General Paramedicine I

Question 1

___ sounds are the sounds that medical personnel listen for when they are taking blood pressure using a non-invasive procedure. These sounds are most commonly observed while measuring blood pressure with a sphygmomanometer and stethoscope over the ___ artery in the ___ fossa.

Answer 1

1. Korotkoff (AKA Korotkov);
2. Brachial;
3. Antecubital;

Note: Korotkoff sounds are named after Dr. Nikolai Korotkov, a Russian physician who discovered them in 1905.

-https://en.wikipedia.org/wiki/Korotkoff_sounds

Question 2

The ___ of the cardiovascular system detect blood levels of CO₂, O₂ and pH. In what two places are these sensors located?

Answer 2

1. Chemoreceptors;
2. Carotid bodies (in the carotid arteries);
3. Aortic bodies (in the aortic arch);
   * -https://www.livestrong.com/article/198480-chemoreceptors-in-the-cardiovascular-system/*

Question 3

The left bundle branch bifurcates into the ___ and ___.

Answer 3

1. Left Anterior Fascicles;
2. Left Posterior Fascicles;
   * -https://en.wikipedia.org/wiki/Bundle_branches*

Question 4

What is cardiac action potential?

Answer 4

1. The cardiac action potential is a brief change in voltage (membrane potential) across the cell membrane of heart cells. This is caused by the movement of charged atoms (called ions) between the inside and outside of the cell, through proteins called ion channels.

-https://en.wikipedia.org/wiki/Cardiac_action_potential

Question 5

With respect to it’s surroundings, what is the general voltage of a non-pacemaker cardiac myocyte at rest (its resting potential)?

Answer 5

1. ~-90 mV;

-https://en.wikipedia.org/wiki/Cardiac_action_potential

Question 6

What is the general voltage of a non-pacemaker cardiac myocyte’s threshold potential (the point at which it becomes guaranteed to depolarize)?

Answer 6

1. ~-70 mV;

-https://en.wikipedia.org/wiki/Cardiac_action_potential

Question 7

The rapid depolarization of a cardiac myocyte during it’s action potential occurs during which phase?

Answer 7

1. Phase 0;

-https://en.wikipedia.org/wiki/Cardiac_action_potential

Question 8

Upon reaching their threshold potential, ___ channels open on non-pacemaker cardiac myocytes.

Answer 8

1. Na⁺;

• -https://en.wikipedia.org/wiki/Cardiac_action_potential*
• • https://www.youtube.com/watch?v=rIVCuC-Etc0*

Question 9

Upon reaching approximately ___ mV, the Na⁺ channels of non-pacemaker cardiac myocytes close.

Answer 9

1. 20 mV;

-https://en.wikipedia.org/wiki/Cardiac_action_potential

Question 10

Which phase of the cardiac action potential represents early rapid repolarization?

Answer 10

1. Phase 1;

Question 11

Which phase of the cardiac action potential is the plateau phase, and at approximately what voltage does it plateau?

Answer 11

1. Phase 2; 2. 0 mV;

Question 12

The influx of ___ during phase 2 of the cardiac action potential allows the cardiac muscle cells to prolong contraction, delaying full depolarization.

Answer 12

1. Ca++;

Question 13

Which phase of the cardiac action potential is the rapid repolarization phase?

Answer 13

1. Phase 3;

Question 14

During phase 3 of the cardiac action potential, ___ ion channels are closed and ___ ion channels are opened, allowing these ions to quickly depart.

Answer 14

1. Fast Ca++ channels; 2. Fast K+ channels;

Question 15

Which phase of the cardiac action potential is the period between one potential and another?

Answer 15

1. Phase 4;

Question 16

What is the mechanism which occurs during phase 4 of the cardiac action potential which serves to prime a cell for repolarization?

Answer 16

1. The Na+ - K+ pump exchanges ions through the cell membrane (three Na+ ions are pumped out for every two K+ pumped in).

Question 17

Why does the Na+ - K+ pump require ATP to work?

Answer 17

1. Both ions must be transported against their concentration gradients.

Question 18

During which refractory period can a cardiac cell not respond to any stimulus, no matter how great?

Answer 18

1. Absolute Refractory Period;

Question 19

During which refractory period can a cardiac cell respond to a stimulus, yet isn’t at rest?

Answer 19

2. Relative Refractory Period (a larger than normal stimulus is required);

Question 20

On a bottle of Adenosine, the description “6 mg in 2 mL” represents what? The “3 mg/mL” represents what?

Answer 20

1. Dose on Hand; 2. End Concentration;

Question 21

“Adam’s Apple” is a term for the ___.

Answer 21

1. Laryngeal prominence of thyroid cartilage;

Question 22

At what approximate rate do obese patients desaturate in comparison with non-obese patients?

Answer 22

1. Twice as fast;

Question 23

When assigning a Mallampati Score, what score should be given when the patient’s soft palate, fauces, uvula and both anterior and posterior pillars can be visualized through their open mouth? What score should be given if none of these structures can be seen?

Answer 23

1. Class I; 2. Class IV;

Question 24

When evaluating an airway using direct laryngoscopy with the Cormack-Lehane classification system, what grade should be assigned when a patient’s vocal chords are fully visible? When not even the epiglottis can be seen?

Answer 24

1. Grade I;
2. Grade IV;
   * - https://en.wikipedia.org/wiki/Cormack-Lehane_classification_system*

Question 25

The pediatric airway is ___ shaped, with the widest part being at the \_\_\_, and the narrowest at the \_\_\_.

Answer 25

1. Funnel; 2. Vocal cords; 3. Cricoid cartilage;

Question 26

When preparing to intubate a pediatric patient, it is recommended to open how many ET tubes?

Answer 26

1. Three (one below and one above the expected size);

Question 27

Toward the head or anterior end of the body.

Answer 27

1. Cephalad;

Question 28

Infants and young children rely more upon the ___ to breathe than adults do.

Answer 28

1. Diaphragm;

Question 29

When possible, in what position should patients who suffer from respiratory conditions be intubated?

Answer 29

1. Upright (laying them flat may worsen their condition);

Question 30

1. Name two varieties of external laryngeal manipulation.

Answer 30

1. Sellick Maneuver (cricoid pressure); 2. BURP;

Question 31

What is the Sellick Maneuver?

Answer 31

1. External pressure applied over the cricoid cartilage to occlude the esophagus and prevent aspiration/regurgitation;

Question 32

Once an action potential is initiated, there is a period of time that a new action potential cannot be initiated. This is termed the ___ of the tissue. This period is approximately equal to the absolute refractory period (ARP), and occurs because the ___ channels remain closed until the cell fully repolarizes.

Answer 32

1. Effective Refractory Period; 2. Fast Na+;

Question 33

Patients near an SPO2 of \_\_\_% are at risk for precipitous desaturation.

Answer 33

1. 90%;

Question 34

What does FiO2 stand for?

Answer 34

1. Fraction of Inspired Oxygen (the percentage of oxygen a patient is inhaling);

Question 35

What size ET tube should be used if a nasal intubation is attempted? Correct placement will typically result in measurements of 26 cm at the nose for women and 28 cm at the nose for men.

Answer 35

1. As large as will be tolerated; 2. 26 cm; 3. 28 cm; * - https://litfl.com/nasal-intubation/*

Question 36

In what position should a supine patient's head be positioned to intubate with an i-Gel? With a King LTS-D ?

Answer 36

1. Sniffing; 2. Sniffing;

Question 37

How deep should the King LTS-D airway be inserted? The i-Gel?

Answer 37

1. Connector to teeth, then backed out until ventilations are easy to deliver; 2. Until a definitive resistance is felt;

Question 38

How much air should be used to inflate the bulbs of the King LTS-D?

Answer 38

1. The entire volume of the syringe provided (can be adjusted up or down afterwards);

Question 39

Name one (of three listed) techniques for keeping the tongue out of the way while inserting a King LTS-D. After insertion, be sure to inflate the cuffs before releasing the \_\_\_.

Answer 39

1. Tongue-jaw lift (thumb fully in the patient's mouth to capture the tongue); 2. OPA left in mouth during intubation; 3. Shoehorn technique with laryngoscope (fully inserted to lift tongue forward); 4. Tongue;

Question 40

What does the "S" in "King LTS-D" stand for?

Answer 40

1. Suction;

Question 41

King LTS-D airways are sized according to patient \_\_\_. I-Gel airways are sized according to patient \_\_\_.

Answer 41

1. Height; 2. Weight;

Question 42

When inserting an i-Gel, how should the jaw be manipulated?

Answer 42

1. The chin should be gently pushed inferiorly, toward the feet (no tongue-jaw lift or fingers inserted into the mouth);

Question 43

How should the i-Gel be taped down?

Answer 43

1. Maxilla to maxilla;

Question 44

The contraction of cardiac myocytes is initiated by electrical impulses known as \_\_\_.

Answer 44

1. Action potentials;

Question 45

An ___ is essentially a brief reversal of electric polarity across a cell's membrane, and is produced by ___ ion channels.

Answer 45

1. Action potential; 2. Voltage-gated;

Question 46

\_\_\_ cells do not have a true resting potential.

Answer 46

1. Pacemaker cells;

Question 47

Which cardiac cells exhibit funny channels (aka funny current)?

Answer 47

1. Pacemaker cells;

Question 48

Classification of drugs ending in -pril.

Answer 48

1. Ace Inhibitors;

Question 49

Classification of drugs ending in -olol.

Answer 49

1. Beta-Blockers;

Question 50

Classification of drugs ending in -ipine.

Answer 50

1. Dihydropyridine Ca++ Channel Blockers;

Question 51

Classification of drugs ending in -xetine.

Answer 51

1. Selective Serotonin Reuptake Inhibitors (SSRIs);

Question 52

Which scheduled drugs must be kept locked in a secured container?

Answer 52

1. Schedule II-V;

Question 53

In which schedule classification do drugs with a high abuse potential and with no recognized medical purpose fall?

Answer 53

1. Schedule I;

Question 54

In what safe temperature range must medications be stored?

Answer 54

1. 55-86 degrees F;

Question 55

Into which Pregnancy Classification do drugs which controlled studies showed no risk to the fetus belong?

Answer 55

1. Class A;

Question 56

Into which Pregnancy Classification do drugs which cause fetal abnormalities (risks clearly outweigh any benefits) belong?

Answer 56

1. Class X;

Question 57

Lusitropy is the rate of myocardial \_\_\_.

Answer 57

1. Relaxation;

Question 58

Hypothermia ___ the efficacy of medications.

Answer 58

1. Reduces;

Question 59

Blow (air, gas or powder) into a cavity of the body.

Answer 59

1. Insuflate;

Question 60

Malignant hyperthermia is a rare side effect of which paralytic medication?

Answer 60

1. Succinylcholine chloride;

Question 61

The ___ is central to the transport and modification of proteins in eukaryotic cells.

Answer 61

1. Golgi apparatus;

Question 62

A ___ is an organelle in the cytoplasm of eukaryotic cells containing degradative enzymes enclosed in a membrane.

Answer 62

1. Lysosome;

Question 63

The most abundant tissue type in the body.

Answer 63

1. Connective tissue;

Question 64

What type of tissue is blood?

Answer 64

1. Connective tissue;

Question 65

Which type of glands secrete their products through tubes, endocrine or exocrine?

Answer 65

1. Exocrine;

Question 66

\_\_\_ is a process of programmed cell death that occurs in multicellular organisms.

Answer 66

1. Apoptosis;

Question 67

The most prevalent ion in extracellular fluid.

Answer 67

1. Sodium (Na+);

Question 68

A high sodium ion level in the blood.

Answer 68

1. Hypernatremia;

Question 69

A high potassium ion level in the blood.

Answer 69

1. Hyperkalemia;

Question 70

The most prevalent ion in intracellular fluid.

Answer 70

1. Potassium (K+);

Question 71

The principle chemical buffer of the human body.

Answer 71

1. Bicarbonate (HCO3-);

Question 72

Oncotic pressure is also called \_\_\_.

Answer 72

1. Colloid osmotic pressure (osmotic pressure exerted by large protein particles);

Question 73

Which law/hypothesis relates the passage of fluid out of a capillary to the hydrostatic and osmotic pressures of the blood and tissue fluid, and states that the net effect of the opposing pressures determines the direction and rate of flow?

Answer 73

1. Starling's Hypothesis;

Question 74

Name the principle components of blood and the percentage they make up.

Answer 74

1. Plasma (54%); 2. Red blood cells (45%); 3. White cells/platelets (1%);

Question 75

RBCs are rendered ___ from a hypertonic solution.

Answer 75

1. Crenated;

Question 76

RBCs can ultimately be rendered ___ from a hypotonic solution.

Answer 76

1. Lysed;

Question 77

Normal range of the body's pH.

Answer 77

1. 7.35-7.45;

Question 78

Chemical formula of carbonic acid.

Answer 78

1. H2CO3;

Question 79

Increased ventilations lead to a(n) ___ in CO2 and a(n) in pH.

Answer 79

1. Decrease; 2. Increase;

Question 80

Decreased ventilations lead to a(n) ___ in CO2 and a(n) ___ in pH.

Answer 80

1. Increase; 2. Decrease;

Question 81

What does DNA stand for?

Answer 81

1. Deoxyribonucleic acid;

Question 82

The most prevalent endocrine disorder.

Answer 82

1. Diabetes mellitus;

Question 83

The amount of blood ejected from the left ventricle in one contraction.

Answer 83

1. Stroke volume;

Question 84

The ___ law of the heart states that the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart (the end diastolic volume) when all other factors remain constant.

Answer 84

1. Frank-Starling;

Question 85

Stroke Volume x Heart Rate = \_\_\_

Answer 85

1. Cardiac output;

Question 86

cardiac output x peripheral vascular resistance = \_\_\_

Answer 86

1. Blood pressure;

Question 87

The signs and symptoms of anaphylactic shock most often present within \_(time period)\_.

Answer 87

1. One minute;

Question 88

What does MODS stand for?

Answer 88

1. Multiple Organ Dysfunction Syndrome;

Question 89

The ___ is a membrane-bound structure found within muscle cells which stores and releases calcium ions.

Answer 89

1. Sarcoplasmic reticulum (SR);

Question 90

With the addition of energy from an ATP molecule, the sodium potassium pump moves ___ sodium ions out of the cell and moves ___ potassium ions into the cell with each turn. The goal of this process is to return, or keep, the cell at a resting state, or resting potential.

Answer 90

1. Three; 2. Two;

Question 91

Cardiac pacemaker cells exhibit ___ response action potential.

Answer 91

1. Slow;

Question 92

In general medicine, ___ drug administration is drug administration by the digestion process in the gastrointestinal tract.

Answer 92

1. Enteral;

Question 93

A ___ reaction is an inflammatory reaction to IV contaminants, and takes approximately ___ minutes to present.

Answer 93

1. Pyrogenic; 2. 30;

Question 94

The upper and lower airways are separated by the \_\_\_.

Answer 94

1. Glottis;

Question 95

The part of the larynx consisting of the vocal cords and the slit-like opening between them.

Answer 95

1. Glottis;

Question 96

Calculation for a patient's ideal weight in kilograms.

Answer 96

1. 50 + [(# inches \> 5') x 2.3];

Question 97

When intubating with a bougie (with a partner available to assist with ET tube placement after bougie insertion), how far should the introducer be inserted into the trachea?

Answer 97

Advance until you encounter "holdup," indicating the bougie has struck the carina or a branch in the bronchial tree, then retract to 25 cm (per EMCrit; if the bougie has entered the esophagus, it would often be possible to insert the entire stylet);

Question 98

The suffix ___ signifies an inflammatory process, while ___ signifies a degenerative process.

Answer 98

1. Itis; 2. Osis; * http://atpplusct.com/itis-vs-osis/*

Question 99

The term edema refers to a discernible excess of \_(location)\_ fluid. ___ edema gives way on palpation, leaving persistent impressions in the skin; ___ edema offers resistance and leaves no impressions.

Answer 99

1. Intersititial; 2. Pitting; 3. Brawny; * https://www.ncbi.nlm.nih.gov/books/NBK348/*

Question 100

\_\_\_, the anion that results from dissociation of lactic acid, is a product of ___ metabolism; specifically it is the end product of \_(metabolic process)\_.

Answer 100

1. Lactate; 2. Glucose; 2. Anaerobic glycolysis; * https://acutecaretesting.org/en/articles/lactate-and-lactic-acidosis*