Critical Care/Flight Paramedic Exam Questions and Answers, Exams of Nursing

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critical care/flight paramedic

examQUESTIONS WITH CORRECT

ANSWERS

babinski reflex - CORRECT ANSWER_ -extension and spreading of toes when bottom of foot is

stroked. sign of nervous system lesion

battles sign - CORRECT ANSWER_ -bruise behind ear, basilar skull fracture

becks triad - CORRECT ANSWER_ -jvd, muffled heart tones, hypotension. from cardiac

tamponade

brudzinski sign - CORRECT ANSWER_ -flexion of the neck results in flexion of the hip. meningitis

coopernails sign - CORRECT ANSWER_ -ecchymosis on perineum, labia, scrotum. sign of pelvis

fracture

cullens sign - CORRECT ANSWER_ -bruising around umbilicus. Sign of pancreatitis or ectopic

pregnancy

grey turners sign - CORRECT ANSWER_ -discoloration of skin around flank. sign of pancreatitis

hammans sign - CORRECT ANSWER_ -crunching sound of heart with asynchronous heart beat.

sign of mediastinal emphysema/tracheobronchial disruption

kehrs sign - CORRECT ANSWER_ -left shoulder pain associated with splenic rupture

kernigs sign - CORRECT ANSWER_ -pain to knee extension when hip is at 90 degrees. sign of

meningitis

levines sign - CORRECT ANSWER_ -pain with clutched fist over midline of chest. sign of cardiac

chest pain

mcburneys sign - CORRECT ANSWER_ -tenderness 2/3 the distance between umbilicus and

ileum. sign of appendicitis

muphys sign - CORRECT ANSWER_ -pt unable to take deep breath on inspiration with deep

palpation beneath right coastal margins. sign of gall bladder issues

S2 "dub" heart tones - CORRECT ANSWER_ -aortic and pulmonary valve closure

s1 "lub" sound - CORRECT ANSWER_ -bicuspic/tricuspid valve closure

stroke volume is affected by - CORRECT ANSWER_ -preload, afterload, contractility

s4 heart tone - CORRECT ANSWER_ -indicative of stiff or noncompliant ventricle, like with an

old MI

s3 heart tone - CORRECT ANSWER_ -ventricle stretch due to fluid overload

right coronary artery is typically repaired by using - CORRECT ANSWER_ -saphenous vein

dresslers sign - CORRECT ANSWER_ -pericarditis from recent MI or cardiac surgery

alpha 1 stimulation results in - CORRECT ANSWER_ -increased SVR/vasoconstriction

beta 1 stimulation results in - CORRECT ANSWER_ -increased HR, contractility

janeway lesions and osler nodes are indicative of - CORRECT ANSWER_ -endocarditis

elevated BNP signals - CORRECT ANSWER_ -increased stretching of ventricles. found in CHF

where should a cardiac transducer be placed? - CORRECT ANSWER_ -phlebostatic axis (4th

intercostal space midaxillary)

what does the dicrotic notch symbolize? - CORRECT ANSWER_ -aortic valve closing

saline from ART line should infuse at what rate - CORRECT ANSWER_ -3ml/hr

normal central venous pressure (CVP) - CORRECT ANSWER_ -2-

when utilizing a swan ganz catheter, never exceed ____mL of air in distal balloon - CORRECT

ANSWER_ -1.

coronary perfusion pressure calculation - CORRECT ANSWER_ -PAWP-DBP (should be 50-60)

PAWP range - CORRECT ANSWER_ -8-

PVR range - CORRECT ANSWER_ -50-

PA pressure - CORRECT ANSWER_ -15-25 systolic, 8-15 diastolic

SVR range - CORRECT ANSWER_ -800-

what does PVR signify - CORRECT ANSWER_ -right heart afterload, pulmonary vascular

resistance

what is PCWP - CORRECT ANSWER_ -same as pAWP

left heart preload is also called - CORRECT ANSWER_ -left ventricular end diastolic pressure

LVEDP

what is CI - CORRECT ANSWER_ -same as CO

what happens to pressures during cardiogenic shock - CORRECT ANSWER_ -decreased cardiac

output (CO/CI), increased everything else

what happens to pressures during hypovolemic shock - CORRECT ANSWER_ -decreased SVR,

increased everything else

what happens to pressures during anaphylactic shock - CORRECT ANSWER_ -increased CO/CI,

decreased everything else

when should PAWP readings be taken - CORRECT ANSWER_ -at the end of exhalation

if a swan ganz catheter is in the right place, the two pressures that can be continuously monitored are -

CORRECT ANSWER_ -CVP and PA (central venous and pulmonary artery)

what should you do if the IABP console shuts down during transport? - CORRECT ANSWER_ -

inflate balloon with air every 3-5 minutes. this prevents formation of clots

most deadly IABP timing error - CORRECT ANSWER_ -late deflation

what does late deflation look like? - CORRECT ANSWER_ -diastolic notch higher than

unassisted, waveform has widened appearance

signs that IABP balloon has migrated? - CORRECT ANSWER_ -decreased urinary output and

decreased pulse to left hand

what does early inflation of IABP look like? - CORRECT ANSWER_ -weak/loss of dicrotic notch

what does early deflation of IABP waveform look like - CORRECT ANSWER_ -"cliff" shape

what does late inflation of IABP waveform look like - CORRECT ANSWER_ -a W shape, widened

do you have to manually purge the IABP at altitude? - CORRECT ANSWER_ -no

for a patient in A-fib what is the best trigger for the IABP? - CORRECT ANSWER_ -pressure mode

normal value of ICP - CORRECT ANSWER_ -5-

ICP above what mmHg has high mortality? - CORRECT ANSWER_ -above 20

normal cerebral perfusion pressure (CPP) - CORRECT ANSWER_ -70-

ICP monitoring waveform looks like - CORRECT ANSWER_ -3 humps, each lower than the last

P1 on ICP waveform - CORRECT ANSWER_ -systole

P2 of ICP waveform - CORRECT ANSWER_ -compliance of brain (percussion wave)

P3 of ICP waveform - CORRECT ANSWER_ -dicrotic notch

what does P2 elevation on ICP waveform signify? - CORRECT ANSWER_ -poor compliance,

increasing ICP

hyperglycemia in brain injuries - CORRECT ANSWER_ -makes it worse

hyponatremia in brain injuries - CORRECT ANSWER_ -associated with brain edema

subdural hematoma CT presentation - CORRECT ANSWER_ -looks like a crescent moon

epidural hematoma CT presentation - CORRECT ANSWER_ -lens shape

central cord syndrome - CORRECT ANSWER_ -upper extremity weakness that is greater than

lower extremeties

anterior cord syndrome - CORRECT ANSWER_ -

most common cause of encephalitis - CORRECT ANSWER_ -Herpes simplex 1

status epilepticus is characterized by - CORRECT ANSWER_ -one seizure lasting longer than 5

minutes or recurrent seizures longer than 30 minuets

scorpion treatment - CORRECT ANSWER_ -atropine and diazepam if you dont have anascorp

crofab, what is it and dose - CORRECT ANSWER_ -snake antivenom. give 4-6 vials initially and

maintenance 2 vials q6 (3 rounds) for 18 hours following

treatment for acetaminophin OD - CORRECT ANSWER_ -mucamyst (N-acetylcystine)

treatment of ethylene glycol toxicity - CORRECT ANSWER_ -fomepizole (antizol)

what happens with phenergan when you administer and they have an upward gaze - CORRECT

ANSWER_ -this is a dystonic reaction. give benadryl

SLUDGE, what is it and what treatment - CORRECT ANSWER_ -cholinergic toxicity. treat with

pralidoxime and atropine

12 lead signs of hyperK - CORRECT ANSWER_ -either flat P wave or peaked T wave

trosseaus sign - CORRECT ANSWER_ -

chvosteks sign - CORRECT ANSWER_ -

what is the only shock with a high cardiac index? (CI/CO) - CORRECT ANSWER_ -septic

what does it mean to have an INCREASED anion gap? - CORRECT ANSWER_ -metabolic acidosis

what is most likely injured in a diving accident? - CORRECT ANSWER_ -C5 and C

Newton's second law - CORRECT ANSWER_ -Mass(force)=acceleration

Newton's first law - CORRECT ANSWER_ -an item in motion will remain in motion unless acted

on by an outside force

Newton's third law - CORRECT ANSWER_ -for every action there is an equal and opposite

reaction

what is the most important predictor in GSW damage? - CORRECT ANSWER_ -velocity

kehrs sign is a sign of a - CORRECT ANSWER_ -splenic rupture

chance fracture - CORRECT ANSWER_ -T12-L1. caused by rear impact

C2 fracture - CORRECT ANSWER_ -hangmans fracture

C1 fracture - CORRECT ANSWER_ -jeffersons fracture

collee fracture - CORRECT ANSWER_ -bilateral distal radial fractures from catching yourself

while falling

most commonly injured hollow organ in abdominal trauma - CORRECT ANSWER_ -small

intestine

what is the most dangerous pelvic fracture - CORRECT ANSWER_ -vertical shear

Le Forte I - CORRECT ANSWER_ -horizontal across maxilla

Le Forte II - CORRECT ANSWER_ -bridge of nose and around mouth, usually from downward

blow to nose

Lefort III - CORRECT ANSWER_ -craniofacial dissociation

for femoral vein cannulation, is artery or vein more lateral? - CORRECT ANSWER_ -artery is

more lateral, vein is medial

do pRBC and FFP require ABO compatibility - CORRECT ANSWER_ -yes

leading cause of death in transfusion reactions - CORRECT ANSWER_ -TRALI - transfusion

related acute lung injury

ABO incompatibility can cause what reaction - CORRECT ANSWER_ -hemolytic

blood urea nitrogen - CORRECT ANSWER_ -8-23 mEq/L

creatinine levels - CORRECT ANSWER_ -0.7 to 1.

normal WBC count - CORRECT ANSWER_ -4500 - 11000

platelet count - CORRECT ANSWER_ -150k - 400k

prothrombin time - CORRECT ANSWER_ -10-13 second

partial thromboplastin time - CORRECT ANSWER_ -21-35 sec

INR levels - CORRECT ANSWER_ -0.9 - 1.

calcium levels - CORRECT ANSWER_ -8.8-10.

anion gap - CORRECT ANSWER_ -12 +- 4

RBC count - CORRECT ANSWER_ -5 million/mL

osmolality # - CORRECT ANSWER_ -275 - 295

what is proper ET placement? - CORRECT ANSWER_ -2-3 cm above carina, level of T2-T4, 1 inch

above carina

what is anectine - CORRECT ANSWER_ -succinylcholine

target for ET cuff pressure - CORRECT ANSWER_ -20-

what is LOAD - CORRECT ANSWER_ -pneumonic for pre RSI meds. Lidocaine, opiates, atropine,

defasciculation dose

7Ps of RSI - CORRECT ANSWER_ -preparation, preoxygenate, pretreatment, paralysis, protect

and position, placement, post intubation

pneumonic for pressure alarms - CORRECT ANSWER_ -DOPE

normal tidal volume - CORRECT ANSWER_ -4-8 ml/Kg

normal minute ventilation volume - CORRECT ANSWER_ -4-8 lpm

VE symbolizes - CORRECT ANSWER_ -ventilation volume

what is important to monitor when using pressure control mode on a ventilator? - CORRECT

ANSWER_ -VTE (expired tidal volumes)

severe hypothermia and what happens - CORRECT ANSWER_ -32C, 89.6F. shivering stops

hypothermia is defined as - CORRECT ANSWER_ -core temp below 95

primary cation lost in heat injuries - CORRECT ANSWER_ -sodium

what ODs can cause diabetes insipidus? - CORRECT ANSWER_ -keppra, pheytoin (dilantin)

diabetes insipidus treatment - CORRECT ANSWER_ -DDAVP

iron overdose treatment - CORRECT ANSWER_ -deferoxamine

what is a patient seeing "yellow and green halos" a sign of? - CORRECT ANSWER_ -digoxin

toxicity

mydriasis - CORRECT ANSWER_ -dilated pupils

beta blockers in cocaine ovrdose - CORRECT ANSWER_ -CCP doesnt want you to give it, can

cause unopposed alpha adrenergic activity

some anticholinergic drugs - CORRECT ANSWER_ -atropine, dramamine, benadryl, anything

that ends in -ine

anticholinergic antidote - CORRECT ANSWER_ -physostigmine

mothers plasma increases by __% during pregnancy - CORRECT ANSWER -40%

late decelerations cause - CORRECT ANSWER_ -uteroplacental insuffiency/pre eclampsia

variable decelerations cause - CORRECT ANSWER_ -cord compression - nuchal cord or

prolapsed cord

tocolytic - CORRECT ANSWER_ -drugs that stop labor

what drugs are tocolytics - CORRECT ANSWER_ -mag and terbutaline

normal fetal heart rate variability - CORRECT ANSWER_ -15-

antidote for mag toxicity - CORRECT ANSWER_ -calcium

HELLP syndrome - CORRECT ANSWER_ -in pregnancy. Hemolysis, Elevated Liver enzymes, Low

Platelets. has jaundice and RUQ pain

treatment for HELLP - CORRECT ANSWER_ -steroids to stimulate fetal lung maturity

how to suction neonate - CORRECT ANSWER_ -mouth before nose

most common cause of neonatal sepsis - CORRECT ANSWER_ -group B strep

abnormality in newborns where bone blocks the nasal passage - CORRECT ANSWER_ -choanal

atresia

hyaline membrane disease - CORRECT ANSWER_ -neonatal ARDS. causes surfactant deficiency

omphalocele - CORRECT ANSWER_ -protrusion of viscera

what has worse outcome, omphalocele or gastrocschisis? and why? - CORRECT ANSWER_ -

omphalocele, these pts typically have underdeveloped lungs as well

treatment for neonatal hypoglycemia - CORRECT ANSWER_ -2ml/kg of D

what do hematomegaly and cardiomegaly in a neonate signify, and what is the treatment? -

CORRECT ANSWER_ -signify CHF, treatment digoxin/digitalis

ventricular septal wall defect is an example of - CORRECT ANSWER_ -right to left shunt

if a neonate deteriorates after oxygen administration what does this mean - CORRECT

ANSWER_ -they need the patent ductus arteriosus to live (PDA. it is closed by oxygen)

what drug keeps the PDA open - CORRECT ANSWER_ -prostaglandin E

what forms after closure of the PDA? - CORRECT ANSWER_ -ligamentum arteriosum

if a child squats down to improve SVR this is a sign of - CORRECT ANSWER_ -tetralogy of fallot

ET tube diameter in peds - CORRECT ANSWER_ -(age + 16)/

what age can you preform a surgical cric on - CORRECT ANSWER_ ->8 yo

hypotension for peds pts formula - CORRECT ANSWER_ -70+ (pt age x2)

peds maintenance infusion formula - CORRECT ANSWER_ -4ml(kg) for first 10kg, then 2ml/kg

for 10-20, then 1ml/kg for each kg over 20

kids show signs of hypotension at loss of ______% blood volume - CORRECT ANSWER_ -25%

ballance sign - CORRECT ANSWER_ -dullness to LUQ associated with splenic rupture

treatment for syndrome of inappropriate antidiuretic hormone - CORRECT ANSWER_ -

hypertonic saline

what to treat pt with liver disease with - CORRECT ANSWER_ -lactulose, decreases ammonia in

blood of liver failure pts

what causes saponification burns - CORRECT ANSWER_ -alkali

asterixis - CORRECT ANSWER_ -flapping of hands, associated with liver failure

barodontalgia happens when - CORRECT ANSWER_ -on ascent

barotitis media happens when - CORRECT ANSWER_ -on descent

treatment for hypothyroid - CORRECT ANSWER_ -synthroid

chovsteks sign - CORRECT ANSWER_ -hyper reactive face muscles. sign of calcium deficiency

tell me about BNP and levels - CORRECT ANSWER_ -B type Natriuretic Peptide is a measure of

heart failure. less than 100, no failure. greater than 300, mild. greater than 600 moderate, greater than 900 severe

what is uremic pericarditis - CORRECT ANSWER_ -post dialysis pericarditis

a base deficit >-4 indicates - CORRECT ANSWER_ -need for blood transfusion

SaO2 90, 80, 70 corresponds to to PaO2 of - CORRECT ANSWER_ -60,50,

what pH and temp shift oxyhemoglobin curve to the left - CORRECT ANSWER_ -decreased

temp, decreased pH

what pH and temp shift oxyhemoglobin curve to the right - CORRECT ANSWER_ -increased

temp, increased pH

what does partially compensated mean - CORRECT ANSWER_ -ph, Co2 and HCO3 are all outside

of normal range

CO2 change 10, what does this do to pH and K+? - CORRECT ANSWER_ -pH goes 0.8 in opposite

direction, K+ goes 0.5 in same direction

pH increases 0.15, what does this do to HCO3? - CORRECT ANSWER_ -changes 10 in same

direction

critical values for intubation - CORRECT ANSWER_ -pH less than 7.2, CO2 greater than 55, PaO

less than 60

number one cause of metabolic acidosis - CORRECT ANSWER_ -lactic acidosis

peds ET tube size - CORRECT ANSWER_ -(16+age)/

age for needle cric - CORRECT ANSWER_ -8yo and below

what is LEMON for - CORRECT ANSWER_ -difficult airway. look, evaluate, mallampati,

obstructions, neck mobility

what is HEAVEN for - CORRECT ANSWER_ -difficult airway predictor. hypoxemia, extremes of

size, anatomic, vomit, exsanguination, neck mobility issues

ET tube cuff pressure - CORRECT ANSWER_ -20-

colormetric saying - CORRECT ANSWER_ -yellow is yes, purple is pull

lidocaine for RSI - CORRECT ANSWER_ -use in head injury patients, blunts the cough reflex to

prevent increase in ICP

atropine for RSI - CORRECT ANSWER_ -use for pts less than 1 yo to prevent reflex bradycardia

defasciculation dose for RSI - CORRECT ANSWER_ -1/10 dose of paralytic

contraindication for etomidate - CORRECT ANSWER_ -renal suppression, shock, copd, asthma

difference in RSI in hemodynamically unstable/shocky pts - CORRECT ANSWER_ -half the

sedation dose and double the paralytic dose. also ketamine is good for shock

how to cut for cric - CORRECT ANSWER_ -vertical incision first

dead space formula - CORRECT ANSWER_ -2ml/kg

biots respirations - CORRECT ANSWER_ -rapid shallow breaths followed by periods of apnea

ataxic respirations - CORRECT ANSWER_ -all over the place. very poor prognosis

gold standard for oxygenation and gold standard for ventilation - CORRECT ANSWER_ -

oxygenation - pulse ox. ventilation - capno

minute volume number - CORRECT ANSWER_ -4-8 L/min

what needs to be monitored with a ventilator using pressure control? - CORRECT ANSWER_ -

volumes

what needs to be monitored with a ventilator using volume control? - CORRECT ANSWER_ -

pressures

PIP and PPLAT numbers - CORRECT ANSWER_ -pip less than 35, pplat less than 30

asthma I:E ratio - CORRECT ANSWER_ -increase to 1:

ARDS PAWP - CORRECT ANSWER_ -high, like 18-

ARDS vent settings - CORRECT ANSWER_ -increased PEEP, increased frequency, low tidal

volumes

major extracellular anion - CORRECT ANSWER_ -Cl-

trosseaus sign - CORRECT ANSWER_ -sign of hypocalcemia, twtiching with bp cuff

bicarb replacement formula - CORRECT ANSWER_ -0.1(kg)(-BE)

heparin overdose treatment - CORRECT ANSWER_ -protamine sulfate

normal INR and therapeutic INR - CORRECT ANSWER_ -1 second normal, 2-3 seconds

therapeutic (like with warfarin/coumadin)

when to increase urine output to 100ml/hr - CORRECT ANSWER_ -electrical burns, rhabdo,

hemolysis

who is more fluid deficient, HNNK or DKA? - CORRECT ANSWER_ -HNNK. can be 8-10 liters

deficient

DI treatment - CORRECT ANSWER_ -vasopressin/DDAVP. fluid admin. usually they are very fluid

deficient

what to avoid in thyroid storm/graves disease - CORRECT ANSWER_ -aspirin - will make it worse

treatment for thyroid storm - CORRECT ANSWER_ -fluids first then beta blockers, steroids,

tylenol

lactate in septic shock - CORRECT ANSWER_ -greater than 4

ambient operating temps of ambulance - CORRECT ANSWER_ -between 68 and 78 degrees

performance temps of ambulance - CORRECT ANSWER_ --30 to 122 degrees

sirens must be audible from a distance of - CORRECT ANSWER_ -500 feet

PVR - what is it and range - CORRECT ANSWER_ -pulmonary vascular resistance. it is right heart

afterload, 50-250

normal troponin - CORRECT ANSWER_ -<.04

code 1200 - CORRECT ANSWER_ -VFR

code 7500 - CORRECT ANSWER_ -hijacking

code 7600 - CORRECT ANSWER_ -communications failure

code 7700 - CORRECT ANSWER_ -emergency

requirements for permanent LZ - CORRECT ANSWER_ -perimeter heading, 2 approach and

departure headings, windsock, D fire extinguisher

land immediately - - CORRECT ANSWER_ -engine failure, fire in cockpit

land as soon as possible - CORRECT ANSWER_ -chip light, low oil pressure, low transmission oil

land as soon as practical - CORRECT ANSWER_ -to look at something non emergent

post crash sequence - CORRECT ANSWER_ -too freaking bad. throttle, fuel, battery

ELT frequency is on - CORRECT ANSWER_ -121.5

who is responsible for search and rescue of a downed aircraft - CORRECT ANSWER_ -civil air

patrol

atmospheric pressure at sea level - CORRECT ANSWER_ -760 torr

physiologically deificient zone - CORRECT ANSWER_ -10k-50k MSL

at what altitude does night vision begin to be affected? - CORRECT ANSWER_ -5k MSL

what are signs of cabin pressure loss - CORRECT ANSWER_ -windows fogging, temp cooler

boyles law - CORRECT ANSWER_ -pressure of a gas decreases as volume of container increases

charles law - CORRECT ANSWER_ -at a constant pressure, volume of gas is directly proportional

to temp of gas

temperature changes in altitude - CORRECT ANSWER_ -every 1000ft MSL increase will cause a

temerature drop of 2 degrees celsius

aircraft performance is worse in what weather - CORRECT ANSWER_ -warm

what is the formula for adjusting FiO2 for ascent? - CORRECT ANSWER_ -P1(FiO2)/P2 = FiO2for

ascent

barodontalgia occurs when - CORRECT ANSWER_ -ascent

types of DCS (decompression sickness) - CORRECT ANSWER_ -type I - joint or skin pain. type 2 -

AMS

normal creatinine levels - CORRECT ANSWER_ -0.7 - 1.4

heparin OD antidote - CORRECT ANSWER_ -protamine sulfate

warfarin over dose treatment - CORRECT ANSWER_ -vitamin K