AEA 01/2014

CLASS TESTLONG and SHORT

INSTRUCTIONS
1. Read the questions thoroughly
2. Answer all the questions on the answer sheet provided
3. Write neatly and legibly ensuring that your answers are clearly numbered.
4. Any attempt at examination fraud will result in immediate disqualification from the
assessment process.
PAGES: 7 (Including cover)
MARKS 84Marks
TIME: 84 Minutes

NUMBER OF PAGES: 13 including

cover page and answer sheets MARKS: Marks
PASS MARK: 50%

1
AEA 01/2014
CLASS TESTLONG and SHORT

Section A
Question 1 [19 marks]
On the answer sheet provided, mark off the most correct answer. NB: There is only one
correct answer per question and negative marking may apply for this section.
1.1 How many milligrams of dextrose are in a 20ml ampoule of 50% Dextrose?
A. 1 000mg
B. 10mg
C. 20 000mg
D. 10 000mg
1.2 Which one of the following statements regarding a normal sinus rhythm is
incorrect?
A. The PR interval represents the conduction of an impulse from the atrio-
ventricular node to the sino-atrial node and should not be longer than 0.12
seconds.
B. The T-wave represents the period of ventricular repolarisation.
C. The rate should be no less than 60 per minute and no more than 100 per minute.
D. The QRS complex should be less than 0.12 seconds in duration and this represents
ventricular depolarization.
1.3 What is the difference between stridor and wheezing?
A. Wheezing is usually caused by lower airway constriction and cannot be treated
effectively by Beta Adrenergic agonists whereas stridor responds well to these
agents.
B. Wheezing is caused by upper airway constriction and can be heard during
anaphylaxis; whereas stridor cannot.
C. Wheezing and stridor are both caused by constriction of the airway: Wheezing
in the lower airway and stridor in the upper airway.
D. Wheezing and stridor differ only because one is heard during inhalation and the other
during exhalation.
1.4 Hyperthermia occurs when:

A. Heat gained exceeds heat lost

B. Heat lost exceeds heat gained

2
AEA 01/2014
CLASS TESTLONG and SHORT

C. Air temperature exceeds body temperature

D. Air temperature drops below body temperature.

1.5 An abdominal injury in which internal organs protrude through the open wound
is known as an:
A. Contusion
B. Amputation
C. Evisceration
D. Avulsion.
1.6 Which statement regarding β2 adrenergic stimulants is false?

A. At a higher repeated dosage the medication may lead to β1 effects on the heart.
B. The duration of action is longer than that of Ipratropuim bromide.
C. The allergy Society of South Africa recommends Salbutamol as the β2 stimulant of
choice.
D. Urinary retention is a common adverse effect of the medication.

1.7 Regarding Activated Charcoal, all of the following statements are correct except:

A. Activated charcoal absorbs poisonous compounds to its surface.

B. An acceptable dose for an adult patient is 1g/kg.
C. The patient may experience mild constipation following administration.
D. Activated charcoal is not indicated for strong alkali and acids.

1.8 Which one of the following is incorrect?

A. Acetyl Salicylic Acid may lead to fetal distress due to obliteration of the fetal ductus
arteriosus.
B. Thromboxane is a chemical mediator that leads to platelets aggregation.
C. The enzyme cyclo-oxygenase inhabits platelet aggregation.
D. Acetyl Salicylic Acids can be considered an example of the generic name, Aspirin is an
example of a trade name.

1.9 Regarding medical oxygen, choose the statement that is false.

A. Oxygen is indicated in the ILS protocol for severe anemia.

B. Oxygen should be moved at least one meter away from defibrillation pads/paddles.
C. During optimal active CPR only 25-30% of the normal cardiac output is maintained and
therefore supplemental oxygen should be administered.

3
AEA 01/2014
CLASS TESTLONG and SHORT

D. Long exposures to high concentration of oxygen may result in retrolental

fibroplasia in children as a direct result of the lens of the eye becoming too dry.

1.10 Regarding Ipratropium Bromide

A. Ipratropium Bromide has cholinergic effects.

B. Mydriasis and urinary retention are common adverse effect of Ipratropuim Bromide.
C. Ipratropuim Bromide will not work particularly well in patient taking Beta-
Blockers as the target receptors will be blocked.
D. Ipratropium Bromide is a schedule 3 medication.

1.11 Acetyl Salicylic Acid is contra indicated on ILS protocol for patients already
receiving platelet aggregation inhibitors. Which one of the following is an
example of a platelet aggregation inhibitor?

A. Prozac.
B. Lasix.
C. Adalat.
D. Ecotrin.

1.12 Which one of the following statements is true regarding organophosphate?

A. The patient may present with tachycardia and dry mucus membrane.
B. The patient may present with facial drooping.
C. The patient may present with meiosis and tachycardia.
D. The patient may present with meiosis and bradycardia.

1.13 An aneurysm is best described as:

A. It is a bulging tumor in the brain.

B. It is a thrombus that moves freely in the blood.
C. It is a clogged up blood vessel within the heart causing chest pain.
D. It is a weakened section of an artery that begins to balloon outward.

1.14 Patient who is moderately dehydrated, weighing 65kg requires:

A.1300ml of colloids over 20 minutes.

B.1300ml of colloids over 8hours.
C.1250ml of crystalloids over 20 minutes.
D. 1300ml of crystalloids over 20minutes.

Questions 1.15 to 1.17 are based on the following scenario:

4
AEA 01/2014
CLASS TESTLONG and SHORT

You are dispatched to a 60year old male patient complaining of severe chest
pain that developed an hour ago. It has not relieved even though he has taken 3
nitroglycerines tablets (TNT).

1.15 What is the most likely diagnosis for this patient?

A. Peptic ulcers.
B. Acute myocardial infarction.
C. Heart burn.
D. Pulmonary edema.

1.16 What causes the condition defined above?

A. A blockage of the coronary arteries.

B. Damage to the heart muscle as a result of an infection.
C. Bleeding around the heart muscle (cardiac tamponade).
D. A narrowing of the coronary arteries.

1.17 If this patient becomes unconscious and stops breathing and has no pulse, would
you attach an Automated External Defibrillator?

A. Yes, because the most likely problem is that the patient will be in asystole.
B. Yes, because the most likely problem is that the patient will be in a shockable
rhythm.
C. Yes, but only after two minutes of C.P.R.
D. No, because C.P.R will be more effective in this case.

1.18 Asprin:

A. Functions as a platelet aggregation inhibitor by blocking the action of the cyclo-

oxygenase enzyme.
B. Is indicated for patients with chest pain of suspected cardiac origin provided there
are no contra-indications present.
C. Is administered at a dose of at least 500mg so as to have the desired effect.
D. Is a schedule 2 non-steroidal anti-inflammatory medication.

1.19 Congestive cardiac failure:

A. Usually begins as right heart failure and is evidenced by pulmonary oedema.

B. Usually begins as left heart failure as the left ventricle is constantly under high
pressure.
C. Usually progresses from the right to the left.
D. Is evidenced by pulmonary oedema during left heart failure and distended neck veins
during right heart failure.

Question 2 [20 marks]

5
AEA 01/2014
CLASS TESTLONG and SHORT

Answer this question on the answer sheet provided by stating whether the following
statements are true or false. N.B: Negative marking may apply to this question.
2.1 According to the National Health Act of 1993 and the Constitution of the
Republic of South Africa:
1. Patients do not have a responsibility to take care of the health records in their
possession since copies are kept at the hospital / clinic and may be referred to during
follow-up visits. F
2. Patients have a right to be treated by a named health care provider and therefore it is
contrary to the charter for practitioners not to display their name badges. T
3. Patients have a right to refuse treatment either verbally or in writing, provided that
such refusal does not endanger the health of others. T
4. Patients have a right to emergency care and therefore it would be acceptable for the
pre-hospital practitioner to transport unstable patients to the nearest medical facility
even if the facility is classified as private and the patient has no medical aid. T
2.2 Regarding Acetyl Salicylic Acid:
1. The desired action of this drug in acute coronary syndromes is that it blocks the
enzyme cyclo-oxygenase thereby inhibiting platelet aggregation by preventing the
formation of thromboxane. T
2. According to protocol, this drug is indicated for suspected myocardial infarction and
this includes angina since it is difficult to differentiate between the two conditions in
the pre-hospital setting. F
3. According to ILS protocol, patients taking Ecotrin or Plavix should not receive this
drug even is the setting of suspected AMI. T
4. This drug is effectively absorbed when placed under the tongue and allowed to
dissolve and therefore this is a route of administration. F
2.3 Regarding tension pneumothorax:

1. Distended neck veins result from the back up of blood into the systemic circulation
due to the increase in intrathoracic pressure. T
2. ILS treatment of this condition involves insertion of a large bore cannula into the
second intercostals space just below the third rib. F
3. Signs of hypoxic hypoxia will develop. T
4. By definition, this condition includes a compromise to both the respiratory and
cardiovascular systems. T

2.4 Regarding neonatal resuscitation:

1. When suctioning the neonate, the practitioner should always suction the nose first
since neonates are nasal breathers. T
2. The most urgent treatment required in neonatal resuscitation is ALS drug therapy. F

6
AEA 01/2014
CLASS TESTLONG and SHORT

3. If the neonate’s heart rate remains below 60 beats per minute after at least 30 seconds
of BVM ventilation with oxygen, the ILS practitioner should begin CPR at a ratio of 3
compressions to 1 ventilation. T
4. Meconium aspiration can be managed effectively by turning the neonate lateral and
suctioning the mouth. T

2.5 Regarding the heart and cardiac conduction:

1. The sino-atrial node is generally considered the physiological pacemaker of the heart
and has an intrinsic rate of between 60 and 100 per minute. T
2. After the sino-atrial node has depolarised, the conduction impulse travels to the AV
node but is somewhat delayed as it travels through the atrial cardiac tissue and this
produces the PR interval on the ECG. T
3. Ventricular systole is usually associated with the QRS complex. T
4. The T-wave on the ECG represents atrial repolarisation. F

Question 3- General (45 marks)

3.1 You are dispatched to the scene of a PVA at 02h00 on June 20th. On arrival you find a
patient who has no palpable pulses but has the following ECG rhythm on the ECG
monitor:

PR- 4 BLOCKS; P WAVE- 2 BLOCKS; QRS 1,5 BLOCKS; HR 40 b/ Min

1. Perform a step-by-step analysis of the above ECG rhythm. (9)
2. What is your diagnosis of rhythm? BRADYCARDIA PEA (2)
3. What is your treatment for this patient CPR, RULING OUT CAUSES
(2)
4. List at least five possible causes for this patient’s condition and describe how you
would manage each one identified according to your existing ILS protocols. (10)

3.2 You are dispatched to a patient complaining of a severe headache, it started 15 minutes
ago, and she is now having difficulty in moving the right side of her body. Explain the
Cincinnati stroke scale test under the following headings: test done; normal findings;
abnormal findings (12)

3.3 Complete the following table on your answer sheet: Sympathetic and parasympathetic
nervous systems (10):

Organ / system Sympathetic system Parasympathetic

system

Skin

Pupils

Heart rate
7
Digestive system

Breathing rate
AEA 01/2014
CLASS TESTLONG and SHORT