RMLS Online Final Exam Copy Copy Copy

Topical Salicylic acid
Scrape it down with a scalpel
Cover with Clingfilm or Saran Wrap
Antifungal powder

You are working in Yemen for a relief organisation when one of your casualties who has been in your clinic for the last 18 hours is now showing signs of blood in the diarrhoea.

What treatment do you do?

Aggressive hydration, antibiotics and loperamide since recent studies shows this to be the best option.
Aggressive hydration, antibiotics but withhold loperamide since recent studies shows that loperamide extends the disease.
Aggressive hydration, loperamide and monitor.
Aggressive hydration only.

You are working as a remote medic for a university group doing archaeological research in Uganda. It is a group of fifteen graduate students ranging in age from 22 to 32 years of age.

One of your group comes up to you and says that they do not feel well after falling from a tree earlier in the day. She says that she feels pain on the very top of her left shoulder. Your examination shows no bruising or point tenderness and you cannot find any injury to the shoulder.

What injury would this be?

Spleen injury from the fall.
She is having a heart attack.
She must have a shoulder injury.
She does not have any injuries.

You are working on the Burma border next to Mae Sot, Thailand. You are treating Burmese refugees who are being refused treatment from the authorities.

One of the elders of the village comes to you with an infected leg wound that is several days old. You have no medical equipment. How do you treat this injury?

Irrigate, remove dead tissue and fill the wound cavity with sugar and wrap in Clingfilm or Saran Wrap. Ask him to return in 12 hours for reassessment.
Irrigate, wipe out the wound cavity and keep open for healing. Ask him to return in 12 hours for reassessment.
Irrigate, remove dead tissue and cover the wound with the cleanest cloth that you can find. Ask him to return in 12 hours for reassessment.
Irrigate and stuff cloth as clean as possible into the wound. Ask him to return in 12 hours for reassessment.

You are working as medical cover for a safari in South Africa. One of your group members comes to you in the middle of the night complaining of fever “gas-like” pain in her lower left belly.

You immediately do a Rapid Diagnostic Test for Malaria even though you know that you are not in an endemic area for that disease. The results come back as negative for p. Falciparum and p. Vivax.

Next, you do a pregnancy test on her which also comes back negative. She denies any sexual contact but agrees to the test anyway.

What is your next diagnosis?

Possible rebound tenderness on the left side of the belly could indicate appendicitis.
Ectopic pregnancy. Never accept the results from a pregnancy test.
Any fever in the tropics is malaria. So, she has malaria.
She has gas and tell her to go back to sleep.

You are working as Remote Medic in Papua New Guinea for a petrol chemical site. You have three weeks into your rotation when one of your 56-year-old pipe fitters comes to you in the middle of the night complaining of back pain.

What tests do you order and why?

Urinalysis looking for blood in the urine to rule out kidney stones.
Back examination because he may have a muscle strain. I would give him ibuprofen 800mg.
I would give him the psoas test to see if he had appendicitis.
I would take his temperature to see if he has nephritis.

What does the ‘N’ in HITMAN stand for? What do you look for during that part of your prolonged field care?

Nursing care. We use the ‘SHEEP VOMIT’ mnemonic to remember all of the skills.
Nutrition. We must remember to hydrate and feed our casualty.
Number of Casualties. We must never assume that we only have one casualty during a trauma event.
Numb. We must make sure that our casualty is not in pain.

During the 10 essential capabilities of Prolonged Field Care, there is a minimum, better best option for patient monitoring. What is the best option for patient monitoring?

Vital Signs Monitor with SPO2, BP, ECG ETC02
EMMA CO2 monitor
BP, stethoscope and pulse oximetry
Ultrasound

What kit is included in the ‘ICU in a RUCK?’

BP
Cuff and Stethoscope
Thermometer
Pulse Oximeter
Foley Catheter
Ultrasound
ECG machine
Ventilator

Which of the following is NOT a Rapid Diagnostic Test?

Blood smear for malaria parasites
Lactate for shock
Malaria test
Urinalysis

You take a urinalysis test on your casualty. What could be wrong with your casualty if he presents with these results?

Urinary Tract Infection
Gallstones
Malaria
Dehydration

You are working on the cruise lines and one of your passengers comes up to you with pain located in the picture below. What is the cause of her headache?

Temporomandibular Joint pain
Tension headache
Subarachnoid haemorrhage
Migraine

You are on a transcontinental flight when the flight attendants ask you to help with one of their passengers who has a bloody nose. They can’t get it to stop.

What is the best way to stop epistaxis?

Have
casualty blow their nose to clear any clots then have them provide 20 minutes of direct pressure over the nostrils just inferior to the cartilage.
Nasal packing with gauze or tampons
Have them tilt their head back and breathe through their mouth.
Have them tilt their head forward and breathe through their mouth.

You are working for a remote site in the Middle East. Due to restrictions, the host nation refuses to allow any narcotics or strong pain medications.

Your site foreman comes into your clinic with a twisted ankle. He says that he does this every few months. You splint the injury and are getting ready to release him back to his office to work when he asks you for ‘something for the 5/10 pain’

What over the counter medications can you give him that will address his 5/10 pain?

1g of Paracetamol or Acetaminophen combined with 800mg of ibuprofen.
Double the dose of Ibuprofen and send him out with 1600mg.
1g Paracetamol combined with 1g Acetaminophen.
100mg of Benadryl will take the edge off.

What is the maximum amount of fluid that is given orally that will not be immediately urinated out?

1L over one hour but taken slowly. About 250mL per 15 minutes.
1L smashed down in one go.
1L taken every thirty minutes, so about 2L.
150mL every 15 minutes.

What is the best way to
treat a burn?

Cool the burn for 20
minutes with drinkable water and make sure to warm the casualty. Then put
Clingfilm or Saran Wrap on the cooled burn.
Aggressively cool the burn for 10 minutes
with normal saline and warm the casualty. Then place burn gel on the wound.
Aggressively cool the burn for 10 minutes
with normal saline and warm the casualty. Then place soft gauze on the wound.
Immediately put water gel on the wound.

Cyst
Nodule
Plaque
Bulla

What is the best way to make sure that your
casualty is completely hydrated?

30mL/kg of urine output per hour.
50mL/kg of urine output per hour.
720mL per 24 hour period.
Once their specific gravity on their urinalysis returns to normal.

Topically with Benadryl or Piriton
Agressive hydration
Epinephrine IM
Salbutamol or Albuterol

Whilst working in a resource-poor environment, what are the best requirements for the qSofa score in order to diagnose that a casualty is, in fact, in a state of shock?

Systolic BP less than 100 mmHg, Respiratory rate greater than 22
breaths per min and Altered mental status.
Systolic BP less than 90 mmHg, Respiratory rate greater than 20 breaths per min and Altered mental status.
Temperature above 38c, BP less than 90 mmHg and blood culture results as positive.
MAP below 65 mmHg, a Respiratory rate greater than 20 breaths per min and a temp below 36c.

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