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ALC PHASE 3 LIMITED PRIMARY CARE/
6 8W ALC PHASE 3 LIMITED PRIMARY
CARE 2025/2026 NEWEST UPDATE
PRACTICE QUESTIONS WITH VERIFIED
SOLUTIONS
What are the mandated events that require MACE -- ANSWER--1) Involved in vehicle associated blast event, collision, rollover 2 3 4 ) Within 50 meters of blast ) Anyone who sustains a direct blow to head ) Command directed, such as but not limited to repeated exposures What is a Red Flag -- ANSWER--Ominous sign of a worsening condition. Level 2 Evacuation Decision Red Flags -- ANSWER--1) Any positive answer to MACE items V-VIII 2 3 4 5 ) Double vision ) Worsening Headache ) Cant recognize people; Disorientation to place ) LOC >5 min
6 ) Weakness/numbness in arms/legs Level 3 Evacuation Decision Red Flags -- ANSWER--1) Progressively declining levels of consciousness 2 3 4 ) Pupil asymmetry ) SZ ) Repeated Vomitting Number one cause of TBI in combat -- ANSWER--Blast injuries What are the three types of TBIs -- ANSWER--Mild, Moderate, Severe S/Sx Mild TBI -- ANSWER--Transient confusion, Delayed verbal or motor response, Disorientation, Slurred or coherent speech, Any period of LOC When would you likely see Lhermitte's sign -- ANSWER--Following a whiplash syndrome injury When visualizing back what should you look for for injuries? -- ANSWER--edema, erythema, ecchymosis, battle sign, neuro changes, step offs Primary spinal cord injury -- ANSWER--Results from cord being cut, torn, or crushed or by its blood supply being cut off
Special Test for muscle spasm -- ANSWER--Blood test Why do you use a blood test for muscle spasms? -- ANSWER--Check Na and other electrolytes for causing factors What is the most common type of TBI? -- ANSWER--Mild. Dead Man Walking S/Sx Moderate/Severe TBI -- ANSWER--LOC, Personality change, Severe persistent Headache, Repeating N&V, SZ, Inability to awaken, Dilation of both pupils, Slurred speech, Weakness or numbness in extremities, Loss of coordination, Increased confusion, What does MACE stand for? -- ANSWER--Military Acute Concussion Evaluation How often should Neuro testing be performed? -- ANSWER--Semiannually or as mission dictates to ID TBIs What are the five domains of MACE? -- ANSWER--Orientation, Immediate Memory, Neurological Screening, Concentration, Delayed Recall High Altitude Illness -- ANSWER--Cerebral and Pulmonary Syndromes that can develop in UN-acclimatized persons shorty after ascent to high altitude
High Altitude Pulmonary Edema (HAPE) -- ANSWER--acute accumulation of fluid in the alveoli due to rapid ascent in altitude High Altitude Cerebral Edema (HACE) -- ANSWER--acute swelling of brain due to rapid ascent in altitude What are the ways to acclimatize a soldier? -- ANSWER--Staged and Graded Staged Ascent -- ANSWER--Soldiers will rise to a moderate altitude and remain there for 3 days or more before moving any higher. Should use several stops on way up Graded Ascent -- ANSWER-- Diffusion -- ANSWER--Flow of gas or liquid from an area of higher concentration to lesser concentration Subjective findings on Dislocated shoulder -- ANSWER--Pain (Severe), Instability, Weakness, Inability to move shoulder, Numbness Objective findings on Dislocated shoulder -- ANSWER--Abnormal appearance, Positive Sulcus Sign, Swelling, Bruising Management of Dislocated shoulder -- ANSWER--1) Reduction
With TBI, it is imperative to focus on what three areas of evaluation? -- ANSWER-- Cognitive, Physical, and Behavioral Cognitive Symptoms associated with TBI -- ANSWER--Attention difficulties, concentration problems, memory problems, orientation problems Physical Symptoms R/T TBI -- ANSWER--Headaches, dizziness, insomnia, fatigue, uneven gait, nausea, vomiting, blurred vision, SZ Behavioral Symptoms R/T TBI -- ANSWER--irritability, depression, anxiety, sleep disturbances, problems with emotional control, loss of initiative, and multiple personal problems Tx options for TBI -- ANSWER--Focus on airway, ventilation, and oxygenation, fluid resusication, px mngt, brain targeted therapy, triage and transport Prognosis of Whiplash Syndrome -- ANSWER--Symptoms may progressively get worse in first 1-3 days but most will mild cases resolve within 7-10 days Prognosis of Sciatica -- ANSWER--Most cases of Sciatica are treatable with px meds and PT. After 3-4 weeks compliance you should see improvement of symptoms Prognosis of Muscle Strain -- ANSWER--Most will recover in 2 weeks
S/Sx of whiplash Syndrome -- ANSWER--Neck stiffness, Injuries to muscles or tendons, Headache, Vertigo, Difficulty swallowing, Paresthesia, Shoulder px, Back px How is Lhermittes sign characterized? -- ANSWER--Electrical sensation that runs down back and in to limbs following bending head forward Therapeutic Interventions for Sciatica -- ANSWER--Hot/Cold therapy Ultrasound S/Sx of AMS -- ANSWER--Headache, Nausea, Vomiting, Anorexia, lethargy, dizziness, feeling like a hangover When do S/Sx of AMS present? -- ANSWER--Usually 6-10 hours following after ascent Management of AMS -- ANSWER--1) Stop ascent 2 3 4 ) O2 therapy @ 2-4 LPM NC ) Antiemetic (Phenergran 12.5-25) ) Diamox 250mg PO q 8-12 h Prognosis of AMS -- ANSWER--With appropriate care should resolve within 24h S/Sx of HACE -- ANSWER--Common: ataxia, altered mental status, headache, fatigue, N&V
) Rest and keep pt warm ) Dexamethasone 4 mg PO, IM, IV q 6h ) Procardia 10mg chew and 10mg swallow stat and then PO q 4h S/Sx of HAPE -- ANSWER--Common cough, SOB, Headache, fatigue, N&V, dizziness Definition of Dislocated Shoulder -- ANSWER--Occurs when humerus head separates from from scapula at the glenohumeral joint, where the glenoid fossa and the head of humerus articulate. Tx for cervical Fx -- ANSWER--Based on significant MOI, immobilize and evac immediately for evaluation Tx for Cervical Strain -- ANSWER--If MOI was significant refer to MD for Xray or manipulation. May need soft C Collar, NSAIDS, muscle relaxants, and follow up in 24 h Prognosis of Whiplash Syndrome -- ANSWER--Symptoms may get worse for the first 1- days but should resolve in 7-10 days Prognosis of muscle strain -- ANSWER--Usually will have full recovery within two weeks Medical Interventions for Muscle Sprasm -- ANSWER--1) Referral if dehydrated 2 ) Ice and compression
) Maintain mobility ) Skeletal muscle relaxer ) Anti-inflamatory ) Corticosteroid Exam findings for Lateral epicondylitis -- ANSWER--Px produced with wrist extension and supination Exam findings for Medial epicondylitis -- ANSWER--Px produced with wrist flexion and pronation Epicondylitis -- ANSWER--painful inflammation of tendons that occurs from over use. Two types: Medial (Golfers Elbow) and Lateral (Tennis Elbow) Special testing for epicondylitis -- ANSWER--MRI, EMG Prognosis for epicondylitis -- ANSWER--Rehab 18 months with 6-8 months decreased activity Medical interventions of Epicondylitis -- ANSWER--1) NSAIDS 2 3 4 ) Rest the elbow until inflammation subsides ) Wear of elastic support or splint ) Local injection of corticosteroids
How does Coronal (Frontal) divide body? -- ANSWER--Anterior and Posterior How does Sagittal (Vertical) divide body? -- ANSWER--Left and Right What are the common areas for stress Fx? -- ANSWER--1) Metatarsals 2 3 4 5 ) Tibia/Fibula ) Femur ) Pelvis ) Vertebra Exam findings for stress fx -- ANSWER--1) Intense tenderness at affected site 2 3 ) Axial (in-line with weight bearing) compression induces px ) VIBRATING TUNING FORK Management of Stress fx -- ANSWER--1) Refer to MO for suspected stress fx 2 3 4 5 ) Orthopedic post op (wooden) shoe for metatarsal stress fx ) RICE ) Profile to avoid weight bearing 3-4 weeks ) Acetaminophen 325-650 mg q 6h
Special test for Trochanteric Bursitis -- ANSWER--While pt is standing, palpate lateral hip area in a cephalic direction beginning below greater trochanter eminence until area of maximal tenderness is ID pharmacology -- ANSWER--study of substances that interact with living organisms through chemical processes medical pharmacology -- ANSWER--science of substances used to prevent, diagnose and treat disease indication -- ANSWER--reason or condition for which a particular medication is given dose -- ANSWER--amount of medication given within a specified period of time (single, maximum, cumulative) strength -- ANSWER--amount of medication contained per tablet, capsule, suppository, etc. titration -- ANSWER--administering a medication with variable strength, interval, and quantity to achieve and maintain a desired observable physiological effect (pain ctrl) contraindication -- ANSWER--medical reason not to give a medication absolute contraindication -- ANSWER--medical reason to NEVER give a medication
peak -- ANSWER--when medication is at its highest concentration trough -- ANSWER--lowest blood level of a medication between doses half-life -- ANSWER--time it takes for the body to eliminate half the dose of medication steady state -- ANSWER--relatively constant blood level of medication which is sustained after 5-6 half lives of a medication tolerance -- ANSWER--when the body has adapted to having a medication regularly and now requires a higher or more frequent doses to achieve the therapeutic effect resistance -- ANSWER--when infectious organisms adapt to antibiotics and it takes either higher doses of same medication or a change to a different medication to kill the organisms metabolism -- ANSWER--process of the body to break down and eliminate medications most metabolized by the liver or kidneys dosing interval -- ANSWER--recommended time period between doses of a medication onset -- ANSWER--time until a medication's therapeutic effect begins
duration of effect -- ANSWER--time until the medication's therapeutic effect wears off duration of therapy -- ANSWER--length of time a course of medication is continued to ensure the desired effect is maintained dosing parameters -- ANSWER--all the limitations, considerations, and instructions required regarding a medication helps achieve the desired physiological response minimize side effects factors affecting dosing -- ANSWER--body weight co-morbidities (other medical problems) age (metabolism slows with age) Pt understanding dosing parameters importance -- ANSWER---too little: not achieve therapeutic effects -too much: increased side effects/toxic levels antibiotics -- ANSWER--medications which kill or inhibit the reproduction of bacteria bacteria classification -- ANSWER--Gram Stain Testing to find out:
minocycline quinolones -- ANSWER--spontaneous tendon rupture Ciprofloxacin (Cipro) Levofloxacin (Levaquin) Moxifloxacin (Avalox) carbapenems -- ANSWER--very powerful broad with low resistance ertapenem (Invanz) imipenem with cilastatin (Primaxin) aminoglycosides -- ANSWER--powerful with low resistance; ototoxic; peak/trough monitoring Gentamycin Streptomycin sulfonamides -- ANSWER--broad, MRSA, allergic rxn (rash), sulfa based Sulfamthoxazole Trimethoprim (Bactrim/Septra) lincosamide -- ANSWER--broad, MRSA, QID Clindamycin (Cleocin)
vancomycin -- ANSWER---glycopeptide antibiotic (Gram Positive) -administered IV unless treating for C. diff (orally) -can cause "Red Man Syndrome" -ototoxic metronidazole (Flaygl) -- ANSWER--Gram negative & positive anaerobes peritonitis after bowel rupture Nitrofurantoin (Macrobid) -- ANSWER--UTI pregnancy category B antibiotic PO -- ANSWER--Moxifloxacin (Avelox), 400 mg PO one a day antibiotic NPO -- ANSWER--Cefotetan, 2 g IV (slow push 3-5 mins) or IM q12 hrs Ertapenem, 1 g IV/IM once a day antifungal -- ANSWER---Imidazoles -Triazoles -Undecylenic Acid
