FPC - CFRN - REVIEW EXAM - VERSION B WITH 100% VERIFIED SOLUTIONS LATEST UPDATE, Exams of Biology

Download FPC - CFRN - REVIEW EXAM - VERSION B WITH 100% VERIFIED SOLUTIONS LATEST UPDATE and more Exams Biology in PDF only on Docsity! FPC - CFRN - REVIEW EXAM - VERSION B - WITH 100% VERIFIED SOLUTIONS LATEST UPDATE |RATED A+ Myxedema coma is also known as... A. Thyroid storm B. Adrenal insufficiency C. Hypothyroidism D. Hyperaldosteronism Hypothyroidism Most common presentation of a patient with hypothyroidism are all of the following, Except... A. Cold intolerance with coarse hair B. Almost exclusively over the age of sixty C. >90% of cases occur in the winter D. Primarily in men Primarily in men Hypothroidism occurs primarily in women, almost exclusively over the age of sixty, with 90% of the cases occurring in the winter months. Your patient presents with following parameters: CVP 0, CI 1, PA S/D 8/4, wedge 3, and SVR 1,800. What is your diagnosis? A. Hypovolemic shock B. Right ventricular infarction C. CHF D. Sepsis Hypovolemic shock Careful interpretation of the CVP is important! Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. Drug of choice for profound hypotension in septic shock is? A. Isotonic crystalloid solution B. Levophed C. Nipride D. Dobutamine Levophed Sepsis is by far the most common cause of distributive shock. The average normal ICP range is... A. 0-10 mmHg B. 10-20 mmHg C. 20-30 mmHg D. >30 mmHg Normal ICP range is 0-10 mmHg, but range can go as high as 15 mmHg. The formula to calculate MAP is A. 2/3 DBP × SBP B. 2 × DBP + SBP divided by 3 C. 2 × SBP + DBP D. 2 + DBP × SBP divided by 3 2 × DBP + SBP / 3 Mannitol: an osmotic diuretic, acts by osmosis to ensure urine production and may prevent heme deposition in the kidney. Can be administered to avoid acute renal failure when fluid administration has been ineffective. Drug choice for cyclic antidepressant OD Sodium bicarbonate Drug choice for beta-blocker OD Glucagon Fentanyl dose Sublimaze (3 μg/kg) Treatment for malignant hyperthermia Dantrium (dantrolene) Drug for GI bleeds Sandostatin (octreotide) You have been requested to transport a twenty-year-old female from an ICU with a history of TCA overdose two hours prior to your arrival at the sending facility. Your cardiovascular assessment of the patient would most likely include all of the following with this type of toxicity, EXCEPT... A. Early sinus bradycardia B. Widening QRS C. Prolonged QT and PR interval D. Early tachycardia Early sinus bradycardia Sinus tachycardia is the most common cardiac disturbance seen following TCA overdose. Rhabdomyolysis treatment - preventing shock and preserving kidney fxn - NS with sodium bicarbonate Your patient presents with ABG's of pH 7.39, pCO2 68 HCO3 32, pO2 82. He has history of COPD and weighs 65 kg. He presents with a history of SOB for 3 days with a RR 20 and is on 4 L/minute of oxygen by NC. He speaks in four- to five-word sentences. What acid-base disorder is present? A. Metabolic acidosis with partial compensation B. Respiratory acidosis with complete compensation C. Metabolic alkalosis with no compensation D. Respiratory alkalosis with no compensation Respiratory acidosis with complete compensation. The pCO2 is elevated, which is the primary disorder, and the compensatory response is the increased HCO3. The pH is normal, so there is complete compensation. Which formula can be used when calculating a cerebral perfusion pressure (CPP)? A. [(DBP × 2) + SBP] divided by 3 B. MAP − ICP C. ICP − DBP D. [(DBP + 2) × SBP] divided by 3 MAP − ICP = CPP Normal range (mmHg): 70-90 You are managing a patient who has been diagnosed with hepatic encephalopathy. His ammonia levels are elevated. Your management in preparing this patient for transport is to inhibit elevated protein level by... A. Administering whole blood B. Stop GI bleeding and evacuate bowel of blood C. Aggressive fluid resuscitation D. Aggressive pain control Stop GI bleeding and evacuate bowel of blood Bowel cleansing is the mainstay of therapy for hepatic encephalopathy. Evacuation of gutderived toxins (intestinal blood, bacteria) and administration of Lactulose (orally or as an enema) is one of the cornerstones of the treatment of hepatic encephalopathy. C. Aortic rupture D. Cardiac tamponade Tracheobronchial injury Hamman's sign is a crunching sound heard with auscultation and may be synchronized with the patient's heart beat. This sign is associated with tracheobronchial injury. Recommended urinary output when managing a burn patient without an electrical injury is: A. 100 mL/hr B. 10-20 mL/hr C. 30-50 mL/hr D. >100 mL/hr 30-50 mL/hr Hydrofluoric burns can be managed with copious amounts of water and... A. Calcium gluconate B. Osmotic diuretics C. Glucagon D. Pyroxidine Calcium gluconate Hydrofluoric acid exposure is often treated with calcium gluconate, a source of Ca2+ that sequesters the fluoride ions. HF chemical burns can be treated with a water wash and 2.5% calcium gluconate gel or special rinsing solutions. However, because it is absorbed, medical treatment is necessary; rinsing off is not enough and in some cases, amputation may be necessary. The management approach for a patient experiencing brain herniation can include all of the following, EXCEPT: A. Serum sodium goal 155 B. Serum osmolality less than 320 C. Hypertonic saline, mannitol D. Hyperventilation to maintain EtCO2 at 20-30 mmHg Hyperventilation to maintain EtCO2 at 20-30 mmHg Routine hyperventilation is not longer recommended in the initial management of the patient with traumatic brain injury. The patient's EtCO2 should be maintained between 35-45 mmHg. Classic picture of neurogenic shock presents with... A. Hypertension B. Absence of tachycardia C. Cool skin D. Pallor Absence of tachycardia Loss of sympathetic tone below the level of the injury results in loss of autoregulation, a decrease in vascular tone, and inability of the heart to increase its intrinisic rate. The classic picture of neurogenic shock presents with the absence of tachycardia. You are transporting a patient with a spinal cord injury above T6 level. His baseline vital signs prior to lift off: BP 160/80, HR 62, RR 20. During transport, the patient begins to complain of a throbbing headache with nasal stuffiness. Your assessment reveals that the patient is becoming increasingly agitated. His skin color is flushed and profusely diaphoretic. Repeat vital signs are a BP 206/100, HR 52, RR 26. Your initial management of the patient would be... A. Insert a foley catheter B. Administer nitroglycerin to help reduce blood pressure C. Hang a Nipride drip if diastolic is greater than 130 mmHg D. Do nothing because increased HTN is expected with altitude and spinal cord injuries. Insert a foley catheter Autonomic dysreflexia (AD), also known as "autonomic hyperreflexia or hyperreflexia," is a potentially life-threatening condition, which can be considered a medical emergency requiring immediate attention. AD occurs most often in spinal cord-injured individuals with spinal lesions above the T6 spinal cord level. Acute AD is a reaction of the autonomic (involuntary) nervous system to overstimulation. Your patient presents with motor loss, numbness to touch, vibration on the same side of the spinal injury, loss of pain, and temperature sensation on the opposite side. You suspect that the most likely spinal cord syndrome present is: skull base, after neurosurgery or otorhinolaryngology, and rarely, spontaneously. Pneumocephalus can occur in scuba diving, but is very rare in this context. Unpressurized aircraft is not recommended for this patient's condition. When performing a pericardiocentesis, the insertion site is... A. Below the subxyphoid process B. Just right of the subxyphoid process C. Just left of the subxyphoid process D. Above the subxyphoid process Just left of the subxyphoid process The initial treatment of a patient with a suspected cardiac tamponade is a rapid intravenous fluid bolus. Pericardial blood will generally NOT CLOT because it has been defibrinated by heart motion. ABG reveals pH 7.41, pCO2 38, HCO3 22, pO2 56 of a 70-kg patient on a ventilator with the following settings: Vt 700, F 14, FIO2 0.5, I:E 1:2, PIP 46, Pplat 40, and PEEP 5. How will you manage this patient? A. Increase FIO2 B. Increase PEEP C. Decrease Vt D. All of the above Increase FIO2 The pCO2 is < 60 mmHg, indicating hypoxemia. Treatment includes increasing the FIO2. Increasing levels of PEEP in critically ill patients may also provide acceptable oxygenation and can reduce the FIO2 to nontoxic levels (FIO2 < 0.5). The level of PEEP must be balanced such that excessive intrathoracic pressure does not occur (preventing barotrauma/decreased venous return). When managing pO2 of <60, you would? A. Increase FIO2 and apply/or increase PEEP B. Increase Vt and apply/or increase PEEP C. Increase FIO2 D. Increase Vt Increase FIO2 and apply/or increase PEEP You are transporting a seventy-five-year-old man with a diagnosis of inferior wall MI. During the flight you note V-Tach. Vital signs are: 70/palp, HR 150, RR 24, SpO2 94% on high flow oxygen with NRM at 15 L/min. He is awake and complains of chest pain and SOB. How will you manage this patient? A. Administer lidocaine and nitroglycerin B. Administer normal saline bolus C. Consider sedation and synchronize cardiovert at 100 joules D. Have the patient cough forcefully Consider sedation and synchronize cardiovert at 100 joules. The patient you are transporting reveals the following ABG: pH 7.51, pCO2 28, HCO3 24, pO2 110. He is a 60-kg male patient with Vt 650, F14, FIO2 0.21, I:E 1:2, PIP 46, Pplat 42, and PEEP 0. What is your ABG interpretation, and how will you correct it? A. Respiratory acidosis; increase respiratory rate (F) B. Respiratory alkalosis; decrease Vt C. Metabolic alkalosis; increase FIO2 D. Respiratory alkalosis; increase PEEP Respiratory alkalosis; decrease Vt The pCO2 is decreased and the pH is increased, indicating a respiratory alkalosis. The HCO3 is normal, indicating there is no compensation. Minute ventilation is... A. RR × weight in kg B. RR × SPO2 C. Vt × weight in kg D. Vt × RR Vt × RR Tidal volume times the respiratory rate equal minute ventilation. Minute ventilation is defined as the total volume of air (gas) moved into and out of the lungs each minute. The formula is known as VE = Vt × f. VE signifies minute ventilation; Vt signifies tidal volume and f signifies respiratory rate. Alveolar minute volume is the amount of gas that reaches the alveoli for gas exchange in one minute. The formula is VAmin = (VT-VD) × Respiratory Rate. High-pressure alarms can be caused by all of the following, EXCEPT: lungs. The test is commonly done to evaluate for the presence of blood clots or abnormal blood flow inside the lungs, such as a pulmonary embolism (PE). Acute respiratory failure is defined as: A. pO2 <60 mmHg and pCO2 >50 B. pO2 <80 mmHg and pCO2 >60 C. pO2 <60 mmHg and pCO2 >30 D. pO2 <90 mmHg and pCO2 >50 pO2 <60 mmHg and pCO2 >50 Acute respiratory failure (ARF) exists when breathing fails in its ability to maintain arterial blood gases within a normal range. By definition, ARF is present when the blood gases demonstrate a pO2 < 60 mmHg (hypoxic respiratory failure) and a pCO2 > 50 mmHg (ventilatory respiratory failure), which is usually accompanied by fall in the pH < 7.3. What personal protective equipment (PPE) should be worn when transporting a patient with bacterial meningitis? A. Mask, gloves, gown, and eye protection B. Gloves only C. Mask and gloves D. Gloves and eye protection Mask, gloves, gown, and eye protection The most common type of decompression sickness typically seen diving emergencies is: A. Musculoskeletal B. Pulmonary C. Arterial gas embolism D. Cutaneous Pulmonary Decompression Sickness (DCS) Musculoskeletal decompression illness (Type I DCS), better known as the "bends," is the most common type of DCS, which may comprise limb or joint pain (shoulder and elbow pain most common), skin rash, pruritus, and joint swelling ("skin bends"). Type II DCS comprises more serious manifestations such as headache, fatigue, visual disturbances, motor/sensory neurologic impairment/deficits, confusion, seizures, coma, and death Situations that involve a LEFT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypocapnia C. Hypothermia D. Increased levels of 2,3-DPG Increased levels of 2,3-DPG The oxyhemoglobin dissociation curve describes the relation between the partial pressure of oxygen and the oxygen saturation. The effectiveness of hemoglobin- oxygen binding can be affected by several factors. Situations that involve a RIGHT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypercapnia C. Hyperthermia D. Increased level of 2,3-DPG Alkalosis Alkalosis causes a left shift. A scaphoid abdomen, unequal breath sounds, dyspnea, and a shift in the PMI are a classic presentation of which of the following in the neonate patient? A. Tension pneumothorax B. Diaphragmatic hernia C. Aspiration pneumonia D. RDS, formerly known as hyaline membrane disease Diaphragmatic hernia Diaphragmatic hernia is caused early in gestation when the pleuroperitoneal cavity fails to close. Abdominal contents migrate into the thoracic cavity, compressing developing lungs and causing pulmonary hyoplasia. Because any distention of the bowel further compromises respiratory function, the transport team should insert a large-bore (10 Fr) orogastric tube and initiate suction. "Cerebral" perfusion pressure which can be calculated by using the following formula: MAP − ICP. Normal range for cerebral perfusion pressure is 70-90 mmHg. Remember that your HEAD is higher than your HEART. Inferior wall MI is caused by an occlusion of which coronary artery? A. LAD B. RCA C. Circumflex D. Inferior vena cava Right coronary artery (RCA) "Lateral Wall" ST elevation in... I, aVL, V5, V6 "Septal Wall" ST elevation in... V1, V2 "Anterior Wall" ST elevation in... V3, V4 "Inferior Wall" ST elevation in... II, III, and aVF Normal CVP/RAP pressures are... A. 15 - 25 mmHg B. 8 - 12 mmHg C. 2 - 6 mmHg D. 8 - 15 mmHg 2 - 6 mmHg Central venous pressure (CVP and Right atrial pressure (RAP) - Reflection of right atrial pressure preload. PCWP (pulmonary capillary wedge pressure) evaluates... A. Right arterial pressures B. Right and left sided heart pressures C. Cardiac output D. Preload to the left side of the heart Preload to the left side of the heart SVR (systemic vascular resistance) measures afterload for the left heart and are Decreased in... A. Hypovolemic shock B. Cardiogenic shock C. Distributive shock D. RVMI Distributive shock If SVR is <800, "think" distributive shock (vasodilatory shock) --- Septic shock, neurogenic shock, or anaphylactic shock If SVR is >1200 "think" hypovolemic shock, cardiogenic shock, or right ventricular myocardial infarction (RVMI) Cardiac output is determined by... A. blood pressure and heart rate B. heart rate and stroke volume C. cardiac index and heart rate D. contractility and preload CO = HR × SV Cardiac output (CO) = 4-8 L/min You are transporting a patient who you note has tea-colored urine in small amount in the foley catheter bag. The nurse reports that his output is only 50 mL in the last twenty-four hours. What treatment would you expect to initiate during the two-hour flight? A. ST elevation in II, III, AVF B. ST depression in II, III, AVF C. ST depression in V1-V4 with abnormally tall R waves D. ST elevation in V1-V4 with abnormally tall R waves ST depression in V1-V4 with abnormally tall R waves Acute respiratory failure is defined as: A. pO2 <60 mmHg and pCO2 >50 B. pO2 <80 mmHg and pCO2 >60 C. pO2 <60 mmHg and pCO2 >30 D. pO2 <90 mmHg and pCO2 >50 pO2 <60 mmHg and pCO2 >50 Acute respiratory failure (ARF) exists when breathing fails in its ability to maintain arterial blood gases within a normal range. ARF is present when the blood gases demonstrate a pO2 < 60 mmHg (hypoxic respiratory failure) and a pCO2 > 50 mmHg (ventilatory respiratory failure), which is usually accompanied by fall in the pH < 7.3. A sign of hyperventilation and hypocalcemia is: A. Kehr's B. Grey Turner's C. Trousseau's D. Brudzinski's Trousseau's To elicit Trousseau's sign, a blood pressure cuff is placed around the patient's arm and inflated to a pressure greater than the systolic blood pressure and held in place for three minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct. You are transporting a forty-year-old man from a rural ICU. The CXR reveals a ground glass appearance. The patient is on a ventilator with settings at: Vt 900 mL, rate of 16, FIO2 0.8 with a PEEP of 5. ABG's reveal: pH 7.34, pO2 76, pCO2 38 and HCO3 of 24. What pulmonary condition do you suspect? A. Pneumothorax B. Pulmonary edema C. ARDS D. Cor pulmonale ARDS ARDS, also known as respiratory distress syndrome (RDS); lungs are typically irregularly inflamed and highly vulnerable to atelectasis as well as barotrauma and volutrauma, which leads to impaired gas change, resulting in a severe oxygenation defect (hypoxemia). ARDS was defined as the ratio of arterial partial oxygen tension (PaO2) as fraction of inspired oxygen (FIO2) below 200 mmHg in the presence of bilateral alveolar infiltrates on the chest x-ray. Also, the pulmonary capillary wedge pressure is normal (less than 18 mmHg) in ARDS but raised in left ventricular failure. You would manage a Pt with ARDS by... A. Increasing the rate B. Increasing PEEP C. Performing a rapid needle decompression D. Administering Lasix Increasing PEEP Positive end-expiratory pressure (PEEP) is used in mechanically ventilated patients with ARDS to improve oxygenation. Hypothermia, low levels of 2,3-DPG, and hypocarbia can cause the oxyhemoglobin dissociation curve shift to go... A. Up B. Down C. Right D. Left Left 90 × 2 = 180; 180 × 2 = 360 360 divided by 3 = 120 120-25 = 95 Calculate the following patient's cerebral perfusion pressure (CPP): BP 150/75, HR 140, RR 28, SpO2 100%, CVP 2, ICP 25. A. 98 B. 125 C. 65 D. 75 75 MAP = [(75 × 2) + 150] divided by 3 = 100. CPP = 100-25 = 75 mmHg MAP = [(DBP × 2) + SBP] divided by 3 CPP = MAP − ICP Henry's law best describes which of the following patient conditions? A. Bends B. Barotrauma C. Shallow water blackout D. Arterial gas embolism (AGE) Bends Henry's law states that at a constant temperature, the amount of a given gas dissolved in a given type and volume of liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid. An everyday example of Henry's law is given by carbonated soft drinks. Poisoning of the cytochrome oxidase enzyme system may cause... A. Histotoxic hypoxia B. Hypemic hypoxia C. Hypoxic hypoxia D. Stagnant hypoxia Histotoxic hypoxia Histotoxic hypoxia interferes with the utilization phase of respiration because of metabolic poisoning or dysfunction. Cyanide, sulfide, azide, and carbon monoxide all bind to cytochrome oxidase, thus competitively inhibiting the protein from functioning, which results in chemical asphyxiation of cells. Methanol [methylated spirits] is converted into formic acid, which also inhibits the same oxidase system. On a long fixed wing flight, an option may be to place water on the ET tube cuff to counteract. Which gas law is it? A. Henry's law B. Graham's law C. Dalton's law D. Boyle's law Boyle's law Boyle's law (expansion or contraction of a gas) describes the inversely proportional relationship between the absolute pressure and volume of a gas, if the temperature is kept constant within a closed system. The air in the ETT cuff, for example, expands with altitude (ascent) and contracts during descent. All of the following are signs of cardiac tamponade, EXCEPT: A. Pulsus paradoxus B. Pulsus alternans C. Kussmual's sign D. Pulseless electrical activity (PEA) Pulsus alternans The patient suspected of having a cardiac tamponade will exhibit signs and symptoms of decreased cardiac output such as, cool, clammy skin, altered mental sratus, tachycardia, pulsus paradoxus (a drop in systolic blood pressure > 15 mmHg during normal inspiration), distant muffled heart tones, jugular venous distention, unless the patient is hypovolemic, hypotension, and electrical alternans. C. Myocardial rupture D. Tension pneumothorax Aortic rupture Aortic rupture with 90% of patients who die at the scene. Chest x-ray findings: widening mediastinum and loss of aortic knob shadow. After administering fluid resuscitation, performing vigorous fundal massage and giving oxytocin, your patient continues with postpartum hemorrhage. Which drug would be indicated to decrease blood loss? A. Apresoline B. Methergine C. Terbutaline D. Magnesium sulfate Methylergonovine (Methergine) 0.2 mg administered intramuscularly or intravenously, is recommended. Methylergonovine should be used cautiously in patients with PIH because of the pressor effects that may result in further elevated blood pressure. Methylergonovine is a blood vessel constrictor and smooth muscle agonist most commonly used to prevent or control excessive bleeding following childbirth and spontaneous or elective abortion. It also causes uterine contractions to aid in expulsion of retained products of conception after a missed abortion and to help deliver the placenta after childbirth. Side effects can include nausea, vomiting, diarrhea, cramping, dizziness, pulmonary hypertension, coronary artery vasoconstriction, and severe systemic hypertension (especially in patients with preeclampsia). Overdue aircraft procedures during flight start after: A. 15 minutes without contact B. 30 minutes without contact C. 45 minutes without contact D. 60 minutes without contact 45 minutes without contact Time between each communication should not exceed 15 minutes while in flight unless a system of continuous automatic position tracking is utilized or 30 minutes on ground transport. Time between communications should not exceed 45 minutes while on the ground. Who has the ultimate authority to initiate or complete a mission? A. The flight paramedic B. The flight nurse C. The PIC D. The communication specialist The PIC (Pilot) Platelets are considered low at: A. <600 B. <450 C. <240 D. <150 <150 In an adult, a normal count is about 150,000-400,000 (150-450) platelets per microliter of blood. If platelet levels fall below 20,000 per microliter, massive bleeding may occur and is considered a lifethreatening risk. How should your flight suit fit to provide space of insulation per CAMTS recommendations? A. ½ in. B. 1 in. C. Skin tight so I look really hot for the firefighters on scene D. ¼ in. 0.25 in. (1/4 in.) The absolute minimum hours required by the Federal Aviation Regulation (FAR) Part 135 with regard to a pilot's "bottle to throttle" rule is... A. 8 B. 12 C. 24 D. 48 8