Concepts and Components Module Quiz

Preparatory: 1 Concepts and Components: 1

1) Which of the following best defines the goal of critical care transport? a) Continuous intensive care bed-to-bed providing the same or higher level of service offered in intensive care units b) Rapid transport of critical patients to trauma centers c) Providing physician-level care to patients outside of the hospital d) Providing care that exceeds the ability of local EMS services

2) There exists a standardized curriculum for providing continuing education credits to critical care transport providers. a) True b) False

3) Failure to ensure that transfer paperwork is complete prior to transferring a patient from one hospital to another may result in an EMTALA violation. a) True b) False

4) The majority of ambulance accidents occur when the vehicle is traveling without lights and sirens. a) True b) False

5) Federal law requires that all emergency personnel working on roadways must wear fluorescent and retro-reflective vests. a) True b) False

6) The critical care transport providers must always assume responsibility and accountability for his or her actions. a) True b) False

Preparatory: 1 Transport Physiology: 2

Transport Physiology Module Quiz

1) Which of the following is an accurate measurement of barometric pressure at sea level? a) 670 mmHg b) 760 mmHg c) 147 mmHg d) 14.7 mmHg

2) List the layers of the atmosphere in order from the earth’s surface to outer space: a) Troposphere b) Stratosphere c) Mesosphere d) Thermosphere

3) Which of the following gases are of concern in aviation medicine (may be more than one correct answer) a) Oxygen b) Carbon monoxide c) Nitrogen d) Nitrous oxide

4) This gas law states, “Gas molecules will move from an area of higher concentration to an area of lower concentration” a) Ideal gas law b) Boyle’s law c) Newton’s law d) Universal gas law

Preparatory: 1 Transport Physiology: 2 5) This gas law states, “The amount of a gas is determined by its pressure, volume, and temperature” a) Ideal gas law b) Boyle’s law c) Newton’s law d) Universal gas law

6) Barotitis media is example of the manifestation of which of the following gas laws? a) Charles’ law b) Dalton’s law c) Boyle’s law d) Henry’s law

7) This gas law states, “The total pressure of a gas mixture is the sum of the individual partial pressures of all the gases in the mixture” a) Charles’ law b) Dalton’s law c) Boyle’s law d) Henry’s law

8) Barometric pressure decreases with altitude and atmospheric molecules move farther away from one another. This is example of which gas law? a) Charles’ law b) Dalton’s law c) Boyle’s law d) Henry’s law

9) Decompression sickness (i.e. “the bends”), is an example of which of the following gas laws? a) Charles’ law b) Dalton’s law c) Boyle’s law d) Henry’s law

Preparatory: 1 Transport Physiology: 2

10) For every increase of 1000 feet in altitude, temperature will: a) Decrease by 2° F b) Decrease by 2° C c) Increase by 2° F d) Increase by 2° C

11) Which of the following statements regarding Gay-Lussac’s law is correct? a) As temperature increases, pressure decreases b) As temperature decreases, pressure increases c) As pressure increases, temperature increases d) As pressure decreases, temperature increases

12) Night vision is lost at what altitude? a) 2500 feet b) 5000 feet c) 7500 feet d) 10,000 feet

13) Inadequate tissue oxygenation secondary to reduced oxygen-carrying capacity of blood is the definition of which of the following? a) Hypoxic hypoxia b) Hypemic (anemic) hypoxia c) Stagnant hypoxia d) Histoxic hypoxia

14) Drinking alcohol can cause the cellular inability to utilize oxygen in the blood. This is an example of which form of hypoxia? a) Hypoxic hypoxia b) Hypemic (anemic) hypoxia c) Stagnant hypoxia d) Histoxic hypoxia

Preparatory: 1 Transport Physiology: 2

15) Your heart failure patient is becoming hypoxic at altitude. This is most likely due to which of the following forms of hypoxia? a) Hypoxic hypoxia b) Hypemic (anemic) hypoxia c) Stagnant hypoxia d) Histoxic hypoxia

16) Write the oxygen-adjustment calculation needed for transporting oxygen-dependent patient’s at altitude:

(%FiO2 X BP1) / BP2 = %FiO2 for altitude

%FiO2 = concentration of inspired oxygen

BP1 = barometric pressure prior to ascent

BP2 = barometric pressure at altitude

17) The time from exposure to an oxygen-deficient environment to the point at which a useful level of consciousness is lost, is the definition of which of the following: a) Time of useless consciousness (TUC) b) Time of useful consciousness (TUC) c) Ineffective performance time (IFP) d) Effective performance time (EFP)

18) A pressurized aircraft cabin simulates which of the following altitudes? a) 1,000 – 4,000 ft b) 5,000 – 8,000 ft c) 9,000 – 12,000 ft d) 13,000 – 15,000 ft

19) List each of the factors that make up the acronym “DEATH” D = drugs E = exhaustion A = alcohol

Preparatory: 1 Transport Physiology: 2 T = tobacco H = hypoglycemia

20) Most patients are loaded along the long axis of the aircraft a) True b) False

Preparatory: 1 Air Medical Considerations: 3

Air Medical Considerations Module Quiz

1) Although debated by historians, the first air medical transport could have occurred in which of the following military conflicts? a) Vietnam War b) Civil War c) Prussian Siege of Paris d) World War I

2) The first helicopter evacuation of a wounded soldier occurred in which of the following military conflicts? a) World War I b) World War II c) Korean War d) Vietnam War

3) Rotor-wing transport is typically used for transports less than ____ nautical miles: a) 50 b) 100 c) 150 d) 200

4) Air medical accidents are usually caused by a single event. a) True b) False

5) List the four major contributing factors to a HEMS crash as identified by the NTSB: a) Human error b) Weather c) Mechanical failure d) Obstacle strikes

Preparatory: 1 Air Medical Considerations: 3 6) Weather has been frequently found to be the primary causes of HEMS accidents. a) True b) False

7) Briefly describe the “cardinal sin” of requesting air medical transport: a) The cardinal sin of air medical transport is having the patient transported by air when they could have reach an appropriate hospital quicker by ground transport

8) ___ minutes or ____ minute ground transport time is considered to be the minimum to which air medical transport is beneficial to the patient (with few exceptions such as extended extrication, weather, traffic, etc.) a) 20, 20 b) 30, 30 c) 40, 40 d) 50, 50

9) Which of the following is a DEBATABLE criteria for the use of HEMS? a) Death of an occupant in the vehicle b) Ejection from a vehicle c) GCS <10 d) Fracture with vascular compromise

10) Which of the following best describes the term “helicopter shopping”? a) When a program views different helicopters to upgrade their current aircraft fleet b) When rotor wing flight teams call around to find a fixed-wing aircraft to transport a patient a long distance c) When a hospital contacts numerous air medical vendors to find one that will manage the flight program at the hospital d) When sequential calls are made to numerous air medical providers in an attempt to find one to take a mission when it has been declined by others

Preparatory: 1 Air Medical Considerations: 3 11) Briefly describe the “51% rule” a) The 51% rule allows any crew member the right to decline a flight without fear of repercussion from administration or other crew members

12) What is the ideal size for a helicopter landing zone? a) 50’ x 50’ b) 100’ x 100’ c) 150’ x 150’ d) 200’ x 200’

13) The slope of the landing zone cannot exceed ___ degrees a) 1 b) 5 c) 10 d) 15

14) Most aircraft are designed to approach the aircraft from a ____ degree angle to the doors a) 25 b) 45 c) 90 d) 180

15) Describe the “SLOW” acronym used to establish a landing zone: a) S= Size of landing zone should be 100 feet by 100 feet b) L= Landing area c) O= Obstacles d) W= Wind

Preparatory: 1 Air Medical Considerations: 3 16) CAMTS standards require “following by a communicator for both flight and ground transports. Aviation need to report position every ___ minutes, and ground needs to report positions every ___ minutes a) 5, 15 b) 10, 30 c) 15, 45 d) 30, 60

17) CAMTS standards require that a post-accident incident plan (PAIP) needs to be implemented __ minutes after a transport vehicle fails to give a position report, or is overdue to arrive a) 10 b) 15 c) 20 d) 25

18) CAMTS standards require that a pilot have ____ flight hours with _____ rotorcraft hours and ____ as pilot in charge. a) 2000, 1200, 1000 b) 1500, 1000, 100 c) 1000, 500, 50 d) 1000, 250, 50

Preparatory: 1 Medical Legal: 4

Medical Legal Module Quiz 1) A verdict in a civil trial only require proof by preponderance of evidence (proof greater than 50%) a) True b) False

2) Concern over patient dumping, refusing to treat patients and premature discharge of patients led to the creation of which of the following laws? a) HIPAA b) COBRA c) US Medical Malpractice Act d) Social Security Act of 1987

3) Failure to maintain EMTALA compliance can result in personal civil liability for the critical care transport provider. a) True b) False

4) All patients presenting to emergency departments must receive a medical screening exam. This exam can be performed by an EMT or a triage technician. a) True b) False

5) EMTALA applies to all buildings on a hospital campus that are contiguous to the main building, or within 250 yards of the main buildings. a) True b) False

Preparatory: 1 Medical Legal: 4

6) EMTALA prohibits hospitals from diverting ambulances from the emergency department. a) True b) False

7) Critical care transport providers can face fines up to $50,000 and up to one year in prison for disclosing protected health information. a) True b) False

8) You have been asked to assist you medical director with protocol development. This is an example of which of the following types of medical control? a) Prospective b) Concurrent c) Retrospective d) Guidance

9) Critical care transport document should be completed in which of the following timeframes? a) Immediately after every call, before placing the unit back in service b) Within 24 hours c) Within 48 hours d) With 72 hours

10) Critical care transport documentation completed 24 hours or more after the call can be questioned in court. a) True b) False

Preparatory: 1 Basic Radiographic Interpretation: 5 Basic Radiographic Interpretation Module Quiz

1) Which of the following typically has a white to light gray color on an x-ray? a) Bone b) Muscle c) Air d) Water

2) The left side of the diaphragm is always higher than the right side. a) True b) False

3) Your patient has a tension pneumothorax. Would you expect for the diaphragm to be elevated or depressed on the chest x-ray? a) Elevated b) Depressed c) The diaphragm would be in a normal position d) You will not be able to see the diaphragm in a chest x-ray

4) Which of the following statements is true regarding endotracheal tube placement on an x-ray? a) A properly placed tube should be 1 – 2 cm above the carina b) A properly placed tube should be 1 – 2 cm below the carina c) A properly placed tube should be 3 – 7 cm above the carina d) A properly placed tube should be 3 – 7 cm below the carina

5) You observe a “steeple sign” on a pediatric x-ray. Which of the following would you suspect? a) Epiglottitis b) Asthma c) RSV d) Croup

Preparatory: 1 Basic Radiographic Interpretation: 5 6) You are transporting a 14-year-old multi-trauma patient that was trampled by a horse. Your patient is intubated and mechanically ventilated. Upon reviewing the patient’s chest x-ray you notice a large black crescent over the apex of the left lung. Which of the following would you suspect? a) Collapsed left lung b) Diaphragmatic rupture c) Cardiac tamponade d) Hemothorax

7) You are participating in monthly quality assurance and you are reviewing run reports. You notice that a crew member described a chest x-ray as having “the presence of cardiomegaly, shaggy appearance around the heart border, and the presence of Kerley-B lines”. This type of description would most likely indicate which of the following? a) Tension pneumothorax b) Congestive heart failure c) Hemothorax d) Acute respiratory distress syndrome

8) On a PA film, the normal heart should be no more than ___ width of the film (otherwise it would indicate cardiomegaly). a) 25% b) 33% c) 50% d) 75%

9) On a head CT, black spots typically indicate an infarct or old blood. a) True b) False

10) On a head CT, white spots typically indicates acute bleeding. a) True b) False

Preparatory: 1 Basic Lab Data: 6

Basic Lab Data Module Quiz

1) This type of test will only result in a positive when the condition is present in a patient. a) Sensitivity b) Specificity c) Accuracy d) Probability

2) ______is the probability that a test will be negative in the absence of a disease a) Sensitivity b) Specificity c) Accuracy d) Probability

3) As respirations increase, you would expect the pH to decrease. a) True b) False

4) As respirations decrease, you would expect hydrogen ions to increase. a) True b) False

5) Which of the following are the two primary acid-excreting organs? a) Liver, kidneys b) Liver, lungs c) Lungs, kidneys d) Lungs, liver

Preparatory: 1 Basic Lab Data: 6 6) Which of the following conditions would result in a left shift (alkalosis)? a) Increased temperature b) Hypoxia c) Hypercarbia d) Hyperbaric oxygen treatment

7) Your patient has a core temperature of 105°F (40.5°C). Would you expect to see a right shift (acidosis) or a left shift (alkalosis)? a) Right shift b) Left shift c) Temperature has no effect on shift d) There is not enough information to determine

8) Which of the following would result in hypercapnia? a) V/Q mismatch b) Hyperventilation

c) Use of an FiO2 of 1.0 d) Increasing PEEP and TV

9) You observe lab values that show an increase in pH, a decrease in PaCO2, and no

change in HCO3. Based on this information, you can assume which of the following to be true? a) This patient is in metabolic acidosis b) This patient is in metabolic alkalosis c) This patient is in respiratory acidosis d) This patient is in respiratory alkalosis

10) You observe lab values that show a decrease in pH, an increase in PaCO2, and no

Preparatory: 1 Basic Lab Data: 6

11) You are treating a patient with a suspected C2 fracture of the spinal cord. Which of the following statements is true? a) This patient is at risk for respiratory alkalosis because of neurogenic hyperventilation b) This patient is at risk for respiratory acidosis because of decreased ventilations c) This patient is at risk for metabolic acidosis due to reflex tachycardia from the spinal cord injury d) Spinal cord injuries such as this typically have no effect on blood gases.

12) You are transporting a 24-year-old body builder who overdosed on diuretics in an attempt to slim down for a competition. Which of the following would you most likely expect? a) Respiratory acidosis b) Respiratory alkalosis c) Metabolic acidosis d) Metabolic alkalosis

13) Your patient is on the transport ventilator. The patient’s end-tidal CO2 is 26 mmHg.

Which of the following statements is most likely the cause of this CO2? a) You failed to hook up the oxygen to the ventilator, and the patient is receiving room air oxygen b) You set the rate to low on the ventilator and the patient is hypoventilated

c) Your patient is in shock and is retaining CO2

d) You are hyperventilating the patient and blowing off the CO2

14) If the HCO3 moves opposite the pH, the metabolic system is compensating for a respiratory imbalance. a) True b) False

Preparatory: 1 Basic Lab Data: 6

15) If the pH goes down, and the PaCO2 goes up, this indicates respiratory alkalosis a) True b) False

16) Your patient has the following lab values: pH = 7.43 PaCO2 = 60 HCO3 = 32 a) This is uncompensated respiratory acidosis b) This is compensated respiratory acidosis c) This is uncompensated metabolic acidosis d) This is compensated metabolic alkalosis

17) Your 32-year-old male patient has a hemoglobin of 5. Which of the following statements is true? a) This is an abnormally low value for this patient b) This is an abnormally high value for this patient c) This is a normal value for this patient d) There is not enough information to decide

18) Which of the following indicates a normal hematocrit value for an adult? a) 5% b) 15% c) 45% d) 65%

19) You are transporting a 25-year-old female who is 72 hours post-partum. She is in full disseminated intravascular coagulation. Would value would you expect for her platelets? a) Her platelets should be elevated b) Her platelets should be low c) Disseminated intravascular coagulation has no effect on platelets d) There is not enough information to decide 4 ©2016 University of Maryland, Baltimore County

Preparatory: 1 Basic Lab Data: 6

20) Which of the following tests measures the effectiveness of Coumadin-type anticoagulant medications? a) Heparin assay b) International normalized ratio c) Partial thromboplastin time d) Prothrombin time

21) Which of the following tests would be most appropriate for determining renal function? a) D-dimer assay b) Blood urea nitrogen c) Partial thromboplastin time d) Serum osmolality

22) Which of the following represent the normal value of sodium? a) 80 - 100 mg/dL b) 80 – 100 mEq/L c) 135 – 145 mg/dL d) 135 – 145 mEq/L

23) You are treating a 62-year-old male patient with a gastrointestinal bleed. The patient’s potassium is 6.5 mEq/L. Which of the following statements is true? a) This is a normal potassium level b) This is a low potassium level c) This is an elevated potassium level d) This patient is in profound hypokalemia

24) Which of the follow cardiac biomarkers is considered most specific for myocardial damage? a) Troponin I b) Creatine phosphokinase (CPK) c) B-type natriuretic peptide (BNP) d) Myoglobin 5 ©2016 University of Maryland, Baltimore County

Preparatory: 1 Peripheral and Central Access: 7

Peripheral and Central Access Module Quiz

1. Which of the following sites is considered optimal for insertion of an intraosseous line? a. Distal femur b. Proximal femur c. Distal tibia d. Proximal tibia

2. Syringes smaller than ___ ml should not be used for hemodialysis shunts in order to prevent catheter damage from excess infusion pressure. a. 1 b. 5 c. 10 d. 20

3. All medications should be flushed with __ ml of saline to avoid clots. a. 5 b. 10 c. 15 d. 20

4. The non-tunneled catheters are designed for short-term or intermediate-term access. a. True b. False

5. Peripherally inserted central catheters are designed for intermediate to long-term venous access a. True b. False

Preparatory: 1 Peripheral and Central Access: 7 6. A power PICC can accommodate pressures up to ____ PSI a. 100 b. 200 c. 300 d. 400

7. Which of the following is TRUE regarding tunneled catheters? a. They can be single, double, or triple lumen large bore catheters b. They are constructed of a thin-walled silicone c. They are designed for short-term to intermediate use d. They cannot withstand high pressures (such as dialysis)

8. SVADs require a special injection non-coring needle called: a. Hickman needle b. Herbert needle c. Huber needle d. Hubert needle

9. If the needle mentioned in Question 8 is not available, a 22ga butterfly needle can be used to access an SVAD port. a. True b. False

10. If a CVAD is infusing sluggishly, it should be vigorously infused with 20 – 30 ml of normal saline. a. True b. False

11. Arterial lines provide systolic and diastolic pressure immediately, and are more accurate than traditional noninvasive techniques. a. True b. False

Preparatory: 1 Peripheral and Central Access: 7 12. Which of the following statements regarding arterial lines is FALSE? a. Arterial lines should always be labeled in red to prevent accidental medication administration b. The carotid artery is the easiest artery to cannulate due to its size c. The 500 ml bag of normal saline should always be pressurized to 300 mmHg to prevent backflow into the cannula and tubing d. Arterial lines typically provide 20 gauge access in adults

13. A dampened arterial waveform typically overestimates blood pressure. a. True b. False

14. Which of the following is NOT a typical reason why dampening occurs? a. Over-pressurization of the pressure bag b. Blood clots in the system c. Compression of air bubbles d. Kinking of tubing

15. The typical arterial line transducer will need to be changed out every ____ hours. a. 24 b. 48 c. 72 d. 96

16. Which of the following is the most important reason to ensure that the arterial line flush bag does not run dry? a. Prevention of backflow of arterial blood into the transducer b. Prevention of arterial occlusion c. Prevention of air embolism d. Prevention of hypotension

Preparatory: 1 Peripheral and Central Access: 7 17. If the arterial line monitor will not produce a waveform, ensure that all clamps are closed. a. True b. False

18. If the transducer is placed to low, the readings will be falsely high. a. True b. False

19. If the arterial line waveform is lost, catheter patency can be checked by attaching a 3 cc syringe to the stopcock and withdrawing blood. a. True b. False

20. In the event of accidental dislodgement of an arterial line, pressure should be maintained over the site for ___ minutes. a. 5 b. 10 c. 15 d. 20

Preparatory: 1 Hemodynamic Monitoring: 8

Hemodynamic Monitoring Module Quiz

1) Which of the following is the most important information obtained from hemodynamic monitoring? a) Oxygenation and perfusion b) Stroke volume c) Cardiac compliance d) Ejection fraction

2) The proximal (blue) lumen measures pulmonary artery pressure. a) True b) False

3) Which of the following measures central venous pressure (CVP)? a) Distal lumen (yellow) b) Infusion port (white) c) Proximal lumen (blue) d) Balloon inflation port (red)

4) Which of the following syringes should be used to inflate the pulmonary artery balloon? a) 1 cc b) 1.5 cc c) 5 cc d) 10 cc

Preparatory: 1 Hemodynamic Monitoring: 8 5) The pulmonary artery catheter must always maintain which of the following constant flows in order to maintain patency of the line? a) 1 – 3 cc/hr b) 3 – 5 cc/hr c) 5 – 7 cc/hr d) 7 – 10 cc/hr

6) Which of the following statements is TRUE regarding placement of the transducer? a) It needs to be level with the 5th or 6th intercostal space b) Placing the transducer too high will result in falsely elevated pressures c) It must be level with the right atrium d) It must be level with the left atrium

7) Which of the following is NOT a typical indication for leveling of the transducer? a) Upon insertion b) During inflation of the balloon c) Upon change in the patient’s position d) Just prior to taking a reading

8) Which of the following values represents normal CVP and RAP? a) 2 – 6 mmHg b) 6 – 12 mmHg c) 15 – 30 mmHg d) 30 – 40 mmHg

9) Which of the following would cause an elevated CVP and RAP? a) Dehydration b) Hypovolemia c) Pulmonary hypertension d) Aggressive use of vasodilators

Preparatory: 1 Hemodynamic Monitoring: 8 10) Right ventricular pressure can only be measured during insertion. a) True b) False

11) The pulmonary artery pressure is the pressure within the pulmonary artery when the balloon in inflated. a) True b) False

12) Inflation of the pulmonary artery balloon should be no longer than ____ seconds. a) 5 b) 10 c) 15 d) 20

13) After wedging, the balloon is allowed to passively deflate and return to the right ventricle. a) True b) False

14) Which of the following values represents a normal range for wedge pressures? a) 2 – 4 mmHg b) 4 – 12 mmHg c) 15 – 30 mmHg d) 30 – 40 mmHg

15) Which of the following patients would typically have a low cardiac output? a) A patient with hyperthyroidism b) A patient who was just given vasopressin c) A patient with anemia d) A patient with a heart rate of 168

Preparatory: 1 Hemodynamic Monitoring: 8

16) Right ventricular preload is the same as central venous pressure (2 – 6 mmHg). a) True b) False

17) The left ventricular preload (LVP) can be indirectly measured by the wedge pressure, and is the same as the left ventricular end diastolic pressure (LVEDP). a) True b) False

18) Your patient has a pulmonary artery catheter inserted. You are now seeing runs of ventricular tachycardia. Which of the following should you suspect first? a) Your patient has just thrown a huge pulmonary embolus b) The patient is having a reaction to one of the medications they are on c) The right ventricular endocardium is being irritated by the catheter tip d) Your patient has a pneumothorax as a result of inadvertent puncture during catheter insertion

19) You note spontaneous wedging. Which of the following is NOT an acceptable action? a) Try turning the patient on their side b) Inflate the balloon and then immediately deflate the balloon in an attempt to dislodge it c) Aspirate for blood return d) Have the patient raise their arm nearest the catheter above their head and cough

20) Which of the following is correct regarding a dampened waveform? a) This can be fixed by attempting to pull the catheter back into the right atrium b) This can be fixed by attempting to pull the catheter back into the right ventricle c) A problem with the monitor should be suspected first d) A dampened waveform heralds impending cardiac arrest

Preparatory: 1 Blood Administration: 9

Blood Administration Module Quiz

1) Where are red blood cells produced? a) Liver b) Bone marrow c) Kidneys d) Platelets

2) An individual who is Rh+ can be exposed to Rh- negative blood without problems. a) True b) False

3) An individual who is RH- can be exposed to Rh+ blood without problems. a) True b) False

4) Which of the following is the universal donor? a) O positive b) O negative c) A d) AB

5) ______are responsible for protecting the body from invasion by foreign substances such as bacteria, fungi, and viruses a) Platelets b) Red blood cells c) Leukocytes d) Thrombocytes

Preparatory: 1 Blood Administration: 9

6) ______is typically used to correct a coagulation factor deficiency a) Whole blood b) Cryoprecipitate c) Fresh frozen plasma d) Platelets

7) ______is typically used to improve oxygen carrying capacity a) Whole blood b) Cryoprecipitate c) Fresh frozen plasma d) Platelets

8) Blood cannot be returned to the blood bank after __ minutes of warming at room temperature a) 10 b) 15 c) 30 d) 60

9) Which of the following would be best suited for a patient in massive hemorrhagic shock? a) Packed red blood cells b) Whole blood c) Fresh frozen plasma d) Cryoprecipitate

Preparatory: 1 Blood Administration: 9 10) Which of the following is TRUE regarding the administration of fresh frozen plasma? a) It should be administered at 25 – 50 ml/hour during the first 15 minutes, then adjusted to infuse within four hours b) Patients receiving large volumes of fresh frozen plasma should be monitored for hypercalcemia c) It is composed of plasma, all coagulation factors, and platelets d) It should be administered as fast as the patient can tolerate

11) For blood administration, the IV catheter must be at least a ___ gauge catheter. a) 16 b) 18 c) 20 d) 22

12) Which of the following is typically used to prime the IV blood tubing?

a) D5W b) Normal saline

c) D5LR d) Lactated Ringers

13) Which of the following medication can be safely added to blood bag or given in IV tubing while blood is being administered? a) Epinephrine b) Benadryl c) Dopamine d) No medication can be safely added

14) Complications from blood transfusions can occur up to __ days post-transfusion a) 2 b) 7 c) 10 d) 14

Preparatory: 1 Blood Administration: 9

15) Patient with hepatic disease may be prone to which of the following complications following a massive blood transfusion? a) Ammonia intoxication b) Dilutional coagulopathy c) Hyocalcemia d) Hyperthermia

16) Your multi-trauma patient has received 20 units of blood. You begin to see EKG changes and suspect citrate toxicity. Which of the following medications would be indicated? a) Benadryl b) Epinephrine c) Calcium d) Magnesium

17) Which of the following best describes the function of 2,3-DPG? a) It is the “crowbar” that forces oxygen on to the hemoglobin b) It is the “crowbar” that forces oxygen off of the hemoglobin c) It helps to initiate clotting factors in platelets d) It is a side effect of citrate toxicity

18) Blood should be warmed to ___ - ___ °C before infusing. a) 29 – 31 b) 31 – 33 c) 33 – 35 d) 32 – 37

19) An acute transfusion reaction is one that occurs within 24 hours after a transfusion. a) True b) False

Preparatory: 1 Blood Administration: 9 20) The most common cause of a transfusion reaction is the inadvertent administration of incompatible blood. a) True b) False

Medical: 2 Respiratory: 1

Respiratory Module Quiz

1) A right shift in the oxyhemoglobin dissociation curve would occur if more oxygen was released from the hemoglobin, resulting in greater oxygen delivery to tissues. a) True b) False

2) Which of the following would result in a left shift of the oxyhemoglobin dissociation curve?

a) Increase in PCO2 b) Hyperthermia c) Alkalosis d) Increase in 2,3-DPG

3) Normal expiration is about ____ times longer than the inspiration a) 1 b) 1.5 c) 2 d) 3

4) This type of respiratory pattern is characterized by irregular breathing with a variation in rate, depth, and rhythm. a) Biot’s b) Cheyne-Stokes c) Neurogenic hyperventilation d) Kussmaul

5) Most patients with COPD will have signs and symptoms of both emphysema and chronic bronchitis. a) True b) False

Medical: 2 Respiratory: 1

6) Your partner is reviewing the chest x-ray of a patient that was recently transported. He observes a flattened diaphragm, wide intercostal spaces, hyperlucent lung fields, and a long, narrow heart shadow. He tells you that he suspects that this patient has COPD/asthma. Which of the following is true? a) This x-ray presents a classic, typical film of the COPD/asthma patient b) This x-ray is typical of ARDS c) This x-ray is typical of a pulmonary embolus d) There is not enough information to make a diagnosis

7) Which of the following blood gases are typically seen in patients with COPD? a) Compensated respiratory alkalosis b) Uncompensated respiratory alkalosis c) Compensated respiratory acidosis d) Uncompensated respiratory acidosis

8) Which of the following is the most common symptom of a pulmonary embolus? a) Hemoptysis b) Pleuritic chest pain c) Cough d) Dyspnea

9) You are treating a 74-year-old female with a history of COPD. She presents in significant respiratory distress. Her pulse oximetry is 85% on 100% oxygen. Her eyes are open, but she is not alert and not oriented to the situation (her baseline is CAOx4). Her daughter advises you that last time she was intubated and they “almost never got her off the vent”. You are 20 minutes from the hospital. Which of the following is the best treatment option? a) Continued nebulizer treatment with 100% oxygen b) Use of CPAP or BiPAP c) Endotracheal intubation with rapid sequence intubation d) Bag mask ventilation

Medical: 2 Respiratory: 1

10) Patients with COPD may require lower ventilator rates in order to prevent breath stacking. a) True b) False

11) Which of the following is the most important diagnostic tool in the investigation of a pulmonary embolus? a) Pulmonary angiogram b) CT scan or CT angiography c) Patient history d) D-dimer assay

12) Arterial blood gases can be unreliable in the setting of a pulmonary embolus. a) True b) False

13) Which of the following cardiac rhythms is most commonly seen in patients with a pulmonary embolus? a) Sinus bradycardia b) Heart blocks c) Sinus tachycardia d) Atrial fibrillation or atrial tachycardia

14) Which of the following is the most common cause of ARDS? a) Pneumonia b) Gastric aspiration c) Prolonged shock d) Sepsis

15) ARDS is primarily an infectious process that develops after a significant physiologic event. a) True

Medical: 2 Respiratory: 1 b) False

16) You are establishing the ventilator settings for your patient who has ARDS. Would you expect the patient to have increased airway pressures, or decreased airway pressures? a) Increased airway pressure due to alveolar destruction and increased pulmonary blood flow resistance b) Decreased airway pressure secondary to a decrease in functional residual capacity c) Decreased airway pressure due to an increase in physiologic dead space d) No change in airway pressure

17) An iatrogenic pneumothorax is one that is caused by a medical treatment or diagnostic procedure. a) True b) False

18) Which of the following statements regarding a tension pneumothorax is TRUE? a) Death occurs as a result of hypoxia b) Death occurs because of interference with the unaffected lung c) Death occurs because of decreased preload leading to decreased cardiac output d) A tension pneumothorax is most likely to present as the aircraft descends because of pressure changes

19) Which of the following is NOT a typical sign of a tension pneumothorax in a mechanically ventilated patient? a) Decreasing SaO2 b) Agitation or “fighting the ventilator” c) Hypotension d) Bradycardia

Medical: 2 Respiratory: 1

20) When placing a chest tube, which of the following represents the most ideal patient position for tube insertion? a) Lying supine b) Head of bed elevated 30 - 60° c) Trendelenburg d) Positioning does not matter

21) Which of the following represents the best location for chest tube placement for fluid removal? a) Midclavicular line, second intercostal space b) Midclavicular line, 4th/5th intercostal space c) Midaxillary line, second intercostal space d) Midaxillary line, 4th/5th intercostal space

22) If there is a suspected blockage in the thoracostomy tube, which of the following is most appropriate? a) Milk or strip the tube to dislodge clots b) Increase the wall suction c) Insert a second tube adjacent to the first tube d) Clamp the tube and notify the physician

23) All distal fenestrations on the thoracostomy tube should be within the thorax. a) True b) False

24) Which of the following is the typical amount of wall suction required for a chest tube?

a) 10 cmH2O

b) 20 cmH2O

c) 30 cmH2O

d) 40 cmH2O

Medical: 2 Respiratory: 1

25) Which of the following mnemonic devices is used to troubleshoot chest tube drainage? a) FLOP b) FLIPPING c) FILLING d) FOCAL

Medical: 2 12 Lead Interpretation: 2.1

12 Lead Interpretation Module Quiz

1) When a cardiac cell is depolarized, positive charges are on the outside and negative charges on the inside of the cell. a) True b) False

2) Which of the following positions is optimal for obtaining a 12 lead EKG? a) Fowlers b) Semi-Fowlers c) Supine d) Lateral recumbent

3) Which of the following statements is TRUE regarding lead placement? a) The lead should be placed on bony prominences when possible b) The leads should be placed on the wrist and ankles if possible c) If leads are placed on the trunk, it should be written on the EKG strip d) For the best tracing, an alcohol pad should be used and the EKG pad applied to the wet skin

4) Which of the following are bipolar leads? a) II, III, and aVF b) I, II, III

c) V1, V2 d) All leads but I, II, and III

5) You have just placed an EKG pad at the left sternal border, at the 4th ICS. Which chest lead is this?

a) V1

b) V2

c) V3

Medical: 2 12 Lead Interpretation: 2.1

6) The “P” wave should typically be upright in leads II, III, and aVF and have a duration less than 0.10 seconds. a) True b) False

7) An elevation or depression of the ST segment of __ mm or more above the isoelectric line may be indicative of myocardial injury or ischemia a) 0.1 b) 0.5 c) 1 d) 2

??????

8) What is the arrow pointing to the in the picture above?

a) The S-S interval b) S’ c) The J point d) The QTc interval

Medical: 2 12 Lead Interpretation: 2.1

9) Which of the following statements is true about the picture above? a) This is a normal ST segment b) This is a depressed ST segment c) This is an elevated ST segment d) The ST segment is prolonged

10) Which of the following statements is true about the picture above? a) This is a normal ST segment b) This is a depressed ST segment c) This is an elevated ST segment d) The ST segment is prolonged

Medical: 2 12 Lead Interpretation: 2.1 11) You are treating a 22-year-old female who developed sudden chest pain and shortness of breath. You observe “Q” waves in Lead III. Which of the following should you suspect? a) Myocardial infarction b) Pulmonary embolus c) Pleurisy d) Mitral valve prolapse

12) Axis determination can be used to assist diagnosing which of the following? a) The presence of hemiblocks b) Atrial fibrillation versus atrial tachycardia c) Myocardial infarction versus angina d) Mitral valve prolapse

13) The electrical impulse that travels toward the electrode is seen as a negative inflection on the EKG tracing. a) True b) False

14) You observe upright QRS complexes in leads I, II and III. Which of the following is true regarding axis deviation? a) This is a normal axis b) This is a pathological left axis c) This is a right axis d) This is an extreme right axis

15) You observe upright QRS complexes in lead I, and downward QRS complexes in leads II and III. Which of the following is true regarding axis deviation? a) This is a normal axis b) This is a pathological left axis c) This is a right axis d) This is an extreme right axis

Medical: 2 12 Lead Interpretation: 2.1 16) Which of the following is true regarding a right axis deviation? a) It is a normal finding in pediatrics, but may indicate a posterior hemiblock in adults b) It is divided by physiologic right and pathological right c) It can indicate aortic stenosis d) It can indicate systemic heart disease

17) Which of the following leads look at the inferior surface of the left ventricle? a) Leads I, II, and III b) Leads II, III, and aVF

c) V1, V2

d) V3, V4

18) Acute MI’s cannot be determined if a left bundle branch block is present. a) True b) False

19) Sodium is primary an intracellular ion. a) True b) False

20) Potassium is primary an extracellular ion. a) True b) False

21) Your patient is in Torsades de pointes. Would you expect this patient to most likely be hypokalemic, or hyperkalemic? a) This patient will most likely be hypokalemic b) This patient will most likely be hyperkalemic c) Torsades de pointes has no correlation with potassium d) There is not enough information to determine.

Medical: 2 12 Lead Interpretation: 2.1

22) What do you suspect with the EKG above? a) Inferior MI b) Lateral MI c) Hypercalcemia d) Hyperkalemia

23) You are transporting a 75-year-old female with heart failure. You notice on her EKG that she has a prolonged QT interval. She appears to have ST elevation in multiple leads, but her Troponin I and CP-K are negative. Which of the following would you expect? a) Hypokalemia b) Hyperkalemia c) Hypocalcemia d) Hypercalcemia

Medical: 2 12 Lead Interpretation: 2.1

24) The EKG tracing above is indicative of which of the following? a) Anterior MI b) Lateral MI c) Inferior MI d) Septal MI

25) If the QRS duration exceeds 0.12 seconds, then there may a bundle branch block. a) True b) False

26) Which of the following is true regarding inferior MIs? a) They will often present with ST elevation in V1 and V2 b) 3rd degree heart block is common c) It involves the right coronary artery d) Reciprocal changes can be seen in II, III, and aVF

27) An anterior MI is usually more massive than an inferior MI because the LAD is the largest coronary artery, and a blockage usually results in a massive infarct. a) True b) False

Medical: 2 12 Lead Interpretation: 2.1

28) The EKG tracing shown above is indicative of which of the following? a) Inferior MI b) Septal MI c) Anterior MI d) Posterior MI

29) The EKG tracing above is indicative of which of the following? a) Right bundle branch block b) Left bundle branch block c) Hyperkalemia d) Septal MI

Medical: 2 12 Lead Interpretation: 2.1

30) The EKG tracing above is indicative of which of the following? a) Inferior MI b) Anterior MI c) Anteroseptal MI d) Septal MI

Medical: 2 Cardiology: 2 Mechanical Circulatory Devices: 2.2.2

Mechanical Circulatory Devices Module Quiz

1) Coronary blood flow increases during systole. a) True b) False

2) ______is the amount of blood pumped out of the left ventricle during each cycle. a) Preload b) Afterload c) Ejection fraction d) Cardiac output

3) Which of the following equations is true regarding cardiac output? a) Cardiac output = End diastolic pressure – systolic pressure b) Cardiac output = Stroke volume x heart rate c) Cardiac output = (Stroke volume x heart rate) / Body surface area d) Cardiac output = Systemic vascular resistance – peripheral vascular resistance

4) The primary benefit of the IABP is that it corrects a supply versus demand mismatch in the heart. a) True b) False

5) Your patient has an IABP. Which of the following statements is true? a) You would expect that this patient would have a decreased coronary blood flow because of the IABP b) Renal blood flow is reduced in patients with an IABP c) The IABP will decrease this patient’s afterload d) The IABP will increase this patient’s heart rate

Medical: 2 Cardiology: 2 Mechanical Circulatory Devices: 2.2.2 6) Which of the following indicates proper positioning of the IABP after insertion? a) It should be placed 1 – 2 cm below the subclavian artery b) It should be placed 1 – 2 cm above the subclavian artery c) It should be placed 1 – 2 cm below the mesenteric artery d) It should be placed 1 – 2 cm above the mesenteric artery

7) Which of the following patients would be a candidate for an IABP? a) A patient with a congenital heart defect b) A patient with unstable angina c) A patient who is in hemorrhagic shock following a motor vehicle accident d) A patient who has a history of SVT

8) Which of the following represents an absolute contraindication for the IABP? a) Cardiogenic shock refractory to pressors b) Cardiac tamponade c) Patients less than the age of 18 d) Severe aortic valve insufficiency

9) You observe what appears to be rust in the IABP tubing. Which of the following should you suspect? a) Mechanical problems with the machine b) Blood in the tubing c) Infiltration of helium into the balloon d) Use of an expired tubing set

10) If the machine fails and the balloon becomes immobile, it must be inflated by hand every _____ minutes. a) 1-5 b) 3-5 c) 5-10 d) 10-15

Medical: 2 Cardiology: 2 Mechanical Circulatory Devices: 2.2.2 11) How much air or helium should be in the syringe that is used to manually inflate the IABP balloon in the event of failure? a) 1 b) 10 c) 60 d) 100

12) Which of the following is the EKG trigger used to determine IABP inflation? a) Diastolic notch b) QRS complex c) The “P” wave d) R wave

13) Which of the following patients would be a candidate for ECMO? a) A patient with advanced multiple organ failure b) A patient waiting for cardiac surgery that has very low cardiac output with end-organ damage c) A patient in septic shock who is unresponsive to other treatments d) A patient who is in severe metabolic acidosis with low cardiac output

14) In ECMO patients, there should be hourly assessments of neurovascular status in cannulated limbs and hourly assessment of urine output. a) True b) False

15) Which of the following statements best describe the purpose of a ventricular assist device? a) It is designed to replace all functions of the heart b) It must be used in conjunction with a pacemaker c) It only assists the right ventricle d) It decreases the workload of the heart while maintaining adequate flow and blood pressure

Medical: 2 Cardiology: 2 Mechanical Circulatory Devices: 2.2.2 16) You are transporting a patient with a VAD. As you are auscultating heart tones, you note that the VAD is making a knocking sound. Which of the following should you suspect? a) The pump has failed in the VAD b) The patient is hypotensive or the VAD is in overdrive (suckdown) c) The patient’s VAD is having electrical inference with something nearby d) The VAD has a valve that is sticking

17) A patient with a VAD can be in a lethal arrhythmia and still be hemodynamically stable. a) True b) False

18) The loss of peripheral pulses in a patient with a VAD always signifies shock or cardiac arrest. a) True b) False

19) Which of the following is first-line treatment in an unstable VAD patient? a) Increase the VAD’s speed b) Externally pace the patient c) Attempt volume resuscitation d) Begin external chest compressions

Medical: 2 Cardiology: 2

Cardiology Module Quiz

1) Your patient is having a massive inferior wall MI. Which of the following vessels is most likely occluded? a) Right coronary artery b) Left coronary artery c) Coronary sinus d) Circumflex artery

2) Your patient is in cardiogenic shock, and you suspect this patient is having an infarct in their left ventricle (“Widow maker”). Which of the following vessels is most likely occluded? a) Right coronary artery b) Left coronary artery c) Coronary sinus d) Circumflex artery

3) If left without input, a single cardiac cell will contract rhythmically at a steady rate. If two cells are in contact, the first one to contract will in turn stimulate the other to contract. This is an example of which of the following cardiac cell characteristics? a) Conductivity b) Excitability c) Automaticity d) Contractility

4) During systole, sodium and calcium move out of the cells. a) True b) False

Medical: 2 Cardiology: 2 6) ______is the amount of blood ejected from the ventricles with each contraction a) Cardiac output b) Stroke volume c) Preload d) Afterload

7) Your patient has a blood pressure of 160/80. What is this patient’s mean arterial pressure (MAP)? a) 86 b) 96 c) 106 d) 116

8) You are treating a patient complaining of severe chest pain that is made worse when the patient lies flat, and is relieved when the patient leans forward. Which of the following would you most likely suspect? a) Unstable angina b) Myocardial infarction c) Prizmetal’s angina d) Pericarditis

9) An abdominal aortic aneurysm typically occurs between the renal and inferior mesenteric arteries. a) True b) False

Medical: 2 Cardiology: 2

10) Which of the following statements is true regarding non-bacterial thrombotic endocarditis (NBTE)? a) The main risk for serious morbidity or mortality is from septic shock b) The main risk for serious morbidity or mortality is from a clot breaking lose and going to the heart or brain c) The main risk for serious morbidity or mortality is permanent damage to the myocardium (loss of stretch fibers) d) The main risk for serious morbidity or mortality is the infection traveling to the brain

11) You are treating a 55-year-old male IV drug user and alcoholic. The patient is having excruciating pain in his back, abdominal rigidity, and has a blood pressure of 52/p. Which of the following do you suspect? a) Gastric rupture b) Lower esophageal varice rupture c) Cardiogenic shock secondary to endocarditis d) Abdominal aortic aneurysm rupture

12) You are transporting a 78-year-old female who just received a diagnostic heart cath (a major blockage was found). The patient is now being transported to a larger facility for open heart surgery. During transport, the patient has sudden onset of chest pain, severe back pain that progress down to her flank, and is extremely diaphoretic. She tells that it feels like something “just tore inside of me”. You are seeing signs of ischemia in several leads on the 12 lead. Which of the following do you most likely suspect? a) She is having an aortic dissection caused by the procedure b) During the cath, a piece of plaque broke free and is blocking one of her coronary arteries c) She is in pericarditis, caused by the heart cath d) She is having a massive MI from the stress of the procedure and the stress of the transport

Medical: 2 Cardiology: 2 13) You are transporting a patient with an AAA, and you fear that he might dissect his aorta. Which of the following below best represents target heart and target blood pressure for this patient? a) Target heart rate between 60 - 80, and systolic blood pressure between 80 – 100 mmHg b) Target heart rate between 100 – 120, and systolic blood pressure between 60 – 80 mmHg c) Target heart rate between 60 – 80, and systolic blood pressure between 100 – 120 mmHg d) Target heart rate between 100 – 120, and systolic blood pressure between 100 – 120 mmHg

14) Which of the following medications is typically NOT given to a patient with a suspected aortic dissection? a) Labetolol b) Fentanyl c) Nicardipine d) Atropine

15) Hypertensive urgency occurs when organ damage occurs as a result of hypertension. a) True b) False

16) Mean arterial pressure should not be lowered more than ___% in the first hour of treatment for patients with hypertensive emergency. a) 10 b) 20 c) 30 d) 40

Medical: 2 Cardiology: 2 17) Which of the following is most likely to occur with a rapid reduction of blood pressure in hypertensive emergency? a) Watershed stroke b) Liver damage c) Congestive heart failure d) Acute respiratory distress syndrome

18) An EKG is diagnostic for angina, and can help to differentiate the presence of absence of the disease. a) True b) False

19) A non-ST elevation MI typically indicates partial obstruction of the coronary artery a) True b) False

20) An MI can often present as general malaise and weakness in the elderly without specific cardiac signs and symptoms. a) True b) False

21) All patients who have had an MI will develop a “Q” wave. a) True b) False

22) Which of the following regarding CK-MB is true? a) It is more specific for cardiac injury than troponin b) It may also be elevated in skeletal injuries c) It typically shows up immediately upon infarct, and then subsides about 4 hours later d) It is the preferred biochemical marker for an MI

Medical: 2 Cardiology: 2 23) Which of the following regarding troponin is true? a) Even slight elevations are indicative of some degree of damage to the heart b) Troponin will be immediately elevated after an infarct c) Troponin does not need to be retested after the initial test d) CK-MB is more specific for cardiac injury than troponin

24) High flow oxygen is indicated in all patients with a suspected MI. a) True b) False

25) Which of the following is true regarding cardiogenic shock? a) It typically does not occur until at least 75% of the heart is damaged b) Most patients will not require intubation and mechanical ventilation c) Mean arterial pressure should be kept below 50 to minimize cardiac workload d) Pacing may be required to maintain an adequate rate

Medical: 2 Renal and Urology: 3

Renal and Urology Module Quiz

1) Which of the following best describes the goal of urine production? a) Maintain regulation of the volume and composition of blood b) Eliminate phosphate c) Eliminated excess fluid from the body d) Assist with acid-base balance

2) Which of the following is the definition of glomerular filtration rate (GFR)? a) It is the amount of urine produced by the kidneys every minute b) It is the amount of filtrate produced by the kidneys each minute c) It is the rate in minutes at which the kidneys filter one liter of blood d) It is the rate at which it takes the kidneys to create one liter of urine

3) Creatinine is produced by the muscles can be used as an indicator of renal insufficiency. a) True b) False

4) You are treating a patient with renal failure; you would expect to see a decrease in creatinine. a) True b) False

5) BUN is a measurement of urea nitrogen in the blood, and measures the metabolism of proteins in the liver and the removal by the kidneys. a) True b) False

Medical: 2 Renal and Urology: 3 6) Which of the following regarding BUN is true? a) Greatly decreased BUN indicates moderate-to-severe renal failure b) Low BUN can be seen in patients with liver problems, malnutrition, and a history of alcoholism c) Liver failure is the most common cause of elevated BUN d) BUN does not have a correlation with GFR

7) As ventilations increase, you would expect to see a resultant decrease in pH. a) True b) False

8) Immediately after kidney injury, the only sign may be decreased urinary output. a) True b) False

9) Which of the following is NOT one of the three types of acute renal failure? a) Prerenal b) Postrenal c) Intrinsic d) Extrinsic

10) This type of acute renal failure results from decreased blood flow to the kidneys, and is the most common form of kidney injury. a) Prerenal b) Postrenal c) Intrinsic d) Extrinsic

11) Your patient has a significant history of kidney stones. This patient would be at most risk for which of the following? a) Prerenal b) Postrenal c) Intrinsic d) Extrinsic 2 ©2016 University of Maryland, Baltimore County

Medical: 2 Renal and Urology: 3

12) You are transporting a patient with an acute kidney injury. Which of the following should you be very suspicious? a) Ventricular tachycardia b) Heart blocks due to hypocalcemia c) Signs of hyperkalemia d) Sinus arrest

13) Patients with renal failure may become hypoglycemia because insulin is renally cleared. a) True b) False

14) Which of the following is the most important concern for a patient with rhabdomyolysis? a) Permanent muscle damage b) Hypokalemia from potassium rushing into the cells c) Blockage of the tubules and kidney failure d) The release of blood into muscle tissue

15) Which of the following electrolyte disturbances is the most immediate life threat in the hours following rhabdomyolysis? a) Hypokalemia b) Hyperkalemia c) Hyperglycemia d) Hypercalcemia

16) Which of the following is an acceptable treatment for rhabdomyolysis? a) Aggressive fluid rehydration b) Supplemental potassium infusion c) Permissive dehydration to prevent pulmonary edema d) Withholding pain management until electrolytes are stabilized

Medical: 2 Renal and Urology: 3 17) Altered mental status from a urinary tract infection is more common in which of the following patients? a) Neonates b) Pediatrics c) Adults d) Elderly

18) Pain management is one of the most important treatments for patients with kidney stones. a) True b) False

19) The signs and symptoms of which of the following mimic that of a kidney stone? a) Rupture appendix b) Leaking aneurysm c) Ectopic pregnancy d) Urinary tract infection

20) Urethral trauma is a contraindication to the administration of a Foley catheter. a) True b) False

Medical: 2 Gastrointestinal: 4

Gastrointestinal Module Quiz

1) Which of the following describes ischemic abdominal pain? a) Pain is often gradual in onset b) Patients will be very fidgety and will not want to sit still c) Pain is frequently controlled with analgesics d) It is most often caused by strangulated bowel

2) In which of the following patients is extreme abdominal palpation contraindicated? a) A patient with a suspected ruptured appendix b) A patient with a suspected aortic aneurysm c) A patient with rebound tenderness d) A patient with suspected gastritis

3) You are treating a patient with an upper GI bleed with significant bleeding. After giving ____ liters of a crystalloid, you should consider switching to FFP or whole blood. a) 1 b) 2 c) 3 d) 4

4) Cullen’s sign is bruising around the flanks and can be indicative of pancreatitis. a) True b) False

Medical: 2 Gastrointestinal: 4 5) Which of the follow medications is the primary offender in drug-related hepatoxicity? a) NSAIDS b) Acetaminophen c) Antibiotics d) Antidepressants

6) Appendicitis pain will frequently migrate from the periumbilical area to which of the following? a) Left upper quadrant b) Left lower quadrant c) Right upper quadrant d) Right lower quadrant

7) Which of the following is NOT typical treatment of a patient with an AAA? a) Establish two large-bore intravenous catheters b) Insert an NG tube c) Insert a Foley catheter d) Give a two liter crystalloid bolus in preparation for rupture

8) Which of the following is a contraindication to gastric lavage? a) Ingestion of a strong alkali b) GI bleed c) Intentional drug overdose d) Gastric distention

Medical: 2 Gastrointestinal: 4

9) Which of the following are two types of long-term feeding tubes? a) PEG, PET b) PEJ, e-wall, c) PEG, PEJ d) PEG, NG

10) You are treating an 8-year-old with a PEG tube. The PEG tube has come out. The tube must be reinstated within ____ hours or new surgery may be required. a) 8 b) 12 c) 24 d) 36

Medical: 2 Neurology: 5

Neurology Module Quiz

1) Which of the following is the middle meninge? a) Pia mater b) Dura mater c) Arachnoid membrane d) Cerebellar membrane

2) Which portion of the brain is primarily responsible for temperature control? a) Midbrain b) Hypothalamus c) Thalamus d) Temporal lobe

3) Which of the following represents the correct formula for determining cerebral perfusion pressure (CPP)? a) CPP = MAP + ICP b) CPP = (MAP – ICP) / 2 c) CPP = MAP – ICP d) CPP = ICP + SBP

4) Your patient has a core body temperature of 39°C. Which of the following would you expect of this patient’s cerebral blood flow (CBF)? a) His CBF would be increased b) His CBF would be decreased c) His CBF would be normal d) Temperature does not influence CBF

Medical: 2 Neurology: 5 5) Which of the following is the hallmark symptom associated with a vertebra- basilar artery occlusion/rupture? a) Facial droop b) Vertigo c) Severe headache d) Blindness

6) You are treating a 14-year-old female with a head injury. Your patient’s ICP is 12 mmHg. Which of the following statements about this patient is true? a) Her ICP is very flow, and her MAP should be increased b) Her ICP is very high, and there is a potential for her to herniate c) Her ICP is within normal range d) You must know her MAP to know if this ICP is normal

7) Your patient has a serious injury and is being transported by ground to a trauma center one hour away. During the transport, how often should you reassess the patient’s GCS? a) Every 5 minutes b) Every 10 minutes c) Every 15 minutes d) Every 60 minutes

8) Which of the following correctly describes contents within the cranium? a) 80% blood, 10% brain, 10% CSF b) 80% brain, 10% water, 10% CSF c) 80% CSF, 10% water, 10% brain d) 80% brain, 10% blood, 10% CSF

Medical: 2 Neurology: 5 9) You are providing bag mask ventilations for a 7-year-old with a severe head injury. Which of the following ventilation rates (per minute) would be appropriate for this patient? a) 10 b) 20 c) 30 d) 40

10) Which of the following is the only clinical indication in ICP management for hyperventilating a head-injured patient? a) You suspect brainstem herniation b) Decrease in GCS from 9 to 7 c) Patient begins to have decorticate posturing d) The patient’s MAP is above 120 mmHg

11) Which of the following end tidal CO2 ranges is acceptable for an adult with a severe head injury? a) 10 – 20 mmHg b) 20 – 25 mmHg c) 30 – 35 mmHg d) 45 – 55 mmHg

12) A subdural hematoma typically results from arterial bleeding, while an epidural hematoma typically results from venous bleeding. a) True b) False

Medical: 2 Neurology: 5 13) To meet the definition of a transient ischemic attack, the symptoms must resolve within ____ hours. a) 8 b) 12 c) 24 d) 48

14) For a patient to be eligible for thrombolytics with an ischemic stroke, most protocols require that the drug be given within ____ hour(s) of onset. a) 1 b) 2 c) 3 d) 12

15) Your patient has suffered a spinal cord injury at C5. Which of the following is true? a) This patient will most likely present in respiratory arrest b) This patient may have diaphragmatic breathing, but will not have use of intercostal muscles c) This patient will most likely be paraplegic d) This patient will have intact bicep and tricep muscles

16) You are treating a gunshot wound patient with a suspected spinal cord injury. The patient has ipsilateral motor loss and contralateral loss of pain and temperature. Which of the following spinal cord injuries has this patient most likely experienced? a) Incomplete spinal cord injury b) Anterior cord syndrome c) Central cord syndrome d) Brown-Sequard

Medical: 2 Neurology: 5

17) Which of the following signs and symptoms should raise your suspicion of the potential for neurogenic shock? a) Tachycardia with hypotension b) Bradycardia with hypotension c) Cool, moist skin d) Increased urinary output with tachycardia

18) Which of the following intracranial pressure monitors is most frequently used? a) Fiberoptic transducer tipped probe b) Epidural catheter c) Intraventricular catheter d) Subarachnoid screw or bolt

19) Which of the following is an advantage of the intraventricular catheter? a) CSF can be drained from the catheter reducing ICP b) There is less risk of infection then with a subarachnoid screw or bolt c) It is easy to place d) The IVC has less risk of clot formation that any other ICP monitor

20) Which of the following represents normal ICP values? a) 0 – 5 mmHg b) 5 – 15 mmHg c) 15 – 25 mmHg d) 25 – 35 mmHg

Medical: 2 Neurology: 5

21) Intraparenchymal monitoring devices are able to allow for CSF drainage. a) True b) False

22) Which of the following is an advantage to the subarachnoid screw or bolt? a) It allows for drainage of CSF b) It is more accurate for monitoring pressure c) It does not require a closed, intact skull d) It typically is easier to place than an IVC

23) Which of the following are typically used when the ventricles are very small, collapsed, or shifted? a) Fiberoptic transducer tipped probe b) Epidural catheter c) Intraventricular catheter d) Subarachnoid screw or bolt

Medical: 2 Endocrinology: 6

Endocrinology Module Quiz

1. Which of the following is referred to as the “master” gland of the endocrine system because it controls the function of all other endocrine glands? a. Hypothalamus b. Pituitary gland c. Thyroid gland d. Adrenal glands

2. Which of the following diseases is caused when the pituitary gland make too much ACTH which in turn stimulate the adrenal glands to produce cortisol? a. Addison’s disease b. Pheochromocytoma c. Adrenal hyperstimulation disease d. Cushing’ disease

3. You are transporting a patient with pheochromocytoma. Which of the following are most often secreted from the tumorous gland? a. Insulin and glucagon b. Epinephrine and dopamine c. Epinephrine and norepinephrine d. Dopamine and insulin

Medical: 2 Endocrinology: 6 4. Which of the following are the two most dangerous untoward effects of pheochromocytoma? a. Severe hypertension and life-threatening cardiac arrhythmias b. Severe hypotension and bradycardia c. Pulmonary edema and kidney failure d. Hypoglycemia and seizures

5. You are transporting a patient three hours by fixed wing for treatment of pheochromocytoma. During flight, you suspect that your patient is having a pheochromocytoma spell. Which of the following treatments is indicated? a. Administer atropine 0.5 mg to prevent bradycardia that accompanies the spell b. Be prepared to give a fluid bolus and administer dopamine to counteract hypotension c. Begin administration of D50 to counteract hypoglycemia d. Collect urine for analysis and keep the specimen dark and cold

6. Type II diabetes mellitus used to be known as juvenile onset diabetes. a. True b. False

7. Which of the following statement is true regarding mortality of children aged 1 – 4 years with Type 1 DM? a. Deaths are usually the result of acute hypoglycemia b. Deaths are usually the result of progressive organ failure from chronic hyperglycemia c. Deaths are usually the result of DKA and subsequent shock d. Deaths usually occur during sleep and are unexplained

Medical: 2 Endocrinology: 6

8. Hyperglycemia is clinically defined as a blood glucose level > ____ mg/dl. a. 150 b. 200 c. 250 d. 300 9. Using the dextrose “Rule of 50”, you are to administer dextrose to a toddler. Which of the following is correct dosing? a. 5 mg/kg of D10 b. 2 mg/kg of D25 c. 2 mg/kg of D25 d. 1 mg/kg of D50

10. You are treating a patient who had a blood sugar of 21 mg/dl. You know that it may take up to ___ minutes for the patient’s blood glucose levels to return to baseline. a. 15 b. 30 c. 45 d. 60

11. Patients with Type II diabetes mellitus will require insulin for the rest of their life. a. True b. False

Medical: 2 Endocrinology: 6 12. With of the following statements regarding DKA is true? a. To meet the definition, the blood sugar has to be above 350 mg/dl b. Most DKA patients will not have electrolyte disturbances because of compensatory mechanisms c. DKA results from excess insulin produced by a damaged or failing pancreas d. A DKA patient will be acidotic, with a pH < 7.3

13. Most patients in DKA will be hyperkalemic. a. True b. False

14. Which of the following is the most important cause of morbidity and mortality in DKA patients that must be aggressively prevented? a. Renal failure b. Cerebral edema c. Acidemia d. Sepsis

15. The use of an insulin bolus is controversial in the management of DKA. Which of the following best describes the controversy surrounding this treatment? a. Insulin often lowers the blood sugar too quickly causing profound hypoglycemia b. Insulin will cause rebound hypoglycemia c. Insulin can worsen the hypokalemia that is frequently seen in DKA d. Insulin can worsen cerebral edema

Medical: 2 Endocrinology: 6 16. You are treating a patient with hyperosmolar hyperglycemia state (HHS). You would expect that this patient’s blood sugar would be in excess of 600 mg/dl and their pH would be < 7.3. a. True b. False

17. Patient in a thyroid storm will often present profoundly hypothermic. a. True b. False

18. Myxedema coma is true life-threatening cardiovascular and metabolic emergency. a. True b. False

19. Patients with myxedema coma can present bradycardia, hypotensive, and in profound shock. a. True b. False

20. Diabetes insipidus is often called the “water diabetes” and results in abnormal urine output, fluid intake, and thirst. a. True b. False

Medical: 2 Hematology & Oncology: 7

Hematology & Oncology Module Quiz

1. ______contain hemoglobin and have the ability to carry oxygen. a. Leukocytes b. Erythrocytes c. Granulocyte d. Lymphocytes

2. Which of the following statements is true regarding fibrinolysis? a. Fibrinolysis is the ability to prevent platelet aggregation in the blood b. Fibrinolysis is the dissolution of clots as vascular injury is repaired c. Fibrinolysis causes a series of steps that ultimately leads to a clot at the site of injury d. Fibrinolysis is measured by the partial thromboplastin time (PTT)

3. You would expect to see an increased bleeding time in a patient with disseminated intravascular coagulation (DIC). a. True b. False

4. Your patient is in acute septic shock. You would expect her platelet count to be elevated. a. True b. False

Medical: 2 Hematology & Oncology: 7 5. The international normalized ratio (INR) is used to test patient response to which of the following? a. Aspirin b. Heparin c. Coumadin d. NSAIDs

6. The partial thromboplastin time (PTT) is used to test patient response to which of the following? a. Aspirin b. Heparin c. Coumadin d. NSAIDs

7. Which of the following is the reversal agent (antidote) for a heparin overdose? a. Vitamin K b. Edrophonium hydrochloride c. Flumazenil d. Protamine sulfate

8. Fresh frozen plasma would be the best product for which of the following? a. A patient who is on warfarin and actively bleeding, or requiring emergent surgery b. A patient with hemophilia A c. A patient with thrombocytopenia d. A patient in hemorrhagic shock

Medical: 2 Hematology & Oncology: 7 9. Fresh frozen plasma contains platelets. a. True b. False

10. Cryoprecipitate requires ABO matching before administration for all patients. a. True b. False

11. Which of the following is typically administered to a patient with an acute sickle cell crisis? a. Whole blood b. Packed red blood cells c. Platelets d. Cryoprecipitate

12. Disseminated intravascular coagulation is a life-threatening combination of clotting at the microscopic level, and free bleeding at the systemic level. a. True b. False

13. Your patient is in DIC. You would expect the platelet count to be low. a. True b. False

Medical: 2 Hematology & Oncology: 7 14. Treatment for DIC can vary between giving blood components or low- dose IV heparin. Which of the following statements is true regarding DIC treatment? a. All patients in DIC should be given concurrent whole blood to replace lost blood and heparin to prevent clotting b. Patients in DIC will all be given platelets and cryoprecipitate c. The decision to give either blood components or heparin depends on whether bleeding predominates, or fibrin deposits predominates d. Patients in DIC are rarely given heparin because this will just accelerate free bleeding

15. Which of the following is the most common genetic bleeding disorder? a. Hemophilia A b. Hemophilia B c. Sickle cell d. von Willebrand’s disease

Medical: 2 Infectious Disease: 8

Infectious Disease Module Quiz

1) HIV is an extremely resilient virus and can live outside of the body for weeks to months depending on the ambient temperature. a) True b) False

2) Patients can stay in the latency stage of HIV for > 20 years. a) True b) False

3) Which of the following is true about hepatitis B? a) It is transmitted by the fecal-oral route b) If the patient is infected as a newborn, they may be asymptomatic for decades c) It is an extremely fragile virus and cannot live more than a few minutes outside of the body d) There is little evidence to suggest that HBV is transmitted by needlesticks

4) You have just completed the three-shot immunization series for HBV. A titer must be performed within __-__ months after completion of the series. After this time, the antibodies may fall to undetectable levels. a) 1 – 2 b) 3 – 4 c) 6 – 12 d) 12 – 18

5) Most of the patients with hepatitis C and hepatitis D will be asymptomatic. a) True b) False

Medical: 2 Infectious Disease: 8 6) Which of the following is transmitted by the same route as hepatitis A? a) Hepatitis B b) Hepatitis C c) Hepatitis D d) Hepatitis E

7) Which of the following is the reason why MRSA is considered a “super bug”? a) It spreads much quicker than many other types of bacteria b) It is much more lethal than other types of bacteria because it attacks the brain c) It is tougher to treat because it resistant to commonly used antibiotics d) It is untreatable

8) MRSA is spread by contact (both direct and indirect contact). a) True b) False

9) A healthcare provider has a latent tuberculosis infection. Which of the following is true about this person? a) They will usually have a normal chest x-ray, but will have a positive TB skin test b) They will usually have an abnormal chest x-ray, but will have a negative TB skin test c) They will usually have a normal chest x-ray, and a negative TB skin test d) There is no way to determine, as a latent tuberculosis infection presents differently in each person

10) All providers must be fit tested prior to using a HEPA filter or N95 mask. a) True b) False

11) Bacterial meningitis is much more prevalent than viral meningitis. a) True b) False

Medical: 2 Infectious Disease: 8

12) Which of the following statements about meningitis is true? a) The classical triad of meningitis consists of nuchal rigidity, photophobia, and headache. b) Viral meningitis is much more contagious than bacterial meningitis. c) The younger the child, the more likely they are to exhibit the signs and symptoms of meningitis. d) Positive Kernig signs and positive Brudzinski signs are very sensitive for diagnosis of meningitis.

13) You have just transported a patient with varicella zoster (chicken pox). You believe that you were exposed. How long is the standard average from time of exposure before the infection develops? a) 24 hours b) 7 days c) 14 days d) 21 days

14) You have transported a patient with bacterial meningitis. Which of the following is true regarding the transmission and post-exposure treatment of bacterial meningitis? a) All patients with meningitis should be respiratory isolation for the duration of the infection b) Anyone with face-to-face contact with an infected person should have post- exposure prophylaxis c) There is no vaccination to prevent transmission of meningitis d) All providers who transport a meningitis patient should be quarantined for at least 48 hours

Medical: 2 Infectious Disease: 8 15) What is the OSHA standard that regulates healthcare provider exposures to communicable diseases? a) OSHA 29 CFR 1030.1910 b) OSHA 29 CFR 1910.1030 c) OSHA 49 CFR 1910.1030 d) OSHA FAR Part 135

Airway: 3 Advanced Airway: 1

Advanced Airway Module Quiz

1. What does the “A” in the mnemonic MOANS stand for? a. Airway b. Apnea c. Age d. Amidate

2. A nasogastric or orogastric tube should be inserted on all patients who have received bag valve mask ventilation and require continued mechanical ventilation. a. True b. False

3. A laryngeal mask airway (LMA) will prevent regurgitation and aspiration of gastric contents if it is placed correctly. a. True b. False

4. Which of the following statements regarding the CombiTube™ is true? a. 80% of the time the tube will be placed in the trachea b. It must be placed under direct visualization c. Studies have shown that ventilation performance is equivalent to endotracheal intubation d. Successful placement rates are very low (less than 50%)

Airway: 3 Advanced Airway: 1 5. The King LT™ airway is not designed to be used with high pressure

ventilation (> 30 cmH20). a. True b. False

6. Which of the following patients would be a candidate for a bougie-assisted intubation? a. A patient with a grade 3 view of the glottis in which the intubator feels that there might be poor view of the trachea b. A patient with a predicted grade 4 view of the glottis in which the intubator is unsure of the tracheal location c. A patient with a suspected trachea-esophageal fistula d. A patient with a suspected transection of the trachea

7. You are passing a bougie into the trachea to facilitate intubation when you were unable to visualize the cords. Which of the following is true regarding the use of the bougie? a. Proper placement of the bougie is confirmed when you see a “glow” emanating from the trachea b. Proper placement of the bouge is confirmed when you feel the bougie bump the carina c. Proper placement of the bougie is confirmed when you feel a “clicking” sensation as the bougie contacts the tracheal rings d. Proper placement of the bougie is confirmed when you are able to pass the endotracheal tube alongside the bougie

8. With proper equipment, a needle cricothyrotomy achieves ventilation, but not oxygenation. a. True b. False

Airway: 3 Advanced Airway: 1

9. What does the “H” stand for in the SHORT mnemonic used for surgical airway contraindications? a. Hyperventilation b. Hematoma c. Hypoxia d. Hypercapnia

10. Your partner has just placed an esophageal detector device (EDD) on the endotracheal tube. The device slowly inflates. Which of the following is true? a. Slow inflation only occurs if the patient was not adequately ventilated prior to use of the EDD b. Slow inflation indicates correct placement of the endotracheal tube into the tracheal c. Slow inflation typically indicates placement of the endotracheal tube in the esophagus d. Slow inflation indicates that the EDD is not properly working and should be replaced

11. Continuous waveform capnography will immediately detect accidental extubation or disconnection from the ventilator. a. True b. False

12. You suspect that your patient has methemoglobinemia. This will decrease the accuracy of pulse oximetry readings. a. True b. False

Airway: 3 Advanced Airway: 1 13. You are preparing to intubate a patient in the operating suite for annual skills check-offs. The anesthesiologist instructs you to perform a “nitrogen washout”. Which of the following best describes this procedure? a. You will administration nitroglycerin to the patient as long as their SBP is > 100 mmHg b. You will begin to push etomidate slowly followed by succinylcholine c. You will preoxygenate the patient to remove carbon dioxide d. You will give the patient a fluid bolus of 1 liter of normal saline or Ringers lactate to washout nitrogen in their blood

14. All patients should receive bag mask ventilation with 100% oxygen prior to attempting RSI. a. True b. False

15. You are preparing to intubate your patient and your partner tells you that he thinks that this patient will be a Grade IV on the Cormack-Lehane. Which of the following would be true regarding your partner’s statement? a. A Grade IV Cormack-Lehane indicates a predicted easy intubation b. A Grade IV Cormack-Lehane indicates that only a portion of the vocal cords can be viewed under direct laryngoscopy c. A Grade IV Cormack-Lehane indicates that no portion of the vocal cords can be viewed under direct laryngoscopy and this will be a very difficult intubation d. There is no such thing as a Grade IV Cormack-Lehane. He has this confused with the Mallampati grading system

Airway: 3 Advanced Airway: 1 16. What is the minimum number of vital capacity breaths your patient must take while on 100% oxygen in order to effectively preoxygenate prior to RSI? a. 6 b. 8 c. 10 d. 12

17. Which of the following is a reason why lidocaine could be administered as a pretreatment drug before RSI? a. Patients who are at risk for increased ICP b. Patients who are receiving etomidate c. To aid in drying increased secretions d. Children under the age of 8

18. Which of the following is the correct dose for lidocaine as a pretreatment drug in RSI? a. 0.3 mg/kg b. 1 mg/kg c. 1.5 mg/kg d. 2 mg/kg

19. You have been ordered by your medical control to administer a defasciculating dose of vecuronium. Which of the following is the correct adult dosage for this drug? a. 0.001 mg/kg b. 0.01 mg/kg c. 0.1 mg/kg d. 1 mg/kg

Airway: 3 Advanced Airway: 1 20. Which of the following statements is true regarding defasciculating agents? a. They should be given to any child under the age of 10, or any patient receiving multiple doses of succinylcholine b. They should be administered immediately after the depolarizing agent to prevent any fasciculations c. They are recommended to be given to any patient who receives a depolarizing paralytic d. They are typically given at 10% of the normal paralyzing dose

21. Which of the following is the correct pediatric and adult dosage of IV etomidate? a. 0.1 mg/kg b. 0.3 mg/kg c. 1.5 – 2 mg/kg d. 3 mg/kg

22. Which of the following is the correct adult dosage of IV succinylcholine? a. 0.1 mg/kg b. 0.5 mg/kg c. 1 - 2 mg/kg d. 3 – 4 mg/kg

23. Attempts at tracheal intubation should be discontinued when the SpO2 falls below ____%. a. 95 b. 90 c. 85 d. 80

Airway: 3 Advanced Airway: 1 24. Which of the following are considered the “gold standard” methods for confirming endotracheal tube placement? a. Positive lung sounds and continuous waveform capnography b. Positive lung sounds and misting in the endotracheal tube c. Direct visualization of the tube passing through the cords and equal lung sounds d. Direct visualization of the tube passing through the cords and continuous waveform capnography

25. You have just intubated your patient and now you are administering a long-term paralytic. Which of the following is the correct adult dosage of vecuronium? a. 0.01 mg/kg b. 0.1 mg/kg c. 1 mg/kg d. 10 mg/kg

Airway: 3 Mechanical Ventilation: 2

Mechanical Ventilation Module Quiz

1. Lung compliance is typically reflected in lower airway pressures. a. True b. False

2. Which of the following is an extrinsic factor that will affect resistance? a. Airway diameter b. Secretions c. Bronchospasms d. Endotracheal tube size and length

3. Which of the following patients would be the MOST appropriate candidate for mechanical ventilation?

a. A patient with a PaO2 of 89 mmHg on 100% oxygen

b. A patient with a PaCO2 of 65 mmHg on 100% oxygen c. A patient with a pH of 7.34

d. A patient with an SpO2 of 90% on room air

4. Your patient is being mechanically ventilated. The patient receives a consistent 14 breaths per minute. This is an example of which of the following? a. Time triggered breath b. Cycle triggered breath c. Patient triggered breath d. Target triggered breath

5. This ventilator mode delivers a preset pressure of gas to the lungs over a given amount of time. a. Volume cycled b. Pressure cycled c. Time cycled d. PEEP

Airway: 3 Mechanical Ventilation: 2

6. When a patient is being ventilated using volume cycled mode, it is very important to monitor which of the following variables? a. Time to deliver the breath b. PEEP c. Plateau pressure d. Tidal volume delivered or exhaled tidal volume

7. When a patient is being ventilated using pressure cycled mode, it is very important to monitor which of the following variables? a. Time to deliver the breath b. PEEP c. Plateau pressure d. Tidal volume delivered or exhaled tidal volume

8. In pressure cycled mode, the tidal volume is set and does not vary breath-to- breath. a. True b. False

9. Which of the following ventilator modes is best suited for long-term ventilatory support? a. Pressure mode b. Volume mode c. BiPAP d. Time-cycled

10. CPAP is a true mode of ventilation because it provides additional pressure during inspiration. a. True b. False

Airway: 3 Mechanical Ventilation: 2

11. NIPPV typically reduces the need for sedation and medication assisted intubations. a. True b. False

12. This ventilation mode delivers a preset volume or pressure at a preset rate. The patient may take additional breaths of any tidal volume without interference from the mandatory breaths. a. Control (Controlled Mandatory Ventilation) b. Assist Control c. Pressure Regulated Volume Controlled (PRVC) d. Synchronized Intermittent Mandatory Ventilation (SIMV)

13. This ventilation mode delivers a preset volume or preset pressure that is delivered at a preset rate. The patient has no active role in the ventilatory cycle and is “locked out” from triggering a breath. a. Control (Controlled Mandatory Ventilation) b. Assist Control c. Pressure Regulated Volume Controlled (PRVC) d. Synchronized Intermittent Mandatory Ventilation (SIMV)

14. This ventilation mode applies a constant pressure throughout inspiration, and the ventilator makes pressure adjustments based on patient airway resistance and respiratory system compliance. a. Control (Controlled Mandatory Ventilation) b. Assist Control c. Pressure Regulated Volume Controlled (PRVC) d. Synchronized Intermittent Mandatory Ventilation (SIMV)

Airway: 3 Mechanical Ventilation: 2

15. This ventilation mode delivers a preset volume or pressure for each patient based on their inspiratory effort. If the patient fails to take a breath, the ventilatory will administer a breath at a preset volume or pressure a. Control (Controlled Mandatory Ventilation) b. Assist Control c. Pressure Regulated Volume Controlled (PRVC) d. Synchronized Intermittent Mandatory Ventilation (SIMV)

16. Which of the following is true regarding Controlled Mandatory Ventilation? a. It is not a failsafe for apneic patients b. Ventilation is not guaranteed c. It cannot be used on spontaneously breathing patients with discomfort d. Patients have an active role in the ventilatory cycle

17. In this ventilator mode, the ventilator can adjust pressure from breath-to-breath in order to deliver a preset tidal volume. (If the delivered volume was too low on the previous breath, the ventilator will increase the pressure for the next breath.) a. Control (Controlled Mandatory Ventilation) b. Assist Control c. Pressure Regulated Volume Controlled (PRVC) d. Synchronized Intermittent Mandatory Ventilation (SIMV)

18. Spontaneous breaths will trigger a ventilator cycle in SIMV mode. a. True b. False

19. Which of the following modes is typically best for patient weaning? a. Control (Controlled Mandatory Ventilation) b. Assist Control c. Pressure Regulated Volume Controlled (PRVC) d. Synchronized Intermittent Mandatory Ventilation (SIMV)

Airway: 3 Mechanical Ventilation: 2

20. You are transporting a patient who is being ventilated with an inverse ratio ventilation (IRV). You would expect for this patient to have decreased cardiac output. a. True b. False

21. You have been asked to place a patient on 70% oxygen concentration. Which of

the following is the correct FiO2? a. 0.07 b. 0.7 c. 7 d. 70

22. Which of the following is typical tidal volume for normal lungs? a. 3 – 5 ml/kg b. 6 – 10 ml/kg c. 10 – 15 ml/kg d. 400 cc

23. Which of the following is typical I:E ratio? a. 1:1 b. 2:1 c. 1:2 d. 1:3

Airway: 3 Mechanical Ventilation: 2

24. You are precepting a new employee and you two are reviewing the ventilator. The new employee asks you the purpose for PEEP. Which of the following is the best answer to give to the new employee? a. PEEP helps to prevent alveolar collapse and increases alveolar gas exchange b. PEEP eliminates dead space and allows for better oxygenation c. PEEP is designed to help keep the airway open and minimize airway swelling d. PEEP decreases FRC allowing for more gas to reach the alveoli

25. Which of the following represents typical initial PEEP settings?

a. 0 cmH2O

b. 5 cmH2O

c. 10 cmH2O

d. 15 cmH2O

26. You are setting the “sigh” function on the ventilator. Which of the following is true regarding this function? a. It is frequently used to prevent atelectasis. b. It is designed to increased alveolar ventilation

c. It is a volume that is 0.5 times the Vt

d. It is a volume that is 1.5 – 2 times the Vt

27. Positive-pressure ventilation can induce hypotension. a. True b. False

Airway: 3 Mechanical Ventilation: 2

28. Which of the following are the three classical signs and symptoms of oxygen toxicity? a. Hypotension, acidosis, and falling oxygen saturations b. V/Q mismatch, diffuse pulmonary infiltrates on CXR, and falling oxygen saturations c. Tachypnea, hypoxia, and hypercarbia d. Hypercarbia, V/Q mismatch, and increased dyspnea

29. Which of the following mnemonics is used to troubleshoot airway problems in an intubated patient? a. POPE b. ROPE c. HOPE d. DOPE

30. You are transporting a patient on the ventilator. You see an alarm indicating “circuit tubing disconnect”. It appears that the circuitry is hooked up appropriately, however the alarm continues. Which of the following is the most appropriate step? a. Increase the PEEP

b. Increase the PIP and ensure that the FiO2 is on 1.0 c. Disconnect patient from the ventilator and manually ventilate d. Ensure the circuitry is connected, and then increase the rate and volume

31. You observe a low pressure alarm on the ventilator. Which of the following would most likely cause this? a. Decreased overall lung compliance b. Patient is disconnected from the ventilator c. Patient holding their breath as the tidal volume is delivered d. Kinked ET tube

Airway: 3 Mechanical Ventilation: 2

32. Which of the following would cause a sudden increased in peak airway pressure in the ventilated patient? a. Tension pneumothorax b. Pulmonary edema c. Atelectasis d. Bronchospasm

33. A displaced ET tube could cause a decrease in peak airway pressures. a. True b. False

34. Tidal volume is fixed in pressure cycled ventilator mode. a. True b. False

Trauma: 4 General Considerations: 1

Trauma Module Quiz

1. Newton’s First Law is best described as which of the following? a. A body at rest or a body in motion will remain in that state until acted upon by an outside force b. The relationship between an object's mass m, its acceleration a, and the applied force F is F = ma c. For every action there is an equal and opposite reaction d. What goes up must come down

2. Which of the following is the highest possible Revised Trauma Score that a patient can achieve? a. 1 b. 2 c. 3 d. 4

3. A negative F.A.S.T. exam successfully rules out the potential for abdominal trauma. a. True b. False

Trauma: 4 General Considerations: 1 4. Which of the following best describes the Le Fort II fracture? a. The maxilla separates from the face b. The palate is separated from the maxilla c. Craniofacial dysjunction is present d. The orbits are free-floating

5. Which of the following treatments are most appropriate for a patient with a Le Fort fracture? a. Insertion of a nasogastric tube to suction blood that is draining into the stomach b. Standard trauma protocol of ABCs and preparation for possible surgical airway c. Nasotracheal intubation because of the predicted difficult airway due to facial fractures d. Mandibular reduction to assist in airway management

6. Patients with neurogenic shock present with hypotension and paradoxical tachycardia due to loss of sympathetic tone. a. True b. False

7. This spinal cord injury is characterized by weakness, which is greater in the upper extremities than the lower extremities, and more pronounced in the distal aspect of the extremities. a. Anterior spinal cord syndrome b. Central spinal cord syndrome c. Brown-Séquard syndrome d. Complete dissection syndrome

Trauma: 4 General Considerations: 1 8. This spinal cord injury involves complete motor paralysis and is caused by compression of the anterior spinal artery. a. Anterior spinal cord syndrome b. Central spinal cord syndrome c. Brown-Séquard syndrome d. Complete dissection syndrome

9. You are transporting a patient with a C2 fracture. Which of the following is your first concern? a. Hypotension requiring aggressive fluid management b. Temperature regulation c. Airway management because of diaphragmatic paralysis d. Administration of high dose steroids to immediately minimize spinal cord swelling

10. Major pelvic fracture hemorrhage is defined as bleeding in excess of _____ ml. a. 500 b. 1,000 c. 2,000 d. 3,000

11. Blood loss of ______ml or greater upon chest tube insertion is an indication for immediate surgical intervention. a. 1,000 b. 1,500 c. 2,000 d. 2,500

Trauma: 4 General Considerations: 1 12. Which of the following statements is true regarding the cause of death of a tension pneumothorax? a. Death is caused by hypoxia / hypercarbia due to the collapsed lung b. Death is caused by trachea shift, in effect “kinking” the airway preventing oxygenation c. Death is caused by compression of the heart decreasing preload and afterload d. Death is caused by respiratory acidosis from a V/Q mismatch

13. A patient may “hide” a tension pneumothorax, and signs and symptoms may not become evident until the patient is receiving positive pressure ventilation. a. True b. False

14. You are treating a patient who has a Swan-Ganz catheter in place. Your patient has a tension pneumothorax. Which of the following values would you expect to see? a. Decreased pulmonary artery pressure and increased cardiac output b. Decreased pulmonary artery pressure and decreased cardiac output c. Increased pulmonary artery pressure and increased cardiac output d. Increased pulmonary artery pressure and decreased cardiac output

Trauma: 4 General Considerations: 1 15. Which of the following represents Beck’s triad? a. Hypertension, bradycardia, irregular respirations b. Hypotension, increased venous pressure, muffled heart sounds c. Tachycardia, muffled heart sounds, hypotension d. Decreased venous pressure, tachycardia, irregular respirations

16. Most patients with aortic injures will have numerous fractures and may present with massive hemorrhage. a. True b. False

17. You are transporting a ventilated patient on pressure control ventilation. Your patient suddenly has a drop in tidal volume. Which of the following should you immediately suspect? a. Cardiac tamponade b. Hemothorax c. Pulmonary contusion d. Tension pneumothorax

18. You are treating a blunt trauma patient who presents in severe dyspnea, severe epigastric pain, and bowel sounds in the chest and up into the shoulder. Which of the following is the most likely diagnosis? a. Diaphragm injury b. Tension gastrothorax c. Hemothorax d. Abdominal rupture

Trauma: 4 General Considerations: 1 19. The clinical diagnosis of rhabdomyolysis is made based on urinary output and creatine kinase. a. True b. False

20. In rhabdomylosis, extracellular contents become intracellular, and intracellular contents become extracellular leading to hyperkalemia. a. True b. False

21. Which of the following is the leading cause of crush injury? a. Motor vehicle accidents b. Industrial accident c. Trench collapse d. Natural disasters including earthquakes

22. After __ hours without perfusion, a limb is considered non-viable. a. 2 b. 4 c. 6 d. 8

Trauma: 4 General Considerations: 1

23. Which of the following is the reason why D50 and insulin is given to a patient with crush injury? a. Most patients will be hypoglycemia, and cells will require insulin to utilize the glucose b. The insulin and glucose helps to activate the sodium/potassium pump, and drive potassium back into the cell c. The insulin and glucose aids anaerobic metabolism until oxygenated blood can be return to the ischemic cells d. The insulin and glucose allows the cells to use oxygen more efficiently

24. You are treating a 58-year old male patient with a severe crush injury. He has a Foley catheter in place. Which of the following is the target urine output for this patient? a. 1 ml/kg per hour b. 2 ml/kg per hour c. 35 ml per hour d. 50 ml per hour

25. You are treating a 14 year-old-male who was helping his grandfather on a farm. The patient has severe GI cramps, diarrhea, tearing of the eye, vomiting, wheezing, and is bradycardic. Which of the following toxic exposures do you suspect? a. Anticholinergic b. Cholinergic, muscarinic c. Cholinergic, nicotinic d. Sympathomimetic

Trauma: 4 General Considerations: 1 26. You are transporting an 8-year-old male who was found unconscious at the bottom of a swimming pool. He was resuscitated on the scene by lifeguards. This patient should be observed in the hospital for a minimum of ____ hours. a. 8 b. 12 c. 24 d. 48

27. CPAP should not be used on near-drowning patients because it will cause further alveolar damage. a. True b. False

Trauma: 4 Burn Care: 2

Burn Care Module Quiz

1. This burn is characterized by blanching of the wound, or mottled cherry red color that does not blanch. a. First degree burn b. Second degree burn c. Third degree burn d. Fourth degree burn

2. When compared to a deep 2nd degree burn, a 3rd degree burn can often be mistaken for unburnt skin. a. True b. False

3. You are treating a 38-year-old female who tried to commit suicide by dousing herself in gasoline and then lighting herself on fire. She is burnt on her head, neck, left arm (circumferential), anterior trunk, and left leg (circumferential). What is her TBSA according to the Rule of Nines? a. 36% b. 45% c. 54% d. 63%

4. The Rule of Palm is not considered accurate for burns greater than ____ TBSA. a. 5% b. 10% c. 15% d. 20%

Trauma: 4 Burn Care: 2

5. Which of the following indicates a normal COHb? a. < 10% b. < 15% c. < 20% d. < 40%

6. Oxygen should be administered to all pregnant patients with suspected carbon monoxide exposure. a. True b. False

7. A nasogastric tube should be placed in all patients with a TBSA greater than ____%. a. 5 b. 10 c. 15 d. 20

8. During the burn response, which of the following is true regarding fluid shift? a. Fluid shifts rapidly from the interstitial space to the intravascular b. Histamines released make the vessels less permeable c. Edema peaks about 1 – 2 hours post-burn d. Fluid shifts rapidly from the intravascular into the interstitial space

9. You are transporting a patient with 70% second degree burns. He was burned approximately five hours earlier. Would you expect for this patient to be hemodiluted or hemoconcentrated? a. This patient would be hemodiluted because of the loss of blood leaking out of the vessels b. This patient would be hemoconcentrated because of the loss of plasma c. There would be no difference in the blood concentration d. There is not enough information to be able to determine 2 ©2011 University of Maryland, Baltimore County

Trauma: 4 Burn Care: 2

10. Oxygen consumption increases up to 150% above normal after a major burn. a. True b. False

11. Burns < ___% TBSA can be cooled with cool water / moist dressings. a. 10 b. 20 c. 30 d. 40

12. Care should be used when administering succinylcholine in patients who are greater than ____ hours post-burn because of the potential for hyperkalemia. a. 24 b. 36 c. 48 d. 72

13. You are treating a 180 pound patient with 55% 2nd and 3rd degree burns. According to the Parkland formula how much fluid should this patient receive in the first eight hours? a. 900 ml b. 9000 ml c. 18,000 ml d. 19,800 ml

14. You are monitoring the urinary output of a 5-year-old child with a severe burn injury. What is the ideal urinary output for this patient? a. 1 cc/kg/hour b. 2 cc/kg/hour c. 4cc/kg/TBSA/hour d. 35 cc/hour

Trauma: 4 Burn Care: 2

15. Which of the following burn patients will typically require greater fluid resuscitation volumes when compared to a standard burn? a. Chemical burn b. Burns in the elderly c. Electrical burns d. Nuclear burns

16. You are on an ambulance transporting a serious burn patient. The driver asks you what you would like the temperature to be set in the ambulance. Which of the following best represents appropriate ambient temperature? a. 25 – 28º C b. 28 – 33º C c. 33 – 38º C d. 38 – 42º C

17. Secondary to airway management, which of the following is the next immediate concern? a. Infection control b. Fluid resuscitation c. Escharotomy d. Pain management

18. Fasciotomies differ from escharotomies in that a fasciotomy only divides burnt tissue and does not divide living tissue. a. True b. False

19. Which of the following is one of the most important treatments in stopping the progression of Stevens Johnson / Toxic Epidermal Necrolysis (SJS/TEN)? a. Rapid administration of high dose steroids to stop the reaction b. Locating the source and immediately stopping it c. Transport to a burn center d. Correcting electrolyte imbalances

Trauma: 4 Burn Care: 2

20. Prompt surgical debridement can significantly increase survival in patients with necrotizing fasciitis. a. True b. False

Medical: 5 High Risk OB: 1

High Risk OB Module Quiz

1. You are treating a patient who is eight months pregnant. Which of the following is true regarding her cardiac output? a. Cardiac output is typically reduced by 20 – 30% as blood is shunted to the placenta b. Cardiac output typically remains the same as pre-pregnancy values c. Cardiac output typically increases 40% and even higher during labor d. Cardiac output typically fluctuates widely depending on the trimester

2. Hypotension develops more readily and more markedly following sympathetic blockage in pregnant patients because vascular tone is more dependent on sympathetic control. a. True b. False

3. Maternal blood glucose is always relatively high (140 – 180 mg/dl) to supply glucose to the growing fetus. a. True b. False

4. Preterm labor is defined as regular uterine contractions prior to Week ___ that are of sufficient frequency and intensity to effect effacement and dilation of the cervix. a. 33 b. 35 c. 37 d. 39

Medical: 5 High Risk OB: 1

5. Which of the following statements is true regarding magnesium sulfate? a. It is given in 4 – 6 mg IV over 20 minutes b. The exact mechanism of action is unknown c. The most dangerous side effect is cardiac arrhythmias d. Should be given mainline, and should never be given IV piggyback

6. Which of the following is the antidote for magnesium sulfate toxicity? a. Naloxone b. Nifedipine c. Calcium chloride d. Calcium gluconate

7. Your patient is a 28-Week gestation, who develops sudden painless, bright red bleeding that occurred without warning. Which of the following do you suspect? a. Uterine inversion b. Uterine irritability c. Placenta abruption d. Placenta previa

8. Your patient has placenta abruption. This patient would typically present with an increased hemoglobin and hematocrit as her body attempts to compensate for the hemorrhage. a. True b. False

9. Which of the following positions would be most appropriate for a patient with a suspected uterine prolapse? a. Place the patient in the knee-chest position b. Place the patient on all fours c. Place the patient in Trendelenburg d. Place the patient in the left lateral recumbent position

Medical: 5 High Risk OB: 1

10. Once a preeclamptic patient has any signs or symptoms, it becomes severe preeclampsia. a. True b. False

11. Eclampsia does not require seizure activity to make the definitive diagnosis. a. True b. False

12. There is a well-defined correlation between progressive blood pressure elevation and predication of eclampsia. a. True b. False

13. You have just delivered a baby, and now you are waiting for the placenta to deliver. This best represents which of the following stages of labor? a. 1st stage b. 2nd stage c. 3rd stage d. 4th stage

14. Which of the following statements regarding PEEP and neonatal resuscitation is correct? a. Initial lung recruitment may require initially high PEEP to expand the lungs b. PEEP should never be used in neonates as it may cause a pneumothorax c. PEEP can be used in neonates, but only after the initial resuscitation phase d. PEEP can be used, but only as a last resort (e.g. during cardiac arrest)

Medical: 5 High Risk OB: 1

15. Which of the following represents a typical respiratory rate for a neonate? a. 20 – 30 breaths per minute b. 30 – 40 breaths per minute c. 40 – 60 breaths per minute d. 60 – 80 breaths per minute

16. Intubation in any 3rd trimester patient should always be considered a difficult airway because of the failure rate of intubation. a. True b. False

17. Pregnancy requires an increased amount of sedation and anesthesia to achieve a therapeutic level. a. True b. False

18. Which of the following is true regarding fluid resuscitation in maternal shock? a. Even if shock is apparent in the mother, fetal outcome is typically good with aggressive resuscitation b. Ringers lactate should be infused at a 4:1 ratio to estimated blood loss c. Blood transfusions are not recommended because of the potential for Rh incompatibility d. Early blood transfusion is preferable to massive crystalloid transfusion

19. What does the “S” in the STABLE mnemonic stable for? a. Surgery b. Stay calm c. Sepsis d. Shock

Medical: 5 High Risk OB: 1

20. Which of the following is the most significant side effect of magnesium sulfate administration? a. Hypotension b. Bradycardia c. Tachyarrythmias d. Respiratory depression

Special Considerations: 5 Pediatrics: 2 Child Abuse: 1

Pediatrics – Child Abuse Module Quiz

1. Repeatedly criticizing a child is a form of psychological abuse. a. True b. False

2. When making the diagnosis of child neglect, it is important to consider the intent of the abuser (i.e. if they intended to harm the child or not). a. True b. False

3. Which of the following is true regarding interviewing a child of suspected abuse? a. Children should always be interviewed with at least one parent present to prevent accusations towards medical providers b. Questions should be short, closed questions to prevent confusion (e.g. “yes” or “no” questions) c. Children should be questioned about all forms of abuse including sexual abuse, domestic violence, and witnessed abuse d. Children should not be questioned by medical providers as this may cause them to become fearful of further questioning

4. Examination of bruises can easily determine the age of the bruise. a. True b. False

Special Considerations: 5 Pediatrics: 2 Child Abuse: 1 5. You are transporting a 2-year-old from a small hospital to a large pediatric ICU. The patient has been diagnosed with a skull fracture. Which of the following is true? a. 95% of children with skull fractures will have serious intracranial injury. b. Skull fractures are typically well tolerated in children because of the small brain and the fontanel’s ability to relieve ICP. c. Epidural hematomas are usually always caused by abuse. d. Child abuse should not be suspected in a child with a skull fracture until all other causes have been ruled out.

6. Which of the following two clinical presentations define “Shaken impact syndrome”? a. Epidural hemorrhage, cervical spine injury b. Epidural hemorrhage, retinal hemorrhage c. Subdural hemorrhage, cervical spine injury d. Subdural hemorrhage, retinal hemorrhage

7. It is not the responsibility of the CCTP to be suspicious of unexplained injuries. This is a responsibility of law enforcement. a. True b. False

8. CCTP documentation of a suspected abused child should provide information about the suspected abuser(s) and rationale for their actions. This is done to assist law enforcement in their investigation. a. True b. False

Special Considerations: 5 Pediatrics: 2 Child Abuse: 1 9. You respond to a 3-year-old that had 20% 2nd burns from hot water in the bathtub. You wrote in your documentation that it was an accidental burn. A week later you heard that the mother is suspected of abusing her child. Which of the following should you do? a. Do not alter your report. If requested by law enforcement, provide a supplemental statement. b. Go back and change your documentation to reflect the new information. c. Attach an addendum to your documentation with the new information. d. Destroy the original report and rewrite a new report.

10. Which of the following physical examination findings is considered to be the hallmark finding of shaken impact syndrome? a. Non-specific bruising b. Bulging head circumference c. Retinal hemorrhage d. Cerebral edema

Special Considerations: 5 Pediatrics: 2

Pediatrics Module Quiz

1. Seventy percent of pediatric critical care transports will require some form of respiratory support. a. True b. False

2. You are transporting a neonate that was 6.8 pounds at birth. One day later, the infant weighs 6.4 pounds. Which of the following statements is true? a. This is normal, as infants will typically lose 5 – 10% of weight immediately after birth b. This is not normal, as an infant should gain weight after birth c. This is a sign of dehydration, and should be treated aggressively d. This infant should be given a fluid bolus of 20 cc/kg and then reweighed

3. You are teaching a pediatric resuscitation class when one of the students asks you the “Rule of thumb” for determining blood pressure. Which of the following is the equation for determining normal systolic blood pressure? a. 70 + (2 x the child’s age in years) b. 80 + (the child’s age in years) c. 90 + (2 x the child’s age in years) d. 90 + (the child’s age in years)

Special Considerations: 5 Pediatrics: 2 4. Children have a higher metabolic rate consume more oxygen than adults. a. True b. False

5. Place the following in order of respiratory distress from least concern to most concerning. a. See-saw respirations → nasal flaring → retractions b. Retractions → mottled skin → tachypnea c. Nasal flaring → retractions → see-saw respirations d. Tachypnea → grunting → nasal flaring

6. Children typically should not drool after the age of ___. a. 1 b. 2 c. 3 d. 4

7. Heart rate, blood pressure, and cardiac auscultation are all key indicators that can help to form an accurate general impression of a child. a. True b. False

8. What three components make up the Pediatric Assessment Triangle? a. Heart rate, blood pressure, capillary refill b. Appearance, work of breathing, circulation c. Work of breathing, heart rate, blood pressure d. Respiratory rate, mental status, capillary refill

Special Considerations: 5 Pediatrics: 2 9. Which of the following represents a critical finding during the pediatric assessment? a. Heart rate of 150 b. Expiratory wheezing c. Nasal flaring d. Vigorous crying

10. Which of the following statements is true regarding pediatric cardiac arrests? a. The progression leading to arrest is much more subtle in children than it is in adults b. The majority of cardiac arrests in children are due to a congenital heart defect c. Children had a very short compensatory phase and a long decompensatory phase prior to cardiac arrest d. Children will typically present in a ventricular arrhythmia, followed by ventricular fibrillation and then cardiac arrest

11. You are treating a 5-year-old patient with severe RSV. Which of the following is a sign of actual respiratory failure (versus potential respiratory failure)? a. Tachypnea b. Hypoxemia as noted on the pulse oximeter c. Altered mental status d. Bradycardia

Special Considerations: 5 Pediatrics: 2 12. You are preparing to RSI a 4-year-old with a severe head injury sustained after ejection from a motor vehicle crash. Your partner asks you for the dose of succinycholine. Which of the following is correct? a. 1 – 1.5 mg/kg b. 2 mg/kg c. 2 – 4 mg/kg d. 150 mg

13. Your partner asks you why your protocol does not have a defasciculating agent for pediatrics, but has one for adults. Which of the following is the most likely the reason? a. Defasciculating agents are not given to children because it will cause an overdose of paralytics once the depolarizing agent is given b. Defasciculating agents are not given to children because they do not have pronounced fasciculations like adults, and it can result in medication error c. Defasciculating agents are not given to children because it can cause chest wall rigidity, preventing bag valve mask ventilation d. Defasiciculating agents are not given to children because nondepolarizing agents have not been proven safe in children

14. You are preparing to intubate a 5-year-old in respiratory failure. Which of the following endotracheal tubes is most likely the correct size for this patient? a. 3 b. 4.4 c. 5.5 d. 6.0

Special Considerations: 5 Pediatrics: 2

15. It is well documented that the pediatric endotracheal tube is at high risk for displacement during patient movement and especially during transport. a. True b. False

16. Which of the following will first detect loss of endotracheal tube patency? a. Heart rate b. Pulse oximetry c. Skin color d. Waveform capnography

17. Which of the following statements regarding mechanical ventilation is true? a. Volume-limited is typically used for larger infants and children, and pressure-limited is typically used for neonates and small infants b. Pressure-limited is typically used for larger infants and children, and volume-limited is typically used for neonates and small infants c. Pressure-limited is typically used for all neonates, infants, and children d. Volume-limited is typically used for all neonates, infants, and children

Special Considerations: 5 Pediatrics: 2 18. You are treating a 3-year-old who presents with rapid onset of fever, respiratory distress, drooling, muffled voice, and stridor. The child appears to be “air hungry” and is near respiratory failure. Which of the following do you suspect? a. Retropharyngeal abscess b. Croup c. Epiglottitis d. Foreign body airway obstruction

19. Which of the following statements regarding croup is true? a. Croup most commonly involves the lower airways including the bronchials b. Inflammation and edema are primarily limited to the lungs c. Croup is a viral respiratory tract infection d. Croup often affects adults more than children, however children are more symptomatic

20. You are looking at the chest x-ray of a 4-year-old with croup. Which of the following is characteristically seen on the x-ray? a. Hamman’s sign b. Thumbprint sign c. Turner’s sign d. Steeple sign

Special Considerations: 5 Pediatrics: 2 21. You have just unsuccessfully attempted to intubate a 4-year-old with epiglottitis. Which of the following statements is correct? a. Immediately attempt a nasotracheal intubation using direct visualization of the cords if necessary b. Immediately attempt a needle cricothyrodotomy c. Attempt bag mask ventilation using long, slow ventilations with two people d. Wait 60 seconds for the swelling to reduce, then reattempt intubation using video assistance

22. Respiratory syncytial virus (RSV) is extremely rare in children, typically affecting less than 1% of children. a. True b. False

23. The primary treatment of RSV is centered on supportive care and ensuring adequate patient hydration. a. True b. False

24. Which of the following is the most important treatment that can be given to a child with bronchiolitis? a. Antipyretics b. Humidified oxygen c. Intravenous rehydration d. Antibiotics

Special Considerations: 5 Pediatrics: 2 25. In utero, blood enters the right atrium, travels through the right ventricle, and then enters the left ventricle through the foramen ovale. This allows for blood to bypass the lungs and the left atria. a. True b. False

26. Acyanotic heart defects result in a left-to-right shunt. a. True b. False

27. You are transporting a two-day-old infant with a ventricular septal defect. Your partner insists on placing the placing the patient on high flow oxygen. You state that this should be avoided unless absolutely necessary. Which of the reasons would justify your answer? a. Oxygen is contraindicated in infants because it can cause injury to the eyes. b. Oxygen can cause a fall in PVR increasing the left-to-right shunt. c. Oxygen is typically not required in these patients, and administration can cause hypocarbia. d. Oxygen is contraindicated because it will fool the brain into not utilizing compensatory mechanisms to prevent shock.

28. You are treating a 3-year-old female who is having a symptomatic TET spell. Which of the following treatments is most appropriate? a. No treatment is indicated as these spells resolve without treatment. b. Oxygen, IV fluid bolus, and dopamine c. Oxygen, morphine, knee-chest position d. Propanolol, Trendelenburg, and dopamine

Special Considerations: 5 Pediatrics: 2

29. Which of the following is the most common cause of bradycardia in infants? a. Congenital heart defect b. Heart block c. Fever d. Hypoxia / anoxia

30. You responded to a 2-year-old with a heart rate of 200 and a blood pressure of 48/P. Which of the following causes must you suspect first? a. Hypovolema b. Fever c. Supraventricular tachycardia d. Uncontrolled atrial fibrillation

31. Infants and children develop dehydration much more quickly than adults. a. True b. False

32. You are a transporting a 1-year-old that has been diagnosed with dehydration. The patient weighs 22 pounds. You have been asked to administer a fluid bolus, and then call the receiving physician back. Which of the following is the correct amount of an initial bolus of a normal saline that this patient should receive? a. 100 cc b. 200 cc c. 440 cc d. 500 cc

Special Considerations: 5 Pediatrics: 2 33. By definition, febrile seizures do not occur after which age? a. 5 b. 6 c. 8 d. 10

34. Hypotension is typically not seen in pediatric patients until 25% of their circulating volume is absent. a. True b. False

35. A new nurse is doing a ride-along with you at your helicopter. She is studying for an upcoming PALS course and asks you what the desired urinary output is in pediatric patients. Which of the following would be the correct answer to give her? a. 0.2 - 0.5 cc/kg/hour b. 1 – 2 cc/kg/hour c. 35 ccs/kg/hour d. 35 – 50 cc/hour

Special Considerations: 5 Sepsis / MODS: 3

Sepsis / MODS Module Quiz

1. You are treating a patient with SIRS and you are reviewing the ABGs.

Which of the following would you expect for the patient’s PCO2?

a. Typically the PCO2 is grossly elevated > 55

b. Typically the PCO2 is < 35

c. There is generally no change in the PCO2

d. The PCO2 is dependent on the whether a bacteria or virus caused the sepsis

2. You are preparing to transport a 64-year-old male in SIRS due to a systemic blood infection. Which of the following is true regarding blood glucose and SIRS? a. Hyperglycemia is common and can significantly increase mortality if not tightly controlled b. Hypoglycemia is common as the bacteria utilizes all available glucose stores c. Patients will only have glucose derangements if they have an underlying history of diabetes (either Type 1 or Type 2) d. There is no correlation between glucose derangements and SIRS

3. You are evaluating the lab values of a 28-year-old female in severe sepsis. Which of the following would you expect? a. Elevated platelets, normal clotting time b. Elevated platelets, prolonged clotting time c. Low platelets, normal clotting time d. Low platelets, prolonged clotting time

Special Considerations: 5 Sepsis / MODS: 3 4. Sepsis is the leading cause of non-coronary death in the ICU in the United States. a. True b. False

5. Sepsis is defined as a systemic infection with one or more signs of organ dysfunction. Which of the following is one of the markers for organ dysfunction?

a. PaO2 of 85 b. Hypotension including oliguria c. Tachycardia with fever d. Chest pain with dyspnea

6. Which of the following is the most frequent cause of sepsis? a. Urinary tract infections b. GI tract infections c. Intravascular devices d. Respiratory infections

7. Colloids are preferred for volume resuscitation in severe sepsis to correct hypoalbuminemia. a. True b. False

8. Septic shock is defined as hypotension refractory to fluid resuscitation in the presence of sepsis. a. True b. False

Special Considerations: 5 Sepsis / MODS: 3 9. Which of the following typically heralds irreversible septic shock? a. Respiratory alkalosis with increased CO2 b. Abnormally high white blood count c. Metabolic acidosis with hypotension d. A fall in cardiac output with accompanying tachycardia

10. You are transporting a patient with MODS. You have been elevating the patient’s blood pressure and mean arterial pressure (MAP) during transport. A MAP less than ____mmHg indicates cardiovascular failure. a. 100 b. 70 c. 50 d. 30

Special Considerations: 5 Organ Donation & Transplantation: 5

Organ Donation & Transplantation Module Quiz

1. Which of the following statements regarding organ donation is true? a. The family should be approached with the idea of organ donation before brain death is determined b. The family should be approached with the idea of organ donation after the decision to withdraw life support is made c. Only a physician is qualified to discuss organ donation with the family d. The patient’s nurse should always be the first person to approach the family about organ donation

2. Which of the following is an absolute exception to organ donation? a. Hepatitis B infection b. Age of 70 years or greater c. Active cancer d. Death from a drug overdose

3. You are treating a patient who has just been declared brain dead. The family would like to donate the organs but you are not sure if the patient is a candidate for organ donation. Which of the following should you do? a. Advise the family that the patient is not a candidate for donation b. Tell the family that a physician will need to make that determination c. Refer the patient to an organ procurement agency and let them decide d. Contact an emergency physician and let them make the decision

Special Considerations: 5 Organ Donation & Transplantation: 5 4. Federal law requires that all Medicare-funded facilities offer the family the option of organ donation for every potential donor. a. True b. False

5. You are observing an apnea test being performed at a local hospital prior to you transporting the patient for organ donation. During the apnea test, you observe the patient bring their arms up to their face towards their endotracheal tube. What is most likely the cause of this? a. The patient has suddenly regained brain function and is trying to signal the medical staff that they can’t breathe b. The patient is experiencing the Lazarus sign, a common reflex

thought to be caused by the buildup of CO2 in the spinal cord c. The patient is attempting to breathe on their own d. The patient is actively seizing

6. Normal sodium values must be maintained before the patient can be declared brain dead. a. True b. False

7. The period from brain death to organ procurement is the when the patient is the most hemodynamically unstable. a. True b. False

Special Considerations: 5 Organ Donation & Transplantation: 5 8. You are transporting a brain dead, organ donation patient. Which of the following best represents optimal mean arterial pressure? a. Below 60 mmHg to prevent damage to the organs that will be harvested b. Above 60 mmHg, but typically not to exceed 100mmHg c. Above 100 mmHg to ensure optimal perfusion d. MAP is irrelevant in the brain dead patient since the organs are going to be harvested

9. For the patient in Question 8, what is their optimal urinary output during transport? a. > 1 cc/kg/hour b. 35 cc/hour c. 50 cc/hour d. > 75 cc/hour

10. Successful outcomes occur more frequently when organ donation is presented by people that are properly trained in end-of-life decisions. a. True b. False