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West Coast EMT BLOCK EXAM #2, Exams of Medicine

University of Massachusetts - BostonMedicine

West Coast EMT BLOCK EXAM #2 West Coast EMT BLOCK EXAM #2

Typology: Exams

2023/2024

Available from 02/17/2024

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West Coast EMT BLOCK EXAM #2
What is the electrical conduction system of the heart? -
- A network of specialized tissue that is capable of conducting electrical current runs throughout the
heart.
- The flow of electrical current causes smooth, coordinated heart contractions.
- The contractions produce the pumping action of the heart.
- Each mechanical contraction is associated with two electrical processes: 1. Depolarization: electrical
charges on the surface of the muscle cell change from positive to negative 2. Repolarization: the heart
returns to its resting state, and the positive charge is restored to the surface
- Electrical impulses begin high in the atria at the sinoatrial node, travel to the atrioventricular node and
bundle of His, and then move through the Purkinje fibers to the ventricles.
What are the layers of the blood vessels? -
Adventitia (outer layer), tunica media (middle layer), tunica (intima) inner layer
What is the function of the adventitia (outlet layer)? -
- provides structural support and shape to the vessel
What is the function of the tunica media (middle layer)? -
- composed of elastic and muscular tissue which regulates the internal diameter of the vessel
What is the function of the tunica intima (inner layer)? -
- consists of an endothelial lining which provides a frictionless pathway for the movement of blood
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West Coast EMT BLOCK EXAM

What is the electrical conduction system of the heart? -

  • A network of specialized tissue that is capable of conducting electrical current runs throughout the heart.
  • The flow of electrical current causes smooth, coordinated heart contractions.
  • The contractions produce the pumping action of the heart.
  • Each mechanical contraction is associated with two electrical processes: 1. Depolarization: electrical charges on the surface of the muscle cell change from positive to negative 2. Repolarization: the heart returns to its resting state, and the positive charge is restored to the surface
  • Electrical impulses begin high in the atria at the sinoatrial node, travel to the atrioventricular node and bundle of His, and then move through the Purkinje fibers to the ventricles. What are the layers of the blood vessels? - Adventitia (outer layer), tunica media (middle layer), tunica (intima) inner layer What is the function of the adventitia (outlet layer)? -
  • provides structural support and shape to the vessel What is the function of the tunica media (middle layer)? -
  • composed of elastic and muscular tissue which regulates the internal diameter of the vessel What is the function of the tunica intima (inner layer)? -
  • consists of an endothelial lining which provides a frictionless pathway for the movement of blood

Name all 6 pulses -

  • Carotid artery pulse
  • Femoral artery pulse
  • Radial artery pulse
  • Brachial artery pulse
  • Posterior tibial artery pulse
  • Dorsalis pedis pulse Where is the Carotid artery pulse located? -
  • At the upper portion of the neck Where is the femoral artery pulse located? -
  • In the groin Where is the Radial pulse located? -
  • At the wrist at the base of the thumb Where is the Brachial artery pulse located? -
  • Medial aspect of the arm, midway between elbow and shoulder Where is the Posterior tibia artery pulse located? -
  • Posterior to the medial malleolus Where is the Dorsalis pedis artery pulse located? -
  • On the top of the foot What is Inhalation? -
  • Active, muscular part of breathing that draws air into the airway and lungs
  • Also a medication delivery route
  • Consists of the nose, mouth, jaw, oral cavity, pharynx, and larynx.
  • Major functions are to warm, filter, and humidify air as it enters the body through the nose and mouth. What is the anatomy of the lower airway and its main function? -
  • Main function of the lower airway is to deliver oxygen to the alveoli.
  • External boundaries consists of the fourth cervical vertebra and the xiphoid process.
  • The trachea/windpipe is responsible for air entry into the lungs
  • Bronchi and heart
  • vena cava and aorta What is the Sternal notch (Jugular notch)? -
  • visible dip in between the neck, between the clavicles
  • trachea lies behind it
  • effortlessly palpated and can be generally seen as an impression on the surface. What is the Xiphoid process? -
  • The narrow, cartilaginous lower tip of the sternum. What is the spinal column and how many bones does it consists of? -
  • central supporting structure of the body
  • composed of 33 bones
  • divided into 5 sections What is the cervical spine? -
  • first seven vertebrae in the neck (C1 - C7)
  • skull rests and attaches to both the first cervical vertebrae (the atlas) and the second vertebrae (the axis) What is the thoracic spine? -
  • 12 vertebrae that lie between the cervical vertebrae and the lumbar vertebrae
  • one pair of ribs is attached to each of the thoracic vertebrae What is the lumbar spine? -
  • lower part of the back
  • formed by the lowest 5 non-fused vertebrae
  • also called the dorsal spine What is the Sacrum? -
  • One of the three bones that make up the pelvic ring (sacrum and two pelvic bones)
  • Consists of five fused sacral vertebrae What is the Coccyx? -
  • tailbone
  • last three or four vertebrae of the spine What are the three types of muscle in the human body? - Skeletal, Smooth, Cardiac What is Skeletal muscle? -
  • Muscle that is attached to bones and usually crosses at least one joint
  • striated or voluntary muscle What is Smooth muscle? -
  • Involuntary muscle
  • constitutes the bulk of the GI tract
  • present in nearly every organ to regulate automatic activity What is Cardiac muscle? -

What are the parietal bones? -

  • The bones that lie between the temporal and occipital regions of the cranium What are the temporal bones? -
  • lateral bones on each side of the cranium
  • the temples What are the occipital bones? - What is the frontal bone? -
  • portion of the cranium that forms the forehead What are the zygomatic bones? -
  • cheek bones What is the mandible? -
  • lower jaw bone What are the nasal bones? -
  • form the bridge of the nose What is the maxillae? -
  • upper jaw bones that assist in the formation of the orbit, nasal cavity, palate
  • hold the upper teeth What is the maxilla? -
  • upper jaw bone

What is the foramen magnum? -

  • large opening at the base of the skull through which the brain connects to the spinal cord How does blood flow through the heart? - Inferior and superior vena cava (1) dump blood into the right atrium (2) Right ventricle (3) 2 pulmonary arteries (4) that lead to the lungs (5) where blood becomes oxygenated Pulmonary veins (6) bring blood from the lungs back to the left atrium (7) Left ventricle (8) is large and muscular to pump blood into the aorta (9) and to the rest of the body (10) Eventually blood will be pumped back to each vena cava (1) What are the major coronary arteries? -
  • right coronary artery and left coronary artery What does the right coronary artery supply? -
  • blood to the right ventricle, the right atrium
  • SA (sinoatrial) and AV (atrioventricular) nodes, which regulate the heart rhythm. What does the left coronary artery supply? -
  • blood to the left atrium and left ventricle What are signs of normal breathing? -
  1. A normal rate ( between 12-20 breaths/min)
  2. A regular pattern inhalation and exhaustion
  3. Clear and equal lung sounds on both sides of the chest (bilateral)
  4. Regular equal chest rise and fall ( chest expansion)
  5. Adequate depth ( tidal volume ) What are signs of abnormal breathing? -

What does the Right Lower Quadrant (RLQ) contain? -

  • contains two portions of the large intestine
  • cecum
  • appendix What does the Left Lower Quadrant (LLQ) contain? -
  • descending and the sigmoid portions of the colon What is the functions of the liver? -
  • Production of bile
  • assists with carbohydrate, protein, and fat metabolism of nutrients within the bloodstream
  • manufactures proteins for immune regulation and clotting
  • detoxification of blood
  • elimination of waste What is the functions of the pancreas? -
  • Exocrine
  • enzymes for protein
  • carbohydrate and fat breakdown within the duodenum
  • Endocrine: insulin ad glucagon What is the functions of the bile ducts? -
  • a series of thin tubes that go from the liver to the small intestine.
  • main job is to allow a fluid called bile to go from the liver and gallbladder into the small intestine, where it helps digest the fats in food. What is the functions of the appendix? -
  • acts as a storehouse for good bacteria, "rebooting" the digestive system after diarrheal illnesses

What is the function of the urinary system? -

  • control fluid balance in the body
  • filter and eliminates wastes
  • control pH balance What is the function of the gallbladder? -
  • storage of bile What are some factors that Impair Ventilation? -
  • blocked airway (foreign body, choking, swelling, trauma, blood, or vomit)
  • asthma attack
  • drug overdose
  • trauma to chest wall
  • allergic reactions What is the Ventilation/Perfusion mismatch (VQ ratio)? -
  • Respiratory compromise
  • V/Q ratio describes how much gas is being moved effectively (ventilation) through the lungs and how much blood is flowing around the alveoli where gas exchange (perfusion) occurs.
  • A mismatch occurs when one of these two variables is abnormal. What is respiratory compromise and what are the negative effects? -
  • Inability of body to move gas effectively.
  • Can result in decreased O2 (hypoxia)
  • increased CO2 (hypercarbia)
  • increased respiratory rate
  • blood O2 levels will fall What is Hypovolemic shock? -

What is Septic shock? -

  • shock resulting from severe infection
  • blood vessels dilate and decreased blood pressure results
  • leads to dysfunction in multiple organ systems and death example caused:
  • severe infection What is Neurogenic shock? -
  • shock resulting from injury to the nervous system example causes:
  • high spinal cord injury What is Anaerobic metabolism? -
  • Metabolism that takes place in the absence of oxygen
  • main by-product is lactic acid What is aerobic metabolism? -
  • Metabolism that can proceed only in the presence of oxygen What are functions of the chemo receptors in the medulla? -
  • monitor O2 and CO2 levels
  • monitor pH of the cerebrospinal fluid
  • provide feedback to the respiratory centers to modify rate and depth of breathing based on body's needs What is tripod position and what does it indicate? -
  • upright position in which the patient leans forward with arms outstretched and head/chin thrust slightly forward
  • usually indicates abnormal breathing What is Surfactant? -
  • chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing What are the steps for the insertion of a OPA? -
  • Select proper size by measuring patient's earlobe or angle of jaw to the corner of their mouth
  • Open patient's mouth with cross finger technique
  • Hold airway upside down with your other hand, insert airway with the tip facing the roof of the mouth
  • Rotate airway 180 degrees
  • When inserted properly the airway will rest in the mouth with the curvature of the airway following the contour of the anatomy What are the steps for the insertion of a NPA? -
  • Select proper size by measuring tip of the patient's nose to the earlobe
  • Airway should be placed in the larger nostril with the curvature following the curve of the floor of the nose (goes in curved up)
  • Continue to maneuver until the flange rest against the nostril, if you feel any resistance or obstruction, remove the airway and insert it into the other nostril. What is intrapulmonary shunting? -
  • bypassing of oxygen-poor blood past nonfunctional alveoli to the left side of the heart.
  • occurs when nonfunctional alveoli inhibit the diffusion of oxygen and carbon dioxide resulting the blood entering the lungs from the right side of the heart to bypass the alveoli and return to the left side of the heart in an unoxygenated state How can inhaling toxic chemicals cause pulmonary edema? -
  • buildup of fluid in the lungs

What is Dyspnea? -

  • Shortness of breath
  • difficulty breathing What is Hypoxic Drive? -
  • condition in which chronically low levels of oxygen in the blood stimulate the respiratory drive
  • seen in patients with chronic lung diseases. What is external respiration? -
  • exchange of gases between the lungs and the blood cells in the pulmonary capillaries; also called pulmonary respiration. What is Acute Coronary Syndrome? -
  • group of symptoms caused by myocardial ischemia; includes angina and myocardial infarction. what is Ischemic heart disease? -
  • disease involving a decrease in blood flow to one or more portions of the heart muscle. What is the EMT treatment for rales with respiratory distress? -
  • treat immediately with high flow oxygen.
  • Assist breathing with a bag-valve-mask (BVM) if the respiratory effort is insufficient as indicated by a slow rate and poor air exchange. What is Passive ventilation? -
  • act of air moving in and out of the lungs during chest compressions. Describe the Mouth-to-mask technique with a one-way valve -
  • properly position patients head, seal mask over face using both hands (EC-clamp method)
  • Breathe into the valve until you notice chest rise
  • remove mouth and watch chest fall during exhalation What is primary assessment? -
    • step within the patient assessment process that identifies and initiates treatment of immediate and potential life threats. What is secondary assessment? -
    • step within the patient assessment process in which a systematic physical examination of the patient is performed.
  • The examination may be a systematic exam or an assessment that focuses on a certain area or region of the body
  • often determined through the chief complaint. What is End tidal Carbon dioxide (ETCO2/capnography)? -
    • ensure a level of level between 30 and 35 mm Hg
  • a noninvasive technique which represents the partial pressure or maximal concentration of CO2 at the end of exhalation.
  • Normal value is 35-45 mmHg. What is tuberculosis? -
    • chronic bacterial disease, caused by Mycobacterium tuberculosis,
  • usually affects the lungs but can also affect other organs such as the brain and kidneys;
  • spread by cough and can lie dormant in a person's lungs for decades and then reactivate. What are the steps to treat active bleeding? -
    • Remove any clothing or debris on the wound
  • Stop the bleeding. ...
  • Help the injured person lie down
  • Don't remove the gauze or bandage
  • Tourniquets: A tourniquet is effective in controlling life-threatening bleeding from a limb
  • Used for asthma, bronchitis, COPD
  • acute
  • NOT chronic What are the Steps of CPR adult and pediatric patients? -
    • Adult and Pediatric: no longer than a 10 second assessment (assess pulse and breath)
  • NO PULSE / NO BREATH = CPR (30:2 for adult , 1 person CPR FOR pediatric 30:2 , 2 person CPR for pediatric is 15:2)
  • 100 - 120 compressions a minute, 2 inch deep compressions
  • Apply AED as soon as you receive it and listen to commands given
  • No breath but active pulse = rescue breaths, 6 rescue breaths every 2 - 3 seconds
  • unresponsive due to choking = modified CPR , 30;2 but check airway for obstruction before delivering breaths. What is visceral peritoneum? -
    • covers most of the abdominal organs What is parietal peritoneum? -
    • a serous membrane that lines the wall of the abdominal cavity
  1. What is an abdominal aortic aneurysm (AAA)? 2) What are the S/S? -
    1. rapidly fatal condition in which the walls of the aorta in the abdomen weaken and blood leaks into the layers of the vessel, causing it to bulge.
  2. sudden severe chest pain, loss of consciousness, shortness of breath, leg pain, difficulty walking, abdomen pain What are Kussmaul respirations? What do they indicate? -
    • Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body.
  • Indicates that the body or organs have become too acidic.

What is the proper EPI administration with auto injector? -

  • Remove blue safety cap
  • Place the orange tip against the middle of the outer thigh (upper leg) at a right angle (perpendicular) to the thigh.
  • Swing and push the auto-injector firmly until it "clicks." - The click signals that the injection has started. Hold firmly in place for 3 seconds (count slowly 1, 2, 3). S/S of a sympathomimetic drug overdose? - Sympathomimetic drugs: Drugs that produce an effect similar to that obtained by stimulation of the sympathetic nervous system. S/S: Hypertension, tachycardia, dilated pupils, agitation or seizures, hyperthermia examples: epinephrine, albuterol, cocaine, methamphetamine. What are the Side effects of an atropine administration? -
  • visual sensitivity to light.
  • blurred vision.
  • dry eye.
  • dry mouth.
  • constipation.
  • decreased sweating.
  • reactions at the site of the injection.
  • intense abdominal pain. How are airborne substances diluted? - Oxygen What is a Silent heart attack? -
  • a.k.a. silent Ischemia
  • No evidence of pain, only a feeling of gastric discomfort