BLOCK 9

1) A 19-year old male was involved in a motor vehicle collision. The steering
wheel created a large contusion on his right upper quadrant of the abdomen.
What is most likely to be injured?

A. Bladder
B. Stomach
C. Spleen
D. Liver

2) You respond to the home of a 2 y/o male with difficulty breathing. On arrival,
you note an alert toddler with supraclavicular retractions, and stridor. His father
reports 2 days of fever and cough for the child, with difficulty breathing for 1
hour. HR is 140, pulse oximetry is 97%, and the patient measures 13kg by length-
based resuscitation tape. Which of the following treatments should be initiated?

A. Position of comfort; albuterol 5mg HHN

B. Position of comfort; epinephrine 5mg via nebulizer (1 mg/ml concentration)
C. Position of comfort; 02 via blow-by
D. Position of comfort; epinephrine 0. 13mg (mg/ml concentration) IM

3) Identify the following rhythm:

A. 2nd degree Heart Block Type II

B. Escape Junctional Rhythm with Blocked PAC's
C. 2nd degree Heart Block Type I
D. 3rd degree Heart Block

4) The patient with a corneal abrasion will usually complain of:

A. Sudden sever pain in the eye with loss of vision

B. Sudden painless loss of vision
C. Seeing halos around lights
D. Pain and a sensation of a foreign body in the eye

5) You respond to the home of a woman who has just delivered. She states that
she was approx. 18 weeks pregnant. Your care should include:

A. Assess the fetus for gestational age and contact base if no palmar creases
B. Determine death since 18 weeks gestation is no viable
C. Assess the fetus for signs of life and begin resuscitation if present
D. Ascertain how the patient knew that she was 18 weeks pregnant
 BLOCK 9
6) Examples of situations that must be reported to appropriate local/state
authorities include all the following EXCEPT:

A. 6 y/o that paramedics suspect is neglected by parents

B. 22 y/o with a gun shot wound to the right calf from a reported accident
C. 32 y/o initially with ALOC, who is now AO×3 and signed out AMA after Narcan
D. 68 y/o that paramedics suspect is being abused by nursing staff

7) The most common psychiatric disorder in the geriatric adult is

A. Alzheimer's disease
B. Depression
C. Bipolar disorder
D. Schizophrenia

8) You have a 200# pt. The base hospital has ordered a medication at 0.1
mg/kg IP. You will administer:

A. 1 mg
B. 100 mg
C. 0.10 mg
D. 10 mg

9) The following is NOT true regarding Angina:

A. Is often associated with exertion

B. May or may not radiate to other areas
C. Occurs only in overweight males with CAD
D. Can occur at night while patient is at rest

10) After administering an IV medication:

A. The paramedic should wait 2-3 minutes before administering the next
medication
B. The paramedic should close off the IV tubing to let the medication circulate
C. The line should be flushed with 10ml of NS prior to administration of the next
medication
D. The line should be flushed with 100ml NS prior to administration of the next
medication
 BLOCK 9
11) The 1st stage of the grieving process is:

A. Denial
B. Bargaining
C. Anger
D. Depression

12) The elderly trauma patient is at higher risk for fluid overload and pulmonary
edema as a result of intravenous fluids therapy due to a decrease in:

A. Number of functioning alveoli

B. Hepatic function
C. Chest wall compliance
D. Renal function

13)A drug causing an increase in heart rate is called a/an:

A. Chronotropic agent
B. Beta agent
C. Alpha stimulating agent
D. Inotropic agent

14) You respond to a 70 y/o female complaining of being light-headed and dizzy.
She is oriented. Skin vitals are pale and diaphoretic and lungs are clear. Vital
signs are: BP 84/56; monitor shows Sinus Brady at a rate of 46 regular, RR 14,
with poor tidal volume and 02 saturation of 88%. You should administer high flow
oxygen, an IV and:

A. Begin transcutaneous pacing at 70 beats per minute

B. Administer Atropine 0.5mg IVP
C. Place patient in supine position and begin transport
D. Place the patient in trendelenburg position

15) Identify the following rhythm:

A. Sinus Tachycardia
B. Sinus Arrhythmia
C. SVT
D. Atrial flutter with 2:1 block
 BLOCK 9
16) If you are looking at lead II and the ventricle is depolarizing in an antegrade
path, on the EKG you will note:

A. A difference in morphology
B. Narrow QRS complex
C. An upright deflection
D. A retrograde deflection

17) Using a blood pressure cuff that is too large for the patient's arm will result in
a reading that is

A. Palpable but not audible

B. Accurate
C. Inaccurately high
D. Inaccurately low

18) You respond to a 3 y/o male whose parents state he had a seizure prior to the
arrival of the ambulance. He is awake but drowsy and is very hot to the touch.
You should:

A. Give midazolam IV to prevent recurrence of seizures

B. Begin passive cooling and transport
C. Contact base for documentation purposes and have parents follow-up with
private physician
D. Rapidly cool the child, give midazolam 0. 1 mg/kg SIVP and transport

19) Grand mal seizures may be caused by:

A. Hypothermia
B. Hypocalcemia
C. Hyperkalemia
D. Cerebrovascular accident

20) Dilated veins that occur in the submucosa of the lower esophagus of cirrhotic
patients and may extend into the upper esophagus and/or stomach are called:

A. Hemorrhoids
B. Peptic ulcers
C. Esophageal varices
D. Diverticula
 BLOCK 9
21)Your patient has the right to make decisions regarding their medical
care. This statement defines:

A. Altruism
B. Values
C. Autonomy
D. Ethics

22) Excessive amounts of sugar in the blood will lead to:

A. Hypoglycemia
B. Polyuria
C. Breakdown of fatty acids
D. Weight gain

23) Dystonic reactions are characterized by:

A. Diarrhea
B. Seizures
C. Ventricular tachycardia
D. Tonic motion of neck

24) You are called to the home of a 26 y/o male c/o trauma to his right forearm. He
states his forearm was trapped for 20-30 min under heavy equipment approx.. 3
hrs ago. On exam there is no deformity or crepitus, but you note tense swelling to
forearm, and pain in the forearm when you attempt to move his fingers for him.
This presentation is most consistent with a

A. Crush syndrome
B. Peripheral neuropathy
C. Compartment syndrome
D. Wrist sprain

25) Which drug is most likely to produce bradycardia and hypotension as adverse
effects:

A. Dopamine
B. Epinephrine
C. Amiodarone
D. Atropine
 BLOCK 9
26) The maximum age for which patient must be transport to a pediatric
facility(EDAP, PMC or PTC) in LA County is

A. 16
B. 18
C. 12
D. 14

27) Which of the following statements is true regarding geriatric patients:

A. older people lose their ability to reason due to the aging process
B. medication doses must be increased to compensate for poor liver function
C. the elderly have an increased risk for fractures
D. Alzheimer's disease is a normal progressive effect of aging

28) You respond to an alert and oriented 67 y/o woman complaining of

progressive shortness of breath for the past day and a non-productive cough.
Skin signs are warm and dry. Assessment shows BP 160/94, HR 120, RR32 with
minimal bilateral rales at lung bases. She is unable to lie down for more than 5-10
seconds. She denies any medical history. A pack of cigarettes is noted on her
coffee table. The monitor shows atrial fibrillation. The most appropriate primary
impression associated with this patient's presentation would be:

A. Respiratory distress - pulmonary edema

B. Respiratory distress - bronchospasm
C. Shock
D. Respiratory distress - other/pneumonia

29) Chronic complications of diabetes may include all EXCEPT:

A. Renal failure
B. Blindness
C. Neuropathy
D. Arthritis

30) You respond to a 53 y/o male c/o headache, blurred vision and weakness to
his left arm for the past 2 hrs. Vital signs are 180/100, P 90, R 16 and fingerstick
glucose is 345. This patient is most likely experiencing:

A. Diabetic ketoacidosis
B. Petit mal (partial) seizure
C. Cerebral vascular accident
D. New onset Multiple Sclerosis
 BLOCK 9
31) According to LA County Ref No. 408; staffing on a public or private ALS unit:

A. Can be staffed with 1 paramedic in areas with run volume of less than 3 calls
a shift
B. Can be staffed with 1 paramedic and 1 EMT if one of the paramedics becomes
ill
C. Must be 2 paramedics at all times
D. Is at the discretion of the provider agency

32) You arrive to a primary care clinic for a pt with a witnessed cardiac arrest.
Clinic staff started CPR immediately and the pt was successfully defibrillated by
AED just prior to your arrival. On your evaluation, pt is lethargic, BP 110/62, HR
64 and irregular, RR 10, 02 saturation is 95%. Monitor shows NSR with frequent
PVCs. Clinic staff report the pt has a history of diabetes and hypertension. Blood
glucose is 85 and pupils are dilated. There are no other abnormalities on your
exam. The most appropriate next therapy for this pt would be:

A. Atropine 0.5mg IV
B. D10W 250mL
C. Transport with BMV
D. Narcan 2mg IV

33) You respond to a pt c/o shortness of breath. The pt is alert and oriented with
pale, warm, dry skin. He c/o moderated mid-sternal chest pain. Monitor shows a
wide complex tachycardia at 110 bpm. 12-lead ECG is as follows... In addition to
establishing an IV you would:

A. Place the pt in supine position

B. Administer Aspirin and transport
C. Perform synchronized cardioversion
D. Instruct the pt on Valsalva technique

34) You respond to a grocery store parking lot to find a 4 y/o girl who is drowsy,
confused and poorly responsive. The mother states the child was left in the car
while she "ran in to get a few things". Outside are temp is 98 degrees. On
assessment BP 65/40, HR 120 weak and thready, R 32 with good tidal volume.
Blood glucose is 65 and her skin is warm to touch, flushed and dry. Appropriate
therapy includes:

A. Convince child to drink 1 cup apple juice. Place IV if not able to take PO fluids
B. Normal saline 10ml/kg in 250ml increments, Domaine or Push dose Epi after
IV fluids
C. Remove hot clothing and apply cool west towels. Administer IV NS
D. Contact police to arrest the mother. Administer D10W while awaiting the police
arrival.
 BLOCK 9
35) After getting punched in the face, a pt. c/o loss of vision in one eye w/out
pain. The most likely injury is:

A. Intercranial hemorrhage
B. Acute glaucoma
C. Retinary artery occlusion
D. Retinal detachment

36) A 24 y/o male with history of diabetes c/o muscle weakness, dizziness and
incoordination after playing soccer. He is pale, cool and diaphoretic. You should
first evaluate for:

A. TIA - cerebellar stroke

B. Heat stroke
C. Ketoacidosis
D. Hypoglycemia

37) In a bed-ridden pt with fractured hip, sudden chest pain and dyspnea w/clear
lungs on auscultation would suggest which of the following:

A. Asthma
B. Pulmonary edema
C. Pulmonary embolus
D. Pneumonia

38) High potential for hypovolemia when associated with traumatic injuries would
arise from the following injuries EXCEPT:

A. Rupture of the bladder

B. Rupture of the kidney
C. Fracture of the liver
D. Pelvic fracture

39) An 82 y/o male fell and sustained multiple rib fractures. He is in significant
pain and doesn't want to take a deep breath. He is at increased risk to develop a
pH of

A. 7.30
B. 7.60
C. 7.50
D. 7.40
 BLOCK 9
40) When dealing with a hostile or aggressive pt, you should

A. lace hand on shoulder and state "you appear upset, can I help you?"
B. restrain the pt with gauze bandages
C. place the pt between you and the nearest exit
D. attempt to talk with pt in a non-threatening manner

41) Distributive shock may occur as a result of

A. cardiac tamponade
B. ascites
C. ectopic pregnancy
D. pelvic inflammatory disease

42) The most reliable sign of early hypovolemia in the pediatric pt is:

A. Poor skin turgor

B. Bradycardia
C. Tachycardia
D. Tachypnea

43) Cardiac arrest in infants and children is most often a result of

A. Electric shock
B. Drowning
C. Heart attach
D. Respiratory failure

44) Geriatric patients are:

A. Less likely to have psychological disorders such as depression

B. More likely to have multiple injuries after trauma than younger adults
C. More likely to be transport by private auto vs EMS
D. Less sensitive to medications due to decreased Gl motility

45) You are treating a 12 y/o female involved in a minor traffic collision. The
patient's mother requests that the pt be transported to their HMO hospital that is
12 min away, the paramedic captain wants the pt to go to the nearest EDAP that is
7 min away, the base hospital wants the pt transported to the Pediatric Medical
Center that is 14 min away. According to LA County Ref. 502 (patient destination):

A. The nearest DAP is always the destination for pediatric patients

B. Transport to the HMO at the mother's request is appropriate
C. The highest medical authority on scene is responsible for pt destination
decisions
D. Final authority for pt destinations rests with the base hospital.
 BLOCK 9
46)Which of the following increases negative pressure in the pleural space:

A. Expiration
B. Flail chest
C. Inhalation
D. Collapsed lung

47) The electricity from defibrillation will:

A. Cause the heart muscle cells to completely depolarize

B. Cause the heart muscle to momentarily stop beating
C. "jump start" the heart
D. cause the heart muscle cells to completely repolarize

48) The paramedic caring for a pt that has overdosed on Elavil

(Amitriptyline) should pay particular attention to the patient's:

A. EKG rhythm
B. Pupillary response
C. Level of consciousness
D. Muscle activity

49) All of the following are possible adverse effects of a medication EXCEPT:

A. Rapid heart rate

B. Itching hives
C. nausea
D. seizures

50) Which of the following statements best describes micro-drip tubing and
identifies its use:

A. delivers 60 gtts/mL; is used for fluid replacement

B. delivers 15 gtts/mL; is used to keep the vein open
C. delivers 60 mcgtts/min; is used as a precautionary line
D. delivers 60 mcgtts/mL; is used for the medication administration

51) You have established an IV and 02 on a 58 y/o male c/o chest pain. He
suddenly has a full body seizure lasting 30 seconds, which stops spontaneously.
Your first action following the seizure should be to:

A. Repeat your primary assessment

B. Get a monitor reading
C. Get a dextrose stick reading
D. Request an order for Midazolam from the base hospital
 BLOCK 9
52) The following is most likely to decrease ventricular filling:

A. Increase in PVT
B. Heart rate of 64
C. Decrease in preload
D. Fluid overload

53) Sudden onset of stridorous inspiration in a previously healthy 2 y/o should be

most concerning for:

A. Pneumonia
B. Epiglottis
C. Foreign body aspiration
D. Croup

54)The most common mode of transmission for Hepatitis A is:

A. Oral-fecal contamination
B. Skin puncture with a contaminated needle
C. Inhalation of infected airborne droplets
D. Dermal exposure to contaminated blood

55) You are caring for a 52 y/o pulseless and apneic male. The monitor initially
shows V-fib. After defibrillation and CPR you note the rhythm shown below.
ETCO2 increases to 40 and the pt has a palpable pulse on the next check. The pt
gags when you attempt to insert an OP airway. Vital signs include BP 84/60, P 68,
R 18 with good tidal volume, 02 saturation is 95% on NRB. The next appropriate
treatment is:

A. Begin Transcutaneous Pacing (TCP)

B. Administer Atropine 0.5 mg
C. Hang 1 liter of NS
D. Monitor and transport

56) Your 26 y/o female pt is c/o 1 day progressive severe left flank pain, pain with
urination, nausea and vomiting. Vitals: BP 106/70, P 100, R 16. Her skin is hot to
the touch. You suspect her pain is caused by:

A. Splenic rupture
B. Pyelonephritis
C. Cholecystitis
D. Pancreatitis
 BLOCK 9
57) The most complete scale identifying level of consciousness is:

A. AVPU
B. Orientation
C. GCS
D. Stimulus and response

58) To best auscultate for aortic stenosis, a paramedic should place his
stethoscope on the:

A. Left 3rd intercostal space

B. Left 5th intercostal space
C. Right 2nd intercostal space
D. Left 2nd intercostal space

59) Breach of duty is best defined as:

A. Touching a pt w/out their consent

B. Requesting that a pt be placed on 72-hr hold
C. Intentionally detaining a person with justification
D. Acting outside the paramedic scope of practice

60) Paramedics respond to the home of a 12 y/o female. Family members state
that she was choking on a candy jaw breaker. The obstruction has been cleared
using abdominal thrusts. The pt remains unconscious; pulse is 120, respirations
are 0. What physiologic state would the pt most likely be in

A. Metabolic alkalosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Respiratory acidosis

61)Which of the following is a true definitive statement regarding hypovolemic

shock;

A. There is no change in blood volume in this condition

B. Can only be caused by blood loss, usually after traumatic injury
C. Venous return to the right heart is reduced in this condition
D. Push dose epinephrine is an effective first line treatment

Missing 1 page - questions 62-65

62) N/A
63) N/A
64) N/A
65) N/A
 BLOCK 9

66) According to LA County Ref. No 519, the authority at the scene of an MCI is
the:

A. Base Station Hospital

B. Highest medical authority on scene
C. Incident Commander
D. Medical Alert Center

67) Your pt presents with chest pain and mild shortness of breath. You do a 12-
lead ECG on him and it reads ***ACUTE MI*** on the top of the print out. You
notice ST elevation in leads II, IlI and aVF. This indicates an infarction to which
area of the heart:

A. Septal
B. Anterior
C. Lateral
D. Inferior

68) The signs/symptoms of carbon monoxide inhalation do NOT include:

A. Nausea/vomiting
B. Cyanosis
C. Headache
D. Confusion

69) A pt has sustained an injury to his right thigh. Physical findings are
suggestive of a fractured femur and you consider applying a traction splint. When
considering application of a traction splint, you must first:

A. Apply manual traction

B. Position splint under affected leg
C. Check distal pulses
D. Apply the groin strap

70) Identify the following rhythm:

A. NSR with PVC's

B. Sinus Bradycardia with PVC's
C. Bigemminy
D. Ventricular Bigemminy
 BLOCK 9
71) Identify the following rhythm: CHECK THE RHYTHM

A. Junctional Tachycardia
B. Sinus Tachycardia
C. Supraventricular tachycardia
D. Atrial fibrillation with rapid ventricular rate

72) You respond to a restless, 64 y/o male c/o dizziness following a syncopal
episode. Vitals - BP 82/46, skin is cool and clammy. The cardiac monitor shows
the rhythm below. The primary contributor to the decreased blood pressure is:

A. Decrease in chronotropy
B. Decrease in cardiac contractility
C. Loss of atrial kick
D. Decrease in diastolic filling time

73) You respond to a pt who has fallen from the roof of a house and impacted his
head on a concrete garden planter. The pt has significant facial trauma and scalp
swelling. GCS 1-1-1. The vitals you might expect to see would include:

A. Hypertension and tachycardia

B. Hypotension and tachycardia
C. Hypertension and bradycardia
D. Hypotension and bradycardia

74) Which of the following is an example of an open-ended question:

A. How do you plan to kill yourself?

B. Are you thinking of hurting yourself?
C. Do you have a weapon?
D. Would you like to go to the hospital?

75) What is present in chronic volume loss that may not present in acute volume
loss:

A. Dry mucous membranes and poor skin turgor

B. Altered level of consciousness and hypotension
C. Altered level of consciousness and thirst
D. Hypotension and tachycardia
 BLOCK 9
76 )A 46 y/o male was involved in a MVA. Exam of the pt reveals an abrasion on
the forehead, slight bruising to his chest and a firm/rigid abdomen. The pt is alert
to name only. Vital signs are BP 80/60, P 114, weak, R 22, good tidal volume.
Breath sounds are clear and equal. Skins are pale, cool diaphoretic. You suspect
hypotension is most likely due to:

A. Intra-abdominal hemorrhage
B. Intoxication
C. Tension pneumothorax
D. Increased intracranial pressure

77) 28 y/o male was stabbed at the level of T4, right posterior thorax. He is c/o
dyspnea. You note diminished breath sounds on the right chest wall. BP 140/80, P
120, R 24 labored. Suspicion is highest for:

A. tracheobronchial injury
B. tension pneumothorax
C. pericardial tamponade
D. open pneumothorax

78) After confirming the placement of the endotracheal tube you note frothy
sputum coming up from the ET tube with ventilations. In order to ensure diffusion
of 02 and CO2 the next appropriate step to take is:

A. hook ET to positive pressure breathing device

B. immediately extubate the pt
C. increase ventilation rate and depth with bag-valve device
D. suction the ET tube to clear the secretions

79) A complication of late pregnancy which results in reduced venous return due
to the gravid uterus compressing on the inferior vena cava is called:

A. Premature labor
B. Placenta previa
C. Eclampsia
D. Supine hypotension

80) When ingestion of multivitamins is suspected in a child, it is critical to

determine whether the preparation contains:

A. Iron
B. Thiamine
C. Ascorbic acid
D. Folic acid
 BLOCK 9
81) A pt sustains a thermal burn to his head and face. The most likely immediate
cause of death would be related to:

A. infection
B. loss of fluid from the burn site
C. cerebral edema
D. respiratory failure

82) Structure is given to the trachea by:

A. smooth muscle
B. cartilaginous rings
C. the thyroid cartilage
D. pharynx

83) You respond to a 26 y/o female who is 9 weeks pregnant, c/o sudden onset of
severe abdominal pain. Vital signs are BP 86/50, P 120, R 24, normal tidal volume.
Skin vitals are pale, cool and moist. Physical exam reveals a tender abdomen.
She denies vaginal bleeding. Of the following the most likely cause of her
symptoms is:

A. Spontaneous abortion
B. Uterine rupture
C. Ruptured ectopic pregnancy
D. Abruption placenta

84) The first sound heard while auscultating a blood pressure is directly
influenced by

A. Ventricular systole
B. Closing of the aortic valve
C. Atrial systole
D. Ventricular diastole

85) The greatest danger to the infant caused by a prolapsed umbilical cord is that
the cord will

A. Strangulate the infant during delivery

B. Block the birth canal and obstruct delivery
C. Become contaminated by the outside environment
D. Be compressed and cut off circulation to the infant
 BLOCK 9
86) Rhythms that may resemble "SVT" include rapid atrial flutter and:

A. Premature atrial tachycardia

B. Wandering pacemaker
C. Sinus tach
D. junctional tach

87) The amount of blood flow needed by the cardiac muscle is directly related to
the:

A. chemo receptors
B. heart's metabolic rate
C. pressure in the aorta
D. patient's blood pressure

88) Paramedics are dispatched to the home of an altered 64 y/o male. Family
states the pt is taking multiple medications but unaware of their names. On initial
inspection the paramedics are concerned the pt may be having a stroke. What
neurologic exam should they perform first and what does that exam include?

A. mLAPSS; facial smile/grimace, finger to nose, leg drift

B. LAMS; facial smile/grimace, grip strength, leg drift
C. LAMS; facial smile/grimace, finger to nose, arm drift
D. mLAPSS; facial smile/grimace, grip strength, arm drift

89) Congestive heart failure is the result of:

A. left ventricular failure, resulting in engorgement of the liver and peripheral

edema
B. increased permeability of cells and fluid shifts into the lungs, secondary to
rapid changes in altitude
C. failure of the left ventricle to effectively pump out the same amount of blood as
that which is returned to the right heart
D. right atrial failure resulting in hypoxia due blood volume shift to the body
 BLOCK 9
90) Write the administration for Nitroglycerin, include does, route and repeat time
frames and how many times it can be given for the treatment of CHF 0.4 mg SL

91) Write the dose of Midazolam for a 3 y/o, 24 kg pt actively seizing. Include all
route(s), repeat dose, repeat times and maximum total dose:

92)Write the route, dose and location of the initial Epinephrine administration
when given to treat an adult pt with anaphylaxis:

93)Write the administration for Midazolam in an agitated delirium pt. include dose,
route, repeat time intervals, and number of times it can be repeated:

94) Narcan 1.0 mg has been ordered. It is packaged in 0.4 mg/1 mL preloads.
How many mL should be administered:

95) Write the IV administration of Atropine for a 180 pound pt with

organophosphate poisoning. Include initial dose, repeat times and maximum
dose:
 BLOCK 9
96)250 ml NS is ordered, to infuse over 10 min. The drip factor is 10 gtt/ml.
What is the appropriate drip rate?

97)Write the correct dose when giving diphenhydramine to a 32 kg pediatric pt

with a dystonic reaction. Include routes, repeat dose and repeat times:

98) Write the administration of Calcium Choride in a Cardiac Arrest. Include dose,
route, repeat dose and time:

99) Write the dose of Morphine for an 8 y/o pt, weight 34kg, with pain from burns.
Include routes, repeat dose, repeat times before and after base:

100) What is the drug classification of naloxone: