal site of implantation of the blastocyst.
b. They are strong suspensory ligaments that hold the uterus in place
c. They secrete follicle stimulating hormone and leutinizing hormone
d. This is the normal site of fertilization of the ovum
Quiz 3-14
1. Place the following neonatal resuscitation procedures in the correct order:
1) tactile stimulation
2) CPR
3) assisting ventilations
4) oxygen administration
5) suctioning
6) administration of cardiac medications
. – – – – – 5,1,4,3,2,6
2. Which of the following statements regarding meconium is NOT true?
a. Meconium-stained fluid indicates a fetal hypoxic event
b. The presence of meconium staining is often difficult to determine.
c. Thin and light meconium does not require aggressive suctioning of the
airway
d. The presence of meconium is often associated with prolonged labor
3. Which of the following refers to the time from conception to birth?
a. Intrapartum
b. Perinatal
c. Postpartum
d. Prenatal
4. You are assisting in the delivery of an infant after extremely prolonged labor.
During delivery of the head, you note presence of thick, green meconium in the
patient’s airway. What should your next cause of action be?
a. Immediately suction the hypopharynx and trachea before completing the
delivery using an ET tube and a meconium aspirator
b. Do not suction the nose and mouth, complete the delivery, then suction the
hypopharynx and trachea using an endotracheal tube and a meconium
aspirator.
c. Do not suction the nose and mouth, complete the delivery, then suction the
oropharynx using and ET tube and meconium aspirator
d. Suction the nose and mouth with a bulb syringe, complete the delivery,
then suction the hypopharynx and trachea using an ET tube and a
meconium aspirator
5. The most important consideration when managing a premature infant is:
a. preventing the loss of body heat
b. determining blood glucose
c. continuously suctioning the airway
d. administering 100% oxygen
6. Which of the following structures allows the delivery of oxygen and nutrients to
and removal of wastes from the fetus?
a. Morula
b. Amnotic sac
c. Placenta
d. Allantois
7. Your patient is 34 weeks pregnant, complaining of a headache and nausea. Her
blood pressure is 150/92, and she tells you that her doctor told her she has protein
in her urine. You note that her face, hands, and feet are edematous. Which of the
following is most likely?
a. Eclampsia
b. Gestational diabetes
c. Hyperemesis gravidum
d. Preeclampsia
8. Which of the following is appropriate in the care of the patient in the first stage of
labor?
a. Allow the newborn to nurse
b. Prepare for delivery
c. History, physical exam, transport
d. Save the placenta in a plastic bag for transport to the hospital
9. Preterm labor is defined as labor that begins before____ weeks of gestation.
a. 40
b. 37
c. 38
d. 36
10. Which of the following is NOT a function of the placenta?
a. Supplying the developing fetus with maternal blood
b. Secreting estrogen and progesterone required to maintain pregnancy
c. Removing fetal waste products
d. Transferring heat and nutrients to the developing fetus
11. Which of the following is NOT useful to the Prehospital care provider when
obtaining the history of a pregnant patient?
a. Estimated due date
b. Outcomes of previous pregnancies
c. The father’s general health
d. History of prenatal care
12. A newborn has blue extremities, a pink torso, a strong an active cry, a heart rate
of 104, and some flexion of its extremities. What is this newborn’s APGAR
score?
a. 8
b. 9
c. 7
d. 5
13. Which of the following is NOT appropriate when assisting with Prehospital
delivery?
a. Suction the mouth as soon as the head delivers
b. Rotate the baby’s head to the side as soon as it delivers.
c. Wait for the umbilical cord to stop pulsating before clamping and cutting
d. Keep the newborn at the level of the vagina until the umbilical cord is cut
14. When assisting with delivery, which of the following sequence is correct after
instructing the mother to stop pushing when the baby’s head has delivered?
a. Suction the mouth first then the nose, direct the baby’s head downward to
deliver the anterior shoulder, direct the baby’s head upward to deliver the
posterior shoulder.
15. All of the following statements about the physiological changes during pregnancy
are true EXCEPT:
a. the urinary bladder is displaced posteriorly and inferiorly
b. renal tubular absorption increases
c. gastrointestinal peristalsis is slowed
d. pelvic joints loosen, causing postural changes and low back pain
16. The structure that connects the umbilical vein directly to the inferior vena cava is
the:
a. foramen ovule
b. foramen ateriosus
c. ductus arteriosus
d. ductus venous
17. Which of the following maternal changes is expected during pregnancy?
a. Decreased stroke volume, decreased heart rate
b. Increased cardiac output, increased blood volume
c. Increased heart rate, increased blood pressure
d. Increased blood pressure, increased cardiac output
18. Which of the following statements about the umbilical cord is TRUE?
a. It has two veins and one artery
b. The umbilical cord is approximately six feet long
c. Arteries connected to the maternal circulation supply blood to the fetus
d. The umbilical vein supplies oxygenated blood to the fetus.
19. The premature separation of the placenta from the uterine wall is called:
a. abortion
b. placenta previa
c. abruptio placenta
d. spontaneous placentae
20. Your patient is a 25-year old female who is 38 weeks pregnant and complaining
of contractions. She states that she has been feeling contractions every 6-8 min
for the past hour, has a crampy feeling in her lower abdomen, and is leaking
amniotic fluid. She states that she has been receiving prenatal care and has been
identified as high risk for placenta previa. Which of the following is most
appropriate?
a. Administer oxygen by NRB
b. Start an IV of normal saline at a keep-open rate, and monitor for active
vaginal bleeding.
c. Start an IV of normal saline at a keep-open rate, and consult with medical
direction about administering terbutaline.
d. Administer oxygen by NRB, and start a large bore IV at 100/ml per hour
21. Which stage of gestation begins at 8 weeks and continues until delivery?
a. Prenatal
b. Perinatal
c. Eembryonic
d. Fetal
22. Your patient is a 32-year old female who complains of the onset of contractions
45 min. ago. She is 39 weeks pregnant, G3P2. She states that the contractions are
2 min. apart but that her membranes have not ruptured. She is anxious and
responds affirmatively when ask if she feels an urge to move her bowels. Which
of the following is most likely?
a. Braxton Hicks contractions
b. Preterm labor
c. Stage one labor
d. Imminent delivery
23. Meconium staining indicate:
a. fetal distress
b. prematurity
c. gestational diabeties
d. eclampsia
24. A 33- year old female who is 30 weeks pregnant is alert and complaining of
steady, bright red vaginal bleeding that began a half hour ago. She denies pain
and contractions, but states that she has had spotting “ON AND OFF” during her
pregnancy. Which of the following is most likely?
a. Eclampsia
b. Placenta previa
c. Abrupto placentae
d. Uterine rupture
25. Which of the following would be considered routine Prehospital care of the
patient exhibiting indications of imminent delivery?
a. Transport in a supine position
b. Rupturing the membranes
c. Establish an IV of normal saline
d. Administering oxytocin
26. Which of the following statements about neonatal resuscitation is NOT true?
a. The endotracheal tube is an acceptable administration route for
epinephrine, atropine, lidocaine, glucose, and naloxone.
27. When the fetal scalp is visible at the vaginal opening during a contraction, this is
known as:
a. crowning
b. stage three labor
c. engagement
d. effacement
28. Which of the following is the most reliable sign of impending delivery?
a. Loss of the mucus plug
b. Meconium stained amniotic fluid
c. Crowning
d. Spontaneous rupture of the membranes
29. Your patient is a 41-year old female who is alert and in obvious distress,
complaining of abdominal pain. The patient states that she is 32 weeks pregnant
and experienced an acute onset of tearing abdominal pain this evening. She
admits to smoking cocaine this afternoon. She is G5P2 with two spontaneous
abortions. Her skin is cool, moist, and pale, and you note about 50 mL of dark
red vaginal bleeding. Her abdomen is rigid to palpation in all quadrant. Which of
the following is most likely?
a. Placenta Previa
b. Preeclampsia
c. Preterm labor
d. Abruptio placenta
30. Which of the following paramedic actions is indicated after uncomplicated
delivery of the newborn?
a. Administering oxytocin
b. Performing fundal massage to maintain uterine contraction
c. Administering oxygen
d. Applying gentle traction to the umbilical cord to assist with the delivery of
the placenta
Block 4
Volume 4 Chapter 1 Trauma & Trauma Systems
1. Which level of trauma facility stabilizes and prepares to transport trauma pt’s to a
higher level facility but does NOT necessarily have surgical capabilities?
a. 1
b. 2
c. 3
d. 4
2. A trauma center that is committed to special emergency department training and
has a dregree of surgical capability but that usually stabilizes and transfers
seriously injured pt’s in a level ___ trauma center
a. 1
b. 2
c. 3
d. 4
3. Which of the following accounts for the highest number of trauma deaths?
a. MVC’s
b. Firearms injury
c. Falls
d. Assault
4. Which of the following is NOT an example of trauma
a. An abrasion to the knee
b. A stab wound to the abdomen
c. Chest pain
d. Cerebral contusion
5. Which of the following means “the anticipation of injury to a body region or
organ”?
a. Newton’s first law of motion
b. Index of injury
c. Index of suspicion
d. MOI
6. Which of the following is NOT true of trauma triage criteria?
a. Comparing pt’s injuries with their mechanisms has been proven to be
essential to decision making surrounding trauma triage criteria.
b. When pts meet trauma triage criteria, you should transport them to the
closest basic emergency facility for stabilization
c. Trauma triage criteria is geared to help you formulate an index of
suspicion when making decisions about your trauma pt
d. Trauma triage are guidelines to help you determine whether your pt needs
transport to a trauma center.
7. A trauma system is based on the principle that serious trauma is a ______ disease.
a. Medical
b. Psychological
c. Trauma
d. Surgical
8. Which of the following is more relevant to the assessment of a trauma pt that to
the assessment of a medical pt?
a. OPQRST
b. SAMPLE
c. DCAP-BTLS
d. AVPU
9. As a paramedic, your role in trauma care consists of all the following EXCEPT:
a. Promoting injury prevention
b. Providing care to seriously injured trauma pt’s
c. Providing rapid transport to appropriate facilities
d. Providing surgical interventions to stop hemorrhage
10. The purpose of determining the MOI and the index of suspicion for the trauma pt
at the same time is to allow you to:
a. Document a complete scene size up
b. Decide whether to transport the pt
c. Identify comorbid factors
d. Anticipate your pt’s injuries
11. Which of the following requires immediate transport to a trauma center?
a. 47-year old involved in a MVC that resulted in the death of his passenger
b. 40 year old who fell 8 feet off a ladder
c. 36 year old female in a MVC who has a BP of 100/60
d. 22 year old motorcyclist who laid his bike down and complains only of
lower extremity pain.
12. Which of the following MOI does NOT call for immediate transport to a trauma
center?
a. MVC with a 20 MPH impact
b. 30 foot fall from a tree
c. Pedestrain struck by a vehicle at 20 MPH
d. MVC requiring 1 hour for pt extrication
13. In addition to handling all types of specialty trauma, which level of trauma center
provides continuing medical and public education programs?
a. 1
b. 2
c. 3
d. 4
14. The leading cause of death in people under age 44 is:
a. Heart attack
b. Cancer
c. Cardiovascular disease
d. Trauma
15. Which of the following is important to the assessment of the trauma pt but not to
the medical pt?
a. The need to identify the MOI
b. The rapid trauma survey
c. The detailed exam
d. The ongoing assessment
16. Which of the following is NOT considered a significant MOI for a pediatric pt?
a. Vehicle collision at moderate speed (25-30mph) where passenger is
appropriately restrained.
b. Fall of less than 5 feet
c. Any collision in which a child is unrestrained
d. Bicycle vs. vehicle collision
17. Which of the following pts is not a candidate for air medical transport?
a. Combative trauma pt
b. Seriously injured pt with cardiac tamponade
c. Brun pt with over 50% second degree burns
d. Pt with prolonged extrication time
18. Written and verbal communication of the MOI and suspected injuries prevents
under triage and insures the pt will receive the appropriate level of care.
a. True
b. False
19. Which of the following physical findings indicates the need for immediate
transport?
a. Fractured right femur
b. Revised trauma score of 12
c. Vital sings: BP 80 by palp, HR 130, and RR 12
d. Second degree burns involving 9% of total body surface area
20. Which of the following is an acceptable way of reducing prehospital time to
maximize the use of the “golden hour” for trauma pts
a. Perform time consuming interventions en route
b. Start all IV’s on scene to allow for more rapid transport
c. Insure all intervention shave been completed prior to getting en route
d. Skip spinal immobilization in the blunt trauma pt
21. Which of the following pts does NOT require specialty center capabilities beyond
that offered by a trauma center?
a. 22 year old with bilateral open femur fractures
b. 4 yr old with a closed head injury
c. 25 yr old with amputation of three fingers
d. 67 yr old with second and third degree burns over 50% of the body
22. Which level of trauma facility has minimal surgical support but can stabilize
before transferring to a higher level trauma facility?
a. 1
b. 2
c. 3
d. 4
23. Which level of trauma facility can handle the most common trauma emergencies
but for more specialized care will have to transfer the pt to a regional trauma
center?
a. 1
b. 2
c. 3
d. 4
24. Upon arriving on a scene where the MOI indicates a potentially life threatening
injury and transport time is prolonged, which of the following interventions will
best help deliver the care that is needed?
a. Ask a surgeon to respond on the scene
b. Re evaluate the scene size up
c. Call immediately for air medical transport to reduce the “golden hour”
d. Initiate transport immediately, delaying assessment until you are en route
25. Which of the following is not a consideration when assessing a trauma pt?
a. Medic alert bracelets
b. Underlying medical conditions
c. Medical insurance coverage
d. SAMPLE history
26. Which of the following acts resulted in the development of modern EMS
systems?
a. Good Samaritan act
b. The trauma care systems planning and development act of 1990
c. Highway safety act of 1966
d. Ryan white act
27. Which of the following is the best, most cost effective way for EMS personnel to
help reduce trauma related morbidity and mortality?
a. Provide complete pt care reports so that accurate data can be entered into
the trauma registry
b. Keep up to date on trauma management knowledge and skills
c. Participate in injury prevention programs
d. Transport all trauma pts to a trauma center
28. Which of the following mechanisms would yield the greatest index of suspicion
for injury?
a. Helmeted bicyclist losing control and falling of his bike onto a gravel
surface at 15 MPH
b. Roll over motor vehicle collision with a restrained driver
c. Fall of 12 feet from a ladder landing in the mud
d. 50 MPH MVC with partial ejection
29. Which of the following statements about trauma is true?
a. Dramatic appearing extremity injuries may draw the paramedic’s focus
from life threatening injuries
b. Life threatening injuries may exist with little external evidence
c. Life threatening injury occurs in less than 10% of trauma pts
d. All of these are true
Volume 4 Chapter 2 Blunt Trauma
1. In frontal impact collisions, which pathway of patient travel results in higher
mortality?
a. Down and under
b. straight
c. Up-and-over
d. Vertical
2. In falls, which section of the spinal column is the most prone to compression?
a. Sacral
b. Thoracic
c. Cervical
d. Lumbar
3. Which of the following statements about the impact of motorcycle helmet usage is
true?
a. Helmet use neither increases nor decreases chance of cervical spine injuryb.
Helmet use is a sure way to protect your cervical spine from injury
c. Helmet use does not protect your cervical spine what so ever
4. Which of the two following factors proportionately affect the kinetic energy of a
bullet fired from a gun?
a. Velocity and mass
b. Acceleration and Deceleration
c. Mass and weight
d. Acceleration and gravity
5. People in which of the following age groups are prone to significant trauma due to
falls?
a. Teenagers
b. College age adults
c. Pediatric population
d. Geriatric population
6. Which of the following injuries is associated with the pressure wave produced by
a blast?
a. Femur fracture
b. Pneumathorax
c. Acute renal failure
d. Decreased range of motion in upper extremities
7. Which of the following impacts the severity of injury sustained in a motor vehicle
collision?
a. Vehicle speed
b. Rate of acceleration or deceleration
c. Gross vehicle weight
d. All of the above
8. Which of the following injuries is most likely in a resr-end collision?
a. Head and neck injuries
b. Pelvic fractures
c. Thoracic and abdominal injuries
d. Lumbar spine injuries
9. Applying Newtons second law of motion to a vehicle traveling 70 miles per hour,
crashing into which of the following would transfer the most force to the patient?
a. Shurbbery
b. A body of water
c. Sign post
d. Bridge abutment
10. Upon arriving at the scene of a single vehicle collision in which the vehicle struck
a utility pole, you note that the windshield is spidered, or starred, and that the
driver was not restrained. Which of the following injuries is most likely?
a. Whiplash injury of the neck muscles
b. Ligamentous neck injury due to rotation beyond the range of motion
c. Compression injury of the cervical spine.
d. Distraction injury of the cervical spine
11. You are dispatched to a building collapse with an entrapped patient who will
require a lengthy extrication. Which of the following meds should you consider
for this patient while awaiting extrication?
a. Sodium Bicarb
b. Diazepam
c. Calcium channel blockers
d. Furosemide
12. In which of the following types of impact should you have a higher index of
suspicion because the degree of injury may be greater than the damage alone
indicates?
a. Rear end
b. rotational
c. Lateral
d. Frontal
13. Which of the following mechanisms in a motor vehicle collision would most
likely result in a tear of the liver at the ligamentum teres?
a. Sudden deceleration
14. Which of the following best defines the term energy?
a. The capacity to do work
15. Which of the following paper bag syndrome injuries may occur due to sudden
compression of the thorax or abdomen?
a. Pulmonary and myocardial contusions
b. Cardiac tamponade, aortic dissection
c. Pneumothorax, ruptured bowel
d. Pneumothorax, myocardial contusion
16. Vehicle airbags are meant to :
a. Absorb the kinetic energy of the occupants bodies
b. Prevent unrestrained occupants from taking the down and under pathway
in frontal impacts
c. Prevent injury from secondary impacts
d. Protect infants and children who ride in the front seat of the vehicle
17. Which of the following injuries is associated with the tertiary phase of a blast?
a. Entrapment
18. Which of the following traumas contributes most significantly to motor vehicle
collision mortality?
a. Head
19. Which of the following contributes to a greater degree of injury than anticipated
from vehicle damage alone in a lateral impact motor vehicle collision?
a. Increased gravitational forces due to multiple changes in direction and
velocity
b. Lack of a crumple zone
c. Taking the up and over pathway
d. The force of side impact airbag deployment
20. You are called to the scene of a vehicle crash in which a car was rear ended while
stopped at a stop sign. Which of the following laws of physics serves as the basis
for analyzing the mechanism of injury and the associated suspicion of index for
injuries?
a. A body at rest will remain at rest unless acted on by an outside force.
b. Energy can neither be created nor destroyed
c. A body in motion will remain in motion unless acted on by an outside
force
d. The amount of energy transmitted to an object is inversely proportional to
its rate of deceleration
21. Which of the following is true of the differences between adult and pediatric
pedestrians when struck by a vehicle?
a. Children tend to be thrown onto the hood of the vehicle
b. Adults tend to be thrown under the vehicle
c. Children tend to turn toward the vehicle
d. Adults tend to turn toward the vehicle
22. In a motor vehicle collision, when the drivers chest strikes the steering wheel,
what produces injury next?
a. The heart continues its forward motion until it strikes the chest wall.
b. The airbag deploy a second time
c. The steering column shears off, causing penetrating trauma.
d. Unsecured objects in the vehicle become projectiles
23. Which of the following is true of supplemental restraint systems?
a. They may deploy during rescue operations, injuring the patient and or
EMS personnel.
24. Your patient, a 23 yo woman who is 6 months pregnant, was the unrestrained
driver of a vehicle that rear ended a parked car. The airbag deployed. For which
of the following injuries should you maintain a high index of suspicion?
a. Fractured sternum
b. Placenta previa
c. Abruptio placentae
d. Anterior flail segment
25. Which of the following factors is NOT a consideration in the severity of injury
related to falls?
a. The initial point of impact
b. Wind resistance
c. Distance of the fall
d. Landing surface
26. Which o the following best describes what happens to the kinetic energy of a
vehicle traveling at 65 mph when it collides into a concrete barrier wall?
a. The body of the vehicle and its occupants absorb the energy.
b. The energy converts to heat through friction
c. The concrete absorbs the energy
d. The energy dissipates as sound waves.
27. Which of the following is true of motorcycle collisions?
a. A rider who “lays down the bike” will generally receive more severe
injuries than a rider who stays with the bike
b. The use of helmets has drastically reduced the incidence of cervical spine
injuries
c. Frontal impact can result in intra abdominal, pelvic, and femur injuries.
d. The structural steel of the vehicle absorbs most of the kinetic energy in a
motorcycle collision
28. Frontal impacts in which the patient takes a down and under pathway typically
result in which of the following injury patterns?
a. Rupture of the diaphragm
b. Traumatic brain injury
c. Rupture of hollow organs
d. Hip and femur fractures
29. Which of the following statements about lateral impact collisions is true?
a. The degree of injury may be greater than the damage alone would
indicate.
30. Which of the following is NOT a complication of crush syndrome?
a. Systemic alkalosis
b. Difficult to control hemorrhage
c. Cardiac dysrhythmias
d. Renal failure
31. The two factors that refer to the rate of change of speed are
a. Deceleration and velocity
b. Mass and weight
c. Acceleration and inertia
d. Acceleration and deceleration
32. Axial loading is most likely to occur in which type of impact?
a. Rear with the head rest too low
b. Lateral on the side of the vehicle oopposite the occupant
c. Frontal with a down and under pathway
d. Frontal with an up and over pathway
33. Which of the following best describes why the occupants of a vehicle moving at
50 MPH will be injured when the vehicle strikes a tree but not when it brakes to
stop?
a. The inertia of the tree increases the kinetic energy transmitted to the
occupants by a factor 10
b. Braking allows the kinetic energy to be absorbed evenly into the frame of
the vehicle, rather than concentrating it at the point of impact
c. The energy gradually dissipates as heat due to the friction of braking,
rather than transfers to the vehicle and its occupants.
d. None of the above
34. Which of the following injuries is NOT associated with the use of vehicle
restraint systems?
a. Abrasions and contusions to the clavicle and chest area
b. Abdominal injury
c. Lumbar spine trauma
d. Traumatic brain injury
35. A vehicle is struck in its right front as it passes through an intersection, resulting
in a rotational impact. Which of the passengers is subjected to the greatest
acceleration forces?
a. The left rear passenger
b. The driver
c. The front seat passenger
d. The right rear passenger
Volume 4 Chapter 3 Physics of Penetrating
Trauma
1. Which of the following statements about stab wounds is true?
a. The size and shape of the weapon allow precise prediction of the injury
b. Damage must be anticipated in a cone shaped area proceeding inward and
increasing in circumference from the point of entry
c. The presence of defense wounds decreases the likelihood of trauma to the
neck, thorax, and abdomen
d. Stab wounds by female attackers are seldom lethal.
2. As the mass of an object increases, which of the following occurs?
a. The maximum speed it can attain increases
b. The amount of energy decreases
c. The amount of energy increases
d. The maximum speed it can attain decreases
3. Which of the following statements about bullets is true?
a. A high velocity bullet is three times less likely to do major harm
b. The hunting rifle’s bullet is usually a lighter bullet, but it travels faster
c. A small, light bullet does the most harm.
d. The larger the bullet the smaller its engergy
4. Which of the following increases a bullets profile?
a. Mushrooming on impact
b. The use of rifiling in the barrel of the firearm
c. Tumbling 180 degrees upon impact
d. A and C
5. Your patient is a 60 yo male with a gunshot wound in the second intercostals
space anteriorly on the left. You note that he has frothy blood coming from his
mouth. For which of the following must you have the highest index of suspicion?
a. Tension pneumothorax
6. The path a projectile follows during a flight is called its:
a. Drag
b. Trajectory
c. Ballistics
d. Cavity
7. Which of the following is true of shotgun ammunition?
a. A shotgun may either fire one slug or use ammo with multiple pellets.
8. To gain an appreciation for the potential for trauma from high velocity projectiles,
it is important to remember that the shock wave produced can exceed atmospheric
pressure by up to —– times.
a. 100
9. Penetrating trauma to the face can complicate airway management by which of
the following mechanisms?
a. Larygotracheal edema
b. Airway obstruction
c. Destruction of anatomical landmarks
d. B and C
10. The initial assessment of a patient with a gunshot wound to the chest should focus
on detecting which of the following/
a. Peritonitis
b. Tension pneumothorax
c. Cardiac contusion
d. Pancreatits
11. Which of the following is typical of the trajectory of a knife when a female
assailant stabs someone/
a. The movement is downward as the assailant raises the knife and swings
downward
12. Which of the following is true of the shock wave that accompanies high velocity
penetrating trauma?
a. The shock wave may be transmitted through blood, resulting in damage to
blood vessels some distance from the primary wound.
13. Which of the following is NOT considered penetrating trauma?
a. A laceration on the forehead as a result of being struck with a metal pipe
14. Which of the following organs would be most likely to be injured by a stab
wound to the 6th intercostals space in the Midaxillary line on the right side?
a. Liver, bladder, kidney, small intestine
b. Stomach, pancreas, lung
c. Spleen, diaphragm, lung, kidney
d. Liver, diaphragm, lung, kidney
15. Your patient is a construction worker who fell 15 feet and has a 3 foot metal
concrete reinforcement bar (rebar) impaled in his right thigh. Which of the
following is the best action?
a. Transport the pt without attempting to shorten or remove the rebar
b. If you can see both ends of the rebar, gently remove it and irrigate the
wound with sterile saline.
c. If the proper tools and personnel are present, have rescuers cut the rebar to
a manageable length.
d. Administer sodium bicarbonate to combat acidosis resulting from the
destruction of muscle tissue.
16. Which of the following bullet characteristics would create the most damage?
a. A small profile
b. Lack of tumble
c. Mushrooming or flattening on impact
d. A full metal jacket
17. Which of the following characteristics of stab wounds is associated with a male
attacker?
a. The victims usually have defensive wounds on their forearms.
18. Which of the following is considered a high velocity weapon?
a. Rifle
19. As the energy from a medium or high velocity projectile pushes tissue from its
path, which of the following occurs?
a. Negative pressure is generated inside the cavity, drawing debris into the
wound.
20. Greater velocity of a bullet will cause a ____ path of travel and a ____trajectory.
a. Flatter, wavier
b. Wavier, straighter
c. More rounded, curved
d. Flatter, straighter
21. You have arrived on the scene of a 17 yo male with a gunshot wound to the thigh.
Police are on the scene. There is significant ongoing hemorrhage from the
wound. The patient is screaming for someone to help him. Which of the
following should you do first?
a. Control hemorrhage with direct pressure
b. Begin high flow oxygen administration
c. Begin high flow oxygen administration
d. Ask the police if they have searched the patient for weapons yet.
22. Which of the following is true of body armor use?
a. Blunt trauma may be significant, but the potential for life threatening
injury is less than if armor had not been worn.
23. Which two factors related to kinetic energy proportionately affect the damage a
projectile will do?
a. Velocity and yaw
b. Fragmentation and velocity
c. Mass and fragmentation
d. Velocity and mass
24. Which of the following abdominal organs is the least affected by the pressure
wave associated with penetrating trauma?
a. Kidneys
b. Liver
c. Spleen
d. Bowel
25. Which of the following statements about entrance and exit wounds is true?
a. Cavitational wave energy is greatest at a bullet’s point of entrance
b. Entrance wounds most often appear as stellate
c. Exit wounds reflect the potential for damage more accurately than
entrance wounds.
d. Exit wounds are usually the size of the bullet’s profile
26. Which of the following statements about low velocity penetrating trauma is true?
a. There is no pressure shock wave with a knife wound as there is with an
arrow wound
b. More injuries are sustained from arrows than from knives
c. Knives, arrows, ice picks, and similar weapons cause damage only in their
direct path.
d. Shorter knives and ice picks may be removed if they are left in the wound
27. Which of the following organs is most susceptible to damage from the pressure
wave when a bullet enters it?
a. Femoral artery
b. Liver
c. Intestines
d. Lungs
28. Which of the following is most important when assessing the damage done by a
gunshot?
a. The size of the bullet
b. The type of gun used
c. The distance from the shooter.
d. Whether there was an upward or a downward trajectory when the bullet
was fired
29. Your patient is an 8 yo male with a pencil impaled 2 centimeters inferior to the
xiphoid process. You note that the pencil is pulsating. Which of the following is
the best action?
a. Stabilize the pencil and transport to the nearest medical facility
b. Stabilize the pencil in place and transport to a trauma center.
c. Remove the pencil and apply direct pressure to the wound
d. Start and IV and request orders fro analgesia and sedation
30. A penetrating injury to which of the following organs is LEAST likely to result in
severe hemorrhage?
a. Kidney
b. Liver
c. Spleen
d. Ureter
31. Which of the following statements is true of the permanent cavity created by
penetrating trauma?
a. It is a space created by a projectile as tissue moves rapidly away on its
path
b. It is the damage done when the projectile fragments penetrate
c. It is a potential space, not an actual space.
d. It fills with disrupted tissues, some air, fluid, and debris.
32. During the scene size up on a call for a patient with a penetrating trauma due to a
stab wound, which of the following should you do?
a. Collect anything that could be used as evidence
b. Check for weapons on or near the patient.
c. Try to find out in which direction the assailant fled
d. Assume that the pt has no weapons if law enforcement is on the scene
33. Your patient is a 50 yo male with a gunshot wound to the right anterior chest. He
is unresponsive. Which of the following should you do first?
a. Check for breathing
34. Your patient is a 30 yo female with a stab wound to the neck. She is sitting up
and appears very anxious and SOB. There is minimal external bleeding noted,
but there is bubbling from the wound. Which of the following should you
suspect, based on the mechanism of injury and assessment findings?
a. Laceration of the ipsilateral carotid artery
b. An injury to the spinal cord at the level of the stab wound
c. Laceration of the trachea
d. All of the above
35. As a bullet tumbles, its potential to inflict damage:
a. Remains the same
b. Increases.
c. Decreases
d. Is determined by the trajectory
36. Which of the following is best described as the area of contused tissue resulting
from penetrating trauma that may be slow to heal due to disrupted blood flow and
tissue damage?
a. Zone of coagulation
b. Zone of injury
c. Permanent cavity
d. Temporary cavity
37. Which of the following is associated with assault rifle wounds but not hunting
rifle wounds?
a. Larger exit wounds
b. Multiple wounds
c. Smaller exit wounds
d. Permanent cavitation
38. Your pt has a gunshot wound to the left posterior thorax. Which of the following
is not appropriate in your initial assessment?
a. Auscultating breath sounds bilaterally in six places, anteriorly and
posteriorly
b. Placing a gloved hand over a sucking chest wound
c. Beginning bag valve mask ventilations
d. Stabilizing a flail segment, should one be noted
39. When assessing a pt with a gunshot wound to the chest, which of the following
findings would tell you the most about the amount of damage?
a. Diminished breath sounds unilaterally
b. A large exit wound
c. Subcutaneous emphysema
d. A stellate entrance wound
40. Which of the following is most likely to occur when military ammunition is used?
a. It will remain intact
b. It will explode
c. It will “mushroom” or flatten
d. It will fragment
41. Which of the following is true of the temporary cavity formed by penetrating
trauma?
a. It fills with disrupted tissues, some air, fluid, and debris
b. It is the damage when the projectile fragments
c. It heals more slowly than the permanent cavity because of the nature of
the tissue damage
d. It is a space indirectly created by a projectile as tissue moves rapidly away
from its path
42. Which statement about ballistics is true
a. When a bullet tumbles, it decreases the damage
b. When a bullet yaws, it increases the damage
c. Damage is less when the bullet does not exit the body
d. In penetrating trauma, the mass of a projectile is more significant than its
velocity when determining kinetic energy
Volume 4 Chapter 4
1. Which of the following mechanisms is responsible for accumulating lactic acid in
shock?
a. Gluconeogenesis
b. Hemostasis
c. Anaerobic metabolism
d. The citric acid cycle
2. Which of the following substances has the most rapid effect when compensating
for hemorrhage?
a. Catecholamines
b. Angiotensin 2
c. Glucocorticoids
d. Antidiuretic hormone
3. Which layer of the arteries controls the diameter of the vessel?
a. Tunica externa
b. Tunica media
c. Tunica intima
d. Tunica adventitia
4. Which of the following types of wound facilitates the effectiveness of normal
blood-clotting mechanisms?
a. Crushing injuries
b. Transverse laceration of the vessel
c. Vessels torn by stretching, such as when a limb is caught in farm
mechanism
d. Longitudinal laceration of the vessel
5. Your patient is a 29-year old male who works in a meat-processing plant. He
received a knife wound in the proximal antero-medial thigh, which is continuing
to bleed on your arrival. He is restless, thirsty, and has pale, cool skin. He has a
weak radial pulse of 130 and a blood pressure of 118/88. this patient is exhibiting
signs and symptoms consistent