FPC / CFRN - Review Exam - Version A 2023 with 100% correct questions and answers

Normal value for monitoring PA pressures are? A. 2-6/8 - 14 mmHg B. 15 - 25/8 - 15 mmHg C. 25 - 35/20 - 30 mmHg D. None of the above 15 - 25 / 8 - 15 mmHg Pulmonary systolic pressure is 15-25 mmHg. Pulmonary diastolic pressure is 8-15 mmHg. Initial intervention for managing a patient presenting with Bariobariatrauma is? A. Administer high flow oxygen B. Decrease oxygen to 4 L/min by NC C. Administer high flow oxygen by NRM 15 minutes prior to lift off D. Maintain cabin pressure at 2500 feet Administer high flow oxygen by NRM 15 minutes prior to lift off. You are on the scene of a 21 YOM gunshot wound to the left chest. The left chest has been decompressed with a needle. The patient is intubated and continues to de-saturate and you note an increase in SQ air. How will manage this patient? A. Re-needle the left chest B. Advance ET tube below the level of the injury; right main stem intubation. C. Decrease respiratory rate down to 10 per minute D. Insert a chest tube Advance ET tube below the level of the injury; right main stem intubation. Drug of choice for treating a GI bleed is? A. Normal saline B. Nipride C. Whole blood D. Sandostatin Sandostatin Your patient has an ICP of 28. BP is 100/60. His cerebral perfusion pressure is approximately? A. 100 mmHg B. 70 - 90 mmHg C. 60 mmHg D. 50 mmHg Answer is 50 mmHg Normally ICP = 0-10 mmHg CPP = 70-90 mmHg CPP = MAP - ICP CPP = 73 - 28 --- 45 CPP Normal MAP = 80-100 mmHg MAP = P dia + 1/3(P sys - P dia) MAP = 60 + .33(100 - 60) --- 73 MAP An expanding ETT cuff in flight is an indication of what gas law? A. Henry's B. Dalton's C. Boyle's D. Charles Boyle's law (expansion or contraction of a gas) The air in the ETT cuff, for example, expands with altitude (ascent) and contracts during descent. You are transporting a 30 YOM involved in a MCA from an outerlying facility. The 70 kg patient is on a ventilator with FIO2 1.0, Vt 500, Rate 16, PIP 22 and Peep 5. The ABG results are pH 7.01, pCO2 68, HCO2 12, base deficit - 8, pO2 280. Interpretation of the blood gas reveals? A. Mixed disturbance B. Metabolic acidosis C. Respiratory acidosis D. Compensated respiratory acidosis Mixed disturbance Metabolic and respiratory acidosis. The pCO2 is high, resulting in a respiratory acidosis, and the pH and HCO3 are low, resulting in a metabolic acidosis. Normal Ranges: pH : 7.35 - 7.45 pCO2 : 35 - 45 HCO3 : 22 - 26 pO2 : 80 - 100 You notice that your patient has the following waveform and is showing VT on the monitor. Your initial intervention of the patient is to? A. Synchronize cardiovert B. Advance catheter by inflating the balloon C. Administer precordial thump D. Pull catheter back into the right ventricle Synchronize cardiovert Pediatric dose for Epinephrine is? 0.01 mg/kg (IV) You arrive on the scene of 21 YOF involved a single roll-over accident who is approximately 28 weeks pregnant. Your assessment reveals palpation of fetal parts over the abdomen. What is your diagnosis of the patient? A. Liver laceration B. Uterine rupture C. Placenta previa D. Abruptio placenta Uterine rupture Abruptio placenta dark red, painful Placenta previa red, painless Terbutaline dose 0.25 (SQ) Define postpartum hemorrhage over 500 mL Uterine rupture Fetal parts can be palpated over abdomen Your IABP begins to purge during ascent. The triggering mechanism for this function was initiated as a result of which gas law? A. Boyle's law B. Gay-Lussac's law C. Charles' law D. Henry's law Boyle's law Beta-blockers are contraindicated with? A. Narcotic overdose B. TCA overdose C. Cocaine overdose D. Aspirin overdose Cocaine overdose The pediatric patient may be pre-treated with which medication prior to administering Anectine? A. Etomidate B. Atropine C. Vasopressin D. Vecuronium Atropine How should your flight suit fit to provide space of insulation per CAMTS recommendations? A. ½ inch B. 1 inch C. Skin tight so I look really hot for the firefighters on scene D. ¼ inch ¼ inch The uniform should fit to allow 0.25 in. (1/4 in.) of air space between the suit and undergarments You are beginning to prepare for landing and you have news reporter riding along for the day. You see a high-rise tower at 1100 high. Sterile cockpit applies how? A. The news reporter can speak anytime during the flight B. Flight crew members are the only one allowed to speak C. Say nothing about the high rise tower D. Pilot is the only crew member to speak during all phases of flight Flight crew members are the only one allowed to speak. You have responded to a fire in a building with 5 victims. You notice that a large portion of the synthetic carpet has been burned in the room where you are treating the patients. The patients are exhibiting increasing signs of respiratory distress and coughing after high oxygen has been applied. What may be causing the patients signs and symptoms? A. Cyanide B. Ammonia C. Carbon dioxide D. Hydocarbon Cyanide You have just crash landed your aircraft and your pilot has asked you to exit the aircraft. What should you take with you? A. Helmet B. Bags of normal saline C. Survival kit D. Seat cushion Survival kit You are en-flight with a 70 YOM cardiac patient on 6 L of oxygen by NC. You are at 5,000 feet and the patient is becoming hypoxic. What is your initial intervention for this patient? A. Decrease cabin pressure B. Increase oxygen delivery to the patient C. Administer fluid bolus to increase perfusion to the heart D. RSI and intubate the patient Increase oxygen delivery to the patient. You are managing a burn patient who weighs 90 kg with a 65 % BSA. How much fluid should this patient receive in the first 8 hours when using the Parkland formula? Answer is 11,700 mL Parkland: 4 mL × kg × TBSA. ½ over 1st 8 hrs, rest over next 16 hours. The balloon has dislodged when treating your IABP patient. Which is the most common site that will be affected? A. Right radial B. Left radial C. Right femoral D. Left femoral Left radial artery You are transporting a 32 week premature neonate with respiratory distress. Which drug may be administered in preparation for transport? A. Antibiotics B. Surfactant C. D10 D. Prostaglandin Surfactant The cornerstone of treatment of RDS (respiratory distress syndrome) is supplemental oxygen to maintain a PaO2 of 60-70 mmHg and an arterial saturation of 92-95%. You are transporting a 30 YOM who was involved in a MVC. He has a closed femur fracture with a history of drinking and driving. Which problems may occur in flight? A. Histotoxic, Hypemic B. Hypoxic, Stagnant C. Stagnant, Hypemic D. Hypoxic, Hypemic Histotoxic hypoxia, Hypemic hypoxia What is your basic management for warming a hypothermic patient? A. Active external, passive external, active internal warming B. Passive external warming, active external, active internal warming. C. Active passive, active internal and passive external warming D. Administer drugs and intubate Passive external, active external, and active internal warming. A neonate who is experiencing repetitive motions of a bicycling type action with lip smacking is presenting with what type of seizure? A. Subtle B. Tonic C. Clonic D. Myoclonic Subtle seizures Repetitive mouth or tongue movement, bicycling movements, eye deviations, repetitive blinking, staring, or apnea. Check BGL immediately. 10% of dextrose (2 mL/kg) Seizures meds: Phenobarbital (luminal), Phenytoin (dilantin), and Lorazepam (ativan). Your patient is PDA (patent ductus arteriosus) dependent. This would indicate likely require the administration of which of the following drugs: A. Indomethacin B. Progesterone C. Prostaglandin D. Synthetic surfactant Prostaglandin Prostaglandin E1 (PGE 1) is indicated for those heart defects that may be dependent on ductal patency for pulmonary blood flow. Heart defects include transposition without ventricular septal defect (VSD), pulmonary or tricuspid atresia, and critical pulmonary stenosis, including tetralogy of Fallot (TOF). Which of the following would calculate an appropriate ETT size for a pediatric patient? A. (age + 12)/4 B. Age + (16/4) C. (Age + 16)/4 D. Age/4+4 (Age in years) + 16 divided by 4 The patient is a breech presentation and delivery appears to be halted upon delivery of the head. The appropriate action would be to? A. Initiate rapid transport, placing mother in a knee-chest position B. Administer tocolytic agents C. Perform Trousseau's maneuver D. Perform Mauriceau's maneuver Perform Mauriceau's maneuver A method of delivering the head in an assisted vaginal breech delivery in which the infant's body is supported by the right forearm while traction is made upon the shoulders by the left hand. The fetal head is maintained in a flexed position by using the Mauriceau's maneuver, which is performed by placing the index and middle fingers over the maxillary prominence on either side of the nose. The fetal body is supported in a neutral position, with care to not overextend the neck. The hallmark indicator that rhabdomyolysis is occurring in a hyperthermic patient is? A. Altered mental status B. Elevated creatinine kinase C. Hyperthermia D. Increased BUN Elevated creatinine kinase (CK) Which patient is not affected with altitude temperature changes? A. Cardiac patient B. Burn patient C. Head injured patient D. Spinal cord injured patient Cardiac patient Patients are more prone to which stressor of flight with altitude? A. High humidity, high temperature B. Low humidity, low temperature C. High humidity, low temperature D. Low humidity, high temperature Low humidity, low temperature CONFIRM You are transporting a fifty-year-old man from a rural facility. Your patient's ECG is demonstrating ST at 112 with peaked P waves. The ABG indicates pH 7.2, pCO2 18, HCO3 12 and pO2 108. CMP reveals Na 130, K 2.3, Cl 95, HCO3 10, BUN 48, creat 2.2, and glucose of 685. The most appropriate diagnosis would be? A. Cardiogenic shock B. DKA C. Hyperglycemic, hyperosmolar non-ketotic syndrome D. Dehydration DKA Acidosis present What is the initial S/S of increasing ICP? A. Hypotension B. Deteriorating level of consciousness C. Tachypnea D. Tachycardia Deteriorating level of consciousness Your 18 YOF patient was ejected during an MVA. She is currently awake and oriented x 3 however she is slow to respond. BP 70/42, HR 68, RR 26, Sats 94%, Temp 98.8 and a CVP of 3. Your patient is exhibiting ? A. S/S of herniation B. Herniation and is 'pre-code' C. A spinal cord injury D. Intoxication, get a refusal and let her sleep it off A spinal cord injury Neurogenic shock: tachypnea, normal heart rate, and hypotension. Hemodynamic parameters to indicate the presence of neurogenic shock would include a decreased SVR 800 and a low cardiac index (CI) 2.5. Your patient is experiencing Hypertonic or Hypertetanic uterine contractions. Appropriate therapy would be to? A. Turn the patient on their side B. Discontinue all tocolytic medications C. Discontinue any oxytocin administration D. Administer Celestone Discontinue any Oxytocin administration A hyperstimulated uterus may have fewer than five contractions in ten minutes, but the interval between contractions is less than one minute. Another term used to describe long, strong contractions is "titanic." An overdose of oxytocin may cause this type of uterine activity. Using the Consensus formula, calculate how much fluid this 70 kg patient with a 50% BSA would receive in the first of 8 hours of care? A. 2,000 - 4,000 ml B. 7,000 - 14, 000 ml C. 3,500 - 7, 000 ml D. 5,000 - 8,000 ml 3,500 - 7, 000 ml [(2-4 mL × weight in kg) × % TBSA] = Total fluids in twenty-four hours with half of the total fluids calculated administered in the first eight hours and the rest in the subsequent sixteen hours. 2 × 70 = 140 × 50% = 7,000 mL, which is the low end of the range and 14,000 mL is the high end of the range. Half of this volume is given in the first eight hours with the remaining half to be administered in the subsequent sixteen hours. This formula excludes first-degree burns, so erythema (redness of the skin) alone is discounted. The patient fetus is exhibiting variable decelerations. This is most likely due to? A. Uterine insufficiency B. Cord problems ( prolapse, nuchal, short, compression) C. Placenta abruption D. Normal neurological waveform Cord problems ( prolapse, nuchal, short, compression) Your patient is experiencing a subarrachnoid hemorrhage. He will likely demonstrate? A. Doll's eyes reflex B. Positive Battle's sign C. Positive Brudzinki's sign D. Ipsilateral papillary dilation Positive Brudzinki's sign Subarachnoid hemorrhage as well as Meningitis. Severe neck stiffness causes the patient's hips and knees to flex when the neck is flexed. Battle's sign... Battle's sign consists of bruising over the mastoid process as a result of extravasation of blood along the path of the posterior auricular artery and can indicate basilar skull fracture. Doll's eye reflex... Doll's eye reflex also known as vestibulo-ocular reflex or oculovestibular reflex is a reflex movement during head movement by producing an eye movement in the direction opposite to head movement. The absence of the doll's eye's reflex (eyes remain in midposition when is being moved from side to side) can indicate injury to the midbrain or pons, cranial nerves III and VI. Ipsilateral (same side) pupillary dilation... Ipsilateral (same side) pupillary dilation can indicate brain herniation. A medication utilized in the neonate that accelerates closure of the PDA is? A. Oxygen B. Dobutamine C. PGE1 D. Oxytocin Ibuprofen, Indomethacin and O2 The most commonly abused organ/system is? A. Head B. Orthopedic C. Integumentary D. Genitourinary Integumentary system The integumentary system is the largest organ system that protects the body from damage, comprising the skin and its appendages (including hair, scales, feathers, and nails). You have experienced a crash landing, which would do first? A. Assume crash position B. Turn off oxygen C. Turn off throttle, fuel then battery D. Turn on ELT Turn off throttle, fuel, then battery Your priority post crash and safe exit from the aircraft is? A. Go for help B. Find water C. Find food D. Obtain protection/shelter from the elements Obtain protection/shelter from the elements. The patient's PA catheter is exhibiting a large, well defined waveform with an obvious "notch" on the left side of the waveform. The distal tip is most likely located in the: A. RA B. PA C. PCWP D. RV Right Ventricle clue: obvious notch on the left side of the waveform. Which drug is recommended for sedation of a patient with asthma? A. Etomidate B. Ketamine C. Versed D. Fentanyl Ketamine You are transporting a 12 YOM weighing 60 kg with diagnosis of status asthmaticus on a ventilator. EtCO2 is 56. Ventilator settings are at Vt 450, FIO2 1.0, Rate 16, I:E 1:2, Peep 5, PIP 48. How will manage this patient? A. Increase tidal volume B. Increase I:E ratio C. Increase PEEP D. Increase respiratory rate Increase I:E ratio The normal inspiration-to-expiration (I:E) ratio to start is 1:2. This is reduced to 1:4 or greater in the presence of obstructive airway disease (asthma, COPD) in order to avoid air-trapping (breath stacking) and auto-PEEP or intrinsic PEEP (iPEEP). CAMTS recommended VFR-day-local minimums are: A. 1000` and 1 mile B. 500` and 1 mile C. 500` and 2 miles D. 800` and 1 mile 500` and 1 mile The emergency transmit frequency is? A. 121.5 B. 155.5 C. 120.5 D. 105.5 121.5 When inserting a chest tube, correct insertion site recommended is? A. 2 ICS midclavicular B. 4 ICS anterior-axillary C. 5 ICS mid-axillary D. 4 - 5 ICS mid-axillary 4th-5th ICS anterior axillary line How much time of useful consciousness do you have with a rapid decompression at 45,000 feet? A. 90 seconds B. 2 minutes C. 30 seconds D. 15 seconds 15 seconds or less Recommended urinary output when caring for an Adult patient should be? A. 100 ml/hr B. 30 - 50 ml/hr C. 1 - 2 cc/kg/hr D. 200 ml/hr 30-50 mL/hour Pediatric : 1-2 mL/kg/hour. Urinary output in Electrical injuries: 100 mL/hour (Adult) 2-4 mL/kg/hour (Pediatric). Your patient presents with epigastric pain, nausea and vomiting for the last hour. He describes his chest pain as "heavy in nature". What does the following 12 Lead ECG show? ST elevation in leads II, III, and aVF. Inferior wall MI ...presents with ST elevation in leads II, III, and aVF. You are asked to respond to a local scene call involving an MVA with multiple injured patients at 2300. You have been having bad weather off and on. The PIC advises you that weather minimums are currently at 800 and 1. What will you do? A. Continue and fly to the scene B. Attempt to fly to the scene and see if you can get there C. Abort the flight due to weather D. Say nothing because the PIC is responsible for deciding weather or not you continue with the mission. Abort the flight due to weather. Minimums recommended for local-night with the use of NVG of a 800 foot ceiling and 3 mile of visibility. You arrive on the scene to manage a fall victim. She presents with a BP 70/palp, HR 62, RR 24, Sats 96 %. EMS reports brief LOC but now has a GCS of 14. You note a deformity to the right femur and she is complaining of neck pain. Your diagnosis of this patient is? A. Neurogenic shock B. Hypovolemic shock C. Epidural bleed D. Subdural bleed Neurogenic shock You are transporting a patient with history of seizures while on a camping trip in July. Her husband drove her to the closest ER for treatment. She has a history of cardiac heart failure and only takes furosemide daily. Labs reveal CK 27,000, LDH 800, BUN 34, CR 1.1, K 3.1, Hgb 15.3, Hct 44, CO2 16, and glucose of 62. The foley bag contains urine that appears dark greenish-brown in color with an output of less than 20 mL in the last hour. She is unresponsive with BP 100/40, HR 144, RR 32, and SaO2 94%. The decrease in urine output and abnormal urine character is most likely the result of which of the following? A. Myocardial infarction B. Brain tumor C. Rhabdomyolosis D. TCA overdose Rhabdomyolosis Late decelerations may indicate? A. Cord compression B. Acidosis C. Hypoxia D. Uterine placental insufficiency Uterine placental insufficiency A late deceleration is one that begins close to the apex of the contraction, gradually decelerates, and gradually returns to the FHR baseline after the contraction is over. There is inadequate oxygen exchange in the placenta during a contraction. Your patient has the following parameters: CVP 28, CI 1.2, PA S/D 48/29, wedge 27 and SVR 2100. Identify the waveform? A. CVP/RA B. PA C. Arterial D. PAWP CVP/RA Rise in atrial pressure as a result of atrial contraction. A wave is generally seen during the PR interval before the onset of the QRS on the ECG. ABG's reveal pH 7.37, pCO2 58, Bicarb 23, Base deficit -2, pO2 106. What is your interpretation? A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis Respiratory acidosis The pH is low and the pCO2 is high, indicating acidosis, so the primary disorder is respiratory acidosis. There is no indication of metabolic compensation. Your 72 kg patient is presenting with 2nd and 3rd degree burns to his entire face, anterior torso and complete left arm. How much fluid should the patient receive in the first 8 hours using the Parkland formula? 4,600 mL Entire face = 4.5%, anterior torso = 18%, complete left arm = 9%, which totals to 31.5% TBSA. Parkland Formula [(4 mL × weight in kg) × % TBSA] = Total fluids in 24 Hours. 4 × 72 = 288 × 32 = 9,216 mL in 24 Hours, with half of the total amount of fluids calculated is administered in the first eight hours. Answer: 4,600 mL in the first eight hours Your 60 YOM patient has been trapped under a tractor for almost 6 hours. Once extricated, his most likely to experience: A. Tension pneumothorax B. Massive hemothorax C. Rhabdomyoloysis D. Compartment syndrome Rhabdomyolysis Your patient was struck from behind while driving. The most common area of injury from a rear-end collision is? T12-L1 injuries The clotting cascade can be triggered through an extrinsic pathway. The triggering mechanism is the release of? A. Fibrinogen B. Prothrombin C. Basophils D. Tissue thromboplastin Tissue Thromboplastin Thromboplastin is the combination of both phospholipids and tissue factor, both needed in the activation of the extrinsic pathway. However, partial thromboplastin is just phospholipids and not tissue factor. Tissue factor is not needed to activate the intrinsic pathway. Partial thromboplastin is used to measure the intrinsic pathway. This test is called the aPTT, or activated partial thromboplastin time. A patient in early shock most probably has which acid-base imbalance: A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis Respiratory alkalosis Increase in respiratory rate in early shock as the body attempts to compensate for blood/volume loss in the compensatory stage. Which blood component does not require typing and crossmatching before administration? A. Platelets B. FFP C. Cyro D. Albumin Albumin Albumin is a blood protein that is mainly produced in the liver and helps maintain volume of the blood by maintaining the oncotic pressure. A medication utilized in pediatrics that accelerates Closure of the PDA (patent ductus arteriosus) is: A. PGE1 B. Oxygen C. Dobutamine D. Oxytocin Indomethacin or Ibuprofen & O2 Closed the PDA = indomethacin and long-term use of high oxygen delivery These medications are given in the stomach and can constrict the muscle in the wall of the PDA and promote closure. You would expect the patient's HR to ________ for each degree above 37 degrees centigrade? A. Decrease 10 BPM B. Increase 10 BPM C. Increase 20 BPM D. Decrease 20 BPM Increase 10 BPM ??? The second stage of labor ends with: A. Crowning B. Onset of contractions C. Dilation of the cervix D. Delivery of the infant Delivery of the infant First stage of labor begins at the onset of labor and ends when the cervix is 100% effaced and completely dilated to 10 centimeters. This is the longest stage of labor and can last 12-17 hours. The second stage begins when the cervix is completely effaced and dilated and ends with the birth of the baby, lasting about 1-2 hours. The third stage begins with the birth of the baby and ends with the delivery of the placenta. This is the shortest stage of labor, lasting 15-20 minutes. The fourth stage begins with delivery of the placenta and ends 1-2 hours after delivery. The fetus of a pre-eclamptic mother during labor will commonly experience: A. Tachycardia B. Late decelerations C. Sinusoidal waveform D. None of the above Late decelerations During transport you note rust colored "flakes" in the IABP tubing. This indicates: A. Helium tank degredation B. IABP pump failure/lubricant leak C. Helium oxidation D. Balloon rupture Balloon rupture A common cause of elevated PA (pulmonary arterial) pressures is: A. Mitral valve stenosis B. Mitral valve regurgitation C. Left ventricular failure D. All of the above All of the above PAP PAS = 15-25 mmHg PAD = 8-15 mmHg The patient's peripheral A-line is showing a very sharp waveform with readings that appear exaggerated. This may be due to: A. Catheter embolus formation B. Catheter whip C. Over-dampening of the pressure system D. Kinking of the pressure tubing Catheter whip Can be caused by hypertension. (Clue: the word "exaggerated." Your patient is experiencing left ventricular diastolic failure. Therapy should be focused on: A. Augmentation of left ventricular clearing B. Decreasing afterload C. Decreasing preload D. Increasing preload / Diuretics and relief of anxiety Diuretics and relief of anxiety Your patient is exhibiting ST elevation in Leads II, III and AVF. ST depression is noted in V1 - V3. Which of the following may prove hazardous? A. Isotonic fluid bolus B. Heparin C. GII/BIIIa inhibitors D. Nitroglycerin Nitroglycerin Inferior wall MI may also have a right ventricular MI present which would affect filling pressures. Medications that decrease preload are not recommended, unless the patient has been managed with IV fluids prior to administration. The primary trigger used for most IABP operations is the: A. A-line B. PA catheter C. EKG D. CVP catheter EKG Most common is the ECG using the R wave. Mainly balloon inflation is set automatically to start in the middle of the T wave and to deflate prior to the ending QRS complex. The arterial waveform can be used when tachyarrhythmias, cardiac pacemaker function, and poor ECG signals may cause difficulties in obtaining synchronization when the ECG mode is used. Inadvertent migration of the IAB may cause which of the following, EXCEPT: A. Loss of renal perfusion B. Loss of flow to subclavian artery C. Loss of flow to the carotid vein D. Loss of flow to the renal arteries Loss of flow to the carotid vein From the insertion site (usually the femoral artery), if the balloon is too distal to the aorta, occlusion of the brachiocephalic artery, left carotid artery, or left subclavian artery may occur. From the insertion site, if the balloon is too proximal (below the renal artery), the celiac, superior mesenteric, or renal arteries may be obstructed. Proximal end of the balloon should be positioned above the renal artery from the insertion site. Pupillary dilation in response to the oculomotor nerve insult that occurs in uncal herniation is a result of: A. Loss of parasympathetic stimulation B. Loss of sympathetic stimulation C. Parasympathetic overstimulation D. Sympathetic overstimulation Loss of parasympathetic stimulation The innermost part of the temporal lobe, the uncus, can be compressed so that it goes by the tentorium and places pressure on the brain. The uncus can compress the third cranial nerve, which can affect the parasympathetic input to the eye on the side of the affected nerve, causing the pupil on the affected side to dilate and fail to constrict in response to light as it should. An early sign of tentorial herniation would be: A. Doll's eyes reflex B. Ataxic breathing C. Paralysis below the diaphragm D. Ispilateral papillary dilation Ipsilateral pupil dilation on the affected side. A common primary complication of PGE1 (Prostaglandin E1) administration is: A. Decreased clotting times B. Apnea C. Constipation D. Increased vascular activity Apnea and hypoventilation The length of transport and the difficulty of placing an ETT during transport must be considered in the decision of whether to place an ETT before transport when prostaglandins are begun. Other side effects can include fever, vasodilation with flushing, and diarrhea. Uncommonly, the vasodilation may result in systemic hypotension requiring intervention. Waddell's triad describes: A. Injury patterns commonly experienced with falls B. Injury patterns consistent with abuse C. Injury patterns consistent with shaken baby syndrome D. None of the above None of the above ??? Waddell's triad is a pattern of injury seen in pedestrian children who are struck by motor vehicles. The triad comprises: Fractured femoral shaft Intra-thoracic or intra-abdominal injuries Contralateral head injury The percentage of oxygen at 25,000 MSL is: A. 4 % B. 21 % C. 18 % D. 7 % 21 % Oxygen concentration remains at 21% regardless of altitude. However, oxygen availability decreases with altitude because the oxygen molecules are farther apart, potentially resulting in hypoxia. The altitude at which one begins to lose their night vision is: A. 500 ` MSL B. 500 ` AGL C. 5000 ` AGL D. 5000 ` MSL 5000 ` MSL Night vision loss occurs at 5,000 feet, which is part of the first stage of hypoxia which is called the indifferent stage. Your patient's ABG's are: pH 7.49, pCO2 61, HCO3 34. You should correct the pH by: A. Hyperventilation B. Ventilating at physiologic norms but greater then than the patient's spontaneous rate. C. Paralyze the patient to completely control vent rate D. Analyze electrolytes and replace deficiency Analyze electrolytes and replace deficiency The pH is normal and the HCO3 is high, indicating a metabolic alkalosis. The pCO2 is high, indicating compensatory response. Metabolic alkalosis is usually the result of decreased hydrogen ion concentration, leading to increased bicarbonate concentration. Your crew made contact upon lifting at 1455. Their second contact was at 1508. They have not been heard from since. At what time should your PAIP have been initiated per CAMTS recommendations? A. 1510 B. 1508 C. 1548 D. 1538 1548 Should not exceed 15 minutes while in flight Which of the following is the most potentially harmful timing error? A. Early deflation B. Early inflation C. Late deflation D. None of the above are potentially harmful Late deflation Timing errors can cause decrease in arterial pressures, decrease in cardiac output, decrease in ejection fraction, increase in heart rate, increase in pulmonary artery diastolic pressures, and increase in capillary wedge pressures. When timing the IABP, inflation should initiate in synchronization with: A. ECG-P wave B. Anacrotic notch of the A-line C. Beginning systole D. Dicrotic notch indicated on the A-line pressure wave Dicrotic notch indicated on the A-line pressure wave It is important that the inflation of the IAB occurs at the onset of ventricular diastole, noted on the dicrotic notch on the arterial waveform. Deflation of the balloon should occur at the end of diastole just prior to the onset of ventricular systole. Balloon synchronization starts usually at a beat ratio of 1:2. This ratio facilitates comparison between the patient's own ventricular beats and augmented beats to determine ideal IABP timing. Your patient would most likely experience barodontalgia during which phase of flight? A. Ascent B. Descent C. Cruise flight D. None of the above Ascent Barodontalgia or aerodontalgia is a toothache that is caused by exposure to changing barometric pressure during actual or simulated flight. Electrical alternans may be caused by: A. Pulmonary embolus B. Pericardial tamponade/effusion C. Tension pneumothorax D. Diaphragmatic rupture Pericardial tamponade/effusion Pericardial effusion leading to cardiac tamponade. Pericardial effusion - Is the development of pericardial fluid as response to injury, acute pericarditis. Electrical alternans can be present on the ECG. Your fast flush test indicates under-dampening of the system present. Which of the following may be the cause? A. Air in the system B. Low pressure bag pressure C. Altitude change D. All of the above All of the above Properly dampened fast flush test waveform with transducer positioned properly at the phlebostatic axis. The phlebostatic axis is the point of the junction of the vena cava and the right atrium where the blood will have the lowest pressure. When attempting to 'wedge' a PA catheter, you should always: A. Fill the balloon with exactly 1.5 ml, no more B. Fill the balloon with exactly 2.5 ml, no more C. Fill the balloon with exactly 0.5 ml, no more D. None of the above None of the above Balloon should only be filled until waveform is obtained but only up to no more than 1.5 mL. Balloon volumes greater than 1.5 mL can rupture the balloon. During transport you experience a complete IABP failure. You should: A. Withdraw the IABP to 10 cm B. Cycle the balloon manually timing with EKG visually C. Cycle the balloon manually timing with the A-line visually D. Cycle the balloon manually every 30 minutes regardless of timing. Cycle the balloon manually every 30 minutes regardless of timing. Your patient's PA waveform has suddenly changed to resemble a low amplitude rolling waveform. This is most likely: A. Inadvertent withdrawal into the RV B. Inadvertent withdrawal into the RA C. Normal during inspiration D. Inadvertent advance to wedge Inadvertent advance to wedge (Clue is the word rolling waveform) You are managing a 4 YOM presenting lethargic with nystagmus. You note he has depressed DTR's and has a profound anion-gap. The patient should be managed with which of the following? A. IV ethanol drip B. Calcium C. Potassium supplement D. Sodium Bicarbonate IV ethanol drip Ethylene glycol poisoning is caused by the ingestion of ethylene glycol (the primary ingredient in both automotive antifreeze and hydraulic brake fluid). The antidotes used are either ethanol or fomepizole (Antizol) administered by intravenous infusion. The antidotes work by blocking the enzyme responsible for metabolizing ethylene glycol and therefore halt the progression of poisoning. Your patient's PA waveform is in wedge position. You would: A. Immediately withdraw the catheter to 20 cm depth B. Have the patient cough forcefully C. Verify chest tube drains are vented appropriately D. Inflate the PA cath balloon to 1.5 ml Have the patient cough forcefully. Have the patient cough forcefully in an attempt to dislodge the balloon. Assure that the balloon is completely deflated, and have the patient lie on their side. The ECG may show peaked P waves, flattened/slulrred T's and appearance of U waves which may indicate? A. Hyperkalemia B. Hypokalemia C. Hypernatremia D. Hyperchloremia Hypokalemia The treatment for Acetaminophen poisoning is: A. Normal saline 2 liters B. N-acetylcysteine (mucomyst) C. Sodium Bicarbonate IV drip D. Pyridoxine N-acetylcysteine (mucomyst) Mucomyst, Acetadote is FDA approved to reduce the extent of liver injury after acetaminophen overdose. The primary toxic effect of acetaminophen is hepatotoxicity caused by the formation of the toxic metabolite N-acetyl-p-benzoquinonimine. You are managing a 25 YOM with burns to the entire face, left forearm, right hand and anterior portion of the entire left leg. His BSA would be? A. 12 % B. 19 % C. 24 % D. 30 % 19 % Entire face 4.5%, left forearm 4.5%, right hand 1%, and anterior portion of the entire left leg 9% = BSA of 19% Treatment of Digitalis toxicity would include all of the following, EXCEPT: A. Digibind B. TCP C. Magnesium D. Beta-blockers Beta-blockers The primary treatment digoxin immune Digoxin (Digibind) should not be given if the apical heart rate is below 60 beats per minute. Other treatments that may be tried to treat life-threatening dysrhythmias until digoxin immune fab is acquired are Magnesium, phenytoin, and lidocaine. Atropine is also used in cases of bradydysrhythmias. In severe cases, hemodialysis may be required to reduce the levels of digoxin in the body. Normal K+ (Potassium) value is: A. 3. 0 - 4.0 B. 3.5 - 4.5 C. 4.0 - 5.0 D. 5.5 3.5 - 4.5 7 can cause ventricular dysrhythmias; ECG findings peaked/tented T wave 5 mm in height. Antidote for Coumadin overdose is? A. Protamine sulfate B. Glucagon C. Vitamin K, FFP D. Physostigmine Vitamin K, FFP Your patient has a chief complaint of dyspnea and weakness with the following vitals: BP 72/64, HR 112, RR 28, SpO2 88%, Temp 99.1 He is on 6 L/min of oxygen via NC. The ECG shows ST with frequent PVC's. Physical exam reveals profound vesicular rales and bronchial wheezing. Your most likely diagnosis is: A. CHF B. ARDS C. Asthma D. Cardiogenic shock Cardiogenic shock Cardiogenic shock because the patient is hypotensive. It is critical that these patients in cardiogenic shock do not receive beta-blockers as their tachycardia is functional because of their severely limited stroke volume from an extensive MI. Perfusion to the brain and vital organs must be maintained (SBP 90 mmHg). The fetus was delivered with obvious meconium staining. His 1 minutes APGAR is 8. Endotracheal suctioning: A. Should be performed via nose, then mouth B. Should be performed via mouth, then nose C. Should be performed endotracheally, then mouth, then nose. D. Should not be performed Should not be performed The most obvious sign that meconium has been passed during or before labor is the greenish or yellowish appearance of the amniotic fluid. After birth, rapid or labored breathing, cyanosis, slow heartbeat, a barrel-shaped chest or low APGAR score are all signs of the syndrome. Scores 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally normal. Treatment of cardiac tamponade includes all of the following, EXCEPT: A. Force fluids B. Pericardiocentesis C. Rapid transport D. Needle thoracostomy Needle thoracostomy Needle thoracostomy should be performed where: A. 4th intercostal space anterior axillary line B. 5th intercostal space anterior mid-axillary line C. 4th intercostal space mid-clavicular line D. 2nd intercostal space anterior mid-axillary line Fourth or fifth intercostal anterior midaxillary line. A patient presenting with Beck's triad is most likely experiencing: A. Tension pneumothorax B. Increased ICP C. Cardiac tamponade D. Intra-abdominal bleeding Cardiac tamponade Low arterial blood pressure, JVD (unless the patient is hypovolemic) Distant, muffled heart sounds. Pulsus paradoxus, a fall in the systolic BP 15 mmHg during normal inspiration and a Narrowing pulse pressure may also be observed prior to hypotension. An object in motion will remain in motion and an object at rest will remain at rest, unless acted upon by a force is known as: A. Newton's first law B. Newton's second law C. Newton's third law D. Ohm's law Newton's first law Every body remains in a state of rest or uniform motion (constant velocity), unless it is acted upon by an external unbalanced force. What is a common problem associated with electrical injuries? A. Myoglobinuria B. Hazmat involvement C. Cardiogenic shock D. Hypokalemia Myoglobinuria Lactic acidosis is common because of the significant muscle damage caused by electrical injury. It is essential to maintain higher rates of urinary output because hemoglobinuria and myoglobinuria are common with electrical injuries. Your patient was in an MVA in which the right side of his head struck the "A-post". Right middle meningeal artery damage has been noted by CT with right sided 'mass effect" resulting. You would expect which of the following: A. Epidural hematoma B. Ventricular collapse C. Cranial midline shift to the left D. All of the above All of the above The patient received a skull fx that appears to have a central focal point with multiple fx's outwards. This skull fx would be described as: A. Linear B. Linear stellate C. Diastatic D. Depressed Linear stellate Linear stellate is a skull fracture with multiple linear fractures radiating from the site of impact. Your patient would likely experience increased in ICP as a result of which action? A. Hip flexion B. Gagging on the ETT C. Adduction of the arms D. Rotation of the head E. All of the above All of the above The patient's mean arterial pressure (MAP) should be maintained at more than 90 mmHg. Fluids and blood products should be administered to maintain blood pressure. The fetus's variability is: A. The best indicator of fetal viability B. Normally 10 - 15 beats per minute C. Expected to increase during active labor D. All of the above All of the above Variability is defined as fluctuations in the fetal heart rate baseline that are two cycles per minute or more and that are irregular in amplitude. The patient with pre-eclampsia is expected to: A. Experience photophobia B. Experience hyprreflexia C. Experience proteinuria D. All of the above Preeclampsia is characterized by hypertension, proteinuria, and edema. Your patient has the following vital signs: HR 118, BP 162/90 (114), RR 24, SpO2 97 %, Temp 99.9 F, ICP 8. Your patient is probably: A. Demonstrating S/S of herniation B. Already herniated and will likely deteriorate further C. Demonstrating S/S of Brown-Sequard syndrome D. Not herniating Demonstrating S/S of herniation The clinical presentation of Cushing's triad is the triad of widening pulse pressure (rising systolic, declining diastolic), change in respiratory pattern (irregular respirations), and bradycardia. It is a sign of increased ICP, and it occurs as a result of the Cushing reflex. The normal average range for ICP is 0-10 mmHg. Your patient's EKG is demonstrating ST at 124 w/ peaked P waves. ABG indicates pH 7.2, pCO2 13, HCO3 10, pO2 104. The patient's CMP reveals: Na 132, K 2.5, Cl 97, HCO3 10, BUN 44, Creat 2.0, Glucose 685. The most appropriate diagnosis would be: A. Primary hypokalemia B. ARDS C. Asthma D. DKA DKA DKA = Serum glucose usually 1,000 mg/dL HHNK is a problem with sugar. HHNK = Serum glucose usually 1,000 mg/dL, (higher than DKA). Hyperglycemic hyperosmolar nonKetotic coma (HHNK) You are transporting a 45 YOM with ARDS and MODS secondary to probable organ rejection after a heart transplant. During transport the patient becomes bradycardic with heart rate in the 30's with hypotension. Which of the following therapies will likely prove fruitless? A. 250 - 500 ml saline bolus B. Dopamine 5 - 20 mcg/kg/min C. Transcutaneous pacing D. Atropine 0.5 - 1 mg IV push Atropine 0.5 - 1 mg IV push Your patient presents with the following: CVP 2, CI 6.4, PA S/D 34/16, wedge 7 and SVR 400. What is your diagnosis? A. Hypovolemic shock B. Septic shock C. Left ventricular failure D. Neurogenic shock Neurogenic shock The SVR 800 is indicative of a distributive shock; the decreased CI 2.5 and bradycardia narrows the type of shock to neurogenic shock. A patient presenting with meningitis may exhibit which sign on assessment? A. Cullen's B. Grey-Turner's C. Kernig's D. Levine's Kernig's and Brudzinski's signs Kernig's sign is essentially a way to demonstrate that the neck is not simply "stiff" but is irritated. With the patient lying flat, the examiner flexes the hip ninety degrees and then attempts to extend the lower leg at the knee. Brudzinski's sign, the patient lies on his or her back, and the examiner puts one hand behind the patient's head and the other on the chest. Using the hand behind the neck to raise the head but pressing on the chest with the other hand, if the hips and knees flex, the neck sign is positive. Your patient was involved in a single car roll-over and is complaining of neck and left shoulder pain. You note bruising to the left chest wall. Vital signs are: BP 80/48, HR 130, RR 28, SpO2 96 %. The most likely cause is? A. Cardiac tamponade B. Tension pneumothorax C. Splenic injury D. Intra-abdominal bleeding Splenic injury Kehr's sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated. Murphy's sign would indicate what condition? A. Splenic injury B. Cardiac problem C. Pancreatitis D. Gallbladder Gallbladder Right upper quadrant pain, may indicate gallbladder disease. A common problem seen with hepatic encephalopathy is? A. Hyperkalemia B. Ammonia toxicity C. Low protein levels D. Low BUN Ammonia toxicity Ammonia levels in the blood rise when the liver is not able to convert ammonia to urea. This may be caused by cirrhosis or severe hepatitis. Hepatic encephalopathy (also known as portosystemic encephalopathy) is the occurrence of confusion, altered level of consciousness, and coma as a result of liver failure. Treatment of pancreatitis would include all of the following, EXCEPT: A. Fluid resuscitation B. NPO and place OG/NG tube C. Morphine for pain D. Antibiotics for sepsis Morphine for pain Morphine has been contraindicated for pain treatment in acute pancreatitis because of its presumed opioid-induced sphincter of Oddi dysfunction. The patient presenting with HHNK has a problem with? A. Sugar B. Insulin C. Overhydration D. Ketoacidosis Sugar Problem is usually higher levels of sugar (higher than DKA), high serum osmolarity, severe dehydration, lack of ketones, and acidosis. Patient with HHNK may also experience more severe and sudden neurologic changes than the patient with DKA. When managing a patient with an electrical injury, you should maintain a urine output of: A. At least 30 - 50 ml/hr B. At least 50 ml/hr C. 1 - 2 ml/kg/hr D. 100 ml/hr 100 ml/hr A minimum of 50-100 mL/hour of urine must be maintained. If blood-colored urine is present, then the fluid volume must be sufficient enough to maintain a minimum output of 100 mL/hr. The treatment of diabetes insipidus is: A. Aggressive fluid replacement and Vasopressin B. Restrict fluids and Mannitol C. Aggressive fluid replacement and Dilantin D. Aggressive fluid replacement and Octreotide Aggressive fluid replacement and Vasopressin Normal cerebral perfusion pressure (CPP) is? A. 80 - 100 mmHg B. 50 - 60 mmHg C. 70 - 90 mmHg D. 100 mmHg 70-90 mmHg Your patient presents with following parameters: CVP 20, CI 1.1, PA S/D 8/4, wedge 3 and SVR 1800. What is your diagnosis? A. Hypovolemic shock B. RVMI C. CHF/LVF D. Sepsis RVMI RVI because of the low PAWP. You are transporting a 50 YOM from ICU to another facility for further evaluation. The patient has been diagnosed with AMI. He has been complaining of increasing CP, SOB and dramatic weight loss. He appears very nervous and you note tremors. His ECG shows AF at 148. The patient may be experiencing: A. Addison's disease B. Thyrotoxicosis (grave's disease) C. Myxedema coma D. Cushing's syndrome Thyrotoxicosis (grave's disease) Thyrotoxicosis, also known as Grave's disease, thyroid storm and hyperthyroidism. Avoid Aspirin because it increases T3, T4 levels and can worsen condition. Hyperthyroidism "Marty Feldman" or "Betty Davis" protruding eyeballs. Atrial fibrillation is common. Anxiety, tremors Weight loss Treatment: correct electrolytes and glucosteroids.