Test 2.2

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246386
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Test 2.2
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2013-11-11 21:15:49
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OB GYN trauma diabetes endocrine
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Test 2.2
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  1. Your patient is a 23 yof in moderate respiratory distress, complaining of difficulty breathing.  She describes an acute onset of SOB 15 minutes ago that has been getting progressively worse and has not responded to her Atrovent inhaler.  Physical examination reveals cool, pale, and diaphoretic skin and clear lung sounds bilaterally.  She has a hx  of asthma, is a smoker, and had breast-reduction surgery yesterday.  Medications include Atrovent and albuterol inhalers and birth control pills.  HR = 129, BP = 100/60, RR = 26, SaO2 = 92%.  In addition to 100% oxygen, which of the following is the most appropriate treatment?

    A. IV of NS with 250 cc fluid challenge
    B. IV of NS at a keep-open rate
    C. Albuterol and Atrovent via nebulizer, IV of NS KVO
    D. Albuterol and Atrovent via nebulizer, epinephrine 1:1000 SQ, IV of NS with 250 cc fluid challenge
    A. IV of NS with 250 cc fluid challenge
    (this multiple choice question has been scrambled)
  2. Your patient is a 70 yom with a hx of emphysema and pulmonary hypertension.  His wife called for EMS because the patient has become progressively more dyspneic over the course of the day.  Which of the following aspects of the history should concern you the most?

    A. the patient is using 2 lpm of oxygen at home
    B. the patient has a fever and productive cough
    C. the patient still smokes half a pack of cigarettes a day
    D. the patient was admitted to the ICU last year and required mechanical ventilation
    D. the patient was admitted to the ICU last year and required mechanical ventilation
    (this multiple choice question has been scrambled)
  3. A patient tells you that she experienced an episode of involuntary "shaking" in her arm.  She describes a 1-2 minute long episode of muscular jerking and contracting of her entire left arm.  She retained consciousness, lacked an aura, and had no pain associated with the episode.  This most indicates a(n) _____ seizure.

    A. absence
    B. petit mal
    C. psychosomatic
    D. simple partial
    D. simple partial
    (this multiple choice question has been scrambled)
  4. Which of the following best explains the cause of the histamine and heparin release in response to exposure to an antigen?

    A. humoral cells have initiated a chemical attack on the antigens
    B. IgE antibodies have attached themselves to the membranes of basophils and mast cells, resulting in degranulation
    C. IgG and IgM antibodies have activated basophils and mast cells, resulting in degranulation
    D. IgE antibodies have activated the membranes of B and T cells, resulting in release of histamine and heparin
    A. humoral cells have initiated a chemical attack on the antigens
    (this multiple choice question has been scrambled)
  5. All of the following are common complications of renal dialysis EXCEPT:

    A. air embolism
    B. bleeding from the needle puncture site
    C. dysfunction of the fistula
    D. localized infection at the needle puncture site
    A. air embolism
    (this multiple choice question has been scrambled)
  6. A 16 yof with a hx of diabetes is found unconscious in a high school bathroom following volleyball practice.  She is tachycardic; has cool, clammy skin; is lethargic; is slightly combative; and is very confused.  She is most likely experiencing:

    A. diabetic ketoacidosis
    B. diabetic coma
    C. hypoglycemia
    D. hyperglycemia
    C. hypoglycemia
    (this multiple choice question has been scrambled)
  7. You are called to a local physician's office where you find a 52 yom patient with a hx of chronic renal failure.  He is conscious, but disoriented.  The physician reports that the patient's wife brought him in because he has had a "chest cold", missed dialysis yesterday, and is now "acting strangely".  Physical examination reveals cool, diaphoretic skin; edema to dependent areas, and lun sounds with rhonchi in the right upper lobe.  HR = 118, BP = 142/100, RR = 20 and deep, Sa02 = 97%, BGL = 79 mg/dL.  Bloodwork performed by the physician in his office indicates a pH of 7.2.  In addition to 15 lpm of oxygen by NRB and an IV of NS KVO, which of the following is most appropriate for this patient in the prehospital setting?

    A. IV dextrose, 25 gm
    B. IV sodium bicarbonate, 1 mEq/kg
    C. IV magnesium sulfate, 10 gm
    D. IV furosemide, 120 mg
    B. IV sodium bicarbonate, 1 mEq/kg
    (this multiple choice question has been scrambled)
  8. Your patient has a hx of epilepsy and is experiencing loss of consciousness, tonic-clonic muscle activity, and erratic ocular movement.  Based on this, you might also expect to find all of the following EXCEPT:

    A. increased oral secretions
    B. impaired respiration
    C. pinpoint pupils
    D. urinary incontinence
    C. pinpoint pupils
    (this multiple choice question has been scrambled)
  9. The administration of a vaccine results in _____immunity.

    A. natural passive
    B. passive induced
    C. active induced
    D. natural induced
    C. active induced
    (this multiple choice question has been scrambled)
  10. Which of the following statements about pulse oximetry is FALSE?

    A. oxygen saturation is the percentage of hemoglobin that is bound with some molecular structure
    B. pulse oximetry should be used on all patients with respiratory complaints
    C. pulse oximetry values can be expected to decrease within seconds in cases of developing hypoxia
    D. pulse oximetry has the ability to noninvasively measure total hemoglobin (SpHb) in addition to Sp02 and other parameters
    C. pulse oximetry values can be expected to decrease within seconds in cases of developing hypoxia
    (this multiple choice question has been scrambled)
  11. A 72 yof has a one week history of 101 degree fever, chills, and dark-brown sputum production.  She also has rhonchi and rales throughout her right lung.  If this condition is left untreated, it could result in:

    A. pnenumonia
    B. chronic bronchitis
    C. cardiogenic shock
    D. septic shock
    D. septic shock
    (this multiple choice question has been scrambled)
  12. You encounter a patient complaining of polyphagia, polydipsia, and abdominal pain.  Based on these complaints, which of the following would you also expect to find?

    A. BGL of less than 70 mg/dL
    B. complaint of chest pain and SOB
    C. Kussmaul's respirations and a fruity breath odor
    D. BGL between 80 and 120 mg/dL
    C. Kussmaul's respirations and a fruity breath odor
    (this multiple choice question has been scrambled)
  13. Your patient is a 44 yof complaining of a 3-day hx of localized abdominal pain in her midepigastric region after eating.  The pain tends to subside with antacids.  Today she is experiencing nausea, and the pain did not subside with antacids.    The patient gives a hx of smoking and moderate alcohol consumption.  The patient's skin is warm and dry, and she has a BP of 128/88, a HR of 84, and respirations of 20.  Your course of treatment should consist of:

    A. sodium bicarbonate IV
    B. high-concentration oxygen by NRB
    C. transporting the patient in a position of comfort and giving reassurance
    D. IV of NS with 250 cc fluid bolus
    C. transporting the patient in a position of comfort and giving reassurance
    (this multiple choice question has been scrambled)
  14. Your patient is a 38 yof with a hx of Crohn's disease.  She is conscious and alert and complaining of abdominal pain.  She describes a one-week hx of increasingly diffuse, crampy abdominal pain.  She also states that she has had nausea and comiting, fever, and diarrhea the past two days.  Physical exam reveals that her skin is warm and dry and that her abdomen is tender to palpation in all quadrants with no masses or distension noted.  HR is 100, BP is 118/78, RR is 14, and Sa02 is 99%.  Which of the following treatments is appropriate in the prehospital management of this patient?

    a. diphenydramine
    b. ketorolac (Toradol)
    c. Methylprednisolone
    d. None of the above
    d. None of the above
  15. Your patient is a 22 yof in mild distress that is complaining of left lower quadrant abdominal pain and nausea.  Which of the following questions would be LEAST helpful when determining the etiology of her abdominal pain?

    A. are you having an vomiting or diarrhea?
    B. when did you last menstrual period start?
    C. when did the pain start?
    D. have you ever had a sexually transmitted diease?
    D. have you ever had a sexually transmitted diease?
    (this multiple choice question has been scrambled)
  16. The most important factor in determining the respiratory rate is:

    A. alveolar p02
    B. arterial pC02
    C. arterial p02
    D. alveolar pC02
    B. arterial pC02
    (this multiple choice question has been scrambled)
  17. Which three mechanisms can produce visceral pain?

    A. blunt trauma, penetrating trauma, and medical illness
    B. peritonitis, cholecystitis, and a ruptured abdominal aorta
    C. distension, ischemia, and inflammation
    D. somatic, referred, and peritonitis
    C. distension, ischemia, and inflammation
    (this multiple choice question has been scrambled)
  18. A series of two or more generalized motor seizures without an intervening period of consciousness is known as:

    A. status epilepticus
    B. a complex partial seizure
    C. hypertonic seizures
    D. a petit mal seizure
    A. status epilepticus
    (this multiple choice question has been scrambled)
  19. Which of the following findings is most suggestive of cystitis?

    A. diffuse, periumbilical abdominal pain
    B. abdominal distension
    C. flank pain radiating to the groin
    D. suprapubic tenderness to palpation
    A. diffuse, periumbilical abdominal pain
    (this multiple choice question has been scrambled)
  20. Your patient is complaining of pain secondary to epididymitis.  Where should you expect the pain to be located?

    A. testes
    B. lower left or right quadrant, depending on which side is affected
    C. suprapubic region
    D. flank
    A. testes
    (this multiple choice question has been scrambled)
  21. A patient with speech impairment following a stroke would have involvement in the _____ lobe of the brain.

    A. temporal
    B. occipital
    C. frontal
    D. parietal
    A. temporal
    (this multiple choice question has been scrambled)
  22. Your patient is a 60 yom who is conscious and alert and sitting on a toilet.  He appears to be in moderate distress and complains of nausea and diarrhea.  The patient states that he is allergic to eggs and accidentally ate pancakes made with eggs this morning.  He describes a 4 hour hx of severe diarrhea and vomiting.  HR is 124, BP is 92/60, RR is 16, nd Sa02 is 98%.  The physical exam reveals no urticaria or angioedema; his skin is cool and clammy, and his lung sounds are clear.  Based on these findings, what should be your greatest concern?

    A. acute dehydration
    B. the patient's discomfort
    C. ventricular dysrhythmia
    D. respiratory failure
    A. acute dehydration
    (this multiple choice question has been scrambled)
  23. Which of the following is NOT associated with chronic alcohol ingestion?

    A. decreased sensation in hands and feet
    B. hyperactivity
    C. esophageal varices
    D. Thiamine deficiency
    B. hyperactivity
    (this multiple choice question has been scrambled)
  24. An allergen's most common route of entry in an anaphylactic reaction is:

    A. inhalation
    B. ingestion
    C. injection
    D. absorption
    C. injection
    (this multiple choice question has been scrambled)
  25. What is the innermost layer of meninges that directly overlies the central nervous system?

    A. arachnoid membrane
    B. cerebrospinal membrane
    C. pia mater
    D. dura mater
    C. pia mater
    (this multiple choice question has been scrambled)
  26. Your patient is a 45 year old type I diabetic complaining of a 5 day hx of abdominal pain, nausea, and vomiting, and increased urination and thirst.  His skin and mucous membranes are warm and dry.  HR is 112 and regular, BP is 12 and regular.  Your treatment for this patient would most likely include:

    A. IV of NS KVO, 50 percent dextrose IVP
    B. IV of D5W KVO, 50 percent dextrose IVP
    C. IV of NS KVO, nitroglycerin 0.4 mg SL, every 3 - 5 minutes
    D. IV of NS 1 - 2 L
    D. IV of NS 1 - 2 L
    (this multiple choice question has been scrambled)
  27. Your patient is a 72 yom patient who is conscious but slow to respond to questions and commands.  He has become increasingly lethargic, unemotional, and easily fatigues over the past two months.  He has had a decreased appetite and has gained weight over the same period.  The patient further states, "I'm constipated and always cold."  Which of the following additional signs or symptoms would be consistent with this patient presentation?

    A. A puffy face, an enlarged tongue, and pale, doughy skin
    B. Goiter, atrial fibrillation, nausea, and vomiting
    C. A "moon-faced" appearance and hyperpigmentation of the skin
    D. Hypothermia, tachycardia, and hypertension
    A. A puffy face, an enlarged tongue, and pale, doughy skin
    (this multiple choice question has been scrambled)
  28. An ER physician tells you that the hyperglycemic diabetic you brought in earlier has a pH of 7.40.  What is the likeliest explanation of this statement?

    A. The patient is a type I diabetic who di not take his insulin and is therefore unable to use glucose for energy
    B. the patient is a type II diabetic who was secreting enough insulin to prevent the use of fats for energy
    C. the patient is a type I diabetic who took his insulin and did not eat, resulting in the breakdown of proteins for energy
    D. the patient is a type II diabetic who was no longer secreting enough insulin to prevent the use of fats for energy
    B. the patient is a type II diabetic who was secreting enough insulin to prevent the use of fats for energy
    (this multiple choice question has been scrambled)
  29. Which of the following is NOT a modifiable risk factor for type II diabetes?

    A. obesity
    B. poor diet
    C. heredity
    D. lack of excercise
    C. heredity
    (this multiple choice question has been scrambled)
  30. Pain at McBurney's point is associated with:

    A. cholecystitis
    B. kidney stones
    C. pancreatitis
    D. appendicitis
    D. appendicitis
    (this multiple choice question has been scrambled)
  31. Restoril and Ativan are examples of:

    A. sedatives
    B. barbiturates
    C. narcotics
    D. benzodiazepines
    D. benzodiazepines
    (this multiple choice question has been scrambled)
  32. Epinephrine administration results in all of the following EXCEPT:

    A. increased cardiac contractile force
    B. increased peripheral vasoconstriction
    C. hypotension
    D. tachycardia
    C. hypotension
    (this multiple choice question has been scrambled)
  33. Secretion of glucagon from the pancreas results in _____, which causes a(n) _____ in blood glucose levels.

    A. glycogenolysis, increase
    B. glucogenesis, decrease
    C. glycogenolysis, decrease
    D. glucogenesis, increase
    A. glycogenolysis, increase
    (this multiple choice question has been scrambled)
  34. McBurney's point, a common site of pain secondary to appendicitis, is located:

    a. at the midway point of a line from 1 to 2 inches above the right iliac crest to the umbilicus
    b. 2 inches above the umbilicus in the midline
    c. 1 to 2 inches above the iliac crest in the right midaxillary line
    d. at the midway point of a line from the symphysis pubis to the right anterior, superior iliac crest
    a. at the midway point of a line from 1 to 2 inches above the right iliac crest to the umbilicus
  35. Which of the following is commonly indicated in the management of cocaine overdose?

    A. Flumazenil
    B. Thiamine
    C. Diazepam
    D. Narcan
    C. Diazepam
    (this multiple choice question has been scrambled)
  36. Which of the following statements concerning Africanized honeybees is accurate?

    A. the venom of Africanized honeybees causes acute renal failure
    B. Envenomation by Africanized honeybees requires treatment with specific antivenin
    C. patients stung by Africanized honeybees tend to have more stings than patients stung by other types of bees.
    D. the venom of Africanized honeybees is more toxic than that of other types of bees
    C. patients stung by Africanized honeybees tend to have more stings than patients stung by other types of bees.
    (this multiple choice question has been scrambled)
  37. Which of the following mechanisms is not characteristic for a rectal foreign body?

    A. accidental swallowing of something
    B. psychosis on the part of the patient
    C. sexual gratification
    D. accidental trauma
    A. accidental swallowing of something
    (this multiple choice question has been scrambled)
  38. Which of the following provides evidence that a patient is using accessory muscles to breathe?

    A. the patient's lips are pursed
    B. there is noticeable contraction of the intercostal muscles
    C. the patient is sitting up, leaning forward to breathe
    D. the patient is using his diaphragm with inspiration
    B. there is noticeable contraction of the intercostal muscles
    (this multiple choice question has been scrambled)
  39. Your patient has a hormone-secreting tumor of the adrenal medulla.  What hormone is most likely to be secreted by this tumor?

    A. ACTH
    B. Cortisol
    C. Epinephrine
    D. Dopamine
    C. Epinephrine
    (this multiple choice question has been scrambled)
  40. Treatment of a patient in acute renal failure may include all of the following EXCEPT:

    A. Potassium
    B. IV normal saline
    C. Furosemide
    D. Dialysis
    A. Potassium
    (this multiple choice question has been scrambled)
  41. Most carbon dioxide from cellular metabolism reaches the alveoli by being transported:

    A. as carbonic anhydrase
    B. as bicarbonate ion
    C. dissolved in plasma
    D. bound to hemoglobin
    B. as bicarbonate ion
    (this multiple choice question has been scrambled)
  42. You patient is a 64 yom who is alert and oriented and visibly upset, sitting on a bench in a shopping mall and complaining of weakness.  He describes an acute onset of left-sided weakness in his arm and leg that made it difficult for him to walk.  Physical exam reveals noticeable left-sided weakness, PERRL, skin warm and dry.  HR is 104, BP is 132/96, RR is 12, Sa02 is 97%.  Which of the following is most appropriate?

    A. 100% 02 by NRB, BGL, transport without delay
    B. 02 4 lpm via nasal cannula, BLS transport
    C. 100% 02 by NRB, transport without delay, IV or NS KVO and 25 gm of dextrose, IV while en route
    D. reassurance, BLS transport
    A. 100% 02 by NRB, BGL, transport without delay
    (this multiple choice question has been scrambled)
  43. A type II diabetic with a blood glucose of 24 mg/dL would most likely be unconscious due to:

    A. insulin shock
    B. gluconeogenesis
    C. diabetic ketoacidosis
    D. cerebral hypoglycemia
    D. cerebral hypoglycemia
    (this multiple choice question has been scrambled)
  44. Your patient is a 24 yom Chinese citizen on vacation in the US.  He is in moderate distress, complaining of difficulty breathing and gives a 4 day hx of runny nose, sore throat, fever, chills, and general malaise with a productive cough.  His sputum production was significantly worse when he woke this morning, and he developed difficulty breathing this afternoon.  HR is 134, BP is 132/84, RR is 26, and Sa02 is 90%.  This presentation is most consistent with:

    A. SARS
    B. Tuberculosis
    C. Pneumonia
    D. Hantavirus pulmonary syndrome
    A. SARS
    (this multiple choice question has been scrambled)
  45. Which of the following is evaluated in the Los Angeles Prehospital Stroke Screen but is not part of the Cincinnati Prehospital Stroke Scale?

    A. Facial droop
    B. Speech
    C. Arm drift
    D. Blood glucose level
    D. Blood glucose level
    (this multiple choice question has been scrambled)
  46. Your patient has ingested cyanide in a suicide attempt.  Which of the following is the primary threat to life you should anticipate?

    A. liver failure
    B. hypotension
    C. cellular asphyxia
    D. pulmonary edema
    C. cellular asphyxia
    (this multiple choice question has been scrambled)
  47. Immediately after virth, an infant is allowed to suckle at the mother's breast.  Palpation of the uterus suggests that the uterus is contracting.  This finding can be attributed to:

    A. secretion of estrogen and progesterone
    B. secretion of oxytocin
    C. inhibition of oxytocin
    D. inhibition of estrogen and progesterone
    B. secretion of oxytocin
    (this multiple choice question has been scrambled)
  48. Which of the following is the most reliable way to differentiate between a hyperglycemic emergency and a hypoglycemic emergency?

    A. Assess the blood glucose level
    B. determine whether the patient is a type I or type II diabetic
    C. follow the conventional wisdom, "Pale, cool, wet: low; red, hot, dry: high"
    D. determine whether or not the patient took his insulin or oral antihyperglycemic medication
    A. Assess the blood glucose level
    (this multiple choice question has been scrambled)
  49. Your patient is a conscious and alert 22 yof who as stung by a hornet.  She states that she has "allergies to bee stings" and has been told that she could die if stung.  Your physical exam reveals a 1 cm diameter, red, edematous area where she was stung on the left forearm.  Her skin is warm and dry, and her lung sounds are clear and equal bilaterally.  HR is 112 and regular, BP is 122/82, RR is 12 and regular, and Sa02 is 98%.  The most appropriate treatment for this patient would include:

    A. IV of NS KVO
    B. 15 lpm oxygen via NRB, epinephrine 1:1000 0.3 mg SQ, diphenhydramine 25 mg IV, transport
    C. transport only
    D. 100% 02 via NRB at 15 lpm, IV of NS 1 - 2 L, epinephrine 1:1000 0.3 mg SQ, diphenhydramine 25 mg IV
    A. IV of NS KVO
    (this multiple choice question has been scrambled)
  50. Your patient is a 15 year old asthmatic who has been having difficulty breathing for 45 minutes but does not have his Xopenex inhaler with him.  Capnography shows an ETCO2 of 45 mmHg.  The best way to interpret this finding is:

    A. this is a high ETCO2, and the patient requires immediate ventilator assistance to prevent respiratory arrest
    B. the patient's ETCO2 first dropped as he began to hyperventilate but now is rising again and may continue to rise to dangerous levels
    C. this is a normal ETCO2, indicating this this is a mild asthma attack
    D. this is a low ETCO2 indicating that the patient is hyperventilating and thus in the early stages of an asthma attack
    B. the patient's ETCO2 first dropped as he began to hyperventilate but now is rising again and may continue to rise to dangerous levels
    (this multiple choice question has been scrambled)

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