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Flashcards in Midterm medicine Deck (93)
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1

You are dispatched to a residence for a 20-year-old male with respiratory distress. When you arrive, you find that the patient has a tracheostomy tube and is ventilator dependent. His mother tells you that he was doing fine, but then suddenly began experiencing breathing difficulty. You should:

A: remove him from the mechanical ventilator and ventilate him manually.
B: remove the ventilator tubing and place an oxygen mask over the tracheostomy tube.
C: check the settings on the ventilator to ensure that it is functioning properly.
D: detach the ventilator, suction the tracheostomy tube, and reassess the patient.

A: remove him from the mechanical ventilator and ventilate him manually.

2

After moving a hypothermic patient to a warmer area, your primary focus should be to:

A: prevent further body heat loss.
B: give warm, humidified oxygen.
C: assess his or her body temperature.
D: provide rapid rewarming.

A: prevent further body heat loss.

3

Which of the following would MOST likely cause a rapid drop in a patient’s blood glucose level?

A: Forgetting to take prescribed insulin
B: Mild exertion after eating a meal
C: Taking too much prescribed insulin
D: Eating a meal after taking insulin

C: Taking too much prescribed insulin

4

A 30-year-old man with a history of schizophrenia cut his wrists and is bleeding profusely. He is confused, combative, and has slurred speech. With the assistance of law enforcement personnel, you and your partner physically restrain him in order to provide care and transport. In this situation, a court of law would MOST likely:

A: determine that the patient had decision-making capacity.
B: consider your actions in providing care to be appropriate.
C: agree that you and your partner are guilty of assault and battery.
D: conclude that you should have had a court order to restrain.

B: consider your actions in providing care to be appropriate.

5

When insulin levels in the blood remain high:

A: glucose is rapidly taken out of the blood to fuel the cells.
B: a fruity odor can be detected on the patient’s breath.
C: the cells starve for glucose and begin to metabolize fat.
D: the patient urinates excessively and becomes dehydrated.

A: glucose is rapidly taken out of the blood to fuel the cells.

Reason:

Insulin is a hormone that promotes the cellular uptake of glucose from the bloodstream. If insulin levels remain high, such as when a diabetic inadvertently takes too much insulin, glucose is rapidly taken out of the blood to fuel the cells. This leads to low circulating blood glucose levels (hypoglycemia) and a condition called insulin shock. By contrast, if insulin levels are too low, such as when a diabetic forgets to take his or her insulin, glucose cannot enter the cells and pools in the bloodstream (hyperglycemia). In the absence of glucose, the cells begin to metabolize fat, which produces ketoacids (diabetic ketoacidosis [DKA]). The respiratory system attempts to eliminate ketoacids from the blood with an increased rate and depth of breathing that is accompanied by a fruity or acetone breath odor (Kussmaul respirations). Hyperglycemia causes the patient to eliminate excess water from the body through urination (diuresis), resulting in dehydration.

6

A 46-year-old man presents with generalized weakness and shortness of breath after he was bitten on the leg by a rattlesnake. His blood pressure is 106/58 mm Hg and his pulse rate is 112 beats/min. In addition to supplemental oxygen, further treatment for this patient should include:

A: ice packs to the wound and splinting.
B: splinting and lowering of the affected part.
C: proximal arterial constricting band and splinting.
D: elevation of the affected part and ice packs.

B: splinting and lowering of the affected part.

Reason:
Care for a patient with a bite from a pit viper (rattlesnake, copperhead, water moccasin) includes keeping the patient calm, administering supplemental oxygen, splinting the affected part, and keeping it below the level of the heart. Do NOT apply ice to a snakebite; this will cause local vasoconstriction and may force the venom deeper into the patient’s circulation. If a constricting band is applied, it should be proximal to the bite and should be tight enough to slow venous return only, not cut off arterial supply.

7

A 28-year-old woman has severe lower quadrant abdominal pain. When assessing her abdomen, you should:

A: ask her where the pain is located and palpate that area first.
B: ask her where the pain is located and palpate that area last.
C: encourage the patient to lie supine with her legs fully extended.
D: auscultate for bowel sounds for approximately 2 to 5 minutes.

B: ask her where the pain is located and palpate that area last.

Reason:
Assessment of a patient’s abdomen includes asking where the pain is located and then palpating that area last. Palpating the painful area first may interfere with the rest of your assessment because of the significant pain the patient will be in. Bowel sounds are of little value in the field and generally are not included in the abdominal assessment. Patients with severe abdominal pain typically prefer to lie on their side with their knees drawn up into their chest (fetal position). Moving them from this position will aggravate their pain.

8

Which of the following structures is responsible for regulating body temperature?

A: Hypothalamus
B: Medulla oblongata
C: Cerebrum
D: Cerebellum

A: Hypothalamus

9

You respond to a baseball field for a person who was struck by lightning. When you arrive, you see one patient who appears confused and is ambulatory; a second patient who is conscious, sitting on the ground, and holding his arm; and a third patient who is supine and motionless. After requesting additional responders, you should:

A: treat the conscious patients because the motionless patient is likely deceased.
B: assess and begin treating the sitting patient first because he is obviously injured.
C: assess the motionless victim and perform CPR and defibrillation if necessary.
D: proceed to the ambulatory patient, sit him down, and assess his mental status.

C: assess the motionless victim and perform CPR and defibrillation if necessary.

10

An 80-year-old woman has pain in the right upper quadrant of her abdomen and a yellow tinge to her skin. You should suspect dysfunction of the:

A: spleen.
B: gallbladder.
C: liver.
D: pancreas.

C: liver

11

Which of the following actions should be carried out during the primary assessment of an unresponsive patient?

A: Assessing the skin
B: Palpating the cranium
C: Obtaining a blood pressure
D: Auscultating the lungs

A: Assessing the skin

12

You are called to the residence of a 39-year-old male with flu-like symptoms. The patient tells you that he has been feeling ill for the last 2 days. He has a fever, headache, and diarrhea, and asks that you take him to the hospital. His blood pressure is 120/60 mm Hg, his pulse is 110 beats/min, and his respirations are 16 breaths/min. You should:

A: advise him that he can drive himself to his family physician.
B: ask him if he has a history of HIV infection or hepatitis.
C: offer oxygen and transport him in a position of comfort.
D: request an ALS ambulance to the scene to start an IV line.

C: offer oxygen and transport him in a position of comfort.

13

You are assessing a 40-year-old male with an apparent psychiatric crisis. According to the mans's wife, he has a history of depression and schizophrenia and takes Zoloft and Zyprexa. A police officer is present at the scene. The patient, who is obviously scared, tells you that he sees snakes everywhere. You should:

A: let him know that it is important for him to be transported as soon as possible.
B: tell him that you do not see any snakes, but they are obviously scaring him.
C: let him know that going to the hospital will keep him safe from the snakes.
D: advise him that you suspect he has not been compliant with his medications.

B: tell him that you do not see any snakes, but they are obviously scaring him.

14

The MOST obvious way to reduce heat loss from radiation and convection is to:

A: increase metabolism by shivering.
B: wear a thick wind-proof jacket.
C: move to a warmer environment.
D: move away from a cold object.

C: move to a warmer environment.

15

A 60-year-old male complains of a tearing sensation in his abdomen. He tells you the pain began suddenly and feels like someone is sticking a knife into his abdomen. He is conscious and alert with a blood pressure of 148/88 mm Hg, a pulse of 120 beats/min, and respirations of 22 breaths/min. In addition to administering high-flow oxygen, you should:

A: vigorously palpate his abdomen to assess for a pulsating mass.
B: perform a rapid head to toe assessment and prepare for transport.
C: auscultate over his epigastrium to assess for bowel sounds.
D: transport at once and be prepared to treat him for severe shock.

D: transport at once and be prepared to treat him for severe shock.

16

Which of the following is a physiologic effect of epinephrine when used to treat anaphylactic shock?

A: As a bronchodilator, it improves the patient's breathing.
B: As a vasodilator, it increases the blood pressure.
C: As an antihistamine, it blocks chemicals that cause the reaction.
D: As a vasoconstrictor, it lowers the blood pressure.

A: As a bronchodilator, it improves the patient's breathing.

17

Which of the following is the MOST significant finding in a patient with a severe headache?

A: Chest discomfort
B: Pain in both legs
C: Unilateral weakness
D: Abdominal tenderness

C: Unilateral weakness (weakness on one side of the body)

18

Which of the following signs or symptoms is MOST suggestive of a systemic reaction following ingestion of a poison?

A: Nausea and vomiting
B: Painful or difficult swallowing
C: Tachycardia and hypotension
D: Burns around the mouth

C: Tachycardia and hypotension

19

Which of the following conditions would be the LEAST likely to be present in a patient who was submerged in water?

A: Hyperglycemia
B: Laryngospasm
C: Gastric distention
D: Spinal injury

A: Hyperglycemia

20

A 50-year-old woman who is conscious and alert complains of a severe migraine headache. When caring for her, you should generally avoid:

A: shining a light into her pupils.
B: transporting her in a supine position.
C: dimming the lights in the ambulance.
D: applying ice packs to her forehead.

A: shining a light into her pupils.

21

You are called to a local park for an ill person. It is a hot day and the humidity is high. When you arrive, a bystander directs you to the patient, a young male who is semiconscious. His skin is flushed, hot, and moist. Your FIRST action in the management of this patient should be to:

A: ensure an open airway.
B: move him to a cool area.
C: begin rapid cooling measures.
D: administer high-flow oxygen.

B: move him to a cool area.

22

When dealing with an emotionally disturbed patient, you should be MOST concerned with:

A: gathering all of the patient’s medications.
B: whether the patient could harm you.
C: safely transporting to the hospital.
D: obtaining a complete medical history.

B: whether the patient could harm you.

23

Which of the following statements regarding the function of insulin is correct?

A: It promotes the entry of glucose from the cell into the bloodstream.
B: It stimulates the liver to release glucose into the bloodstream.
C: It causes the pancreas to produce glucose based on the body’s demand.
D: It facilitates the uptake of glucose from the bloodstream into the cell.

D: It facilitates the uptake of glucose from the bloodstream into the cell.

24

A 42-year-old male presents with fever, a severe headache, and a stiff neck. He is conscious, but confused. His wife tells you that he does not have any medical problems and does not take any medications. You should be MOST suspicious for:

A: influenza.
B: meningitis.
C: acute stroke.
D: tuberculosis.

B: meningitis

Reason:
Meningitis is an inflammation of the protective coverings of the brain and spinal cord (meninges). Common signs and symptoms of meningitis include fever, headache, neck stiffness (nuchal rigidity), and vomiting. An altered mental status is common in severe cases. Meningococcal meningitis, caused by a bacterium, is the most contagious and potentially fatal type of meningitis. The patient’s signs and symptoms are not consistent with acute stroke, tuberculosis (TB), or influenza (the flu). Although fever is common with both TB and the flu, neither causes neck stiffness. Acute stroke may be associated with a headache, especially a hemorrhagic stroke; however, stroke patients typically do not have a fever.

25

You should not attempt to actively rewarm a patient with moderate or severe hypothermia in the field because:

A: active rewarming has been shown to cause severe hypertension.
B: the risk of inadvertently inducing hyperthermia is too high.
C: rewarming too quickly can cause a fatal cardiac dysrhythmia.
D: it is painful for the patient and you cannot give analgesic drugs.

C: rewarming too quickly can cause a fatal cardiac dysrhythmia.

26

A middle-aged man was found floating facedown in a small pond. When you arrive at the scene, bystanders are present, but nobody has removed him from the water because they thought he was dead. After reaching the victim, you should:

A: stabilize his head as you remove it from the water and open his airway by tilting his head back.
B: grab him by his clothing, remove him from the pond, and assess for breathing and a pulse.
C: float a buoyant backboard under him, remove him from the pond, and begin rescue breathing.
D: move him to a supine position by rotating the entire upper half of his body as a single unit.

D: move him to a supine position by rotating the entire upper half of his body as a single unit.

27

Hypoglycemia and acute ischemic stroke can present similarly because:

A: both oxygen and glucose are needed for brain function.
B: they are both caused by low levels of glucose in the blood.
C: the most common cause of a stroke is hypoglycemia.
D: the majority of stroke patients have a history of diabetes.

A: both oxygen and glucose are needed for brain function.

28

Law enforcement requests your assistance to evaluate a young female who they believe has overdosed. The patient is conscious, is displaying bizarre behavior, and is very restless. Her BP is 170/90 mm Hg and her heart rate is 130 beats/min. You see needle tracks on both of her arms. She is MOST likely under the influence of a:

A: sedative-hypnotic.
B: powerful narcotic.
C: methamphetamine.
D: benzodiazepine.

C: methamphetamine.

29

You are called to an assisted living center where an attendant found a 72-year-old man unresponsive. The patient had recent hip surgery and has been taking Vicodin for pain. His respirations are slow and shallow and his pulse is slow and weak. You should:

A: request an ALS ambulance to respond to the scene.
B: apply the AED in case he develops cardiac arrest.
C: apply high-flow oxygen via a nonrebreathing mask.
D: begin ventilation assistance with a bag-mask device.

D: begin ventilation assistance with a bag-mask device.

30

When insulin levels in the blood remain high:

A: the cells starve for glucose and begin to metabolize fat.
B: a fruity odor can be detected on the patient’s breath.
C: glucose is rapidly taken out of the blood to fuel the cells.
D: the patient urinates excessively and becomes dehydrated.

C: glucose is rapidly taken out of the blood to fuel the cells.