Test Queations 3

Question 1

What is the target in cerebral perfusion pressure for the pediatric patient?
50
60
70
80

Answer 1

60
<59 ischemic changes in ultimate infarction
Goal 3 H’s:
Hypervolemic give volume
Hyperdynamic administer an inotrope
Hypertensive administer levophed

Question 2

During a three hour critical care transport in a rotor wing aircraft, a flight crew notices that the patient’s blood sugar has decreased more than expected. The team suspects that this is likely due to which stressor of flight?
Vibration
Noise
Hypoxia
Temperature

Answer 2

Vibration

The primary stressor of flight that has a direct impact on the bodies. BMR is vibration. Vibration causes an increase in patient’s metabolism further depleting their glycemic stores. 

Question 3

ELT Activated with an impact exceeding?
Two Gs
Three Gs
Four Gs 
Five Gs

Answer 3

Four Gs

Question 4

A six-year-old patient has ingested eight peach pits. What is a toxicology concern for this type of ingestion?

Central nervous system depression
Central nervous system stimulant
Cyanide toxicity
Lengthened QTC

Answer 4

Cyanide toxicity

Cytogenic glycosides are naturally occurring compounds found in the pits of various fruit, including peaches. Signs of cyanide toxicity include headache, vomiting, dizziness, abdominal cramping. Hallmark laboratory findings include metabolic, acidosis, and elevated lactate level. 

Question 5

Salt water, drowning, aspirating 250 mils of fluid. Which of the following would not be a concern for potential problems?
Hyperosmolar Shift
Hemolysis
Dilution of surfactant
Plasma hemoconcentration

Answer 5

Hemolysis

Hemolysis is seen with freshwater, drowning, as fluid is hypo osmolar, causing fluid to enter the blood stream leading to hemolysis. With salt water, drowning the hyper osmolar fluid causes a shift, allowing fluid and exudates to enter the IV spaces quickly. L

Question 6

A 16-year-old sustained an aortic arch tear during a motor vehicle collision, which is commonly associated with which of the following?

Blunt force injury to the chest wall
Penetration injury to the chest wall
Acceleration/deacceleration injury
Cardiac contusion

Answer 6

Acceleration/deceleration injury

Acceleration/deceleration injury causes a sheering tear of the aortic arch. Approximately 80% of patients die within minutes with this type of large vessel tear. 

Question 7

Sneak bite, which of the following lab values would be suggestive of disseminated intervascular coagulation DIC

Answer 7

Decreased platelets, decrease fibrinogen, prolonged PT/PTT, prolonged thrombin time

Question 8

A patient experiencing a plastic sickle cell crisis typically presents with power, tachycardia, weakness, and fatigue as well as
JVD
Rhonchi
Facial rash
Bradycardia

Answer 8

Facial rash 

Question 9

A pediatric patient presenting with signs of spinal cord injury after diving accident. They have no lower extremity movement however, can flex their arms, but not extend them. Where is the fracture?
C4
C5
C6
C7

Answer 9

C7

C3 to C5 controls the phrenic nerve and diaphragm
C5 to C6 controls elbow flexion
C7 controlling wrist and elbow extension
Because the patient can flex but not extend the arms the injury would be at C7 

Question 10

A basilar skull fracture is associated with all of the following, except

Cerebral spinal fluid rhinorrhea
Cerebral spinal fluid otorrhea
Seventh cranial nerve palsy
11th cranial nerve paralysis

Answer 10

11th cranial nerve paralysis

Basilar school fractures may present with CSF rhinorrhea otorrhea bruising over the mastoids (battle sign) and bruising around the eyes. Facial palsy, nystagmus and facial numbness can occur due to compression or injury to CN VII

Question 11

The intra-aortic balloon pump begins to purge during ascent. The triggering mechanism is a result of which gas law.

Boyles law
Charles Law
Henry’s law

Answer 11

Boyles law

Any ascent question think Boyles law
IABP will purge in an attempt to equalize the increase in volume from a decrease in atmospheric pressure. The IABP will purge every 1000 feet of a scent and every 2000 feet of descent

Question 12

The proper shutdown procedure for most aero medical aircraft would be in what priority

Throttle battery fuel rotor brake oxygen
Throttle fuel battery rotor brake oxygen

Answer 12

Throttle fuel battery rotor brake oxygen 

Question 13

Fractures of 1st and 3rd ribs should indicate a high index of suspicion for which injury?
Esophageal rupture
Aortic dissection
Pulmonary contusion
Liver laceration

Answer 13

Aortic dissection 

Question 14

Injury patterns associated with rear impact collision are?

T-12-L1 and c spine fractures
C spine fractures, clavicle, and pelvic fractures 

Answer 14

T-12-L1 and c spine fractures

Question 15

Pediatric burn patient 20 kg 45% TBS A. Injury occurred two hours previously in referring facility administered 300 mils of LR. Using the consensus formula what would the fluid resuscitation amount be for the first eight hours, taking into account volume already administered?

1050ml, 175ml/hr
1350ml, 169 ml/hr
1400Ml, 180ml/hr
1800ml, 200ml/hr

Answer 15

1050ml, 175 ml/hr

Total volume would be 2700 mls/24 hours. Administer half of the total fluids during first eight hours post burn. Taking into account volume already administered fifth 1350 should be administered in the first eight hours and the patient already received 300 mls so 1050 mls is left to administer over the next six hours since it has already been two hours post injury 

Question 16

CVP 1
CI 1.8
PA S/D 11/5
PCWP 4
SVR 1800

Hypovolemic shock
Left systolic dysfunction
Neurogenic shock
Septic shock

Answer 16

Hypovolemic shock

CVP low indicates preload problem. CI low means cardiac output low.
PA S/D & PCWP low left side preload is dec.
SVR hyperdynamic

(neurogenic shock would have a normal CI)

Question 17

Which type of medication blocks the RAA system to help with heart failure

Beta blocker
Calcium channel block
Ace inhibitor
Thiazide diuretic

Answer 17

Ace inhibitor

Ace inhibitors block stimulation of the RAA system. When hypoperfusion of the kidney stimulates the RAA system, it causes vasoconstriction and sodium and water retention. Blocking stimulation of the RAA system helps prevent further vasoconstriction and retention in a heart failure patient.

Question 18

What does the oxygen consumption equation used to identify?

Oxygen content in the arteries
Oxygen uptake by the cells
Amount of oxygen bound to hemoglobin
Oxygen uptake by the muscle muscles

Answer 18

Oxygen content in the arteries

Question 19

What is the pitot on an aircraft used for?

Pressure measurement
Flow velocity
Water velocity
Delta P

Answer 19

Pressure measurement.

Pitot tube on an aircraft is used to determine air speed and altitude. It has two holes that are used for measurement that measure stagnation pressure and static pressure. The difference between the two is dynamic pressure which is used to determine airspeed and altitude. 

Question 20

What would be anticipated finding in the early stages of septic shock?

Answer 20

Increased cardiac output, cardiac index, decreased SBR, increased SvO2

Question 21

When applying pressure support in a neonate on SIMB, what is the stopping point for allowing the patient to take a spontaneous breath?

Answer 21

Spontaneous breaths > 75% of the controlled set Vt

Question 22

During the treatment of DKA and a pediatric patient what glucose level would you start dextrose maintenance infusion?

100 to 150
150 to 200
200 to 250
250 to 300

Answer 22

250 to 300 

Question 23

Myoglobinuria is left untreated will cause what critical condition

Hyperkalemic crisis
Acute tubular necrosis
Cardiomyopathy
Polycystic kidney disease

Answer 23

Acute tubular necrosis

Myoglobinuria is the presence of myoglobin in the urine, associated with rhabdo or muscle destruction if left untreated can cause acute tubular, necrosis and profound renal failure 

Question 24

The main focus when treating a patient with DIC is
Administer heparin
FFP
Correct, underlying pathology
Replacement of clotting factor factors

Answer 24

Correcting underlying pathology

Question 25

Which lab finding would be an anticipated with diabetes insipidus Elevated capillary blood glucose Relative hyperkalemia Relative hypo Urinary hypo osmolality

Answer 25

Urinary hypoosmolality Diabetes insipidus occurs from low level ADH, causing patient to lose significant amount of water through urination. Increase an output leads to an increase in serum sodium and increase in serum osmolality in a decrease in urinary osmolality.

Question 26

A 15-year-old has a diagnosis of subarachnoid hemorrhage secondary to a previously undiagnosed AVM. What is the systolic blood pressure goal for this patient during transport? 120 130 140 150

Answer 26

140 It’s essential to maintain systolic blood pressure at 1:40 with sub, adenoid hemorrhage. Unlike treatment goals associated with interest cerebral hemorrhage, which says systolic blood pressure needs to be 160 due to location of bleed and the required map needed to perfuse that level of the brain. In contrast, subarachnoid hemorrhages have a very high probability of re-bleeding. As such the systolic BP and associated in map need to be lower. 

Question 27

Cushing’s triad

Answer 27

Increased systolic blood pressure, bradycardia, and change in Respiratory status

Question 28

DAI Diffuse axonal injury will most likely represent how on a CT scan?

Answer 28

Subtle and sometimes unidentifiable CT scans reveal what appears to be normal findings in 88% of the time and non-hemorrhagic situations with diagnosis needed via MRI. DAI is an injury that causes severe sharing of the axons of the nerve cells throughout the brain. 

Question 29

Concerning the hypothermic, patient shivering is limited by what? Cardiac output Muscle mass Glycogen stores Lactic acidosis

Answer 29

Glycogen stores 

Question 30

During the morning briefing the pilot states that current conditions are 1,000 & 3. What does this mean? 1,000’ ceiling and 3 mile visibility 1,000’ visibility and a 3 mile ceiling

Answer 30

1,000’ ceiling and a 3 mile visibility

Question 31

8yo has orbital wall and floor fracture which can be associated with which of the following? Optic nerve compression Unilateral blindness Entrapment of extraocular muscles Nystagmus

Answer 31

Entrapment of extraocular muscles