General A-EMCA Flashcards
(149 cards)
1
Q
- Broca is production of?
2. Wernicke’s is?
A
- Speech
2. Understanding Speech
2
Q
- This is the main autonomic regulation center for smooth muscle, cardiac muscle, and endocrine muscle
- Concerned with POSTURE and fine muscle control
A
- Hypothalamus
2. Cerebellum
3
Q
- Brainstem 3 sections are?
2. This is located in the medulla oblongata if it is disturbed can cause a concussion
A
- Pons, Midbrain and Medulla Oblongata
2. RAS, Reticular Activating System
4
Q
- 3 layers of the meninges from outer to inner
2. Where is CSF located?
A
- Dura, Arachnoid and Pia
2. Between ventricles and subarachnoid space, acts as a cushion to protect brain and spinal cord tissue
5
Q
- CSF otorrhea, periorbital ecchymosis, battle signs (late signs) S+S of what injury?
- Concussions and contusions are considered primary or secondary injuries?
A
- Basilar Skull Fracture
2. Primary
6
Q
- An epidural bleed is associated with what artery being injured?
- __,___ and __ (spinal cords) keeps you alive, injuries above these spinal cords will cause innervation of the diaphragm to be ceased → respiratory arrest
A
- Middle meningeal artery (most common to head trauma in subarachnoid hemorrhage) (MMA)
- C3 C4 C5
7
Q
- _____ occurs when the blood vessels that carry oxygen and nutrients from your heart to the rest of your body (arteries) become thick and stiff
- ____ is a specific type of arteriosclerosis, but the terms are sometimes used interchangeably. Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaque), which can restrict blood flow.The plaque can burst, triggering a blood clot.
A
- Arteriosclerosis. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries.
- Atherosclerosis
8
Q
- Cardiac Output formula?
- What is the right valve called? Left?
- Preload determines how much CO will be, so greater the diastolic filling +(filling of heart at rest of valve) (systolic=contraction) what law is this?
A
- SV X HR (CO = perload)
- Right = tricuspid valve, Left = bicuspid/mitral valve
- Frank Starling law of the heart
9
Q
Name the following Hepatitis
- Related to pregnancy and + fecal oral transmission
- Can only propagate with patients who have B
- Fecal oral transmission
- Exposure to infected blood and body fluids
- blood to blood contact (IV drug use and poorly sterilized drug use)
A
- E
- D
- A
- B
- C
10
Q
What part of the brain has control over the vasomotor tone (vascular tone)
A
Brainstem
11
Q
- What are common causes of pancreatitis? (GB + AA)
- If they can’t breath in they can have cholecystitis (inflammation of gallbladder). 4fs (fatty diet, fair, female, febrile) are most common with this sign.
A
- Gallstone blockage and alcohol abuse
2. Murphy’s sign
12
Q
- What the the posterior pituitary gland secrete?
- What medication is given for hypothyroidism?
- What is the main product of glucocorticoids?
- Mineralocorticoids = ?
- Which gland releases melatonin for sleep?
A
- ADH, oxytocin
- Levothyroxine, synthroid = brand name
- Cortisol
- Sodium and water balance in body,
- Pineal gland
13
Q
- Which cells secrete insulin?
2 What is the mechanism of glucagon?
- Why do we not give glucagon to someone with pheochromocytoma?
- What is the main difference between HNNK and DKA? (diabetic ketoacidosis and hyperosmolar hyperglycemic state)
A
- Beta cells
- Stimulates the conversion of glycogen to glucose which is then released into the blood
- Pheochromocytoma may cause release of catecholamine from the tumor producing HTN, tachycardia and possible stroke
- Main difference between hnnk and dka is there is no abdo pain in hnnk patient. hnnk pts can still produce some insulin so not burning off so much fat that the will produce kussmaul breathing.
14
Q
- Gravids is and para is?
- What is the compression to ventilation ratio for neonate?
- What is the formula for hypo-tension for pediatrics ?
- What age is the limit for NPA regarding pediatrics?
- What condition presents with high grade fever, swelling of throat and drooling. Rapid transport and seated upright
A
- Gravida = pregnancies while para is parents = how many children from those pregnancies
- 3 compression to 1 ventilation
- 70+ (age x 2)
- less than 5 y/o don’t NPA
- Epiglottitis
15
Q
- What do inotropic drugs do?
- Are dopamine, epinephrine and amiodarone positive or negative inotropic drugs?
- Is labetalol a negative or positive inotropic drug?
A
- Affect force of contraction
- Positive
- Negative
16
Q
- What do chronotropic drugs do?
- Name 3 examples of positive chronotropic drugs (A, E, T)
- Name 3 negative ones (D, M, A)
A
- Affect rate of cardiac circulation
- Atropine, throphyline and epi
- Digoxin, metoprolol and acteocholyine
17
Q
- ____ is defined as occurring most days for at least three months in a year for two consecutive years.
- Why do we see muscle cramps in hyperthermia?
- ____ is rapidly shown after diver exits water, ____ ____ takes longer (Henry’s law applies to decompression sickness)
A
- Chronic
- We are losing sodium through sweat which our muscle needs
- AGS, decompression sickness
18
Q
- What is the weight limit for the stair chair?
- KED?
- Scoop?
A
- 500 Ib
- 500Ib
- 350Ib
19
Q
- Leeds II, III and aVF will see depression in which leeds?
- V1-V6 should see depression in which leeds?
- What can dextrose do to cell?
A
- V1-V6
- II, II and aVF (inferior leeds)
- Can cause necrosis
20
Q
Does lower or higher blood pH increase affinity for 02 to hemoglobin?
A
Lower blood pH increases oxygen’s affinity for haemoglobin
21
Q
The___ _____and ___ ____ are anatomical features of a mature fetus which bypass the pulmonary circuit and the _____ ________ bypsses the liver
A
ductus arteriosus , foramen ovale, ductus venosus
22
Q
What is the lethal triad of trauma?
A
Hypothermia, coagulopathy and acidosis
23
Q
- ___ can be used to reduce the effect of the poisoning by blocking muscarinic acetylcholine receptors, which would otherwise be overstimulated, by excessive acetylcholine accumulation (cholinergic crisis)
A
Atropine (anticholinergic)
24
Q
This organ contains a reserve of blood, processes iron, acts as a lymph node, and metabolizes hemoglobin to bilirubin
A
Spleen
25
1. Name 2 examples of anticoagulants
| 2. Name an antiplatelet
1. Heparin and warfarin (Coumadin is warfrain brand name)
| 2. Aspirin
26
1. What is the triad for pre-eclampsia?
2. What is Becks triad?
3. What does Cushings triad of?
1. Proteinuria, HTN and peripheral edema *2nd or 3rd trimester)
2. For cardiac tamponade = Muffeled heart sounds, hypotension and JVD
3. HTN, bradycardia, irregular respirations (usually trauma to the head) cheyne stokes respirations
27
1. Which disease is from producing too little cortisol from the adrenal glands?
2. How about too much cortisol?
1. Addison's disease
| 2. Cushing's syndrome
28
Commotio cordis typically results from __________ (BFT) and can possibly lead to the lethal
arrhythmia known as __________ resulting from __________ phenomenon.
Blunt force trauma, torsades de pointes, R on T phenomenon
29
What are the three ossicles responsible for our sense of hearing? (I, M, S)
Incus, malleus, stapes
30
1. What is the most common intracellular cation
2. What is the most popular intracellular anion?
3. Cation is positive or negative?
1. Potassium
2. Phosphate
3. Positive
31
A lateral MI usually indicates an occlusion of which blood vessels
Left cirumflex artery
32
1. What is Daltons Law?
2. What is Boyle's Law?
3. What is Henry's Law?
4. Which one applies to diving injuries?
1. In a mixture of non-reacting gases, the total pressure exerted is equal to the sum of the partial pressures of the individual gases.
2. Pressure of a gas tends to increase as the volume of the container decreases.
3. The solubility of a gas in a liquid is directly proportional to the partial pressure of the gas above the liquid
4. Dalton's law
33
The body’s centre for temperature regulation is located where?
Hypothalamus
34
Rank haemoglobin’s affinity for these gasses from highest to lowest. O2, CO2 and carbon moxodie
1. Carbon monoxide, CO2 then O2
35
A patient presenting with Beck’s triad (pericardial tamponade) could be classified into what type of shock
Obstructive Shock
36
What does Cushing’s Triad indicate?
Cerebral Herniation
37
A substance which has an effect on the heart’s rate is termed a?
Chronotrope
38
Digoxins is aka? and is it chrono dromo or inotrope?
1. AKA digitalis elps an injured or weakened heart pump more efficiently. Inotrope
39
Which nerve is responsible for innervation of the diaphragm?
Phrenic Nerve
40
An adult patient receiving IV fluid therapy should be reassessed for signs and symptoms of fluid overload how often?
Every 250 ml
41
```
Diarrhoea
Urination
Miosis/muscle weakness
Bronchorrhea
Bradycardia
Emesis
Lacrimation
Salivation/sweating
All of these are signs and symptoms of what overdose?
```
Cholinergic overdose. Dumbbells, Atropine is treatment
42
You see the crowning of the baby’s buttocks at the vaginal opening. What position is this called?
Frank Breech
43
What is the mechanism of epi in regards to relief of bronchoconstriction?
Stimulation of the β2-adrenergic receptors. allowing smooth muscle relaxation of the bronchial tree
44
What is the mechanism for Salbutamol with regards to relief of bronchoconstriction?
Relaxes bronchial smooth muscle by action on β2-receptors
45
According to the Highway Traffic Act, what is the maximum speed above the speed limit
and Ambulance may travel when responding to an emergency call?
No Listed Maximum. the 20KM/H rule is by paramedic services not by the traffic act.
46
Contraindication for traction splint is ___fracture
Pelvic
47
Sciatica: is severe pain along the course of the sciatic nerve, usually felt at the back of the thigh and running down the leg
What are common causes? (DH, IT)
Disk Herniation and intraspinal tumor
48
___ SHOCK: Patient BP drops because brain signals to control the body are interrupted. Vasoconstriction is limited particularly below level of injury and therefore the lack of sympathetic tone causes veins and arteries to dilate. As they dilate they enlarge the body’s bucket size (vascular scope), causing hypovolemia
Neurogenic Shock
49
How do you define a flail chest?
three or more adjacent ribs are fractured in two or more places (can present with paradoxical chest wall movement)
50
An exaggerated fall in systolic BP during inspiration; may occur during acute asthma exacerbation is known as this
Pulsus Paradoxus
51
Aortic dissection vs aortic aneurysm: aortic dissection is the degradation of the wall of the aorta, while an aortic aneurysm is a rupture of the aorta itself
Some symptoms of AA: chest pain (tearing or ripping), back pain, feeling of fullness without having eaten a large amount, pulsating mass or strong pulse in abdomen, diaphoresis, dizziness, and others.
52
Tetralogy of Fallot name all 4 defects
Ventricular septal defect (VSD), pulmonary valve stenosis, a misplaced aorta and a thickened right ventricular wall (right ventricular hypertrophy)
53
1. Dimenhydrinate and diphenhydramine is a antihistamine __ antagonist
2. Sartan drugs are ____ receptor blockers → treat high BP
1. H1
| 2. Angiotensin II
54
1. ANP where is it produced?
| 2. Funtions?
1. Atria of the heart
| 2. To regulate BP by promoting the excretion water and sodium by activity of the kidney --> lower BP
55
1. ADH produced where?
2. Function?
3. Also known as?
1. Produced in the hypothalamus but released by the posterior pituitary gland
2. Promote water re-absorption via kidneys to increase BP
3. Vasopressin
56
Pantoprazole (Protonix) treats what?
Stomach Ulcers and GERD (gastroesophageal reflux disease)
57
Put the following in order of the three branches of the aorta once it exits the heart, from patients right to left.
Left common carotid, Braciocephlic trunk , left subclavian
Brachiocephalic Trunk, Left Common carotid and left subclavian
58
According to the ambulance act, what is the minimum amount of time that an ACR must be maintained in records?
7 years
59
What is the maximum speed allowed over the posted speed limit as per the Highway traffic act?
No specific limit. the 20 km/h rule is set by TPS not the highway act.
60
What medical document is utilized by physicians, as well as police officers through power appointed to them, in order to issue a 72 hour hold on a patient
due to risk of suicidal or homicidal actions?
Form 1
61
What is the dose for glucagon how is it determined.
By weight, if less than 25 KG give 0.5mg if more than 25KG give 1mg glucagon.
62
What cardiac receptors are activated by sympathomimetics causing the observed raise in heart rate?
Beta 1
63
What kind of drug is Diltiazem, amlodipine and nifedipine.
Calcium Channel Blocker
Calcium channel blockers relax blood vessels, therefore increasing blood supply and oxygen to the heart, reducing the heart's workload and lowering blood pressure.
64
What is a common use for digoxin to treat for
A fib
65
What is the common suffix for ACE inhibitors? and what do they treat?
ACE inhibitors have the common suffix "pril". Treat high blood pressure, heart problems
66
Where is insulin produced?
Beta cells in Islets of Langerhans
67
Adult rule of 9s
1. Chest?
2. Back?
3. Whole arm?
4. whole leg?
5. Genitals?
6. Head?
1. 18%
2. 18%
3. 9%
4. 18%
5. 1%
6 .9%
68
Child rule of 9s
1. Chest?
2. Back?
3. Whole arm?
4. whole leg?
5. Genitals?
6. Head?
1. 18
2. 18
3. 9
4. 14
5. 1
6. 18
69
1. What is a normal PR interval?
| 2. QRS complex?
1. The normal PR interval is 0.12 to 0.20 seconds
| 2. Duration less than or equal to 0.12 second
70
1. Where is glycogen stored? (2 sites)
2. What term is the breakdown of the molecule glycogen into glucose, a simple sugar that the body uses to produce energy
3. What is the term to produce glucose from non carb sources? such as fats and proteins?
1. Live and skeletal muscle
2. Glycogenolysis
3. Gluconeogenesis
71
Larynx Pharynx and trachea carina put in order
Pharynx, Larynx Trachea carina
72
For COPD or asthma patients who have an initial ETCO2 of >50 mmHg, attempt to maintain ETCO2 between __-___ mmHg
50-60mmHg
73
hyperthermia ≥ __°C
40°C. Overdose of tricyclic antidepressants, antihistamines and β-blockers, as well as cocaine, Ecstasy or amphetamine abuse may also lead to heat stroke
74
1. Presence of fever: >___C
| 2. Presence of any one of: o SBP
1. 38.5°C
| 2. 90, 22
75
What is Atelectasis?
Atelectasis is collapse of lung tissue with loss of volume
76
1. What are baroreceptors?
| 2. Where are they located?
1. Mechanoreceptors, their function is to sense pressure changes by responding to change in the tension of the arterial wall. Control BP
2. Aortic arch and carotid sinus
77
This sensory receptor which receives stimuli from within the body, especially one that responds to position and movement.
Proprioceptor
78
Which law states that the amount of dissolved gas in a liquid is proportional to its partial pressure above the liquid
Henry's Law
79
Which law states that the pressure of a given mass of an ideal gas is inversely proportional to its volume at a constant temperature.
Boyles Law
80
Which law states hat in a mixture of non-reacting gases, the total pressure exerted is equal to the sum of the partial pressures of the individual gases.
Dalton's Law
81
```
Confused
Dilated pupils
Tachycardia
Dry mouth
Urinary retention
flushed skin
```
Anticholinergic crisis
82
Oxygen dissociation curve.
Right or left? Which way means oxygen is dissociating from hemoglobin and being released into tissues
1. Right, if the curve moves to the right
83
Oxygen dissociation curve.
Right or left? Which way means oxygen is staying bonded to hemoglobin and not being released to tissues
Left
84
Oxygen dissociation curve.
Decrease in pH (increase in H+) ie acidosis
Increase in temperature
Increase in altitude
Increase in BPG or DPG
Do these factors move the curve to the right or left?
Right
85
Oxygen dissociation curve.
Increase in pH (alkalosis)
Decrease in temprature
Decrease in altitude
Decrease in BPG or DPG
Do these factors move the curve to the right or left?
Left, staying bonded to hemoglobin
86
What receptors are parasympathetic?
Nicotinic and muscarinic
87
1. What happens when you stimulate muscarinic receptors?
| 2. When this is overstimulated we get an anticholinergic crisis, which drug is used to block muscarinic receptors?
1. Causes a decrease in the heart rate, a decrease in heart contractility and a decrease in the size of the bronchioles. When we are at rest, we can slow down and conserve energy.
2. Atropine
88
Key Terms
1. __ force exerted by ventricles at end of diastole phase
2. __ pressure against the ventricles must pump to eject blood
3. ___ pacemaker cells initiating their own electrical impulse
4. ___ability of cardiac muscle cells responding to outside stimulus
5. ___ability to receive and conduct electrical impulse to adjacent cardiac cells
6. ___ability of cardiac cells to shorten and contract in response to electrical stimulus
1. Preload
2. Afterload
3. Automaticity
4. Excitability
5. Conductivity
6. Contractility
89
1. What is the heart conduction system in order? AV, SA, Purkinjie Fiber system and Bundle of His
2. What is the rate of the SA, AV, AND PF nodes?
1. SA, AV, Bundle of Hisa and Purkinjie Fiber system
| 2. SA= 60-100bpm, AV= 40-60bpm, PF= 20-40bpm
90
The AV valves, mitral and tricuspid, are attached by the chord tendinae to the edges of the valves and anchored to the papillary muscles. This ensures they will not be regurgitated back into the atria during the contraction of the ventricles
Two major factors; Intrinsic and extrinsic
Major intrinsic factor is venous return (Frank Starling Law of the Heart) “the greater diastolic filling, the greater the cardiac output”
Extrinsic factors relate to autonomic nervous system, controlling rate and contractility
Atria contains mix of parasympathetic and sympathetic innervations while ventricles are majority sympathetic
91
Two major coronary arteries. right and left, left divides into which two?
Into the left anterior descending (LAD) and the left circumflex (CX)
92
Major aortic branches form right to left (of heart); brachiocephalic (branches into the right subclavian and right common carotid), left common carotid, left subclavian
Jugular vein distention can be an important clinical indicator of conditions such as tamponade and heart failure, know its location
93
Where is the vasomotor tone control system located?
Brainstem, keeping the vascular system in constant partial contraction called “vasomotor tone”. Vasomotor centre controls vasoconstriction and cardiac activity
Cortex also assists vasomotor centre, fear for example
94
What is the regular MAP?
80-120 mmHg
95
Angina Pectoris
Pain as a result from MI. Results from imbalance in the supply of blood being provided to the heart versus the oxygenated blood demands of the heart
96
Unstable Angina
Looks similar to MI
Can come on at rest or from activity
Will wake pt from sleep
Lasts 10-15 minutes on average
Pain can radiate and is described as atypical
Pain is not relieved or delayed to relief from nitro
Stable angina
pain usually brought on by stress or physical activity
typically lasts 1-5 minutes and is the same as previous attacks
pain rarely radiates and is the only reported symptom
often relieved by rest or nitro spray
97
Heart failure is a progression as the heart fails to keep up with its work demands
The heart will attempt to enlarge, increase muscle mass, and pump faster
The body will also begin to stay in a vasoconstrictor state to maintain higher blood pressure
The body will also attempt to shunt blood towards key organs and away from others (ex. kidneys)
Right Ventricular Heart Failure
Primarily occurs following pt diagnosis of LVHF
S/S:
JVD, ascites, swelling to abdominal organs (liver, spleen), swollen extremities, hypotension
98
```
Which surface articulates with the head of femur, and is formed by the ischium, ilium, and
pubis?
(A) Acetabulum
(B) Greater trochanter
(C) Medial condyle
(D) Articular cartilage
(E) Foreamen Obturator
```
(A) Acetabulum
99
```
With respect to blood flow, what is the second branch originating from the aorta?
(A) Right subclavian
(B) Left subclavian
(C) Descending aorta
(D) Left common carotid
(E) Brachiocephalic artery
```
(D) Left common carotid
100
```
Place the respiratory tract in order from superior to inferior
(A) Carina
(B) Cricoid ring
(C) Mainstem bronchi
(D) Alveoli
(E) Secondary bronchi
(F) Vocal Cords
(G) Turbinates
(H) Nares
(I) Hypopharynx
(J) Nasopharynx
(K) Terminal bronchi
(L) Oropharynx
(M) Trachea
```
(A) H, G, J, I, L, B, F, A, M, C, E, K, D
(B) D, K, C, E, A, M, F, B, L, I, J, H, G
(C) D, K, E, C, A, M, B, F, L, J, I, G, H
(D) H, G, J, L, I, F, B, M, A, C, E, K, D
(E) The order listed is correct
(D) H, G, J, L, I, F, B, M, A, C, E, K, D
101
```
Which mental health act document allows patients to be detained in a psychiatric facility
against their will?
(A) Mental Health Act Form 1
(B) Mental Health Act Form 2
(C) Mental Health Act Form 3
(D) Mental Health Act Form 4
(E) Mental Health Act Form 5
```
(C) Mental Health Act Form 3
102
```
Which mental health act form refers a patient for psychiatric evaluation?
(A) Mental Health Act Form 1
(B) Mental Health Act Form 2
(C) Mental Health Act Form 3
(D) Mental Health Act Form 4
(E) Mental Health Act Form 5
```
(A) Mental Health Act Form 1
103
```
The ALARM acronym in emergency childbirth is designed to assist in what kind of delivery
presentation?
(A) Nuchal cord
(B) Transverse breech
(C) Footling breech
(D) Frank Breech
(E) Shoulder dystocia
```
(E) Shoulder dystocia
104
A Primary Care Paramedic (PCP) may monitor intravenous administration of all of the
following, except:
(A) Thiamine
(B) Medications within their level of certification
(C) Potassium Chloride
(D) Parenteral nutrition
(E) Lactated Ringer’s solution
(D) Parenteral nutrition
105
Using Sgarbossa’s criteria, it is possible to identify myocardial infarction in the presence of
a bundle branch block (BBB). Which of the following is not a criterion?
(A) ST elevation ≥1 mm in a lead with positive QRS deflection
(B) ST depression ≥1 mm in lead V1, V2, or V3
(C) ST elevation ≥5 mm in a lead with a negative QRS deflection
(D) Inverted T-wave morphology, >3mm in lead II
(E) All of the above are Sgarbossa’s criteria
(D) Inverted T-wave morphology, >3mm in lead II
106
```
The muscles responsible for ensuring heart valves remain shut during contraction are called
the:
(A) Arrector pili
(B) Valvular sphincter
(C) Tensor fascia
(D) Tensor valvae
(E) Papillary
```
(E) Papillary
107
It is a cold February day when you are called CTAS-2 for a patient complaining of a sudden
headache, blurred vision, dizziness, and weakness, and nausea. On arrival, you meet a 78 year old male sitting in the dining room of their home, wearing a jacket, winter boots, and a toque. He tells you his name is Albert, and you begin your assessment. What is yourpriority in treating Albert?
(A) Obtaining a complete set of vitals to include: HR, RR, SBP, SPO2, ETCO2
(B) Speaking with Albert to determine a timeline for his illness
(C) Ensuring adequacy of respiratory effort and circulatory status
(D) Obtaining a blood-glucose level
(E) Assessing Albert’s pupils
(C) Ensuring adequacy of respiratory effort and circulatory status
108
```
On further examination of Albert, you observe that his nail beds and lips are slightly cyanosed. Your partner returns with the following vitals:
HR: 80, regular, full, bilateral
RR: 24, regular, full
SPO2: 99% on room air
SBP: 110/79 NIBP
Temperature: 37.0ºC tympanic
BGL: 4.0 mmol/L
Your most appropriate treatment plan for Albert at this time is to:
(A) Administer oral glucose
(B) Administer 50mL of D50W, IV
(C) Administer 1.0mg of glucagon, IM
(D) Begin oxygen via NRB, 15L/minute
(E) Package Albert for transportation
```
(D) Begin oxygen via NRB, 15L/minute
109
He tells you he ‘just feels dizzy’. As you continue to gather history, Albert explains to you he suffered a TIA last year for which he is now taking Xarelto, and that it has left him with transient deficiency in strength on his right side. He says he is dressed to keep warm because his “furnace kicked out” and he “was about to call a repair guy”. Albert rates his health to be overall well, except for his TIA.
En route, Albert begins to speak with more certainty. On reassessment, you notice that colour is returning to his nail beds and to his lips. Your differential diagnosis for Albert’s condition is that Albert:
(A) Is suffering from another TIA or CVA
(B) Is suffering from carbon monoxide exposure
(C) Was mildly hypothermic
(D) Is mildly hypoglycaemic
(E) All of the above
(B) Is suffering from carbon monoxide exposure, dizzy is a symptom of cyanide toxicity and spo2 still within range but still cyanosed
110
```
Which of Albert’s symptoms would be concordant with suspicion of him suffering another TIA?
(A) Sudden onset of headache
(B) Dizziness
(C) Cyanosis
(D) Weakness
(E) Blurred vision
```
(A) D only
(B) A and C
(C) A, B, C, D
(D) A, B, D, E
(D) A, B, D, E
111
What is the reasoning for high-concentration oxygen being administered to a patient with suspected carbon monoxide poisoning?
(A) To force oxygen binding to haemoglobin
(B) To improve patient presentation via placebo effect
(C) To encourage ventilation of carbon monoxide via diffusion
(D) To saturate blood with free oxygen to compensate for hypoxia
(E) There is no benefit for high-concentration oxygen in suspected CO poisoning
(C) To encourage ventilation of carbon monoxide via diffusion
112
```
These hormone are directly released by the pituitary gland:
(A) Oxytocin
(B) Inhibin
(C) Testosterone
(D) Antidiuretic hormone (ADH)
(E) Follicle stimulating hormone
(F) Adrenocorticotropic hormone
(G) Epinephrine / Norepinephrine
```
```
(A) All of the above
(B) B and E only
(C) B, C, D, F
(D) A, D, E, F
(E) A, C, D, E, F
```
(D) A, D, E, F
113
```
You know Torsades de Pointes (T de P) is considered a lethal arrhythmia. What is the best classification for T de P?
(A) Juncitonal escape rhythm
(B) Coarse atrial fibrillation
(C) Non-diagnostic
(D) Ventricular Tachycardia
(E) Supraventricular rhythm
```
(D) Ventricular Tachycardia
114
The RAAS compensates for hypo-perfusion by increasing circulating fluid volume. How does it do this?
(A) Angiotensin stimulates antidiuretic hormone (ADH) causing the body to retain fluid
(B) Aldosterone increases sodium retention
(C) Aldosterone causes hypertrophy of red blood cells (RBC’s) causing increased
volume
(D) Renin expands plasma volume, compensating for fluid loss
(E) Aldosterone causes peripheral vasoconstriction, shunting fluid to the core to be
circulated
(B) Aldosterone increases sodium retention
115
```
Which is the most abundant intracellular cation?
(A) Potassium
(B) Chloride
(C) Sodium
(D) Magnesium
(E) Phosphat
```
Potassium
116
___ is the major cation of the EXTRAcellular fluid.
Sodium
117
You’re called CTAS 1 for ineffective breathing for a 20 day old female. You arrive at a well-kept residence and deem the scene safe as you meet frantic parents who lead you to a crib. There, you find a still patient, non-responsive to any stimuli, warm to the touch, but cyanosed at the mouth and hands.
9. What is your first priority in managing this patient?
(A) Assess the patient’s pulse
(B) Engage dispatch to send ALS assistance
(C) Survey the scene for signs of foul play
(D) Begin ventilations immediately via BVM
(E) Apply SPO2 for an accurate diagnosis of the cause for cyanosis
(A) Assess the patient’s pulse
118
You begin managing your patient as determined in Question 9. You note that your patient is apneic, and has no palpable pulse. What is your next step in managing this patient?
(A) Begin to stimulate the patient through warming and stimulation
(B) Evacuate the patient immediately to your ambulance and expedite transport to the nearest ED
(C) Delegate to your partner to retrieve the paediatric defibrilation pads while you begin chest compressions for 30 seconds
(D) Begin ventilations via BVM on room air for 30 seconds
(E) Begin ventilations via BVM on 100% oxygen for 30 seconds
(D) Begin ventilations via BVM on room air for 30 seconds
| warm dry and stimulate are for newborns under 24 hour, if not new born go to BVM on room air
119
You delegate to your partner and student to assess Lorraine’s baseline vitals while you concurrently ask Will about Lorraine’s condition. He tells you that Lorraine has a history of fibromyalgia, sciatica, chronic migraines, IDDM, and an unknown adrenal disorder that he describes as a ‘growth’. He hands you her medication list which is as follows:
Humalog Mix 25
Lantus, 100u/mL, 200 q.d.
Tylenol 2, 300mg PRN
Medic Sense A-EMCA Exam #2 %4 of %17
Your partner returns with Lorraine’s vitals which are:
HR - 115
RR - 18 Full, regular
SBP - 130/90 NIBP
SPO2 - 96% on room air
BS - 3.1mmol/L
Weight estimated to be 80Kg
Your management of Lorraine at this point should include what?
(A) Initiate cardiac monitoring for 12-lead as she may meet atypical presentation
(B) Prepare a meal of simple carbohydrates for Lorraine, such as toast and peanut butter
(C) Glucagon, 1mg IM
(D) Begin transfer of Lorraine to your stretcher for further assessment in ambulance and transport to the closest appropriate treatment facility
(E) Dextrose D50W, 25g by IV push.
(E) Dextrose D50W, 25g by IV push.
120
```
You are called CTAS-2 for an injured female at a local quarry which has been converted to a SCUBA park. No other call details are given. You arrive on scene and are briefed by a firefighter who explains water rescue is underway, and directs you to a safe are to set up for
patient care once they are recovered.
18. With your knowledge of diving physiology, what information will be helpful in determining how to manage this patient?
(A) Diver’s intended depth
(B) Diver’s maximum depth
(C) Time at depth
(D) Rate of ascent
(E) Last oral intake
(F) Tank pressure prior to diving
(G) Tank pressure after ascent
(H) Purpose of dive
```
```
(A) A, C, E, G
(B) A only
(C) D only
(D) A, D, H, F
(E) B, C, D
```
(E) B, C, D
121
The body’s centre for temperature regulation is located where?
(A) The thymus gland
(B) The cerebellum
(C) A complex network involving the SNS and PNS
(D) The hippocampus
(E) The hypothalamus
(E) The hypothalamus
122
```
What core body temperature is generally considered to be severe hypothermia?
(A) 36ºC - 34ºC
(B) 34ºC - 32ºC
(C) 32ºC - 30ºC
(D) < 30ºC
(E) ≤ 28ºC
```
(D) < 30ºC
123
On which sort of would is packing indicated?
(A) Penetrating thoracic trauma
(B) A traumatic head injury with cranial contents exposed
(C) Abdominal trauma with sever hemorrhage
(D) Severe postpartum hemorrhage
(E) Extremity injury which a tourniquet cannot adequately control
(E) Extremity injury which a tourniquet cannot adequately control
124
```
Salbutamol (Ventolin) may cause which of the following cardiac effects?
(A) Increased heart rate
(B) Decreased heart rate
(C) Bundle branch block
(D) Hypertonicity
(E) No effect at all
```
(A) Increased heart rate
Salbutamol-induced tachycardia is due to the direct stimulation of cardiac β2-adrenoceptors [13] as well as indirect activation of peripheral receptors [14], inducing vasodilatation and consequent reflex vagal withdrawal
125
```
This ECG waveform is characterized by a ‘slur’ or Delta-wave on the R-wave
(A) Left bundle branch block (LBBB)
(B) Benign early repolarization
(C) R-on-T phenomenon
(D) Prolonged QT interval
(E) Wolff-Parkinson White (WPW) syndrome
```
(E) Wolff-Parkinson White (WPW) syndrome
126
```
Which ECG presentation is characterized by a downward-sloping ST segment with
flattened or short T-waves?
(A) Cyanide toxicity
(B) Digoxin toxicity
(C) Varicella Zoster Virus
(D) Viral meningitis
(E) None of the above
```
(B) Digoxin toxicity
127
Which of the following is not a normal reflex of the respiratory system?
(A) Apnea
(B) Sneezing
(C) Coughing
(D) Sighing
(E) All of the above are normal respiratory reflexes
(A) Apnea
128
You are called CTAS-2 for a 16 year old male patient who is reported to be behaving erratically. You arrive to find your patient in the front yard of his residence in PD custody. On approach, you notice that the patient’s skin is flushed, they have stripped down to their undergarments, and are incoherently rambling. You introduce yourself to the police officer on scene who tells you “kid’s just rambling. I don’t know what he’s on and he isn't’ making any sense”.
45. Your next course of action for managing this patient should be:
(A) Return to the ambulance until the patient has calmed down and update CACC of
the situation
(B) Calmly introduce yourself to your patient
(C) Observe the scene for signs of illicit drug use
(D) Establish a baseline set of vitals on your patient
(E) Gather more history of your patient’s behaviour from the PD
(B) Calmly introduce yourself to your patient
129
```
Based on what you know in terms of substance abuse, what type of drug would you expect the above patient to be impaired by?
(A) Anticholonergics
(B) Cholonergics
(C) Opiates
(D) Sympathomimetics
```
(A) Anticholonergics
130
```
What scale would be your best way of doing an immediate assessment on a sick paediatric patient?
(A) GCS
(B) PAT
(C) TICLS
(D) SAMPLE
(E) RTS
```
(B) PAT (pediatric assessment triangle)
131
When you have concluded your meal break, you are placed on a call to a day-care centre for a male patient who is currently unresponsive. Upon arrival, you are met by an early childhood educator who brings you to the office where the child currently is laying semi prone in recovery position on a couch. You were made aware of the patients current severe allergy to peanuts as
well as the recent illness he has had according to mom, causing decreased oral intake. As you get closer, you hear snoring respirations, see chest rise, and have drool apparent on the side of the cheek. Following your primary assessment you find the 3 year old female patient to have a slow pulse rate present, a respiratory rate of 16, and the same snoring respirations.
53. What is your first method of action in this situation?
(A) Attempt a sternal rub to rouse the young patient
(B) Insert an oral airway to correct the airway issue
(C) Attempt to place the child into sniffing position with a blanket behind the shoulders
(D) Auscultate lungs to ensure good air entry
(E) Begin compressions as the respirations may be rapid atonal respirations as the patient is not rousing
(C) Attempt to place the child into sniffing position with a blanket behind the shoulders
132
The above decision you made has allowed the airway to become patent, following this you apply the monitor and receive the following vital signs; HR 80, RR 16, SpO2 93%, ETCO2 of 50, BP 68/35, BGL 2.2. What is the most likely cause of the current unresponsive state of the patient?
(A) The patient is having an anaphylactic reaction to the peanuts in another students snack
(B) The patient has continued to become sicker from his possible flu or other virus
(C) The patient is beginning to experience symptoms of epiglottis, due to the snoring respirations and the sickness described by mom
(D) The patient is currently hypoglycemic due to lack of food recently and possible undiagnosed Type 1 diabetes
(D) The patient is currently hypoglycemic due to lack of food recently and possible undiagnosed Type 1 diabetes
Hypoglycemia
If age is above 2 y/o sugar must be below 4.0
If age less than 2y/o sugar must be less than 3.0
133
```
Now that you have worked together to determine that you will treat the hypoglycaemic patient as per the hypoglycaemia protocol, what is the appropriate dose of glucagon for the
patient?
(A) 0.5mg
(B) 0.5g
(C) 1mg
(D) 2.5mg
(E) 25mg
```
(A) 0.5mg
134
```
Based on what you know about glucagon, what is required in order for this medication to be effective and where is that stored?
(A) Insulin, Pancreas
(B) Glycogen, Pancreas
(C) Insulin, Liver
(D) Glycogen, Liver
(E) Glucose, Pancreas
```
(D) Glycogen, Liver
135
When you ask the wife about her child bearing history, she tells you she is G3P2, what does this mean?
(A) 3 pregnancies, 2 spontaneous premature abortions
(B) 2 pregnancies, 3 attempted conceptions
(C) 3 pregnancies, 2 successful live births
(D) 3 pregnancies, 2 premature cesarian births
(C) 3 pregnancies, 2 successful live births
136
```
You see the crowning of the baby’s buttocks at the vaginal opening. What position is
this called?
(A) Complete breech
(B) Buttock breech
(C) Frank breech
(D) Footling breech
```
(C) Frank breech
137
AVPU AND THEN ABC, DETERMIN LEVEL OF CONSCIOUSNESS FIRST
.
138
Which of the following is a not contraindication under the STEMI Bypass Protocol?
(A) Patient VSA without a ROSC obtained
(B) 12 Lead ECH shows LBBB, ventricular paced rhythm, or other STEMI mimicker
(C) < 18 years of age
(D) CTAS 1 with inability to secure pt airway
(C) < 18 years of age
139
This patient appeared to be showing signs and symptoms of a stroke, and then the diagnostic assessment and diagnostic tools began to show that he may be having a cardiac event. Why would the presence of a cardiac event lead to the symptoms described above for this patient?
(A) This patient is likely experiencing a stroke as the primary problem and there may have been a portion of the brain becoming hypoxic and reducing the heart rate
(B) As per the 12-lead ECG, the patient appears to be having an Inferior Myocardial Infarction, leading there to be a reduction in perfusion of oxygenated blood to the brain and in turn causing the stroke like symptoms
(C) With the given history of the patient, the high cholesterol may have caused an increased build-up in the arteries and lead to a small piece detaching and forming an obstruction within an arteriole in the brain
(D) In many cardiac instances, the demand of the heart for oxygenated blood is not being met, in turn it will cause the chemoreceptors to react and decrease heart rate as well as reduce blood pressure
(B) As per the 12-lead ECG, the patient appears to be having an Inferior Myocardial Infarction, leading there to be a reduction in perfusion of oxygenated blood to the brain and in turn causing the stroke like symptoms
140
What is atelecasis?
A complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid
141
The right lung is larger than the left and has 3 main sections; the superior, middle, and inferior lobe.
Which lobe is the left lung missing?
Middle lobe as that space is taken up by the heart.
142
1. Respiratory control is primarily governed by the ____
| 2. Controlled in response to increased or decreased O2 or CO2 levels?
1. Brainstem
| 2. CO2 levels determine rate of respiration
143
1. What is emphysema?
| 2. How will patients present?
1. Significant destruction of the alveolar septa (walls) causing the collapse of the bronchioles and decreases gas exchange. Leads to increased air flow obstruction and overinflation of air sacs
2. “Pink Puffers” due to their thin, anxious, alert, dyspneic, tachypneic and hyperventilation presentation
Pursed lips on expiration is common as it increase airway pressure which splints the airway
No current treatment other than lung transplant
144
1. What is bronchitis?
| 2. How do patients present?
1. Is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. People who have bronchitis often cough up thickened mucus, which can be discolored
2. “Blue Bloaters” because of the central cyanosis noted in these patients due to shunting occurring in lung, lowering O2 saturation
Usually larger person, cyanosis present, chronic cough, often productive sputum
Emphysema people will be thin while bronchitis people will look bloated
145
1. What is pneumonia?
| 2. Signs and symptoms?
1. Infection of the lungs leading to inflammation of bronchioles and alveoli.
2. S/S = SOB, fever, chills, pleuritic chest pain, brown/green sputum, cough
146
Change in pain upon deep inspiration and on palpation is most likely non-cardiac
Ischemia chest pain is constant and will not get better over time. Intervention in the hospital is the only thing that will make it better. ASA just helps it from getting worse.
147
Options: Cheyne-Stokes, Kussmaul, Biots
1. Seen in DKA commonly, also metabolic acidosis
characterized by rapid deep laboured breathing
2. Seen in TBI, heart failure, stroke patients
characterized by deeper and faster breathing followed by gradual decrease in breathing and possible apnea
3. Seen in meningitis, CNS causes, head injuries,
rapid deep inspirations, with short pauses between sets
1. Kussmaul
2. Cheyne-Stokes
3. Biots
148
Oxygen dissociation Curve (MedicS)
1. The curve will always move to the right (releases to tissues) when pH decreases, temprature increases, pCO2 increases.
acidic always to the right
149
Digitalis (digoxin toxicity) include all except which of the following
a) bradycardia
b) blurred vision
c) PVC's
d) Tachycardia
d) tachycardia
