Medical
A 78-year-old-male patient mentions to you that he would like to start jogging to lose weight. He has
purchased a new pair of running shoes and is ready to go. Considering all of the changes that geriatric
people experience, your biggest concern with this person starting this activity would be the:
A: Decreased bone density.
B: Increase in viral illnesses.
C: Increase in economic strain.
D: Decrease in perception of touch.
A: Decreased bone density.
The geriatric patient may have developed a decrease in bone density. This may affect joints such as the hip, knee and foot. These joints will then be affected by the impact of jogging or running. It would be best to suggest to this patient that he just walk every day to improve his health.
You have a patient who is breathing at 10 times per minute, is unable to walk, has an open airway, and has a
delayed capillary refill time. This patient would fit what category of the START Triage System?
A: Red.
B: Hold.
C: Yellow.
D: Delayed.
2. Red Because the patient cannot walk and has a delayed capillary refill time but is breathing, he would fit the red or immediate category.
You are the first on scene to the high school where a student is having trouble breathing. The student is
sitting in the bathroom up against a wall. As you approach the student you hear audible expiratory wheezing.
The student’s color is poor and he is unable to talk. There is an inhaler of albuterol in his hand. Which of the
following actions would you take at this time?
A: Call medical control.
B: Prepare the student for transport.
C: Assist the student to use the inhaler.
D: Call for assistance from your supervisor.
C. Assist the student to use inhaler
Because this patient has audible wheezing, poor color and is unable to talk, this exhibits a critical level of airway compromise. The patient needs a bronchodilator to stop the bronchospasm. This person will also need oxygen and transport to the hospital.
Which of the following indicates an immediate need for chest compressions in a newborn?
A: Heart rate less than 100.
B: Presence of meconium.
C: Heart rate less than 60.
D: Diaphragmatic hernia.
C: Heart rate less than 60.
Newborns are heavily rate-dependent for their perfusion and should have compressions adminstered any time their heart rate falls below 60 or does not stay above 80 with ventilation
A 53-year-old male is experiencing a suspected heart attack. Which piece of equipment is LEAST likely to be
used with this patient during care?
A: Nasal cannula.
B: EMS stretcher.
C: Non-rebreather mask.
D: Automated external defibrillator.
D: Automated external defibrillator.
All of the options could be used on a heart attack call. The AED is the least commonly used device on this list. AUTHOR'S NOTE: AHA guidelines allow for either a non-breather mask or nasal cannula to be used on heart attack patients. The heart attack patient is not in cardiac arrest, where the AED would then be applicable.
You are called to a patient who has urticaria, itching, coughing, and tachycardia after eating shellfish. The
patient also states he is having difficulty breathing. Which of the following is an expected finding in an
anaphylaxis case?
A: Bronchodilation.
B: Bradycardia.
C: Hypertension.
D: Angioedema.
D: Angioedema.
This patient is experiencing anaphylaxis and will be hypotensive rather than hypertensive. Angioedema as the vessels become more permeable.
Rescuers have just returned from a call involving a teen who overdosed on pain killers and ultimately died.
What common emotional reaction should you expect to see in these responders after such a call?
A: Hallucinations and nightmares.
B: Short-term loss of appetite.
C: Anger toward society.
D: Suicidal ideas.
B. Short term loss of appetite
When a rescuer responds to a call involving significant emotional stress, it would be common for the rescuer to lose his or her appetite for a short period of time. It is possible for the rescuer to have all of the other symptoms, but those symptoms would not be the common reactions.
While treating a 1-year-old for severe respiratory failure, you find him semi-responsive with snoring-type
breathing at 14 breaths per minute. What is your highest priority after you have repositioned the patient's
head?
A: Suctioning.
B: High-flow oxygen by mask.
C: Bag-valve-mask assistance.
D: Rolling the patient on his side.
C. BVM assistance
This patient is not breathing adequately as demonstrated by the slow respiratory rate and he must have his breathing assisted. This should be done with a BVM. Snoring-type respiration does not indicate the need for suctioning, but for better positioning of the patient's airway to move the tongue.
Which of the following is an adventitious lower airway sound associated with the pediatric patient?
A: Snoring.
B: Columnar sounds.
C: Rhonchi.
D: Stridor.
C: Rhonchi.
Stridor indicates upper airway obstruction against a narrowed trachea. Snoring is typically caused by the tongue. Columnar refers to cell structure/type.
While treating a homeless person at a park for chest pain and dizziness, he tells you the chest pain is the
worst pain he has ever had. After checking his vital signs which are: Pulse-88, Respirations-16, and Blood
Pressure-120/80, you should:
A: Test his blood glucose.
B: Check for medical alert tags.
C: Assist him with his own nitroglycerin.
D: Apply the automated external defibrillator to his chest.
C: Assist him with his own nitroglycerin.
The patient who experiences chest pain and is prescribed nitroglycerin should take his medicine as allowed by medical control. You must be sure he is not hypotensive which in this case he clearly is not. If needed, applying oxygen would be another indicated treatment. The other actions will not likely benefit this patient and applying the AED could be harmful.
As you are taking your stretcher out from the emergency department to your unit, a woman is seen assisting a
man out of the car. As you move to assist the man, he collapses into your arms. His skin is mottled and he is
wheezing audibly. The wife says she thinks her husband is having a heart attack after receiving a bee sting.
Your partner approaches with an Epipen to administer to the patient. The IM epinephrine most likely will be
ineffective because:
A: His heart may not be pumping.
B: It doesn’t work on large people.
C: Too much histamine is in his system.
D: The peripheral circulation is shut down.
D: The peripheral circulation is shut down.
When patients are in anaphylaxis, the peripheral circulation begins to shunt blood to the vital organs. So any medication deposited in the muscle may not be circulated into the system for quite some time. Getting this patient into the ED is imperative, as most likely he will need IV epinephrine and artificial ventilation.
You are an EMS rescuer inside the vehicle where the Jaws of Life are being used to extricate the patient.
What specific personal protective equipment should you wear?
A: Hearing protection.
B: Non-latex work gloves.
C: Spark and flame resistant clothing.
D: Full turnout gear, including a helmet.
D. Full Turnout gear, including a helmet
Another name for full turnout gear is bunker gear. It is the same PPEs that the fire department personnel wear. The other options are not the best choices when compared to turnout gear.
You are assessing an adult patient who suddenly complains of shortness of breath. The patient is also
complaining of severe pain in the right chest. Which of the following assessments would be the MOST
critical?
A: Lung sounds.
B: Pulse equality.
C: Capillary refill.
D: Tracheal deviation.
A. Lung Sounds
This patient’s complaints are consistent with a spontaneous pneumothorax. A deviated trachea is a late sign of this condition. An early assessment of lung sounds will help you to verify your suspicion. Capillary refill and pulse equality are circulatory assessments, which are not as critical at this time.
Which age group accounts for receiving the highest percentage of all reported child abuse cases?
A: Females 16-18 years old.
B: Children 1-7 years of age.
C: Male teenagers 13-18 years old.
D: Infants less than 1 year of age.
B: Children 1-7 years of age.
According to the 2010 US Department of Health and Human Services Report on Child Maltreatment. Children less than 1 year of age account for 12.7% of all abuse cases. However, it should be noted that the less than 1 age group is the largest group to die as a result of the abuse. Children from 1 to 7 account for 44.7% of all cases of child maltreatment. The total 16-18 population accounts for 6.2%. The total 13 to 18 population accounts for 23.5%.
You are caring for a 90-year-old-patient that you believe may have had a stroke. You are waiting for ALS to
arrive at the private residence to provide transport. The patient has slurred speech, facial and left body
paralysis. Which of the following would lead you to suspect the patient’s stroke is continuing to get worse?
A: The development of an irregular pulse.
B: A significant increase in blood pressure.
C: A decrease in respiratory rate from 24 to 20.
D: A radiating pain to the jaw and down the left arm.
B: A significant increase in blood pressure.
A significant increase in blood pressure would indicate the development of an increase in intracranial pressure, which would be a very bad sign. The development of an irregular pulse and the radiating pain would be cardiac issues and not cranial in nature. The decrease of the respiratory rate from 24 to 20 is not a significant finding. If the rate had decreased to less than 12, then that would have been another ominous sign.
You are requested by the police to assist them with an 18-year-old male patient who has barricaded himself in
a hallway. The scene is safe. Neighbors say they saw him acting normal just a few minutes ago. You observe
that the patient is hallucinating. What is your FIRST consideration?
A: Was he recently fired from work?
B: Was there a recent fight with a significant other?
C: Has the patient ever had a mental health exam?
D: Did a medical cause bring on this behavioral disturbance?
D: Did a medical cause bring on this behavioral disturbance?
The influence of substance abuse or other medical emergencies must always be considered when there is an abrupt onset to a behavioral emergency. A “psychotic break” can always come about abruptly. The role for EMS is to rule out life-threatening conditions, restrain the patient safely and transport to the appropriate hospital for further evaluation and treatment.
At the hospital an EMS provider is ignored during his report to the hospital staff. Why should this be
considered a serious problem?
A: It violates federal HIPAA standards.
B: It potentially offends the rescuer and patient.
C: It may subject the patient to unnecessary questioning.
D: It exposes the patient to tests and procedures he may not need.
D. It exposes the patient to tests and procedures he may not need.
A member of the health care team may order unnecessary tests if he doesn't listen to a complete assessment and history from the transporting crew. The other concerns are not as critical.
You are called to treat a patient with severe dyspnea. Which of the following tank sizes would be the most
appropriate to bring to the patient’s side when you anticipate a 10-minute transfer from the patient’s bed to the
ambulance?
A: A D-tank with 1200 psi.
B: An E-tank with 700 psi.
C: An M-tank with 300 psi.
D: A K-tank with 250 psi.
A. A D tank with 1200psi
The D-tank at 15 lpm will last for 10.7 minutes. The E-tank at 15 lpm will only last for 9.3 minutes. The other two tanks are too large to bring to the patient’s side.
Regarding SIDS, which of the following statements is true?
A: It is more common in spring and summer months.
B: A major percentage may be abuse-related.
C: It is more common in males than in females.
D: The peak incidence occurs between 5-8 months.
C: It is more common in males than in females.
SIDS deaths are markedly higher in males than in females.
Your protocol for a patient with chest pain, who appears to be having a heart attack, is to give ____.
A: Aspirin.
B: Epi.
C: Oxygen.
D: Nitroglycerin.
E: A,C,D
F: A,D
E: A,C,D
You are on the scene of a 23-year-old patient complaining of excruciating pain in the left flank. He has
vomited and his skin is pale and cool to the touch. Which of the following would you suspect?
A: Acute renal failure.
B: Chronic renal failure.
C: Renal calculi.
D: Urinary tract infection.
C: Renal calculi.
Initially the pain starts as vague and within 30-60 minutes progresses to an extremely sharp pain that may stay in the flank or migrate lower.
At the scene of a fireworks factory explosion, you find multiple victims that have penetrating injuries, and
some with missing limbs. The closest Level I Trauma Center is 75 miles away. The closest Level II and Level
III centers are fifteen miles away. How would you manage the ten patients that are triaged at the highest
priority?
A: Transport all patients to the Level I trauma center.
B: Transport all patients to the Level II trauma center.
C: Split number between the Level II and Level III centers.
D: Transport patients with amputations to the Level I trauma center.
B: Transport all patients to the Level II trauma center.
Most likely the ten high priority patients can be handled by the Level II trauma center. Of course communications are necessary to determine their ability to handle this number of patients and to prepare for transporting patients to the Level I center after being stabilized in the Level II center.
You are called to the scene of an 18-year-old male who suddenly became short of breath and is complaining
of left shoulder pain. The symptoms began 15 minutes ago after he tried to tighten a lug nut on his car. Lung
sounds are slightly diminished in the left upper lobe, there is no JVD or tracheal deviation, and the patient is
breathing at 24 times per minute. Which of the following is MOST likely the cause of the patient’s dyspnea?
A: Asthma.
B: Rib fracture.
C: Pulmonary embolism.
D: Spontaneous pneumothorax.
D. Spontaneous Pheumothorax
This patient is suffering from a spontaneous pneumothorax. Asthma would yield wheezing for lung sounds. A pulmonary embolism would be unlikely given the history and the lung sounds would not be affected yet. A rib fracture in this age group would result from a direct blow.
EMS providers respond to a child experiencing trouble breathing and difficulty swallowing. According to the
parents, the patient went to sleep without complaint and woke up with severe dyspnea. Which finding would
suggest a higher risk of epiglottitis?
A: Sleeping in freshly painted room.
B: Presence of a new cat in the home.
C: The patient is between 3 and 7 years old.
D: History of a recent puncture injury from a rusty nail.
C: The patient is between 3 and 7 years old.
Although any age person could be diagnosed with epiglottitis, children between the ages of 3 and 7 are at highest risk. Presence of a new pet or sleeping in a freshly painted room would be more suggestive of an allergic reaction.
You have just delivered a newly born, non-asphyxiated female. Which of the following is your preferred target
for her temperature?
A: 32.5 to 36.5°C.
B: 36.5 to 37°C.
C: 37.5 to 39.5°C.
D: 39.5 to 41.5°C.
B: 36.5 to 37°C.
The 2015 AHA Guidelines stresses the importance of maintaining the temperature near normal.