Pretty Bay, Malta
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Your patient is a 27-year-old male who has fallen from a 24-foot ladder. As you are approaching and forming your general impression, you note that he is conscious and talking. What should you do first?
In a motor vehicle crash, which of the following would be most important to understand in relation to the force of collision and the potential for injury?
You note snoring sounds during your initial assessment of a semiconscious trauma patient. What is your next step?
A patient with left shoulder pain may have a
With the START triage method, several vital signs are quickly assessed to determine the order to care for and transport patients.
According to the START method, which of the following patients would receive immediate treatment to support hemodynamic status without further assessment?
A patient in compensatory hemorrhagic shock would most likely present with which set of vital signs?
A patient has fallen off a 20-foot ladder, striking his back on a railing. He is experiencing pain at the injury site and a loss of bladder control. Which part of the spinal cord is most like affected by this mechanism?
An unrestrained driver of a small car struck a tree at high speed. He has a distended abdomen that is tender when palpated. Vital signs are pulse, 120 beats per minute; respirations, 20 per minute; and blood pressure, 116/90 mmHg. What would be the most likely cause of the abdominal tenderness?
Where would you expect to see a wound that is described as distal to the knee?
Answer questions 10–13 on the basis of the following information.
You respond to a 63-year-old male who is complaining of sudden onset of extreme substernal chest pain that, he says, “feels like my insides are tearing.” The patient states that the pain radiates to the middle of his back between his shoulder blades.
Which condition is this patient most likely suffering from?
Which of the following is a predisposing factor for this patient’s condition?
Which of the following medications may be ordered by medical control to treat this patient?
Progression of this condition may cause
Your patient has survived a vehicle rollover in which another passenger in the vehicle died. He is alert and not complaining of pain. His vital signs are: pulse, 100; systolic BP, 90; respirations, 28. What additional procedures are required prior to initiating transport?
Which statement about motorcycle crashes is correct?
What is a positive Battle’s sign an indication of?
A contrecoup contusion is a brain injury that
Your patient is a car-crash victim who was unconscious prior to your arrival but is now awake. As you examine the patient, you notice that he is becoming disoriented. What should you suspect?
Your trauma patient opens her eyes, pulls her hand away when pinched, and speaks only in garbled sounds. What is her Glasgow Coma Scale score?
Your trauma patient is agitated and apprehensive. She is increasingly cyanotic, and breath sounds are rapidly diminishing over her left lung. She is exhibiting signs and symptoms of shock. You should suspect
A child has third-degree burns over the front of her trunk and the entire front of her right leg. According to the rule of nines, what percentage of her body surface area is affected?
Your patient is a 34-year-old woman who has been in an automobile crash. Her respiratory rate is 34 with normal chest wall expansion; systolic blood pressure is 78; capillary refill is delayed; and her Glasgow Coma Scale score is 10. This patient’s Revised Trauma Score score is
Which group of vital sign changes is associated with Cushing’s reflex?
Which of the following is the best way to examine a patient with abdominal pain?
You suspect that a trauma patient has a pelvic injury. She is cool and diaphoretic, with a heart rate of 134 and blood pressure of 100/72. Which of the following procedures is most appropriate in the management of her condition?
When caring for a patient with a pulmonary contusion, it is essential not to
What does ascites refer to?
Which type of hepatitis is spread via the fecal or oral route?
Your patient is a 60-year-old woman who has fallen down her front steps and has possibly fractured her ankle. Which assessment finding may be considered abnormal in this patient?
Which of the following drugs does not commonly cause toxicity in elderly patients?
Which dysrhythmia is considered normal in an athletic adult?
Which statement about the vital signs of a patient with an AMI is correct?
A patient has been stabbed in the back. Which of the following signs would most likely make you suspect that the patient has a kidney injury?
Your patient is a 24-year-old female who shows signs and symptoms of pelvic inflammatory disease. What is the goal of prehospital care for this patient?
Which of the following factors would normally cause a decrease in a patient’s respiratory rate?
While ventilating a patient with a bag-valve mask, you note decreasing compliance. How should you react to this finding?
What would a pulse oximetry reading of 88% indicate for your patient with acute respiratory distress?
The primary use of the Magill forceps in the field is to
Which of the following signs most likely indicates imminent birth?
Which of the following is a sign of esophageal intubation?
Answer questions 41 and 42 on the basis of the following information.
You are called to the home of a 68-year-old female who is complaining of severe dyspnea. She states that it started about 45 minutes ago and has been getting progressively worse. She has a cardiac history but denies chest pain at this time. Her breathing is very congested. During your assessment, you notice accessory muscle use and rales bilaterally.
Which of the following conditions is this patient most likely suffering from?
In addition to oxygen, this patient should also be treated with which of the following medications?
A pregnant patient complains of painful, irregular labor contractions. The patient states that she is 37 weeks pregnant and her amniotic membranes ruptured two days ago. Based on this information, you would
What is the primary treatment of metabolic acidosis?
Which drug is an example of a beta 2 agonist?
What is the condition that is present when the pleural space expands because air enters from an interior wound?
Which of the following statements is true in regard to the prehospital management of a very ill neonate?
What does the term stridor refer to?
A patient who is 37 weeks pregnant is having contractions and states that her water broke about 20 minutes ago. The vaginal exam reveals that the baby’s foot is present in the birth canal. Your next action would be to
What is the primary treatment for a patient with chronic emphysema who is not severely hypoxic?
Epinephrine 1:1,000 may be indicated in
You are on the scene of a vehicle crash involving a bus. As triage officer, the first patient you encounter is sitting on the ground, conscious, confused, and breathing 40 times per minute. She states that she was thrown out of her seat and struck the side of her head. Your next action would be to
Answer questions 53–55 on the basis of the following information.
You are called to the home of a 17-year-old female who was found by her parents hanging from a rope in the garage. The patient was cut down by her father approximately six minutes prior to your arrival, but she is unconscious and unresponsive to pain or voice. She is breathing spontaneously but has coarse inspiratory stridor.
What is the most probable cause of the inspiratory stridor?
Upon examination of the patient’s upper chest and neck, you note the presence of a large swollen area that extends from her throat to her shoulder. When you press on this area, you feel crackles under the skin. What is this condition called?
Which of the following is an appropriate treatment for this patient?
Your partner and you are evaluating a patient experiencing a behavioral emergency. Your patient is visibly upset and is pacing back and forth. He is verbally confrontational, and his hands are in fists. At times, he displays aggressive actions, both physical and verbal. Which of the following actions is most appropriate for this situation?
A critically traumatized 18-year-old male is entrapped. It will be at least 15 minutes before he is freed. The community hospital is 20 minutes away by ground. A medical helicopter can be to the scene in eight minutes. A Level I trauma center is one hour away by ground. Given the situation, which is the best mode of transport for this patient?
What is the first sign of laryngeal edema in a patient suffering from anaphylaxis?
What does the disease process of emphysema cause within the lung tissues?
Answer questions 60–65 on the basis of the following information.
You are called to the home of a 78-year-old male who is having difficulty breathing. The patient is sitting upright in a tripod position and you note profound accessory muscle use. His skin is pale, cool, and clammy. Vital signs are: blood pressure, 180/72; heart rate, 90; and respiratory rate, 40. Breathing is shallow and labored with a coarse rattling sound during expiration. Auscultation reveals coarse rales to the nipple line with no air movement in the bases. The patient can speak only in one- or two-word sentences. Family members inform you that the patient was sleeping when this episode began and that this has happened several times since his AMI one year ago. He has mild pedal edema and neck veins are nondistended. His family first noticed the patient having dyspnea about 25–30 minutes ago.
This patient is exhibiting the signs and symptoms of which of the following diseases?
Which of the following medication should be used for this patient?
A patient with the symptoms and history described may exhibit which of the following symptoms prior to an acute onset?
Priorities for the management of this patient include all of the following EXPECT
This patient would most likely benefit from which of the following?
If this patient were experiencing right-side heart failure, you would expect to find all of the following symptoms EXCEPT
When performing water-related rescues, use of personal flotation device is required when
An isotonic solution is one that
What is the most common cause of cardiogenic shock?
The use of PASG/MAST is indicated for which of the following conditions?
A patient has been violently beaten. Which of the following statements is true surrounding the care provided by EMS?
An injury to the ligaments surrounding a joint that is marked by pain, swelling, and bruising is called
When administering IV fluids to a trauma patient, it is critical to continuously monitor which vital sign?
Why is morphine sulfate used in the management of AMI patients?
Paroxysmal nocturnal dyspnea (PND) is commonly a sign of which of the following conditions?
Management of left-side heart failure includes high-flow oxygen, IV of crystalloid solution, ECG monitoring, and the administration of which pharamcological agents?
You are inserting the tracheal tube when you begin to hear the sound of the patient’s breathing. Your next action would be to
What is the initial electrical treatment for a patient with third-degree AV block who is symptomatic?
A patient suspected of having an abdominal aortic aneurysm will receive oxygen, an IV, ECG monitoring, and rapid transport as part of his or her treatment. What else should you do when treating such a patient?
A 52-year-old male has been ejected from a car. He is apneic, with a slow pulse palpated at the femoral artery. Which of the following procedures would best manage this patient’s airway?
Vagal maneuvers are used to treat which type of dysrhythmias?
Which part of the ECG tracing reflects repolarization of the ventricles?
The length of the normal P-R interval is
A 3-year-old female is unresponsive and not breathing. Parents state that she was eating grapes when she suddenly made a high-pitched whistling noise and turned blue. Your immediate action would be
While assessing a patient complaining of difficulty breathing, you note an altered mental status, stridor, chest tightness, and tachycardia. Based on these symptoms, you should suspect which of the following conditions?
In a patient with ventricular tachycardia, the QRS complex is
A patient with non perfusing ventricular tachycardia would receive the same treatment as a patient with which other rhythm?
Which of the following indicates that an AMI patient is developing cardiogenic shock?
Which of the following are signs and symptoms of right-side heart failure?
Which of the following is often the first sign of the onset of the development of a potentially lethal dysrhythmia in an MI patient?
Why are easing anxiety and relieving pain considered major goals for prehospital care of MI patients?
Dopamine can be used to
A patient is short of breath after impact with the steering wheel in a motor vehicle crash. Breath sounds are diminished on the left. Which of the following conditions is most likely the cause of the patient’s complaint?
Which of the following is a possible cause of pulseless electrical activity?
Some treatments for suspected MI patients mask the elevated cardiac enzyme levels that are used to diagnose MI in the hospital setting. To prevent this, you should NOT administer
Your patient is a 67-year-old male who is complaining of chest pain. The chest pain continues after two doses of nitroglycerin. He reports a history of angina and says that all his previous attacks have been relieved by nitroglycerin.
How should you treat this patient?
What is the most common complication of an acute myocardial infarction?
In addition to oxygen, what is the first-line pharmacologic agent used for the treatment of malignant PVCs?
Which of these following rhythms might indicate a need for cardioversion?
Your patient, who has had a recent tracheostomy, tried to remove himself from the ventilator and dislodged the trach cannula. Subcutaneous emphysema is now evident. What should you do next?
Answer questions 100–102 on the basis of the following information.
You are called by the police department to a neighborhood where you encounter a male patient approximately 20–30 years old. The police officer states that neighbors called because the patient was “freaking out.” Witnesses say they saw him smoking something just before he started acting in a bizarre manner. During your assessment, you notice that the patient is hyperactive and anxious. His pupils are dilated, and he is hypertensive and tachycardic.
This patient is most likely experiencing
The appropriate treatment for this patient consists of oxygen, IV, ECG monitoring, and
When treating this patient, you should be prepared for which of the following complications?
Your patient is in respiratory distress. He is exhibiting jugular venous distension. Crackles are auscultated throughout his lung fields. He is tachycardic, hypertensive, and tachypneic. Which of the following sets of treatment is indicated for this patient’s presentation?
A patient is complaining of chest pressure and shortness of breath. He has jugular venous distension and pedal edema. His lung sounds are clear and equal. Which of the following conditions most likely cause these findings?
Your patient has a suspected hand injury. How can you best immobilize the hand in the position of function?
When splinting a limb with a suspected fracture, one caregiver applies the splint while another
You are caring for a patient whose finger was just cut off in an accident. What should you do with the amputated finger?
Which of the following is not characteristic of a mild or moderate pit viper envenomation?
How should you treat a patient who has sustained dry lime burns to the hand and arm?
A patient in a very early stage of hypoglycemia may complain of
Diabetic patients may develop hypoglycemia if they take too much insulin or if they
With which of the following conditions is central neurogenic hyperventilation commonly associated?
A patient is in respiratory distress. She has a valid DNR order. Which of the following treatments is correct?
You have secured the airway and immobilized the cervical spine for your patient with an altered mental status. What is your next priority of care?
You are called to the home of a 36-year-old man who is having a seizure. His wife reports that he has not taken his “seizure pills” lately and that he has now had three seizures in a row without regaining consciousness. You have secured the airway and are now ventilating with the bag valve mask. What should you do next?
What is the primary treatment for severe anaphylaxis in an adult?
An adult patient has overdosed on an unknown medication in a suicide attempt. She is alert, oriented, and refusing treatment and transport. What is your most appropriate next action?
Which of the following patients is considered to be at high risk for a heat-related emergency?
A late sign of hypoxia in children is
What is the most important treatment consideration for a patient who is suffering from decompression sickness?
When interviewing patients who are distraught or potentially violent, you should do all of the following EXCEPT
What term best describes a patient who talks nonstop and is restless and overactive?
Lifting improperly may most likely result in an injury to which part of the back?
After experiencing a sudden syncopal episode, a 41-year-old female is complaining of pleuritic chest pain and shortness of breath. Her vital signs are RR = 28, P = 126, and BP = 88/60. The pulse oximeter reads 89% on high-flow oxygen. Her breath sounds are clear. Which of the following conditions best describes the patient’s signs and symptoms?
What is the management for a patient with a head injury and an unusual respiratory pattern?
Answer questions 126 and 127 on the basis of the following information.
You respond to a 56-year-old male who appears to be intoxicated. He is belligerent and disoriented and has a laceration on his forehead. You have made several attempts to convince him of the need for treatment, but he refuses treatment or transport.
Given this situation, you should
Regardless of any of the options considered in the previous question, the patient continues to insist he does not need medical attention. In this situation, which of the following is most important?
You are called to treat a patient who is unconscious and responsive to painful stimuli only. Which of the following treatment modalities is appropriate for this patient?
During a basketball game, an 18-year-old male is complaining of sudden shortness of breath and sharp chest pain that increases with inspiration. He is alert, warm, and diaphoretic. His vital signs are RR = 24, P = 100, and BP = 122/84. His breath sounds are diminished in the lower right lung field. He denies any medical history, does not smoke, and takes no medication. Which of the following conditions best describes the patient’s signs and symptoms?
A 64-year-old male complains of weakness and dizziness. He is anxious, with a patent airway with adequate breathing. The pulse is rapid and skin cool and diaphoretic. Auscultation of the lung reveals bilateral rales. His vital signs are pulse, 156; respirations, 28 per minute; blood pressure, 82/60 mmHg; and SpO2 92%. His ECG is depicted in Figure 4.1.
The best treatment for this patient is to
Which of the following statements regarding a spontaneous pneumothorax is true?
The best place to assess for cyanosis in an infant or child is the
Your patient is a 4-year-old girl who awoke in the middle of the night with a cough that her mother describes as sounding “like a seal barking.” The patient feels more comfortable sitting up. Vital signs are: respirations, 26/min; pulse, 100; temperature, 101° F. On physical exam, you hear stridor on inspiration. From this scenario, you should suspect which condition?
What volume of fluid bolus should be given initially to a severely dehydrated child?
Answer questions 135–138 on the basis of the following information.
You are called to the home of a 21-year-old female in active labor. She is two weeks from her expected due date and is having contractions of 1.5 minutes duration, which are three minutes apart. This is her second pregnancy. Her first child was delivered vaginally at full term.
What is your first course of action for this patient?
Your patient suddenly tells you she feels something slippery between her legs. Upon visual examination, you notice a two-inch segment of the umbilical cord protruding from the vagina. What is this condition called?
Which of the following is NOT an appropriate treatment option for this patient?
You are ready to transport this patient. If the umbilical cord is still exposed, how can you use it to evaluate the infant’s perfusion?
You arrive at the scene of an imminent delivery in the field. The first responder, who called for assistance, reports that the patient is a 32-yearold female who is “G4, P3.” What does this mean?
Your patient is a 28-year-old female who reports that she is nine weeks pregnant. She is complaining of severe abdominal pain, shoulder pain, and vaginal bleeding. Vital signs are within normal limits, and a physical exam reveals tenderness in the lower-left quadrant. What should you suspect is occurring?
What does the term effacement refer to?
Your patient is a 33-year-old woman who is nine months pregnant. She complains of severe abdominal pain and abdominal tenderness. She reports there is no vaginal bleeding at this time. What should you should suspect?
Which of the following signs and symptoms would be present in a pregnant patient with preeclampsia?
When does the third stage of labor begin?
What is the correct procedure for cutting the umbilical cord after the birth of the baby?
What is the appropriate range for the heart rate of a healthy neonate immediately after birth?
What does the presence of meconium on the neonate or in the amniotic fluid indicate?
You would perform chest compressions on any newborn whose heart rate is less than how many beats per minute?
Medications and drugs are most often delivered to a newborn through the use of which circulatory vessel?
Answer questions 150–152 on the basis of the following information.
You respond to a 2-year-old female who is postictal following seizure activity. The patient’s parents report that the child was sleeping when she began to shake and turn blue. She has had a runny nose, but she has had no medications lately. There is no history of seizures.
This patient is most likely suffering from which condition?
Which of the following vital signs would you expect this patient to have?
What would be the appropriate treatment if this patient continues in a prolonged postictal state?
You are caring for a 63-year-old male patient with renal failure. He is pulseless and apneic. Figure 4.2 depicts his ECG. Appropriate treatment for this patient would include all of the following EXCEPT
Which situation would constitute a moral dilemma for a paramedic?
A patient with a PMH of emphysema experiences a sudden onset of respiratory distress and sharp chest pain. His skin is warm and dry. His breath sounds are diminished on the left side. Your strongest suspicion is
You are called to a physician’s office to care for a patient who is experiencing symptoms of a myocardial infarction. The physician tells you that she will stabilize the patient herself and that she is assuming responsibility for care. She does, however, wish for you to transport the patient to the hospital. How should you proceed?
What does a type II ambulance usually consist of?
What do you call a legal document that specifies what type of treatment a patient does and does not want to receive?
At what age is a person considered capable of giving consent to treatment?
An unconscious patient has snoring respirations. When should this condition be corrected?
What is the process of transmitting physiological data from the field to the hospital over the phone lines called?
You are caring for a female patient who was struck by an automobile. She opens her eyes to voice command only, localizes pain when you pinch her arm, and is awake but confused. Her Glasgow Coma Scale is
You are the first paramedic unit to arrive on the scene of a multi-injury bus crash. What is your first responsibility?
A patient presents with shallow breaths at a rate of six per minute. What should you do next?
Under the START triage method, which patient would receive immediate respiratory treatment without further assessment?
What does a red tag mean in the METTAG triage system?
Your friend experiences severe anxiety when crossing bridges. She refuses to cross any bridges and alters her travel routes accordingly. This is an example of which of the following conditions?
What is the difference between bulimia and anorexia nervosa?
On reaching the scene of a single-motor-vehicle accident, you note that the driver is pinned behind the steering wheel. You also note the presence of two sets of spiderweb patterns on the windshield. What does this alert you to?
Which patient is likely to need rapid transport to a trauma center rather than assessment and stabilization on the scene?
A male patient is complaining of crushing chest pressure and shortness of breath. His vital signs include RR = 20, P = 54, and BP = 132/74. The EKG shows a sinus bradycardia with a first-degree AV block. Which of the following treatments would be most appropriate?
For which procedure is it necessary to wear a mask and protective eyewear?
What is the most common job-related source of HIV infections among healthcare workers?
What is the leading cause of death among the elderly?
What should you do when confronted with a patient whom you suspect to be a victim of elder abuse?
Your patient is 2 years old. How can you reassure her before listening to her chest with your stethoscope?
Battle’s sign and periorbital ecchymosis are classic signs of which of the following conditions?
There are many factors to consider when assessing a patient for suicide risk. Which of the following accurately accounts for one suicide risk factor?
What sort of communication system would you need to be able to carry on a two-way conversation with a physician while also transmitting telemetry?
Which of the following is not a component of the start triage method?