Download 1 - Hatzalah of Miami-Dade

1.
2.
The direct responsibility for the care given by an EMS provider lies legally with the:
a)
educational institution
b)
employer
c)
System Medical Director
d)
State Health Department
You are at the scene of an attempted suicide by a 20 Y/O male.
The patient is refusing transport, eventhough he may die without hospital care.
If the patient is transported against his will:
3.
4.
a)
metal handcuffs should be applied to restrain the patient
b)
the decision to transport should be made jointly by both EMS providers
c)
it should be done upon the direction of a police officer
d)
Diazepam (Valium) should be administered for sedation
When communicating with a Medical Control physician from the field, the EMS provider should:
a)
not provide any information on patient changes unless the physician requests such information
b)
be sure to use medical terminology at all times
c)
question orders that do not seem appropriate for the patient’s condition
d)
use Magill forceps and laryngoscope to clear the airway
An adult male with a foreign body obstruction of the upper airway is experiencing inspiratory stridor and
respiratory difficulty, but is still coughing forcefully.
Of the following, the BEST action for yout to take:
5.
a)
prepair for nasal intubation since he is still breathing
b)
obtain Medical Control’s permission for a cricothyroidotomy
c)
encourage the patient to keep coughing to see if he can dislodge the obstruction himself
d)
use Magill forceps and laryngoscope to clear the airway
An unconscious 20 Y/O female injured in a motor vehicle accident responds to pain only above the nipple line.
Her vitals are BP: 100/70, P: 70, RR: 34 (shallow).
The BEST method of ventilating this patient is:
a)
the esophagial obturator airway and demand valve
b)
the head-tilt/chin-lift and demand valve
c)
the jaw-thrust maneuver and non-rebreathing mask
d) endotracheal intubation and BVM
6.
For abdominal trauma victims who are in severe hypovolemic shock with a systolic BP of less than 50
mm/Hg,
management can BEST be accomplished by:
a)
direct pressure and IV
b) the MAST and IV
7.
c)
IV and Fowler’s position
d)
Fowler’s and Trendelengurg positions
A 67 Y/O male with history of COPD presents with respiratory distress of 3 hours in duration.
Physical examination reveals that he is cyanotic, and the use of accessory muscles is noted.
He is lethargic, vital signs are BP: 120/90, P: 110, RR: 36.
Which one of the following devices is MOST appropriate for this patient?
a)
nasal cannula @ 2 LpM @ 40% oxygen
b) BVM with a reservoir @ 90-100% oxygen
c)
Venturi mask @ 4 LpM @ 24% oxygen
d)
non-rebreathing mask @ 8LpM @ 90-100% oxygen
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8.
9.
The tissue lining the trachea is:
a)
ciliated, mucous secreting
b)
non-ciliated, mucous secreting
c)
ciliated, non-mucous secreting
d)
non-ciliated, non-mucous secreting
When responding to a call from a nursing facility, an EMS provider finds a 78 Y/O unresponsive female
slumped in a dining room chair.
An attendant reports that the patient suddenly became unresponsive while eating.
A quick initial assessment (Primary Survey) reveals a complete airway obstruction.
To remove the obsrtuction, which of the following actions should be INITIALLY attempted?
a)
back blows
b) abdominal thrusts
10.
c)
chest thrusts
d)
removal of the obstruction with a Magill forceps
A 50 Y/O male has had sefvere epigastric pain radiating to his umbilicus for the past 8 hours.
His vitals are BP: less than 50 systolic, P: 124, RR: 30, the patient has pale conjuctivae, cool diaphoretic skin,
non-distended neck veins, and is breathing normally.
In addition to administration of oxygen, the treatment for this patient should include:
11.
a)
MAST, rapid infusion and transport
b)
IV TKO, Lidocaine (Xylocaine) and transport
c)
IV TKO, Dopamine (Inotropin) and transport
d)
Nitroglycerine, rapid IV infusion and transport
In hypoperfusion (shock) caused by dehydration, oxygen deprivation at the cellular level results in:
a)
metabolic alkalosis
b) metabolic acidosis
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13.
c)
respiratory acidosis
d)
respiratory alkalosis
Harsh, high-pitched sounds heard on inspiration and caused by upper airway obstruction are called:
a)
inspiratory rales
b)
wheezing
c)
stridor
d)
laryngeal rhonchi
Restlessness, anxiety, weak and rapid pulse, low blood pressure, amrked jugular vein distension,
tracheal deviation and cyanosis are signs and symptoms of:
14.
a)
simple rib fracture
b)
chest decompression
c)
tension pneumothorax
d)
emphysema
Which of the ollowing histories would be MOST pertinent in a patient with hypoperfusion (shock)?
a)
history of asthma
b)
recent weight gain of 5 pounds
c)
monthly migrain headaches
d) black bowel movemwnts for the past 3 days
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15.
A non-breathing patient is removed from a swimming pool after diving into the shallow end.
When managing this patient, you should FIRST:
a)
tilt the head and ventilate with a BVM
b)
intubate and ventilate the patient immediately
c)
suction as much water as possible from the lungs
d) manually stabilize the head in a neutral position
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17.
Which of the following is a CORRECT statement regarding the lungs?
a)
gas exchange takes place primarily in the alveoli
b)
the membrane that covers the lungs is known as the parietal pleure
c)
total lung capacity is normally 2 liters
d)
at the start of inspiration, air pressure in the lungs is greater than atmospheric pressure
For an adult patient who has a foreign body obstruction but is able to forcefully cough, the EMS Provider’s
MOST approriate action is to:
a)
perform laryngoscopy
b) not interfere and monitor the patient
18.
c)
perform up to 5 abdominal thrusts
d)
perform back blows followed by abdominal thrusts
In the medical history of a patient complaining of a sudden onset of difficulty breathing, which of the following
pieces of information would be important to note?
19.
20.
21.
22.
a)
the patient has had a recent hip-replacement operation
b)
the patient is seeing a doctor for arthritis
c)
the patient has cataracts
d)
the patient suffers from hemorrhoids
The MOST important INITIAL signs and symptoms of a spontaneous pneumothorax are:
a)
a sudden attack of dry, hacking cough accompanied by pain
b)
immediate air hunger and mild cyanosis followed by slow and shallow respirations
c)
sudden sharp chest pain and sudden shortness of breath
d)
sudden shortness of breath and expectoration of rusty sputum
Which of the following statements regarding the use of a cervical collar is MOST accurate?
a)
it is essential to include spinal immobilization on a long board
b)
it is needed only in cases of severe trauma
c)
it completely stabilizes the neck, obliviating the need for manual stabilization
d)
it is used only in cases of rapid extrication
Cricoid pressure (Sellick maneuver) will move the:
a)
trachea slightly posteriorly
b)
epiglottis laterally
c)
larynx anteriorly
d)
esophagus superiorly
All of the following are indications of proper endotracheal tube placement, EXCEPT:
a)
audible epigastric sounds
b)
improved patient color
c)
equal breath sounds
d)
bilateral chest excursion
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23.
24.
The diameter of the endotracheal tube for an average-sized adult is:
a)
3.0 – 5.0 mm
b)
5.0 – 7.0 mm
c)
7.0 – 9.0 mm
d)
9.0 – 11.0 mm
You are treating a patient with a gunshot wound to the face who has major airway problems.
Which of the following adjuncts would be BETS for securing the airway of this patient?
25.
a)
endotracheal intubation
b)
oropharyngeal airway
c)
nasopharyngeal airway
d)
esophageal obturator airway
The primary reason that petroleum-based lubricants are NOT used in nasotracheal intubation is that:
a)
they will cause necrosis of the esophageal lining
b)
they are ineffective
c)
aspiration of such lubricants can lead to serious complications
d) they will cause damage to the tube and the cuff
26.
Which of the following is the MOST common problem associated with a prolonged intubation attempt
in a non-breathing patient?
a)
laryngospasm
b) hypoxia
27.
c)
esophageal rupture
d)
regurgitation
The head of a non-trauma patient about to be intubated should be in a:
a)
flexed position
b) sniffing position
28.
c)
neutral position
d)
hyperextended position
Which one of the folowing statements concerning endotracheal intubation is true?
a)
it should be used as the initial means of providing an open airway
b)
it increases the force needed for compressions during CPR
c)
it cannot be introduced while an esophageal obturator airway is in place
d) when a straight blade is used, it should be inserted beneath the epiglottis
29.
The MAIN purpose of blood circulating to all of the organs of the body is to:
a)
keep the tissues warm
b) provide oxygenation
30.
c)
provide hormones
d)
keep the tissues lubricated
The treatment for hypovolemic shock due to blood loss includes the rapid infusion of large amounts of fluids.
IV infusion volumes can be maximized by using:
-4-
a)
short and large diameter IV catheters
b)
long IV tubing to increase the seed of te fluid
c)
cool IV solutions that have a high viscosity
d)
a non-pressured IV bag system to maxaimize the rate of flow
31.
32.
Which one of the following abnormalities may be effectively treated by ventilation management with a BVM?
a)
repiratory alkalosis
b)
metabolic alkalosis
c)
respiratory acidosis
d)
metabolic acidosis
EARLY complications of intravenous therapy include all of the following, EXCEPT:
a)
air embolism
b) thrombophlebitis
33.
c)
local infiltration
d)
catheter shear
In patients with heart disease, rapid infusion of an IV solution may precipitate:
a)
hypotension
b)
hypovolemic shock
c)
increased intracranial pressure
d) pulmonary edema
34.
Which of the following CANNOT be performed with the MAST completely inflated?
a)
urinary bladder catheterization
b) palpation of the abdomen
35.
c)
EKG
d)
CPR
When an IV is being inserted, the needle should NEVER be reinserted in the catheter, because of the
possibility of:
a)
thrombophlebitis
b) shearing of the catheter
36.
c)
infiltration
d)
putting the needle through the vein wall
Abnormal dilation of blood vessels may be due to:
a)
smoking
b)
hypovolemia
c)
administered Epinephrine
d) sepsis
37.
When a combination of 2 medications produces a patient response that exceeds the sum of their individual
effects, the combined action is termed:
38.
a)
synergy
b)
idiosyncrasy
c)
cumulative action
d)
potentiation
Which one of the following medication routes has the quickest absorption time?
a)
inramuscular
b)
subcutaneous
c)
intravenous
d)
sublingual
-5-
39.
You are ordered to give a 198 lbs patient a medication at a dosage of 0.5 mg/kg.
Your prefilled syringe is labeled 100 mg / 10 ml.
How much of this medication should you administer to this patient?
a)
2.2 ml
b) 4.5 ml
40.
41.
c)
5.0 ml
d)
9.0 ml
One kilogram equals:
a)
0.5 pound
b)
500 miligrams
c)
2.2 pounds
d)
2000 miligrams
A physician orders 1000 mg of a drug; the ampules available to the EMS provider contain 0.5 g/ml each.
How much should the EMS provider administer?
a)
0.5 ml
b) 2 ml
42.
43.
44.
c)
5 ml
d)
20 ml
A cardiac patient is receiving an IV via a microdrip (60
a)
10 ml
b)
20 ml
c)
30 ml
d)
120 ml
gtts/ml
) running at 20
gtts/min.
The correct gauge needle length for administering a subcutaneous injection to an average sized adult is:
a)
22 gauge; 5/8 inch
b)
22 gauge; 1½ inches
c)
25 gauge;
d)
25 gauge; 1½ inches
5/8
inch
Intramuscular and subcutaneuos injections are generally ineffective for the patient who is:
a)
complaining of pain
b)
obese
c)
experiencing respiratory distress
d) cold, clammy and pale, with poor capillary refill
45.
An EMS provider is ordered to administer a drug at 2
mg/ml
by IV drip. The administration set delivers 60
The EMS provider should set up 2 g in 500 ml of IV solution to run at which of the following rates?
a)
15
gtts/min
b)
30
gtts/min
c)
45
gtts/min
d) 60 gtts/min
-6-
gtts/ml
.
46.
You have refused an order to infuse 300
Your administration set delivers 10
ml/hr
gtts/ml
of Lacteted Ringer’s solution into a trauma patient.
.
At which rate will you need to run the set to achive the order?
47.
48.
a)
50 gtts/min
b)
75
c)
100
gtts/min
d)
300
gtts/min
gtts/min
If a patient’s head is found in a non-neutral position, it should be immobilized in that position when there is:
a)
loss of motor function
b)
decreased distal sensation
c)
resistance to movement
d)
cervical tenderness
A conscius 20 Y/O female jogger is lying supine on the street after having been struck by a motorcycle.
She comlpains of left-sided upper quadrant pain with radiation into the left shoulder.
On physical examination, she is found to be cool, pale and diaphoretic.
Capillary nailbed refilling time is delayed, and radial pulses are barely palpable.
She has sustained bruises on the upper left quadrant of the abdomen, andx on both the left arm and left leg.
During the Expanded Primary Survey, the EMS provider should:
49.
a)
administer oxygen via non-rebreathing mask
b)
immobilize the spine and pass an endotracheal tube
c)
immobilize the neck, administer oxygen and start an IV
d)
start a large-bore IV and splint the shoulder
A patient presents with left-sided chest pain associated with shortness of breath and cyanosis.
On percussion, the left side is hyperresonant. The patient is MOST LIKELY suffering from:
a)
pulmonary edema
b)
hemothorax
c)
pneumonia
d) pneumothorax
50.
51.
The MAJOR problem that results from a pneumothorax is that:
a)
alveolar function is impaired
b)
the mediastinum shifts toward the affected side
c)
pressure is exerted on the diaphragm
d)
the arterial carbon dioxide pressuer fails
While driving, a 65 Y/O male was involved in a two-caar motor vehicle accident.
Upon examination, he is complaining of chest apin and tenderness of the sternum.
You would consider all of the following, EXCEPT:
52.
a)
scapular injury (fracture)
b)
cardiac contusion
c)
steranl injury (fracture)
d)
ruptures aorta
Breathing difficulty related to paradoxical movement of the chest due to blunt trauma is BEST treated by:
a)
CPR
b) assisting ventilations via BVM and oxygen
c)
inhalation of oxygen via non-rebreathing mask
d)
placing 2 sandbags on the chest
-7-
53.
You arrive at the scene of a gang fight and find an unconscious patient with a stab wound to the
left anterior chest. The patient is breathing rapidly, and has distended neck veins and a midline trachea.
Vital signs are BP: 90/70, P: 140 thready, breath sounds are bilaterally equal and heart sound cannot be heard.
These signssuggest:
54.
a)
pericardial tamponade
b)
flail chest
c)
tension pneumothorax
d)
airway obstruction
Which one of the following serious complications occasionally occurs following fracture of a long bone?
a)
air embolus
b) fat embolus
55.
c)
coronary thrombus
d)
cerebral hemorrhage
A 16 Y/O girl has been hit by a car. Her right femur is swollen and tender, her right leg is shorter than the left.
Her systolic BP is less than 50
mm/Hg,
P: 140, capillary refill is delayed, skin is cool and moist.
management of this patient would include:
a)
2 traction splints and 2 Ivs on the scene
b)
a touniquet to control bleeding
c)
local aplication of an Epinephrine solution to stop bleeding
d) the MAST and large-bore IV of a crystalloid en route to the hospital
56.
A 55 Y/O female has been struck by an automobile. On arrival, the EMS provider finds that the patient is
responsive to voice and is lying supine.
The detailed physical examination (Secondary Survey) elicitspain on lateral compression of the pelvis and
a rigid abdomen. Vital signs are BP: 84/50, P: 120, RR: 20; skin is cool to touch.
The MOST appropriate treatment would include:
57.
a)
immediate transport and monitoring of vital signs en route
b)
spinal immobilizaton and traction splint
c)
the MAST and rapid IV infusion of Normal Saline solution en route
d)
the MASt without inflation until systolic BP drops below 50
Which one of the following is usually NOT a sign or symptom of isolated head injury?
a)
increasing headache
b)
irregular respirations
c)
vomiting
d) decraesed blood pressure
58.
59.
The reason for hyperventilating a patient with a head injury and signs of transtentorial herniation is to:
a)
reduce carbon dioxide levels
b)
lower the pH
c)
cause cerebral vasodilation
d)
increase intacranial pressure
In a patient with a spinal cord injury, which of the following causes a drop in blood pressure and shock?
a)
loss of parasympathetic function
b) loss of sympathetic function
-8-
c)
presence of blood in the spinal canal
d)
injury to the thoracic cage
60.
You are called to examine a patient who has fallen from the third floor of a building.
He lies supine in the street, unconscious, with the following vital signs: BP: 190/100, P: 54, RR: 6,
the patient is cyanotic and his respirations are shallow and labored.
After establishing in-line neck stabilization, the IMMEDIATE treatment for this patient should be:
61.
a)
start an IV of Normal Saline and apply the MAST
b)
start BVM ventilations and place an esophageal airway
c)
start BVM ventilations and place an endotracheal tube
d)
administer high-concentration oxygen via NRB
Hypoventilation occurs in the patient with spinal cord injury as a result of:
a)
internal injuries elsewhere
b) damage to nerve fibers supplying the diaphragm
62.
63.
64.
65.
66.
67.
c)
the patient guarding due to pain on inspiration
d)
damage to nerve fibers supplying the lungs
In the assessment of a patient for spinal injury, the most important information can be obtained by:
a)
assessing the overall severity of the patient’s condition and the mechanism of injury
b)
using the Trauma Score as a measureof underlying injury
c)
looking for an abnormal posture and assessing for pupil reaction
d)
examining and palpating the surrounding tissue
When managing a patient with burn injuries, the treatment priorities are to:
a)
stop the burning process, secure an airway, and administer oxygen
b)
start large-bore IV, give oxygen, and cover with a wet steril dressing
c)
debride the wound, administer oxygen, and treat for shock
d)
remove all clothing and jewelry, keep blisters intact, and administer oxygen
Inhalation of which of the following is MOST likely to cause burns to the lower airway / lungs?
a)
carbon monoxide
b)
nitrogen gas
c)
superheated air
d)
toxic smoke
Which one of the following conditions usually causes localized wheezing?
a)
asthma
b)
foreign body aspiration
c)
smoke inhalation
d)
chronic bronchitis
Patients with COPD may have lost the normal stimulus for ventilation. For them the stimulus to breath becomes
a)
high oxygen concentration
b)
high carbon dioxide pressure
c)
low oxygen pressure
d)
low carbon dioxide pressure
Which one of the following is an indication for the administration of diphenhydramine (Benadryl)
in the perhospital setting?
a)
status asthmaticus
b) severe allergic reaction
c)
status epilepticus
d)
severe vertigo
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68.
The goal of therapy for a patient suffering from hyperventilation syndrome is to:
a)
decrease oxygen pressure
b)
decrease carbon dioxide pressure
c)
increase oxygen pressure
d) increase carbon dioxide pressure
69.
In addition to chest pain, the signs and symptoms MOST characteristic of pulmonary embolism are a:
a)
sudden onseet of pleuritic pain associated with bilateral wheezing
b) sudden onset of dyspnea that is accompanied by tachycardia
70.
71.
c)
gradual onset of substernal pain accompanied by dyspnea
d)
gradual onset of dyspnea associated with bilateral rales and rhonchi
Which of the following statements concerning status asthmaticus is true?
a)
it is usually responds to an initial dose of Epinephrine (Adrenalin)
b)
auscultated breath sounds are usually pronounced
c)
it fails to respond to initial dose of Epinephrine
d)
Morphine is administered to terminate the seizure
You arrive at a diner where a male customer has been choking.
The patient is lying unconscious on his side, with vomitus around his mouth and central cyanosis.
A BLS ambulance crew tells you that they applied the Heimlich maneuver just prior to ypur arrival.
The patient’s pulse rate is 60 and the respirations are absent.
Which of the following would be the MOST appropriate treatment for this patient?
a)
ispect the airway for a foreign body and initiate back blows
b)
perform head-tilt/chin-lift and await spontaneous respirations
c)
perform aggressive suctioning, insert an oropharyngeal airway, and supply high-concentration oxygen via
non-rebreathing facemask with supplimental oxygen
d) perform direct laryngoscopy, initiate endotrachealintubation, and ventilate with supplimental oxygen
72.
A 54 Y/O male is found unconscious in a car with the motor runnung.
His respirations are 18 per minute and his volume is adequate.
The EMS provider should administer oxygen with which one of the following devices?
a)
bag-valve-mask resuscitator
b)
esophageal obturator airway
c)
venturi mask
d) non-rebreathing mask
73.
The drug that is indicated for treatment of organophosphate poisoning is:
a)
Dopamine (Inotropin)
b) Atropine
74.
c)
Norepinephrien (Levophed)
d)
Isoproterenol (Isuprel)
You have responded to a residence to find a 68 Y/O male in cardiac arrest.
As you begin CPR, the family informs you that the patient has terminal cancer, and you find a DNR bracelet
on the patient. In this case you should:
a)
recognize that implied consent overrides the DNR order
b) continue CPR and transport the patient
- 10 -
c)
stop the resuscitation immediately
d)
contact the patient’s physician
75.
The MOST frequent cause of death in myocardial infection is:
a)
ventricular aneurysm
b) dysrhythmia
76.
77.
c)
cardiogenic shock
d)
pulmonary edema
The structure of the heart is composed of:
a)
2 chambers and 4 valves
b)
2 chambers and 2 valves
c)
4 chambers and 4 valves
d)
4 chambers and 2 valves
In a healthy heart, the dominant pacemaker is the SA node because compaired to other potential pacemakers,
it has:
a)
a faster conduction velocity
b) the most rapid intrinsic rate of firing
78.
c)
a higher fibrillation threshold
d)
a shorter repolarization phase
Ventricular repolarization is represented on the EKG by the:
a)
P wave
b)
R wave
c)
S wave
d) T wave
79.
The relative refractory period of the ventricle is associated on the EKG with the:
a)
P-R interval
b)
QRS complex
c)
P wave
d) T wave
80.
Which of the following statements regarding observation of the jugular veins is MOST appropriate?
a)
the jugular veins flatten during right heart failure
b) the jugular veins are best observed with the patient lying at a 45⁰ angle
81.
c)
pericardial tamponade will distend the right jugular vein more than left
d)
the jugular vein should be occluded while examining for distention
If the SA node fails to fire, at what rate will the AV node fire?
a)
20-40 times a minute
b) 40-60 times a minute
82.
c)
60-100 times a minute
d)
100-120 times a minute
A pacemaker implanted in a ventricle causes the EKG to show a spike:
a)
before a narrow QRS
b)
after a narrow QRS
c)
after a wide QRS
d) before a wide QRS
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83.
84.
Each of the following statements conserning supraventricular tachycardia is true EXCEPT the statement that it:
a)
may be caused by digitalis overdose
b)
may reduce cardiac output by reducing stroke volume
c)
indicates an irritable ventricular focus
d)
indicates that the pacemaker is above the bundle of HIS
A characteristic of premature atrial contractions which distinguishes them from prematuere ventricular
contractions is that premature atrial contractions usually have:
a)
inverted P waves
b) a normal QRS complex
85.
86.
c)
no T wave following contractions
d)
prolonged P-R intervals
In a person with 3⁰ block with an escape rhythm at the level of the AV junction, usual EKG presentation will be:
a)
an irregular R-R interval with a wide QRS
b)
a regular R-R interval with a wide QRS
c)
a regular R-R interval with a normal QRS
d)
an irregular R-R interval with normal QRS
All of the following may contribute to the development of diabetic ketoacidosis in an insulin-dependent
diabetic, EXCEPT:
a)
a recent infection
b)
an inadequate dose of insulin
c)
excessive alcohol consumption
d) not eating meals
87.
A 64 Y/O female is found at the foot of a staircase in a basement apartment.
Her home aide explains that the patient was about to ascend the stairs when she slumped to the floor.
The patient has a history of diabetes, vital signs are within normal limits.
The patient respons to pain by abnormal flexion. A quick physical examination reveals that she is diaphoretic
and pale, her lung sounds are clear, and her heart sounds are normal.
In addition to starting an IV, management priorities for this patient would be to:
a)
maintain a patent airway, monitor vital signs, and administer D₅₀ IV bolus
b)
assist ventilations with a BVM, administer an IV fluid challenge, and transport
c)
administer oxygen via partial-rebreathing face mask, transport, apply the MAST, and
administer an IV fluid challange
d)
88.
maintain axial stabilization, apply a cervical collar, and administer oxygen
In a patient with diabetes, the role of insulin is to:
a)
promote the synthesis of glucagon
b) allow glucose transport into muscle and fat cells
89.
c)
convert glycogen to glucose in the liver
d)
assist in beta-cell stimulation in the Islets of Langerhans
With regard to diabetic ketoacidosis, all of the following statements are correct, EXCEPT the statement that it:
a)
is caused by relative insulin deficiency
b) responds rapidly to 50% glucose IV push
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c)
causes Kussmaul respirations
d)
may produce signs of dehydration
90.
You are called to attend a 67 Y/O woman whose daughter called for an ambulance because her mother
“ just stopped talking “.
The daughter tells you that her mother is under a doctor’s care for hypertension and is taking
Hydrochlorothiazide (HydroDiuril) and Methyldopa (Aldomet).
On examining the patient, you find that she is anxious and alert and is able to follow most commands,
but cannot move her right arm or leg.
You suspect:
a)
myocardial infarction
b) cerbrovascular accident
91.
c)
syncope of vagal origin
d)
postictal state resulting from a seizure
For a patient who is experiencing a severe anaphylactic reaction with inadequate tissue perfusion,
the EMS provider should be prepaired to administer:
92.
93.
a)
1:10,000 Epinephrine (Adrenalin), SQ
b)
1:1,000 Epinephrine (Adrenalin), IV
c)
1:1,000 Epinephrine (Adrenalin), IM
d)
1:10,000 Epinephrine (Adrenalin), IV
Naloxone (Narcan) can reverse the effects of all of the following, EXCEPT:
a)
cocaine
b)
meperidine (Demerol)
c)
Methadone
d)
propoxyphene (Darvan)
Which of the following pharmaceutical agents is MOST likely to be lethal if it is taken in combination
with heavy alcohol consumption?
a)
Amphetamine
b) sedative hypnotic
94.
c)
hallucinigen
d)
antihistamine
Which one of the following groups consists of infections that are transmitted by respiratory secretions?
a)
diarrhea, shingles, hepatitis A
b)
meningitis, HIV, syphilis
c)
HIV, hepatitis B, herpes simplex
d) chickenpox, common cold, tuberculosis
95.
96.
The time interval during which an infectious disease can spread to other hosts is called:
a)
communicability period
b)
latent period
c)
incubation period
d)
disease period
What communicable disease, transmitted through respiratory secretions, is characterized by hemoptysis,
fatigue, wieght loss and chest pain?
a)
mononucleosis
b)
whooping cough
c)
polyomyelitis
d) tuberculosis
- 13 -
97.
A 78 Y/O patient is complaining of chest pain and dyspnea presents with premature ventricular contractions.
You elect to administer Lidocaine (Xylocaine). The initial loading dose for Lidocaine is 1.5
however the Medical Control physician orders 0.75
mg/kg
mg/kg
,
to be administered.
The reason for this reduced order is that:
a)
the elderly are often on many medications, such as diuretics, that may potentiate Lidocaine
b)
in the elderly, frequent unifocal PVCs are a less significant finding that in the younger population
c)
the elderly have a decreased myocardial mass requiring a reduced amount of antiarrhythmic medications
d) the elderly patient has decreased liver and renal functions for drug absorption, elimination and metabolism
98.
You are evaluating an elderly patient who is supine in bed.
Suddenly, the patient experiences a syncopal episode for 1-2 minutes while talking to you and then
regains a normal level of consciousness.
This is MOST likely due to:
a)
nervousness
b) a cardiac dysrhythmia
99.
100.
c)
simple fainting
d)
a closed head injury
As the heart rate reaches approximately 200 BpM, the cardiac output will:
a)
decrease
b)
increase greatly
c)
increase slightly
d)
remain the same
Non-cardiogenic pulmonary edema is caused by all of the following, EXCEPT:
a)
smoke inhalation
b) syncope
101.
102.
c)
overdose of an opiate
d)
extremely high altitudes
The MOST common physical finding of right heart failure is:
a)
jugular venous distention
b)
cerebrovascular accident
c)
pulmonary edema
d)
nausea / vomiting
A mass that is carried through the circulatory system and that can lead to occlusion of blood vessels is called:
a)
aneurysm
b) embolus
103.
c)
plaque
d)
thrombus
A patient suffering from a dissecting thoracic aneurysm is likely to:
a)
experience relief of pain with nitroglycerine
b) have pain in the chest and interscapular area
- 14 -
c)
have had hypotensionprior to occurrence of aneurysm
d)
have equal pulses in the periphery of the brachcial and femoral regions
104.
A 43 Y/O male patient appears apprehensive. His skin is cool to the touch.
He denies chest pain, yet holds a clenched fist to his chest. BP: 110/60, P: 62 (irregular), RR: 22.
The MOST probable diagnosis is:
a)
left heart failure
b) acute myocardial infarction
105.
c)
conjestive heart failure
d)
acute anxiety
Signs and aymptoms that may be associated with hypertensive crisis include all of the following, EXCEPT:
a)
orthostatic changes
b) major motor seizure
106.
107.
c)
headache and vomiting
d)
altered mental state
Left ventricular failure frequently produces which one of the following results?
a)
decreased alveolar capillary permeability
b)
decreased systemic venous pressure
c)
increased pressure in the aorta
d)
increased pressure in the pulmonary veins
You respond to a call at 2:00 am for a 60 Y/O male who has awakened due to difficulty in breathing.
the patient is orthopneic, denies pain, and has a history of 3 previous heart attacks.
You should suspect:
a)
angina pectoris
b) conjestive heart failure
108.
c)
spontaneous pneumothorax
d)
paroxysmal supraventricular tachycardia
Physiological causes of syncope include all of the following, EXCEPT:
a)
reduced cardiac output
b)
vasovagal response
c)
reduced perfusion of the brain
d) increased peripheral vascular resistance
109.
A 44 Y/O male presents with an enlarged liver, distended neck veins, and dependent edema.
These findings are characteristics of:
a)
right heart failure
b)
acute pulmonary edema
c)
mitral valve replacement
d) left heart failure
110.
A correct statement about stable angina is that it:
a)
is indicative of futher obstruction and may be termed preinfarction angina
b) is predictable in that it usually follows a pattern
c)
usually develops after myocardial infarction
d)
necessitates increasing the dosage of Nitroglycerine to counteract it
- 15 -
111.
All of the following are usually associated with conjestive heart failure, EXCEPT:
a)
pitting edema
b) paroxysmal nocturnal dyspnea
112.
c)
bradycardia
d)
orthopnea
A 75 Y/O female has fainted. You find her pulse to be 42 BpM and her BP is 60/40
mm/Hg.
The EKG shows sinus bradycardia with frequent premature ventricular contractions.
After oxygen, tour initial pharmacological treatment would be:
113.
a)
Atropine IV bolus
b)
Isoproterenol (Isuprel) drip
c)
Lidocaine (Xylocaine) IV bolus
d)
Dopamine (Inotropin) IV drip
Lidocaine (Xylocaine) should be used for all of the following, EXCEPT:
a)
sinus rhythm with multifocal premature ventricular contractions
b)
ventriculara tachycardia
c)
following successful defibrillation from ventricular fibrillation
d) complete heart block
114.
115.
The MOST common cause of poor oscilloscope EKG pattern is:
a)
low battery
b)
60-cycle interference
c)
poor electrode contact
d)
reversed leads
Which of the following conditions may result from excessive administration of potent diuretics?
a)
increase in body weight
b) hypotension
116.
c)
hypertension
d)
diabetics
Which one of the following conditions may result from the administration of Morphine?
a)
hypertension
b)
pupil dilation
c)
hyperpnea
d) respiratory depression
117.
118.
In the EKG, the first upward deflection of the QRS complex is the:
a)
P wave
b)
Q wave
c)
R wave
d)
T wave
The effect of Lidocaine (Xylocaine) on the heart is to:
a)
decrease the QRS interval
b)
increase conduction velocity
c)
raise the fibrillation threshold
d) lower the fibrillation threshold
- 16 -
119.
120 .
121.
All of the following statements regarding the use of Epinephrine are true, EXCEPT that it:
a)
increases peripheral vascular resistance
b)
causes bronchodilation
c)
decreased automaticity
d)
increases sympathetic tone
Nitroglycerine is used for angina pain because it:
a)
anesthetizes the myocradium
b)
increases the oxyen-carrying capacity of the blood
c)
reduces cardiac workload
d)
interrupts the pain sensations at the synapse
You are treating a patient who is experiencing crushing chest pain.
The Medical Control physician has ordered you to administer Morphine Sulfate.
Immediately after administrationof the Morphine Sulfate, the patient goes into respiratory arrest.
The MOST appropriate treatment for this patient is to:
122.
a)
ventilate the patient and then administer Naloxone (Narcan)
b)
ventilate the patient and then administer Epinephrine (Adrenalin) IV push, followed by Lidocaine (Xylocaine)
c)
administer Epinephrine (Adrenalin) SQ, followed by diphenhydramine (Benadryl) IM
d)
intubate the patient, ventilate with a BVM, and transport without delay to the hospital
The upper limit of the duration of the normal QRS complex is:
a)
0.04 second
b) 0.12 second
123.
c)
0.16 second
d)
0.20 second
Tachycardias and bradycardias are especially dangerous in a patient with acute myocardial infarction
because they may result in:
a)
decreased diastolic pressure
b) decreased cardiac output
124.
125.
c)
increased systolic pressure
d)
increased intra-atrial conduction
Providing care within the scope of practice would be considered behavior in accordance with:
a)
the sovereign immunity doctrine
b)
approved protocols
c)
professional standards
d)
institutional standards
As you lift a patient into the rear og the ambulance, a reporter recognizes the patient as a State Senator.
Immediately, the media representatives demand to be told what has happened to the Senator.
You should;
a)
advise the press that you are unable to comment
b)
deny that the patient is the Senator
c)
tell the press your diagnosis
d)
advise the press to contact the Senator’s family for information
- 17 -
126.
127.
If the patieent care protocols have been revised, it is the EMS provider’s responsibility to:
a)
attend in-service training with the agency medical director to become familiar with the new protocols
b)
continue to use the old protocols because they are already familiar
c)
begin to use the new protocols as soon as the agency receives them
d)
operate only when in direct communication with the physycian
During Initial Assessment, you are assessing a conscious trauma patient complaining loudly of pain in the leg.
You should:
a)
begin to obtain the history
b)
assess the leg immediately
c)
discontinue the Initial Assessment and start the Detailed Physical Examination
d) continue with your Initial Assessment
128.
129.
130.
The overall purpose of the Initial Assessment is to:
a)
identify and correct life-threatening problems and set priorities
b)
ensure that the airway is open and locate breathing problems
c)
identify and trteat major exttremity injuries
d)
identify minor problems and provide definitive treatment
Systolic blood pressure indicates the pressure when the:
a)
atria are contracting
b)
atria are relaxing
c)
ventricles are contracting
d)
ventricles are relaxing
In what order is the Detailed Physical Examination ususally conducted on an adult patient?
a)
head, neck, extremities, chest, pelvis, abdomen
b) head, neck, chest, abdomen, pelvis, extremities
131.
132.
c)
head, neck, abdomen, chest, pelvis, extremities
d)
head, chest, abdomen, neck, pelvis, extremities
In assessing a pediatric trauma patient’s capillary refill time, an abnormal finding would be a refill time of:
a)
greater than 5 seconds
b)
less than 2 seconds
c)
greater than 2 seconds
d)
greater than 4 seconds
All of the following are symptoms, EXCEPT:
a)
headache
b) weak pulse
133.
- 18 -
c)
chest pain
d)
nausea
Which of the following is an example of a sign?
a)
cyanosis
b)
nausea
c)
dizziness
d)
chest pain
134.
All of the following are part of the respiratory system, EXCEPT the:
a)
alveoli
b) esophagus
135.
c)
epiglottis
d)
bronchi
Foreign matter is kept from entering the trachea by the:
a)
pharynx
b)
esophagus
c)
uvula
d) epiglottis
136.
You arrive at the scene of a call and find an unconscious adult victim.
The initial attempt to ventilate proves unsuccessful. The next step should be:
137.
a)
deliver 5 abdominal thrusts
b)
check the carotid pulse
c)
reposition the head and attempt to ventilate again
d)
reposition the head and perform a finger sweep
According to the CPR guidelines, when ventilating a non-breathing child (1-8 Y/O), how many times per minute
should ventialtions be performed?
a)
10
b)
12
c)
15
d) 20
138.
139 .
The management of airway obstruction in the infant includes
a)
back blows and chest thrusts
b)
back blows, abdominal thrusts and chest thrusts
c)
abdominal thrusts and chest thrusts
d)
finger sweeps, back blows and abdominal thrusts
In caring for a non-breathing patient with a stoma or tracheostomy tube, the EMS provider should:
a)
use a nasopharyngeal airway
b)
use extra force with each ventilation
c)
cover the neck opening
d) vetilate through the neck opening
140.
A correct statement concerning airway management of a patient who has a suspected spinal cord injury is that:
a)
the cord injury takes precedence over the airway; the patient can be ventilated only if this can be done
without moving the cord
b)
the airway always takes precedence over the cord injury; the airway must be opened regardless of
the damage it might do to the cord
c)
there is no difference in management; in the presence of cord injury, airway’s still opened in the usual way
d) special techniques must be employed to open the airway without moving the cord
141.
The ratio of compressions to ventilations when one rescuer applies CPR to an adult is:
a)
5:1
b)
5:2
c)
15:1
d) 15:2
- 19 -
142.
143.
144.
When CPR is being performed on a child (1-8 Y/O), the rate of chest compressions is:
a)
60/min
b)
70/min
c)
100/min
d)
120/min
In placing the hands on a patient’s sternum to perform CPR, the EMS provider should:
a)
hold the fingers of the bottom hand in a fist formation and the fingers of the top hand curved up
b)
fold the fingers under, making a firm fist
c)
hold the fingers outward and slightly away from the chest wall
d)
allow the fingers to curve and conform to the patient’s chest
You are performing two-rescuer CPR on a child. The rescuer who has been ventilating informs you that the
patient is now breathing spontaneously. What should you do?
a)
continue to provide ventilations and compressions, since you should not stop CPR once you have begun
b) stop compressions and place the child in the recovery postition
145.
146.
c)
keep both hands on the sternum in order to be ready to assume compressions
d)
stop ventilations but continue with the compressions
Which one of the following statements concerning the performance of CPR is correct?
a)
quick jabs and sudden jerking movement should be avoided when compressing the chest
b)
quick jabs are effective in providing pulses of blood to the brain
c)
70% of the cycle should be compressions and 30% of the cycle should be relaxation
d)
quick jabs produce jets of blood flow out of the heart and enhance stroke volume
Keeping the heel of the hand lightly in contact with the chest during the relaxation phase of chest compression
is important because:
a)
stomach distention can be prevented
b) correct hand position can be maintained
147.
148.
c)
overexpantion of the chest can be avoided
d)
the pressure enhances cardiac contraction
While performing ventilations on an infant or a child in respiratory arrest, you should ventilate once every:
a)
3 seconds
b)
4 sceonds
c)
5 seconds
d)
6 seconds
Which of the following statements regarding nasopharyngeal airways is TRUE?
a)
nasopharyngeal airways should be used only in the left nostril
b) nasopharyngeal airways should be coated with a water-soluble lubricant prior to insertion
c)
nasopharyngeal airways are more likely to stimulate a gag-reflex than an oropharyngeal airway
d)
if an obstruction is encountered as a nasopharyngeal airway is first introduces, you should immediately
switch to an oropharyngeal airway
149.
You have inserted an oropharyngeal airway into the mouth of an unconscius victim who reacts by having
a gag-reflex. You should:
- 20 -
a)
remove the airway
b)
remove the airway, then reinsert it
c)
pull the airway out slightly
d)
use a smaller-sized airway
150.
In mouth-to-mouth ventilation, the stomach is likely to be distended if too great a force is used to inflate
the lungs. Lung ventilation may become more difficult because stomach inflation:
a)
causes a spasm of the larynx
b) pushes up on the diaphragm and increases the likelyhood of vomiting
151.
c)
produces back pressure that pushes the epiglottis forward
d)
causes a displacement of the lungs, resulting in deviation of the trachea
An unconscious, breathing 18 Y/O patient has been rescued from a car that had the engine running.
The patient’s skin is red, vitals are: BP: 110/70, P: 110, RR: 18.
Oxygen should be administered with which of the following devices?
a)
nasal cannula
b)
simple face mask
c)
venturi mask
d) non-rebreathing mask
152.
You are called to the home of a patient who is on physician-prescribed low-concentration oxygen,
and who is NOT in acute respiratory distress.
According to NYS BLS Treatment Protocols, which type of oxygen delivery should you use during transport?
a)
non-rebreathing mask
b)
demand valve
c)
simple face mask
d) nasal cannula
153.
154.
You are suctioning a trauma patient who has large blood clots present in the mouth. You should:
a)
use alcohol to clear blood clots from the suction tip
b)
insert the suction tip with the vacuum on
c)
sweep the slots out of the mouth before suctioning
d)
ensure that your suction unit does not exceed 200
mm/Hg
of negative pressure
A patient tells you that he was thrown against the dashboard of the car and complains of chest pain and SOB.
Vitals are: BP: 96/60, P: 120, RR: 22, he is cyanotic and has great difficulty talking to you.
The IMMEDIATE treatment for this patient should be to:
155.
a)
immobilize the injured are a with sandgabs
b)
administer oxygen via nasal cannula
c)
administer high-concentration oxygen
d)
assist him in taking his Nitroglycerine pill
Which liter flow is inappropriate for oxygen administration via nasal cannula?
a)
0-2 LpM
b)
2-4 LpM
c)
4-6 LpM
d) 8-10 LpM
- 21 -