Test Questions Flashcards by Sophia Gilmore

In a salicylate overdose, the primary acid based disturbance is blank, followed by blank?

Respiratory alkalosis, metabolic acidosis
Respiratory alkalosis, metabolic alkalosis
Respiratory acidosis, metabolic alkalosis
Respiratory acidosis, metabolic acidosis

Respiratory alkalosis, metabolic acidosis

Aspirin stimulates respiratory center in the brain, causing hyperventilation & Respiratory alkalosis . Then leads to state of metabolic acidosis as hydrogen ions are exchanged for potassium and potassium is lost in the urine.

How well did you know this?

Not at all

Perfectly

Federal aviation administration guidelines state that an aero medical program may only fly?

Visual flight rules VFR in visual meteorological conditions VMC
Instrumental flight rules, IFR in visual meteorological conditions VMC

VFR in VMV

Remember VFR equals VMC. IFR requires a filed flight plan and an IFR equipment aircraft that includes auto pilot dual engines IFR trained pilot GPS approach and certified landing zone or airport.

How well did you know this?

Not at all

Perfectly

Left axis deviation is noted on the EKG for a one hour old neonate. This one indicate?

Normal findings
Right ventricular hypertrophy
A cyanotic heart defect
Left ventricular hypertrophy

Left ventricular hypertrophy

Left access deviation should never be seen in the newborn period. Left access deviation indicates left ventricular hypertrophy and a left sided out flow obstruction defect. Neo needs to have a high pressure right side in utero when they are born, they should always show right axis deviation because of this. This changes to a normal axis within the first week of life.

How well did you know this?

Not at all

Perfectly

When monitoring, invasive intracranial pressure lines, the transducer should be leveled where?

Foramen of Monro
Foramen Ovale
Foramen of Kellie
Foramen of Magnum

Foramen of Monro

The transducer should be leveled at the point of the patient’s face, which is the Foramen of Monro. This location is the outer canthus of the eye.

How well did you know this?

Not at all

Perfectly

A patient is experiencing left ventricular diastolic failure. What is the focus of first line therapy?

Increasing preload
Decreasing preload
Augmentation of left ventricular clearing
Increasing afterload

Augmentation of left ventricular clearing

Augmentation of the left ventricle revolves around allowing the ventricle to fill appropriately. Often, treatment of hypertension with ace inhibitors and beta blockers are first line treatments, along with digoxin for inotropic augmentation and contractility.

How well did you know this?

Not at all

Perfectly

After receiving massive transfusion, PRBCs, the patient is experiencing cellular hypoxia secondary to what?

Decreased calcium levels
Hemolytic reaction
Hyperthermia
Decrease levels of 2,3 DPG

Giving many units of PRBC’s patient can become hypothermic. Also citrate, which is added to PRBCs for storage binds with 2,3 DPG. The finding causes the Hgb to lose the ability to release oxygen to the tissuesb(increased affinity) and drives the oxyhemoglobin curve to the left. There should be consideration in administering calcium replacement because citrate binds with calcium and magnesium, causing the patient to have decreased levels of both. Giving calcium increases SVR and helps with contractility in the shock patient.

How well did you know this?

Not at all

Perfectly

The primary trigger used for most intra-aortic balloon pump (IABP) operations is?

Pulmonary artery catheter
CVP waveform
Arterial line
ECG wave form

ECG waveform

Initial set up trigger will always utilize the ECG as the primary trigger. Using the ECG tracing gives a more precise timing in comparison to the dichotic notch on the airline. If the ECG in the dichotic notch, which indicates aortic valve closure, or matched up the end of the T wave would represent the same timeframe in this cardiac cycle. And a line trigger parentheses pressure trigger parentheses will be used if the IABP console cannot time due to artifact, interference, or irregular ECG rhythms. However, a line use for triggering has limitations and does not time well.

How well did you know this?

Not at all

Perfectly

The following hemodynamic parameters are obtained: CVP 8 CI 1.4 PCWP 13. This could indicate what problem for the patient?

Septic shock
Hypovolemia
Heart failure
Anaphylactic shock

Heart failure

Those values indicate left sided failure. The CVP is high showing that there are high pressures upstream, left side are elevated. The CI is a direct reflection of CO, which indicates poor left ventricular function. PCWP is a direct reflection of left ventricular and diastolic pressure and is elevated, leading to a diagnosis of left sided heart failure.

How well did you know this?

Not at all

Perfectly

The patient is demonstrating an increase in Venus oxygen saturation, SvO2, and a decrease in oxygen consumption VO2 and pH. What type of shock do you suspect?

Septic
Cardiogenic
Anaphylactic
Hemorrhagic

Septic

In the early hyperdynamic phase of septic shock, oxygen delivery increases, but the tissues cannot extract and use the oxygen, therefore the consumption is decreased, and the Venus oxygen saturation is increased. Lactic acidosis ensues because the cells become hypoxic from not being able to utilize the oxygen.

How well did you know this?

Not at all

Perfectly

A base receives a complaint that the pilot always chooses a landing zone that is different from what the incident commander has assigned. How should this be handled?

Direct the complaint to the corporate office
Ignore the complaint
Tell the pilot to land per the incident commander
Provide LZ training for the local fire department

Provide LZ training for the local fire department

Safety is priority if the pilot deemed the LZ unsafe, they will make the decision where to land.

How well did you know this?

Not at all

Perfectly

When assessing a patient’s fractured, elbow, damage to the radial and older nerves would present as

Loss of sensation to the thumb and pinky ipsilateral to the fractured elbow
Delay, capillary refill in the extremity ipsilateral to the fractured elbow
Phantom pain in the extremity on the contralateral side of the injury
Loss of sensation to the scapula and glenoid area of the injured extremity

Loss of sensation to the thumb and pinky ipsilatetal to the fractured elbow

Nerve damage to radial an older nerves would present as loss of sensation. Radial and older nerves are prone to damage because of their proximity to the elbow. Damage to the radial nerve would present as a loss of sensation to the thumb and injury to the older nerve would present as lacking sensation in the pinky

How well did you know this?

Not at all

Perfectly

What is the normal systemic vascular resistance SVR measure measurement?

400 to 1000
200 to 400
1200 and 1800
800 and1200

800 and1200

How well did you know this?

Not at all

Perfectly

The team is called to transfer a five month old infant with TOF with DiGeorge syndrome. Enroute the patient begins to have seizures, which are most likely secondary to what?

Hypoglycemia
Hypomagnesemia
Hypocalcemia
Hyponatremia

Hypocalcemia

DiGeorge is a primary immuno deficiency disease caused by T cell deficiency, congenital heart, defects, and hypocalcemia

How well did you know this?

Not at all

Perfectly

PGE starting dose

.05-.1

How well did you know this?

Not at all

Perfectly

The high vascular resistance in the fetal along is due to, which of the following physiologic mechanisms?

Changes in pH and CO2 tension
Changes in O2 tension
Pulm arterial vasoconstriction
Inc in systemic vascular resistance

Pulm arterial vasoconstriction

Pulmonary arterial vasoconstriction prevents blood from flowing through the fetal lungs and causes oxygenation to occur in the placenta. At birth, pulmonary adaptation occurred after a complex series of events, switching oxygenation from the placenta to the lungs.

How well did you know this?

Not at all

Perfectly

A neonate as sudden decompensation two days after going home. Infant was full of full term and healthy. On assessment preductal SPO2 right hand 90% lower extremity SPO2 70%. No femoral pulse is noted there’s distended abdomen what is suspected clinical diagnosis?

Acyanotic heart defect
Left outflow obstruction defect
Ventral septal defect
Atrial septal defect

Left outflow obstruction defect

No femoral pulses on lower extremities indicates left side, outflow obstruction defect, such as coarc

How well did you know this?

Not at all

Perfectly

1 yo LUL PNA BP 70/36, HR 138, RR 48, SpO2 87% T 102. ABG pH 7.2, PaCO2 68 HCO3 32, PaO2 65

Left shift w dec SaO2
Right shift with dec SaO2
Left shift w inc SaO2
Right shift inc SaO2

Right shift w dec SaO2

Bohr Effect. In the presence of increased acid hemoglobin has less affinity to oxygen. Decrease affinity means hemoglobin molecules dumped off loads of oxygen to the tissues instead of storing oxygen like normal. There’s an abundance of hydrogen ions in CO2. Those take a seat on the hemoglobin molecule and do not leave room for oxygen to be stored. Decreased room for oxygen on a hemoglobin molecule results in higher amounts of dissolved oxygen in the blood high PaO2 and a lower SaO2 & SpO2O2

How well did you know this?

Not at all

Perfectly

Innate, who is experiencing repetitive motion of a bicycling type action with lip smacking is presenting what type of seizure?

Subtle
Myoclonic
Clonic
Tonic

Subtle

Subtle seizures consist of repetitive mouth tongue movements, bicycling, eye deviation and rapid blinking

How well did you know this?

Not at all

Perfectly

Dopamines alpha adrenergic effects are related to?

Beta, one peripheral vascular resistance
Decreased renal, vascular resistance
Dilation of peripheral vascular resistance
Coronary vasoconstriction

Coronary vasoconstriction

Dopamine alpha effects will cause coronary vasoconstriction and primary chronotropic effects. Coronary vasoconstriction leads to reduction and cardiac output at doses greater than 10 mcg/kg/min

How well did you know this?

Not at all

Perfectly

You respond to Transfer a patient with a diagnosis of a skull fracture that is described as multiple fractures that radiate from a compressed area. What type of school fracture does this patient have?

Basilar fracture
Stellate fracture
Depressed skull fracture
Diastatic fracture

Study These Flashcards

Stellate fracture

A stellate skull fracture occurs with multiple linear fractures, radiating from the site of impact

When inserting a chest tube of the recommended insertion site is?

Fourth, fifth intercostal space, anterior axillary
Third, fourth intercostal space midclavicular
Fifth, sixth intercostal space, mid axillary
Fourth, fifth intercostal space midclavicular

Study These Flashcards

Fourth, fifth intercostal space anterior axillary

A patient was exposed to a substance that is inhibiting ATP production by blocking the electron transport chain in their mitochondria. What antidote management would best suit this patient?

Sodium nitrite/amyl nitrate and sodium thiosulfate
Oxygen
Physostigmine
Atropine and 2PAM

Study These Flashcards

Sodium nitrite/amyl nitrate and sodium thiosulfate

Administering a cyanide antidote is essential. Hydroxocobalamin (Cyanokit) is now considered first line therapy. However, if unavailable sodium nitrite or ammo, nitrite and sodium thiosulfate are still utilized and recommended.

The ________measures filling pressures on the right side of the heart as the tip of the catheter lies in the right atrium

PCWP
CVP
RV pressure
LVEDP

Study These Flashcards

CVP

Spinal Fractures

Study These Flashcards

A patient with paralysis from nipple line down has a spinal cord injury at the level of T4

If a patient has paralysis from the clavicle down, this indicates fracture at a level above C4

If a patient has paralysis from the umbilicus line down, injury is at level of T 10

If a patient has paralysis from groin area, suspect injury at level of L1

An eight-year-old has an orbital wall and floor fracture, which can be associated with which of the following findings? Unilateral blindness Entrapment of extraocular muscle muscles Nystagmus Optic nerve compression

Entrapment of extraocular muscles Entrapment of extraocular muscle muscles can occur with orbital wall floor fractures, which can result in restricted gazed double vision, ecchymosis, and ptosis

What is the best treatment choice in someone with diabetes insipidus? Aggressive correction of acidosis using bicarbonate administration Aggressive glucose control with insulin Aggressive, fluid management and administration of DDAVP Aggressive diaries is using diuretics

Aggressive, fluid management and administration of DDAVP Diabetes insipidus is caused by an adequate ADH production from pituitary gland. DDAVP or vasopressin is essential.

PCWP norm

8-12 Direct reflection of left atrial preload as well as left ventricular end diastolic pressure LVEDP

A three-year-old patient sustained traumatic injuries after being involved in a motor vehicle collision. They have become hypovolemic and is demonstrating signs of shock. Which of the following would be an anticipated along with this? Chronic renal failure Renal failure Pre-renal failure Post renal failure

Pre-renal failure There is failure before the kidneys due to hypovolemia. The kidneys are not being perfused enough leading to acute pre-renal failure and a decreased in diathesis.

Identify underlying problem: CVP 1 CI 1.6 Pa S/D 12/8 PCWP 5 SVR 300 Hypovolemic shock Septic shock Neurogenic shock Left systolic dysfunction

Septic shock Preload is low with CVP of 1. Cardiac output is low with a CI of 1.6. PA pressure is looking at LEDP and shows the left ventricle is not able to sufficiently provide enough stroke volume. PCWP is low and matches low PA pressures. SVR is only 300. No restriction and no compensation is occurring. Hint… sepsis, or septic shock is the only thing that will show low hemodynamic numbers in all categories.

A patient was bitten on the hand by a spider. History and physical examination reveals diaphoresis if abdominal cramping with board like rigidity, tachycardia, hypertension, global weakness, nausea, vomiting. Based on the presentation use suspect. Black widow spider Brown recluse Tarantula Funnel web spider

Black widow spider. Black widow venom is an ion channel poison that promotes excess release of neurotransmitters, causing muscular and autonomic nervous system responses like hypertension and tachycardia. Keywords board like abdominal rigidity should clue you in.

Normal SVO2 50 to 60% 70 to 90% 60 to 80% 30 to 50%

60 to 80% Most accurate way to determine tissue oxygenation goal is to maintain greater than 70%

How much circulating blood volume does your pediatric patient have? 65 to 70 ml/kg 55 to 60 85 to 90 75 to 80

75 to 80. Remember it takes 25% blood loss to see clinical signs of decompensation.

A six-year-old patient treated for DKA is showing signs of deterioration. Which of the following assessment findings would confirm the suspicion? An increase in bicarbonate from 22 to 25 Urine pH less than 5.8 Potassium levels decreasing from 6.3 to 5.2 Deep tendon reflexes decreasing from +2 to +1

Deep tendon reflexes decreasing from +2 to +1 A decrease in DTR indicates and drop in pH and worsening metabolic acidosis. A urine pH of less than six shows kidneys are greeting acid. Increase in bicarb suggest improvement and current acid state and potassium levels are expected to slightly decrease as acidosis is corrected in potassium is shifted back into the intercellular space. The decreased to 5.2 is not worrisome at this time as it is still on the higher side of normal.

Causes of metabolic alkalosis include all of the following except Decreased levels of potassium Decreased levels of chloride Retention of hydrogen ions Increased levels of magnesium

Retention of hydrogen ions Excess hydrogen ions cause acidosis

What is the new emergency transmit frequency that utilizes 800MHz technology and satellite tracking?

406

If pulmonary artery diastolic pressure is more than 5 above the PCWP it signals which abnormal condition? Elevated svr Pphn LV failure Mitral valve inefficiency

Pphn

Pt involved in traumatic fall from 30’ associated upper extremity weakness but not lower. What type of spinal cord injury is suspected? Brown sequard Anterior cord Central cord Sciwora

Central cord

CVP 0 CI 6.1 PA S/D 30/14 PCWP 6 SVR 400 Right sided heart failure Cardiogenic shock Neurogenic shock Septic shock

Neurogenic shock Low CVP preload low Normal CI PA S/D indicates LVEDP high PCWP left side preload is low SVR low means no compensation

CVP 2 PCWP 12 CI 1.5 SVR 1800 Cardiogenic shock Hypovolemic shock Neurogenic shock Septic shock

Hypovolemic shock

Black and blue ecchymosis around the umbilicus is called what? Kehr’s sign Cullen’s sign McBurney’s point Grey-Turners sign

Cullen’s sign Cullen’s sign consists of superficial edema and bruising around the umbilicus. It can occur with scute pancreatitis, bleeding from blunt trauma, bleeding from a ruptured abdominal aortic aneurysm or bleeding from a ruptured ectopic pregnancy

Spinal cord injuries that cause respiratory and diaphragmatic paralysis would be at what? At the level of C1-C2 Above the level of C3 Above the level of T At the level of T5

Above the level of C3

Common causes of elevated PAP include all of the following except: Right ventricular failure Left ventricular failure Mitral valve stenosis Mitral valve regurgitation

Right ventricular failure

Infants are born with _______ axis deviation Normal Right Left Extreme right

Right Left acid deviation would be indicative of left sided outflow obstruction defect

PCWP best described as Indirect reflection of afterload Direct reflection of right sided preload Indirect reflection of right sided ventricular pressure Direct reflection of left atrial pressure

Direct reflection of left atrial pressure Also a direct reflection of left ventricular end diastolic pressure. Reflects left side preload

When transporting and assessing a patient with a pulmonary catheter, if the pulmonary artery diastolic pressure is more than 5mmHg above the PCWP it signals which abnormal condition? Elevated SVR PPHN Left ventricular failure Mitral valve insufficiency

PPHN

Dead space is calculated by using which formula? 50% of VT or approximately 4ml/kg 20% of VT or approximately 1ml/kg 33% of VT or approximately 1ml/pound of IBW 7.5% OF VT OR APPROXIMATELY 120ml

33% of VT or approximately 1ml/pound of ideal body weight

In 1985 Congress enacted COBRA: legislation requiring that the: Referring hospital assume liability for adequacy of stabilization before a transfer Receiving hospital assume liability for the transfer Referring hospital legally assumes patient care and provides a full work up Referring hospital not transfer the patient to a high level of definitive care

Referring hospital assume liability for adequacy of a stabilization before a transfer

When obtaining a PCWP on a cardiac patient there is a large V wave present in the waveform. What condition is suspected? Tricuspid valve regurgitation Pulmonic valve stenosis Aortic valve stenosis Mitral valve regurgitation

Mitral valve regurgitation It indicates left atrial filling against a closed mitral valve and shows mitral valve disease/regurgitation

Test Questions Flashcards

(48 cards)