Fall 2009 / Spring 2010 Recertification Pre-Course Quiz

Transcription

1 Fall 2009 / Spring 2010 Recertification Pre-Course Quiz Advanced Care Paramedic Paramedic Name: Please answer ALL of the following 50 questions to the best of your ability and bring the completed quiz with you to your recertification day (ALL QUESTIONS APPLY TO ALL ACP Paramedics in the SWORBH Region!) If you fail to complete the quiz prior to your recertification day you will have to reschedule your recert day. Please also complete the Contact information sheet!

2 Rhythm Interpretation: 1) Identify the following rhythm. a) normal sinus rhythm b) atrial fibrillation c) 2nd degree AV block d) 3 rd degree AV block 2) Identify the true statement from the following: a) The p wave represents atrial depolarization and atrial contraction b) in the normal heart, impulses move through the conducting system from the apex of the heart to the base. c) the AV node is the normal pacemaker of the heart. d) there will always be mechanical activity following electrical activity in the heart. 3) The three most common cardiac arrest rhythms are: a) asystole, ventricular fibrillation, PEA/electrical mechanical dissociation b) sudden death, ventricular tachycardia, ventricular fibrillation c) ventricular tachycardia, asystole, premature ventricular contraction d) sudden death, premature ventricular contraction, PEA / electrical mechanical dissociation 4) The most common life-threatening dysrhythmia associated with myocardial infarction is: a) atrial tachycardia b) atrial fibrillation c) ventricular fibrillation d) premature ventricular contractions Page 2 of 15

3 5) Which of the following patients should not be defibrillated? a) VSA, monitor shows ventricular fibrillation b) VSA Electrical Rhythm of 60 bpm. c) VSA patient, ventricular fibrillation, has an implanted cardiodefibrillator (ICD) d) VSA, monitor shows ventricular tachycardia at 225 b/m 6) Bradycardia is defined as? a) A cardiac rate between 30 and 60 beats/min. b) A cardiac rate less than 60 beats/min. c) A cardiac rate between 60 and 100 beats/min. d) A cardiac rate greater than100 beats/min. 7) The following patient is unresponsive with vital signs absent. Identify the following rhythm. a) ventricular tachycardia b) ventricular fibrillation c) pulseless electrical activity d) atrial flutter e) CPR artifact Page 3 of 15

4 8) You and your partner are attending to a patient who is complaining of severe SOB and chest pressure. You proceed to assess the patient. At the same time your partner attaches the cardiac monitor and the following rhythm is on the monitor. What would your actions be? a) CPR, initiate cardiac arrest protocol b) Check patient, obtain vital signs, if stable obtain 12 lead, patch for adenosine c) Precordial thump, analysis d) Check patient, obtain vital signs, if stable obtain 12 lead, transport, monitor vitals q 5mins 9) Identify the following strip in a patient with no palpable pulse. a) 1 st degree heart block b) Pulseless Electrical Activity c) 3 rd degree heart block d) Sinus Bradycardia e) Ventricular Tachycardia Page 4 of 15

5 10) Identify the following rhythm in a patient complaining of dyspnea. a) sinus bradycardia b) normal sinus rhythm c) 1 st degree heart block d) 3 rd degree heart block General Protocol Questions 11) Please indicate the correct dosage of Epinephrine that a 9 month old who weighs 8 kg would get when being treated for Croup a) 0.5 mg (0.5 ml) in 2 ml NS b) 2.5 mg (2.5 ml) c) 5.0 mg (5.0 ml) d) None 12) A patient redevelops chest pain enroute to the hospital after you have successfully resolved it on scene with ASA and 2 sprays of Nitro. Your next treatment would be? a) Continue transport and patch for orders. b) Reassess the patient repeat ASA and Nitro directive. c) Reassess the patient and repeat Nitro directive. d) Pull over and attach defibrillation pads due to possible sudden cardiac arrest secondary to Myocardial Infarction. 13) In a Blunt Trauma arrest: a) Defibrillator pads should be attached. b) Monitor pads should be attached. c) No rhythm analysis is required as all blunt traumas meet obvious death requirements. d) Only attach defibrillator if the patient is less than 16 years of age. Page 5 of 15

6 14) Enroute to hospital your 40 year old patient who is suffering from chest pain goes unresponsive. What is your next treatment? a) Immediately defibrillate the patient as it is a witnessed arrest. b) Start CPR and continue transport to the hospital. c) Pull over, confirm the patient is pulseless and complete full cardiac arrest protocol. d) Pull over, confirm the patient is pulseless, perform one rhythm interpretation (shock if indicated), 2min of CPR then resume transport. 15) During a Cardiac Arrest (Non Traumatic), pulse checks are performed: a) To initially confirm the patient is pulseless and before each rhythm interpretation. b) To initially confirm the patient is pulseless and after each rhythm interpretation. c) To initially confirm the patient is pulseless and immediately after each shock that was delivered. d) To initially confirm the patient is pulseless and immediately after each rhythm interpretation that is not shockable 16) You arrive on scene to find a 25 year old patient who is unresponsive. You confirm that the patient is vitals signs absent and has no air entry with BVM ventilations. Your partner is performing CPR. What are your next appropriate steps? a) Re adjust airway, attempt ventilation, if unsuccessful attempt to visualize foreign body, and remove with Magill Forceps if successful perform one rhythm interpretation and transport b) Attempt to visualize foreign body and remove with Magill forceps if successful perform one rhythm interpretation and transport c) Re adjust airway, attempt ventilation, if unsuccessful attempt to visualize foreign body, and remove with Magill Forceps if successful perform full medical cardiac arrest protocol d) Attempt to visualize foreign body and remove with Magill forceps if successful perform full medical cardiac arrest protocol e) None of the above Page 6 of 15

7 17) One shock in total has been completed during a cardiac arrest. On the second rhythm interpretation you determine that patient is in sinus bradycardia. What is your next action? a) Continue with BVM and initiate rapid transport. b) Initiate rapid transport as the heart is now working and the patient needs a hospital. c) Check for a pulse and initiate rapid transport. d) Check for a pulse and continue with the appropriate treatment directive. 18) It is February and you arrive on scene to find a 23 year old patient who was found unresponsive in a river. How long should the pulse check be performed to confirm absence of spontaneous pulse? a) 15 seconds b) 10 seconds c) 45 seconds d) 60 seconds 19) An unresponsive patient post return of spontaneous circulation should have: a) CPR with BVM continued until they regain responsiveness b) Active rewarming to increase cerebral blood flow. c) Hyperventilation with BVM to hyperoxygenate the brain. d) The head of the stretcher elevated approximately 30 degrees to assist with cerebral perfusion pressures. 20) You have a 5 year old whose chief complaint is a possible anaphylactic reaction to a bee sting. You have decided to administer Epinephrine. Please indicate the correct dosage. a) 0.3 mg or 0.3 ml b) 0.1 mg or 0.1 mls c) 0.2 mg or 0.2 mls d) 0.5 mg or 0.5 mls e) 1.0 mg or 1 ml Page 7 of 15

8 21) You are sent code 4 to a residence for a pediatric VSA. You arrive to find the Fire Performing CPR with SAED attached. The child is 6 years old. The Captain of the Fire Dept. tells you that they have analyzed 4 times all No Shock Indicated. CPR is adequate and you are confident in the story from the Fire Captain. Your next action is: a) Start your medical cardiac arrest protocol from the beginning because we don t trust their story b) Perform one manual rhythm analysis then initiate rapid transport of the patient if the patient is in PEA or asystole. Perform procedures en route (IV / IO and Endotracheal intubation). c) Initiated rapid transport of the patient. Perform procedures en route (IV / IO and Endotracheal intubation). d) Call BHP for direction because the Fire Dept. does not follow the same protocols as you. 22) You are enroute with the 6 year old child from question 21 and you have a ROSC. The child 2 minutes later subsequently re-arrests. a) Pull Over, perform 2 minutes of CPR and then perform manual rhythm interpretation b) Pull Over, perform 1 minute of CPR and then perform manual rhythm interpretation c) Continue transport, perform 2 minutes of CPR and then perform manual rhythm interpretation. d) Pull Over, perform manual rhythm interpretation immediately. e) Continue transport, begin CPR & BVM 23) In a patient with untreated newly diagnosed diabetes the patient s random blood sugar will be: a) < 4 mmol / L b) 4-11 mmol / L c) > 11 mmol / L d) Less than their insulin level 24) Is it acceptable to immediately transport a patient <16 years old when a rhythm that is deemed unshockable with manual rhythm interpretation is detected? a) yes b) no c) only after a BPH Patch d) only if CCP back up is not en route Page 8 of 15

9 25) A 5 year old patient becomes VSA en route to the ER for the first time, you pull over and the patient is in Ventricular Fibrillation - you defibrillate appropriately, next you should: a) Resume transport with CPR and IV attempt en route and no further analysis b) Resume transport with CPR and IV attempt and pull over again in 2 minutes c) Start CPR and attempt IV, interpret rhythm again in 2 minutes d) Start CPR and attempt IV, analyze again in 2 minutes transport regardless of rhythm on 2 nd analysis 26) When performing a Termination of Resuscitation with a traumatic VSA the minimum age the patient has to be is: a) 12 b) 14 c) 16 d) 18 27) You are an ACP on scene with a 25 year old male patient that has been ejected from a vehicle. The patient has some bleeding from his forehead; contusions to his left iliac crest and arm. He has no palpable pulses. His pupils are fixed and dilated. He has no spontaneous limb movement. He does not meet the BLS VSA Transportation Standard (i.e. he is not obviously dead ). You have applied the defib pads and you see a wide slow rhythm on the monitor. Your next step would be to: a) Begin CPR, Immobilize the patient, load and go. b) Perform 4 rounds of CPR (2 min each) with rhythm interpretation every 2 minutes on scene and treat accordingly. c) Begin CPR, Immobilize the patient, Load in the back of the ambulance then contact a BHP for possible Termination of Resuscitation. d) Begin CPR, Contact a BHP for possible Termination of Resuscitation e) None of the above 28) When performing a Termination of Resuscitation it is acceptable to honor the order if it comes from: a) An R.N. b) A Nurse Practitioner c) The patient s family d) A respiratory therapist e) None of the above. Page 9 of 15

10 29) You are presented with a 25 year old male patient that has suffered a stab wound to the anterior chest wall between the 1 st and 2 nd intercostal space. The knife is on the ground and the scene is safe. The patient is VSA. You attach your electrodes and observe that the rhythm is an accelerated idioventricular rhythm at 50 beats per minute. He has no palpable pulses, no spontaneous respirations. You are located in the middle of a county road 30 min from the nearest ER.: a) Perform a patch to BHP for possible Termination of Resuscitation b) Transport the patient with CPR only. c) Pronounce the Obviously Dead d) Call for CCP backup 30) With all penetrating traumatic VSA s we always: a) Attach the monitoring electrodes. b) Attach the defibrillation pads c) Attach whatever mode of analysis is most readily available Medical Knowledge Questions: 31) You arrive on scene to a 30 year old male patient who has overdosed on an unknown drug. He is on the couch with his eyes closed and only opens his eyes when you provide painful stimuli. When provoked with pain he makes incomprehensible sounds. He will not follow commands with his arms but he withdraws them to painful stimuli. What is his GCS? a) 14 b) 10 c) 8 d) 7 e) 4 32) You respond to a local restaurant for a 65 year old male with right sided weakness. Bystanders state that 5 minutes ago patient was in the buffet line when he collapsed to the floor and became weak and unable to speak. Vital signs are HR 100 beats/min, BP 160/100 mmhg; RR 20 breaths/min and GCS 9 (E = 4, V = 1, M = 4). He denies having a headache by shaking his head no. This patient most likely has or is having a(n): a) Ischemic stroke b) Hemorrhagic stroke c) Absence seizure d) Amyotrophic Lateral Sclerosis e) Acquired Brain Injury Page 10 of 15

11 33) You respond to a local gym for a 32 year old man who was working out and then began reporting the worst headache of my life that came on suddenly after his last exercise a few minutes ago. On your arrival, the patient is forcefully vomiting and as you assess him he begins to seize. His vitals are HR 52 beats/min, BP 190/110 mmhg, RR 32 breaths/min, and GCS 4 (E = 1, V = 1, M = 2). This patient is most likely having a(n): a) Ischemic stroke b) TIA c) Hemorrhagic stroke d) Absence seizure 34) Which of the following is a cause for an embolic stroke? a) Air b) Fat c) Blood clot d) Aortic Valve vegetation from Endocarditis e) All of the above 35) Which of the following are considered possible signs and symptoms of a stroke? a) Headache b) Forceful vomiting c) Visual disturbances and blurry vision d) Seizures e) All the above 36) Which of the following are conditions that affect the upper airway in the pediatric patient? a) Asthma, bronchiolitis, and pneumonia b) Bacterial tracheitis, epiglottitis, and bronchiolitis c) Bronchiolitis, croup, and asthma d) Croup, epiglottitis, and bacterial tracheitis Page 11 of 15

12 37) You arrive on scene to a 55 year old woman who has a past medical history of Asthma. She had a bowel resection 2 weeks ago for Colon Cancer and has been recovering at home since discharge from Hospital. Her only medications are Ventolin as needed and Tylenol #3. She describes a sudden onset of severe chest pain that is worse with a deep breath and severe shortness of breath. She has tried her ventolin and it provided no relief. On exam she has normal air entry and no wheezes or crackles. Her oxygen saturation is 92% on room air. The most likely diagnosis is: a) Acute Coronary Syndrome b) Asthma Exacerbation c) Pulmonary Embolism d) Congestive Heart Failure e) Anxiety 38) An adult has a burn that involves his entire left leg, half of his right arm, and the anterior trunk. According to the rule of nines, his TBSA burned is: a) 30% b) 36% c) 40% d) 48% 39) You respond to a large church for a patient who has passed out. Bystanders report that your patient stood up rapidly during a sermon, stated that she felt dizzy, and then fell to the unconscious. After approximately 30 seconds the patient awoke and is now completely alert and oriented. She denies any current pain or discomfort. Which of the most likely describes her condition? a) Cardiac Arrest b) Tonic-clonic seizure c) Syncope d) TIA e) Vertigo Page 12 of 15

13 40) You arrive on the scene of a 45 year old woman who has pain in the right upper quadrant of her abdomen. She complains that it is a sharp pain and she has vomited everything that she has eaten today. You palpate her right upper quadrant and she has focal tenderness worse when she takes a deep breath. Which of the following is the most likely cause of her pain? a) Cholecystitis b) Crohn s disease c) Gastroenteritis d) Peptic Ulcer Disease e) Drug Seeking Medical Math 41) During a Shortness of Breath call you have administered 2 nebulized treatments of Drug X to a 25 year old female. Each treatment consisted of 1 ml of 0.5 % solution of Drug X diluted in 2.5 ml of Normal Saline. How much Drug X have you given to this patient? a) 2 mg b) 5 mg c) 7.5 mg d) 10 mg e) 20 mg 42) You respond to a 4 year old with a severe Asthma exacerbation. You are going to give Epinephrine: i) What is the patient s weight? ii) How many mg of epinephrine is to be administered? iii) How many mls are to be administered? 43) During an interfacility transport - You are ordered to administer 5mcg/kg/min of dopamine at a concentration of 400mg/250cc. The patient s weight is 70kg. How many gtts per minute are to be administered (10 gtt set)? Page 13 of 15

14 44) You are to transfer a 70kg patient who is to receive 0.9% NS at 200 ml / hour. You are working with a 10 gtt set. How many drops per minute should the patient receive? 45) You are to administer versed IV to a patient who is actively seizing. The doctors order is to administer 0.2mg/kg of versed. The patient s weight is 100kg. The concentration of versed is 10mg/2ml. How many mls are required? 46) You arrive on scene to a 3 year old patient who you determine to have severe anaphylaxis. The patient s mom does not know how much the patient weighs. How much Epinephrine will you give this patient: a) 0.3 mg IM b) 3 mg nebulized c) 0.15 mg IM d) 3 mg IM e) 1.5 mg IM 47) You are to administer Drug B IV to a patient. The doctors order is to administer 0.2mg/kg of Drug B. The patient s weight is 100kg. The concentration of Drug B is 10mg/2ml. How many mls are required? 48) You are ordered to give an exact dose of 0.1mg/kg of Epi s/c to a patient with anaphylaxis. Concentration of Epinephrine is 1mg/1ml. i) How many mg should you give to a 44 lb patient? ii) How many ml are needed to attain this amount? Page 14 of 15

15 49) You are working with a 15gtts. I/V drip set. How many drops are required to deliver the following volumes (Fill in ALL the blanks): a. 5.0ml = drops b. 250ml = drops c. 12ml = drops d. 0.10ml = drops 50) You print off a 6 second rhythm strip. There are 15 QRS complexes on that rhythm strip, what is the electrical heart rate: Page 15 of 15