NREMT PARAMEDIC REVIEW EXAM-496
QUESTIONS AND ANSWERS 2024
Intracellular - answer Fluid inside of a cell
Extracellular - answer Fluid outside of a cell
Interstitial - answer Around a cell
Mydriasis - answer Dilated pupils
Can be caused by a CNS stimulant (like cocaine) or lack of oxygen to the brain
Miosis - answer Constricted pupils
Anisocoria - answer Unequal pupils
Nystagmus - answer Rapid, involuntary eye movement
Subcutaneous Emphysema - answer Air under the skin
Ecchymosis - answer Bruising
Ataxic respirations - answer Also known as Biot's respirations
Anoxia - answer Without oxygen
Apnea - answer Without breathing
Eupnea - answer Normal breathing pattern + rate
Osmosis - answer Fluid movement from a lower concentration to a higher concentration
Diffusion - answer Gas movement from a higher concentration to a lower concentration
Erythrocytes - answer Red blood cells; transports oxygen and carbon dioxide
Leukocytes - answer White blood cells; fight infection
Thrombocytes - answer platelets; blood clotting
Homeostasis - answer The body's ability to maintain stability in spite of changes
MAP/Mean Arterial Pressure - answer Average arterial pressure during a single cardiac cycle
Aphasia - answer Lack of or altered speech
Dysarthria - answer Difficulty speaking, slurred speech
Thrombus - answer Blood clot that forms in a vein
Embolus - answer Intravascular particle that moves and becomes lodged in a vessel
Thromboembolus - answer Small pieces of a blood clot that break off; potentially becoming
an embolus
Photophobia - answer Sensitivity to light
Syncope - answer Brief loss of consciousness due to lack of blood to the brain
Neoplasm - answer Tumor, new growth
Encephalitis - answer Inflammation of the brain
Diplopia - answer Double vision
Exophthalmos - answer Protruding eyeballs
Hemoptysis - answer Coughing up blood or blood-stained sputum
Hemophilia - answer Blood clotting disorder that can lead to uncontrolled bleeding
Leukocytosis - answer Too many WBCs
Leukemia - answer Cancer of blood cells
Lymphoma - answer Cancer of the lymphatic system
Thrombocytosis - answer Too many platelets
Thrombocytopenia - answer Destruction of platelets
Polycythemia - answer Increase in RBCs
Epistaxis - answer Nosebleed
Otitis externa - answer External ear infection
Otitis media - answer Middle ear infection
Ataxia - answer Loss of control of body movements
Menarche - answer Onset of menses; first period
Menopause - answer End of menses
Mittelschmerz - answer Abdominal pain during ovulation
Cor Pulmonale - answer Enlargement of the right side of the heart due to disease
Hepatomegaly - answer Enlarged liver
Splenomegaly - answer Enlarged spleen
Apneustic - answer Characterized by long deep breaths with periods of apnea. Typically
occurring with CNS injury/stroke
Biot's (Ataxic) - answer Irregular periods of breathing or gasping with apnea. Typically
occurring in cases of increased ICP
Cheyne Stokes - answer An increase in rate and depth, then a decrease and so on, with
periods of apnea. Typically seen in neurological conditions
Kussmaul - answer Rapid and deep breathing, usually seems in DKA
If you hear rales and crackles when auscultating a patients lungs; what can you infer? answer Fluid is present in the smaller airways/alveoli
If you hear rhonchi when auscultating a patients lungs; what can you infer? - answer mucus
or fluid is present in the larger airways/bronchi
Audible wheezing is caused by? - answer Bronchoconstriction secondary to edema
What organs (or portion of an organ) are located in the RUQ? - answer Liver, stomach,
gallbladder, kidneys
What organs (or portion of an organ) are located in the LUQ? - answer Liver, stomach, spleen,
pancreas, kidneys
What organs (or portion of an organ) are located in the RLQ? - answer Male/Female
reproductive organs, appendix, kidneys
What organs (or portion of an organ) are located in the LLQ? - answer Male/Female
reproductive organs, kidneys
What organs are located in all 4 abdominal quadrants? - answer Large and small intestines,
kidneys
What should you expect if you have a patient complaining of LUQ pain that radiates to
his/her back? - answer Pancreatitis
Peritonitis - answer Inflammation of the abdominal lining
What is visceral pain and what can it indicate? - answer Pain is usually vague, the site of pain
cannot be pointed to specifically. described as a dull pressure. It can indicate organ injury .
What is somatic pain and what can it indicate? - answer Pain is typically sharp and localized.
It can indicate peritoneal lining irritation.
What is referred pain? - answer Pain that is perceived in other parts of the body.
Cullen's sign - answer Bruising around the umbilicus; indicates abdominal cavity bleeding.
Grey Turner's - answer Bruising on the flanks; indicates bleeding from the kidneys and may
present with hematuria.
Kehr's - answer Referred pain to shoulder; indicates injury to the spleen or blood under the
diaphragm.
Murphy's - answer RUQ pain associated with cholecystitis
What is the difference between a persons systolic and diastolic blood pressure known as? answer Pulse pressure
What do narrowing pulse pressures indicate? - answer Shock
What do widening pulse pressures indicate? - answer Increased ICP
Characteristics of Cushing's Triad include? - answer Increased systolic blood pressure,
decreased respiratory rate and pulse rate.
Normal Blood Glucose Range BGL - answer 80-140 mg/dL
When should you check a patients BGL? - answer In all patient with AMS, seizures, head
trauma and history of diabetes.
Normal Pulse Ox range - answer 95-100%
What does a Pulse Ox measure? - answer It measures the O2 saturation of hemoglobin
Normal ETCO2 range - answer 35-45 mmHg
Carboxyhemoglobin - answer A compound of carbon monoxide and hemoglobin that forms in
RBCs, causing CNS depression, headache, dizziness, confusion, seizures, coma, and cardiac
ischemia, eventually death by ventricular fibrillation
Hemoglobin - answer Molecules that carry O2 on red blood cells
Normal hemoglobin ranges - answer Male 14-17.4 g/dL Female 12-16 g/dL
Methemoglobin - answer Hemoglobin with oxidized iron that cannot bind to oxygen.
What can cause Methemoglobin and what are the effects? - answer Amyl nitrate,
benzocaines, nitrates, nitroglycerin and cyanide. Changes include skin color changes from
grey to cyanotic, CNS changes, delirium and eventually death.
What it comes to cardiac enzyme tests done in hospitals, the enzyme Creatine Kinase (CK) is
found where? - answer In muscle
Where can the enzyme CK-I be found upon blood testing? - answer In the brain and smooth
muscle
Where can the enzyme CK-II be found upon blood testing? - answer In the heart muscle
Where can the enzyme CK-III be found upon blood testing? - answer In skeletal muscle
Elevated CK can indicate what? - answer MI myocardial infarction or skeletal muscle trauma
What is the first enzyme to elevate in myocardial infarction? - answer Creatine Kinase
Where can the enzyme Lactic Dehydrogenase (LD) be found upon blood testing? - answer In
heart and skeletal muscle but can also be found in the liver, kidneys and RBC's
Elevated Lactic Dehydrogenase (LD) indicates what? - answer Acute Myocardial Infarction
(AMI)
The enzyme Myoglobin can be found where upon blood testing? - answer In striated muscle
Elevation of Myoglobin can indicate what? - answer Damage to cardiac or skeletal muscle
The enzyme Troponin can be found where upon blood testing? - answer In cardiac muscle
Elevation of what enzyme is very specific to cardiac injury/ischemia? - answer Troponin
What are positively charged ions called? - answer Cations
What are negatively charged ions called? - answer Anions
What is the chemical abbreviation for calcium? - answer Ca++
What is the chemical abbreviation for chloride? - answer Cl
What is the chemical abbreviation for magnesium? - answer Mg++
What is the chemical abbreviation for potassium? - answer K+
What is the chemical abbreviation for sodium? - answer Na+
What is the most common extracellular anion? - answer Chloride
What is the most common intracellular cation? - answer Potassium
What is the most common extracellular cation? - answer Sodium
What what determines blood pH levels? - answer The amount of hydrogen ions in blood
Normal blood pH range - answer 7.35-7.45
What is a blood pH of less than 7.35 considered? - answer Acidotic
What is a blood pH greater than 7.45 considered? - answer Alkalotic
PCO2 measures what? - answer The partial pressure of CO2 in blood
Normal PCO2 range - answer 35-45
What is a PCO2 reading of less than 35 indicate? - answer Respiratory Alkalosis
Respiratory Alkalosis can be caused by what type of breathing? - answer Kussmaul
respirations, Hyperventilating, Hypocarbia (breathing too fast)
If you suspect respiratory alkalosis, what should your treatment involve? - answer Decreasing
their respiratory rate or your ventilation rate
What is a PCO2 reading greater than 45 indicate? - answer Respiratory Acidosis
Respiratory Acidosis can be caused by what type of breathing? - answer Decreased tidal
volume and respiration rate, Hypercarbia (breathing too slow)
If you suspect respiratory acidosis, what should your treatment involve? - answer Increasing
your ventilation rate, Intubation
What is the fluid of choice in cases of hemorrhaging? - answer Blood
What are colloid solutions? - answer Solutions with large particles and proteins that do not
leak out of blood vessels
What are some examples of Colloid solutions? - answer Albumin, Dextran, Hespan and Blood
Plasma
What are crystalloid solutions? - answer All other solutions NOT used in fluid replacement,
but when giving medications
What are some examples of crystalloid solutions? - answer Normal Saline, D5W, Lactated
Ringers
What is used for fluid replacement in the field? - answer Isotonic fluids
Why are isotonic fluids used for fluid replacement in the field? - answer Fluid stays in the
blood vessels longer
Examples of isotonic fluids - answer Normal Saline and Lactated Ringers
Example of hypertonic fluids - answer 10% Dextrose (D10)
Example of hypotonic fluids - answer 1/2 Normal Saline
Whats another name of RBCs? - answer Erythrocytes
What are hemoglobin? - answer Molecules that contain iron that transport O2
What is Hematocrit? - answer The percentage of RBCs in whole blood
Average hematocrit - answer 45%
Another name of WBCs and what are their functions? - answer Leukocytes // Fight infection
Another name of Platelets and what are their functions? - answer Thrombocytes // Promote
clotting in hemorrhage
What blood type is the universal donor? - answer O Negative
What blood type is the universal recipient? - answer AB Positive
Dose for fluid replacement in adults and children - answer 20 mL/kg
Dose for fluid replacement in newborns - answer 10 mL/kg
What chemical is released when the parasympathetic nervous system is activated? - answer
Acetylcholine
What chemical is released when the sympathetic nervous system is activated? - answer
Norepinephrine
The RAAS system is activated when what physiological change occurs? - answer A fall in blood
pressure
The kidneys release Renin into the bloodstream which converts the plasma protein
Angiotensin to what? - answer Angiotensin I
Enzymes in the lungs convert Angiotensin I to what? - answer Angiotensin II
What are the effects of the RAAS system/Angiotensin II? - answer Vasoconstriction which
increases blood pressure and restricts blood flow to the kidneys decreasing the kidneys
ability to excrete water
When the RAAS system is activated, the adrenal cortex is stimulate to release what
hormone? - answer Aldosterone
Hypovolemic shock - answer Loss of blood/fluid due to trauma, burns, dehydration, vomiting
(non-hemorrhagic)
3 types of Distributive shocks - answer Neurogenic, Anaphylactic, Septic shock
Examples of Obstructive shock - answer Pulmonary embolism, Cardiac tamponade, Tension
Pnuemothorax
Drugs such as LSD and heroin are Schedule I drugs because? - answer They have a much
higher abuse potential with no recognized medical necessity
Drugs such as cocaine, PCP and morphine are Schedule II drugs because? - answer They have
a high potential for abuse but have some accepted medical uses in the US
Narcotics will do what to a persons pupils? - answer Constricted pupils
Stimulants will do what to a persons pupils? - answer Dilated pupils
Examples of Narcotics - answer Opium, heroin, fentanyl, morphine, codeine.
Examples of Stimulants - answer Cocaine, methamphetamines.
Narcotics have what effect on the user? - answer CNS and Respiratory depression
A person who has taken a stimulants will most likely present with what kind of behavior? answer Restlessness and agitation
Physiological effects of stimulant usage - answer Increased B/P, HR and RR
Treatment for Tricyclic antidepressant (TCA) overdoses - answer Sodium Bicarbonate
Treatment for Organophosphate poisoning - answer Atropine in high doses
Basic treatment for Carbon Monoxide poisoning - answer Remove the patient from the scene
immediately, SpO2 and CO2 monitoring
A medication would be classified in Pregnancy Category A if; - answer It presents no risk to
the fetus
A medication would be classified in Pregnancy Category X if; - answer Research has proven it
to cause fetal abnormalities and in using it, the risks far outweigh the benefits
Examples of Catecholamines (Sympathomimetics) - answer Epinephrine, Dopamine,
Norepinephrine
Alpha medications cause - answer Vasoconstriction
Beta 1 medications cause - answer Beta 1 works on the heart causing vasodilation
Beta 2 medications cause - answer Beta 2 works on the lungs causing bronchodilation
A medication with an inotropic effect will do what? - answer Effect the strength of
contraction
A medication with an chronotropic effect will do what? - answer Effect the rate of contraction
A medication with an dromotropic effect will do what? - answer Effect the rate of conduction
5 rights for medicarion administration - answer 1) Right dose 2) Right drug 3) Right patient 4 )
Right route 5) Right time
1mg is equal to how many mcg? - answer 1,000mcg
1mcg is equal to how many mg? - answer 0.001mg
Drugs given enteral are given via what route? - answer Via the GI tract; Orally, Sublingually,
NG tube, Rectally
What conditions can be directly attributed to chronic unresolved stress? - answer Impotence
What is an evidence-based decision making model? - answer Care provided based on medical
research findings
What critical body functions does Cortisol do? - answer Gluconeogenesis, Promotes gastric
ulcer formation in times of chronic stress, Decreases bone function, Enhances urine excretion
Cortisol levels rise during times of; - answer Stress, maintaining normal vitals signs and
helping to control emotions
Evidence-based research focuses on; - answer Improving medical practices
Clinical research focuses on; - answer Improving patient outcomes
What is the function of the Trigeminal cranial nerve? - answer Assist with chewing control
and facial sensation
The fifth cranial nerve is also known as? - answer Trigeminal
What is the function of the oculomotor cranial nerve? - answer Eye movement
The third cranial nerve is also known as? - answer Oculomotor
When transferring a patient with Hep A, what statement is most accurate? - answer Wear
gloves when assisting the patient with a urinal
When a cell experiences changes in osmotic pressure and begins losing water, shrinking in
size, this process is referred to as? - answer Crenation
Example of being a patient advocate - answer Notifying social services at the hospital that an
elderly patient living alone can no longer adequately take care of themselves.
Define patient advocate - answer The healthcare provider "speaks" for the patient and the
patients well being when the patient cannot do so.
What services as the initial barrier to an organism invading the body? - answer The body's
production of mucus works to trap and expel the organism
What is the body's best barrier to prevent the cross-contamination of diseases? - answer
Integumentary system
A widespread proliferation of atypical cells is defined as; - answer Cancer
What is a goiter? - answer Swelling of the thyroid gland due to thyroid abnormality
Types of abuse - answer Emotional, Physical, and Sexual
What is best described as pandemic? - answer H1N1 virus
To meet pandemic criteria, a disease must; - answer Affect many people across a large region
and it must be infectious in nature
What document identifies the structure and guidelines for teaching EMS programs? - answer
National EMS Education Standards
What should you suspect when the alveolar plateau appears reversed in waveform
capnography? - answer Emphysema
The majority of carbon dioxide transported in the blood is carried; - answer As Bicarbonate
In a patient with pneumonia, where would you most likely hear adventitious lung sounds
(crackles, rhonchi) - answer Right middle posterior chest
If you are properly ventilating through port #2 of a dual lumen ETC, where is the tip of the
device? - answer In the trachea
If you are properly ventilating through port #1 of a dual lumen ETC, where is the tip of the
device? - answer Occluding the esophagus and ventilations are exiting the tube through
perforations near the trachea
What role do central chemoreceptors play? - answer To detect carbon dioxide and hydrogen
levels in the bloodstream to aid in the negative feedback control of breathing
tPa (Alteplase) is only effective within how many hours of coronary ischemia? - answer 6
hours
Per NREMT any onset of Hemiparesis is indicative of what? - answer Stroke
What is a Grand Mal seizure? - answer A generalized seizure
What is status epilepticus? - answer A prolonged generalized seizure
What is the most common cause of seizures in children? - answer A fast spike in body
temperature
What is Hydrocephalus? - answer A buildup of fluid in the ventricles of the brain
The purpose of an NG tube is to do what? - answer Relieve gastric distention
Prerenal - answer A decrease in blood flow to the kidneys
Intrarenal - answer Disease or damage within the kidneys
Postrenal - answer Blockage to the urine collecting system
Acute renal failure - answer A sudden loss of kidney function due to trauma, illness or toxin
Chronic renal failure - answer A long, slow process of the kidneys inability to function
End stage renal disease (ESRD) - answer A complete and permanent loss of kidney function
Hyperthyroidism is also called what? - answer Graves Disease
Exophthalmos - answer Protrusion of the eyeballs
Another name for untreated hyper-thyrotoxicosis - answer Thyroid storm
A patient presenting with "Moon Face" most likely has what type of condition? - answer
Hypothyroidism
Function of the Thymus - answer Located between the sternum and the heart, it produces Tlymphocytes to help fight infection
Function of the adrenal glands - answer Located on the superior portion of the kidneys,
produces epinephrine and norepinephrine
An adrenal insufficiency is also known as; - answer Addison's disease
An overproduction of adrenal hormones - answer Cushing's syndrome
Insulin - answer Produced in the beta cells of the Islets of Langerhans, decreasing blood
glucose
Glucagon - answer Produced in alpha cells, increasing blood glucose
NIDDM - answer Non Insulin Dependent Diabetes Mellitus
Treatment for Hypoglycemia in the field - answer Oral Glucose or 50% Dextrose (0.5-1 g/kg)
slow IV, or Glucagon (0.5-1 mg) SQ or IM
Hyperglycemia-Diabetic Ketoacidosis DKA - answer Gradual onset, usually over a number of
days. Skin will appear dry and hot, patient may have a fever and be dehydrated. The patient
may also appear tired/unconscious. Other S&S include abdominal pain, N+V, Kussmaul
respirations
Polyuria - answer Production of abnormally large volumes of dilute urine.
Polydipsia - answer Abnormally great thirst as a symptom of disease
Polyphagia - answer Excessive hunger also known as hyperphagia
Hypoglycemia - answer Sudden onset, usually over a couple of hours. Skin will appear pale
and clammy. The patient may exhibit bizarre behavior or experience seizures. Other S&S
include headache, shaking, dizziness and tachycardia
Most common cause of anaphylaxis - answer Penicillin Injections
Second most common cause of anaphylaxis - answer Hymenoptera (Bee, wasp) stings
Systemic Lupus - answer An autoimmune disease occurs when the immune system attacks
the body because it confuses it for something foreign.
Scleroderma - answer A chronic connective tissue disease generally classified as one of the
autoimmune rheumatic diseases, causing hardening and tightening of the skin and connective
tissues.
Most common STD - answer Chlamydia
2nd most common STD - answer Gonorrhea
Cause of Hantavirus - answer Contact with contaminated rodent waste
Cause of West Nile Virus - answer Mosquito bite
Cause of Lyme Disease - answer Deer tick bite
Cause of Rocky Mountain Spotted Fever - answer Tick bites
Tonic seizure - answer a sudden stiffening and contracting of the muscles
Clonic seizure - answer a rhythmic jerking of one or several muscles
Tonic-Clonic seizure - answer Also known as a Grand Mal seizure, a type of generalized
seizure that is a combination of Tonic and Clonic seizing in a specific pattern
What is necessary when restraining a patient? - answer Use 4-5 people, move fast, tie one
arm above the patients head and the other arm to their side with the ankles places together,
monitor the patients circulation while they are restrained and ONLY remove the restraints if
you need to obtain access or their circulation becomes compromised.
Alcoholism is common among what age group? - answer Geriatrics/elderly
Delirium Tremens are possible side effects of what condition? - answer Alcohol withdrawal
S&S of TCA overdose - answer Blurred vision, altered mental status, seizures, heart blocks,
wide QRS on EKG, torsades de pointes, V-tach
Treatment for TCA overdose - answer Sodium Bicarbonate
S&S of Salicylates-aspirin overdose - answer Hyperventilation, tachycardias, fever, sweating,
ringing in the ears.
Tinnitus - answer Ringing in the ears
Treatment for Aspirin overdose - answer Large amounts of IV fluids, patient may require
dialysis
S&S of Organophosphate poisoning - answer SLUDGE; Salivation, Lacrimation, Urination,
Diarrhea, GI problems, Emesis
Treatment for Organophosphate poisoning - answer Large amounts of Atropine
Otitis Externa - answer External ear infection
Otitis Media - answer Middle ear infection
Proliferative Phase of the menstrual cycle - answer First 2 weeks of the cycle, Estrogen levels
increase
Secretory Phase of the menstrual cycle - answer Time of ovulation
Ischemic Phase of the menstrual cycle - answer Estrogen and Progesterone levels decrease if
fertilization does not occur
The ovaries secrete what two important hormones? - answer Estrogen and progesterone
Role of estrogen - answer Aids in the development of breasts and regulates the menstrual
cycle in females. Maintains healthy libido and maturation of sperm in males.
Role of progesterone - answer Necessary for the implantation of a fertilized egg in the uterus,
also for maintaining pregnancy. In late pregnancy, progesterone levels fall.
Uterine contractions are stimulated by what hormone? - answer Oxytocin
Menarche - answer Onset of Menses, First period
Menopause - answer End of Menses
Mittelschmerz - answer Abdominal pain during ovulation
AB - answer Number of abortions or miscarriages
Bloody show - answer Blood-tinged mucus from the cervix, occuring during cervical dilation
Cephalic Delivery - answer Head first delivery
Lightening - answer Fetus is moving down into the birth canal
Braxton Hicks Contractions - answer Irregular contractions "False Birth"
Gravida - answer Number of times pregnant
Primigravida - answer First pregnancy
Para - answer Number of deliveries (Multiples, like twins count as one delivery)
Primipara - answer First delivery
Postpartum - answer After birth
Prenatal and Antepartum - answer Conception until birth; Before birth
Where does fertilization of the egg take place? - answer Fallopian tubes
Where does the fertilized egg implant? - answer Uterine wall
Embryo - answer Up to 8 weeks
Fetus - answer Up to delivery
Newborn / Neonate - answer From birth to one month
Role of the Placenta - answer Provides nutrients to the fetus and gets rid of waste products
Umbilical Cord - answer Connects the fetus to the placenta, consists of 2 arteries and 1 vein
Normal pregnancy period - answer Nine months; 40 weeks
In pregnancy, a drop in blood pressure is common in what trimester? - answer 3rd Trimester
What questions are important to ask any OB patient? - answer Past medical history. Is she
having any bleeding/spotting? When is her due date? If she is in active labor ask when was
the onset. How far apart are her contractions? Did her water break? If so, what color was the
fluid? Does she feel like pushing?
S&S of abortion/miscarriage - answer Bilateral lower abdominal pain, vaginal bleeding that is
bright red in color and may contain clots/tissue
S&S of ectopic pregnancy - answer Unilateral lower abdominal pain, spotting, shock
Abruptio Placenta - answer Occurs when the placenta tears away from the uterine wall
S&S of abruptio placenta - answer Trauma/MOI, Tearing abdominal pain, Dark red vaginal
bleeding
Placenta Previa - answer Occurs when the placenta implants partially or completely over the
cervical opening
S&S of placenta previa - answer The patient may have no pain at all but will present with
bright red vaginal bleeding
Preterm Labor - answer Labor occuring before 38 weeks gestation
Another word for Toxemia - answer Preeclampsia
Preeclampsia - answer Hypertension during pregnancy; before seizure
Eclampsia - answer Hypertension during pregnancy; after seizure
Treatment of Eclampsia - answer Magnesium Sulfate FIRST if seizing, Valium if seizing
continues
Hyperemesis Gravidarum - answer Excessive vomiting during pregnancy
Rh- Mother + Rh+ Baby - answer The mother produces antibodies that attack the baby's RBC's
1st stage of labor - answer Complete dilation
2nd stage of labor - answer Delivery of the baby; expulsion
3rd stage of labor - answer Delivery of the placenta
Procedure for an amniotic sac intact delivery - answer Pinch the amniotic sac open and
remove it from the babies face
Procedure for Breech (Buttocks first) presentation - answer Using a sterile, gloved hand, reach
into the vagina with your palm towards the baby's face, creating a "V" shape with your
fingers to provide an airway for the baby
Limb (arm/leg protruding) presentation procedure - answer DO NOT try to delivery, rapid
transport, position mom in the knee-chest position with her pelvis elevated
How much blood loss within 24 hours is considered postpartum hemorrhage? - answer 500
mL
You've just delivered a newborn in the back of your ambulance, the newborn's body is pink
but extremities are cyanotic, heart rate is below 100, you hear no sounds coming from the
newborn with little to no limb movement, respirations are slow and irregular. What APGAR
score does this newborn currently have? - answer 3
After birth, an APGAR score should be taken when? - answer At one and five minutes
Order of resuscitation in a newborn - answer Warm, position, dry, clear airway, stimulate to
breath / Supplemental O2 / BVM / Intubate / Chest compressions / Medications
Most common problems in newborns - answer Respiratory distress and hypothermia
If a newborn is bradycardic, what is your first action - answer Look for signs of hypoxia,
provide O2
Average weight of a newborn - answer 7 lbs
Average weight of a 6 month old - answer 14 lbs (weight doubles)
Average weight of a 1 year old - answer 21 lbs (weight triples)
Law of inertia - answer A body in motion (or at rest) will remain in motion (or at rest) unless
acted upon by an outside force
Law of conservation of energy - answer Energy cannot be created or destroyed but can be
changed from one form to another
Kinetic energy - answer Energy an object has while in motion, with speed being the most
important factor.
Formula for Kinetic Energy - answer Mass(weight) x Velocity(speed)^2 / 2
What injuries would you suspect a patient to have in a MVC with frontal impact who went up
and over the dashboard? - answer Injuries to the head, neck and chest
What injuries would you suspect a patient to have in a MVC with frontal impact who went
down and under the dashboard? - answer Injuries to the knees, femur, hip and pelvis
What injuries are most common in rear-end collisions? - answer Neck and back injuries
Calcaneus - answer Heel bone
Example of a weapon used in low velocity penetrating injuries - answer Knife
Example of a weapon used in medium velocity penetrating injuries - answer Handgun,
Shotgun
Example of a weapon used in high velocity penetrating injuries - answer Military weapon
Primary phase in blast injuries - answer Pressure waves, hollow and air-filled organs are
affected
Secondary phase of blast injuries - answer Struck by shrapnel
Tertiary phase in blast injuries - answer Injuries due to patient being thrown into the air
Quaternary Injuries - answer All other injuries resulting from a blast; crush, asphyxia, burns,
toxic exposure
Compensatory Hypovolemic Shock - answer Perfusion is able to be maintained, Blood
pressure will be normal for patient, delayed cap refill. Patient may appear anxious, restless,
combative, weak, have dilated pupils, etc
Decompensated (uncompensated) shock - answer Decrease in blood pressure is a late sign.
Decreased level of consciousness or may be unconscious, unable to feel pulses
Irreversible shock - answer Damage to vital organs. Bradycardia is a terminal sign
Layers of the skin - answer Epidermis (outermost layer), Dermis (connective tissue, blood
vessels, nerves), Subcutaneous (adipose tissue)
Superficial partial thickness burns - answer Red, painful, but with no blisters
Deep partial thickness burns - answer Red, painful and with blisters
Full thickness - answer Black, yellow or white. No pain and no blisters
Ohm's Law - answer Role of voltage and resistance
Joule's Law - answer Relationship between heat production, current and resistance
Abduction - answer To move away from
Adduction - answer To move towards the body
Dislocation - answer Bones end is displaced from joint
Flexion - answer Angle of a joint decreases
Extension - answer Angle of a joint increases
Ligament - answer Connects bone to bone
Medial - answer Position closer to the midline of the body
Lateral - answer Position further away from the midline of the body
Sprain - answer Injury to a ligament
Strain - answer Injury to a muscle
Subluxation - answer Partial displacement of a bone at a joint
Tendon - answer Connects bone to muscle
6 P's in fractures and dislocations - answer Pain, pallor, paresthesia, paralysis, pressure, pulse
Paresthesia - answer Numbness
Principles of Splinting - answer Assess PMS before and after applying the splint, immobilize
the joint above and below, cover any wounds before splinting, pad splint.
Function of the Cerebrum - answer Personality, Intelligence, Eyesight in occipital area
Function of the Cerebellum - answer Fine motor movement, balance, coordination
Function of the Brain Stem (Medulla Oblongata) - answer All vital functions; blood pressure,
heart rate, breathing, consciousness
The Meninges cover the brain and spinal cord and are made up of what layers? - answer Dura
mater (outermost layer) Arachnoid, Pia mater
Afferent Nerves - answer Ascending, sensory nerves bring messages from the body to the
brain
Efferent Nerves - answer Descending, motor nerves take messages from the brain to the body
Difference between aqueous and vitreous humor - answer Aqueous humor can be
replenished
Hyphema - answer blood in the anterior chamber of the eye usually from a direct blow to the
eye
Battle Signs and Raccoon eyes are a sign of what? - answer Basilar skull fracture
How do you calculate Cerebral perfusion pressure? - answer CPP = MAP - ICP
Epidural Hematoma - answer Bleeding between the Dura mater and the skull
Subdural Hematoma - answer Bleeding between the Dura mater and the arachnoid
Coup/contracoup - answer Injury to tissues under the site of impact as well as injury to the
opposite side of impact
Normal ICP - answer 2-12 mmHg
In increased ICP, Cushing's response presents with - answer Increased blood pressure,
decreased pulse rate and irregular respirations
Early signs of increased ICP - answer Vomiting without nausea, headache, altered mental
status
Treatment for increased ICP - answer Spinal precautions, assist ventilations to maintain PO2
of 90 mmHg
Flail Chest - answer Multiple ribs fractured in several places, Paradoxical respirations
Treatment for a Flail Chest - answer Positive pressure ventilations
Treatment for hypovolemic shock - answer C-spine, O2, airway control, bleeding control, keep
them warm, Isotonic crystalloids- 20 mL/kg, may repeat twice more for a total of 60 mL/kg,
rapid transport
Difference between a Tension Pneumothorax and a Hemothorax - answer A tension pneumo
will present with JVD and a hemothorax will present with flat neck veins
Position of Pleural Decompression - answer 2nd intercostal space midclavicular above the 3rd
rib, 5th intercostal space midaxillary above the 6th rib
Beck's Triad in Cardiac Tamponade - answer Muffled heart sounds, JVD, Decreased blood
pressure
Commotio Cordis - answer Direct blow to the chest causing a disruption in heart rhythm, CPR
and Defibrillation
Solid organs - answer Kidneys, liver and spleen
Hollow organs - answer Stomach, bowels and bladder
Grey-Turner's Sign - answer Bruising/hematoma in the flanks
Most common cause of trauma in the elderly - answer Falls
Role of the Hypothalamus - answer Controls body temperature
Treatment for Hypothermia - answer Remove from the cold, rewarm slowly, remove any wet
clothing, O2, cover in blankets, hot packs in groin and armpits
Treatment for Frostbite - answer Remove any wet clothing, thaw in warm water that is less
than 106 degrees, do not massage frozen parts
Structures of the upper airway - answer Nasopharynx, oropharynx, laryngopharynx (epiglottis
and vallecula), larynx (vocal cords)
Structures of the lower airway - answer Trachea, bronchi, alveoli, etc
Smallest area of the adult airway - answer Glottic opening at the vocal cords
Alveoli - answer Where oxygen and carbon dioxide are exchanged
Anoxia - answer Without oxygen
Apnea - answer Without breathing
Atelectasis - answer Lack of surfactant causing alveoli to collapse
Carina - answer Distal end of the trachea where bronchi split into the left and right main
stem. Angle of Louis is located at this level
Dyspnea - answer Difficulty breathing
Eupnea - answer Normal breathing
Hemoptysis - answer Coughing up blood
Hering-Breuer - answer Reflex that prevents overexpansion of the lungs
Hypercarbia - answer Increased CO2 in the blood
Hypoxemia - answer Decreased oxygen in the blood
Hypoxia - answer Decreased oxygen to the tissues
Minute Volume - answer Amount of air inhaled or exhaled in one minute
Formula for Minute Volume - answer MV = TV(tidal volume) x RR
Orthopnea - answer Difficulty breathing while lying supine
The Phrenic nerve innervates what? - answer The diaphragm
Surfactant - answer Chemical in alveoli that keeps them from collapsing
Tidal Volume - answer Amount of air taken in, in one breath
What is the body's main stimulus to breathe? - answer An increase in CO2 detected by the
brainstem (medulla)
Purpose of your airway assessment - answer Identify an inadequate, unstable or potentially
difficult airway.
Yankauers/Rigid suction - answer Insert only as far as you can see
French/Soft - answer Measure from the tip of the nose to the ear lobe or from the corner of
the mouth to the ear lobe
Suctioning time - answer Less than 10 seconds in adults, then ventilate for 2 minutes. Less
than 5 seconds in infants and children, while only suctioning on the way out.
Per NREMT, a gurgling sound indicates; - answer The need to suction; always look for "suction
when necessary"
Steps for verifying tube placement - answer Visualize the tube passing between the vocal
cords, misting present in the tube, positive lung sounds, absent epigastric sounds,
capnography
Shark-fin Capnography indicates; - answer Asthma, COPD
Anatomical structures in order in reference to Cricothyrotomy - answer Thyroid cartilage,
Cricothyroid membrane, Cricoid cartilage
Induction agents in RSI - answer Etomidate, Midazolam, Ketamine, Propofol
Paralytics in RSI - answer Succinylcholine, Rocuronium, Vecuronium
Ventilations ratio for adults - answer 12-20 BPM
Ventilation ratio for children - answer 15-30 BPM
Ventilation ratio for infants - answer 25-30 BPM
Artificial ventilation device - answer BVM
Purpose of PEEP; Positive end-expiratory pressure - answer Increases the amount of air that
remains in the lungs with each ventilation following expiration, keeping the alveoli open
When should you use an oxygen delivery device? - answer Signs of shock, SpO2 less than 94%
Anatomical airway differences between pediatrics and adults - answer Smaller nose and
mouth become easily obstructed, Larger tongue takes up more space in the airway, Narrow
trachea that should not be hyperextended at risk of closing off the airway
Pediatrics are "Belly Breathers", what does that mean? - answer They use their diaphragms to
breath, less chest rise.
Smallest structure of the pediatric airway - answer Cricoid ring
Up to what age should an uncuffed ET tube be used? - answer 8 years of age
What is the most common cause of cardiac arrest in infants and children? - answer Hypoxia
If a patient is referred to as a "Pink Puffer" what chronic disease do they most likely have? answer COPD/Emphysema
Forms of COPD - answer Emphysema, Chronic Bronchitis
S&S of Emphysema - answer Pursed lips/Puffing, Barrel chest, JVD
S&S of Chronic Bronchitis - answer Cyanosis, green mucus, cough, rhonchi, JVD
If a patient is referred to as a "Blue Bloater" what chronic disease do they most likely have? answer Chronic Bronchitis
Last resort medications in cases of Status Asthmaticus - answer Epinephrine and Magnesium
Sulfate
Pneumonia - answer Infection in the lungs; bacterial viral, and fungal
S&S of Pneumonia - answer SOB, high fever, tachypnea, dyspnea, productive cough with
yellow/green mucus, crackles or rhonchi
Pneumonia is most common in what age groups? - answer The elderly and children
S&S of Pulmonary Embolism - answer Sudden onset, chest pain, JVD, cyanosis from the nipple
line and up, shock and respiratory distress
Hyperventilation - answer Respiratory Alkalosis
You would most likely hear stridor in; - answer Partial upper airway obstruction
Laryngotracheobronchitis-Croup (Upper Airway) - answer Viral, seal bark cough, no fever,
slow onset, KEEP CALM
Epiglottitis (Upper Airway) - answer Bacterial, drooling, high fever, rapid onset, transport in a
position of comfort, do not put anything in mouth
Pertussis-Whooping Cough (Lower Airway) - answer Highly contagious, whooping sound
when coughing
Cystic Fibrosis - answer Genetic, thick mucus production, life threatening
If a patient with cystic fibrosis is on a ventilator that is not adequately breathing for the
patient, what should you do? - answer Increase the volume on the ventilator
Valves on the right side of the heart - answer Tricuspid and Pulmonary Valve
Valves on the left side of the heart - answer Bicuspid and Aortic Valve
Layers of the heart - answer Endocardium, myocardium, epicardium/pericardium
Intrinsic firing rate of the SA node - answer 60-100 BPM
Intrinsic firing rate of the AV node - answer 40-60 BPM
Intrinsic firing rate of the Purkinje Fibers - answer 20-40 BPM
Stroke Volume - answer Amount of blood pumped with each contraction
Cardiac Output - answer Amount of blood pumped in one minute. CO = SV x HR
Preload - answer Blood (pressure) coming back to the right side of the heart
Afterload - answer Pressure the left ventricle had to pump against
Frank-Starling Law - answer The further the heart muscle is stretched, the harder it will
contract
More than 1 mm of elevation in the inferior leads - answer Check V4R
Changes on the EKG in cases of Hyperkalemia - answer Tall, peaked T-waves
5 H's - answer Hypovolemia, hypothermia, hypoxia, hydrogen ion acidosis,
hyper/hypokalemia
5 T's - answer Pulmonary/Cardiac Thrombus, tension pneumothorax, cardiac tamponade,
toxins/overdose
Pediatric Joule settings for Defibrillation - answer 1st; 2 joules/kg. 2nd; 4 joules/kg
What makes a patient considered unstable? - answer CASH; Chest pain, Altered mental
status, SOB, Hypoperfusion (shock)
Cor Pulmonale - answer Abnormal enlargement of the right side of the heart
Sudden Infant Death Syndrome usually occurs during what age? - answer 4-6 months
When was the EMS White Paper published? - answer 1966 by the National Academy of
Sciences
What is a paramedics primary role in public health? - answer Preventing diseases, education
and vaccination
Offline medical control - answer protocols, standing orders
Online medical controls - answer calling for orders by phone or radio
Stages of Stress - answer Alarm, resistance, exhaustion
Death and Dying stages in order - answer Denial, anger, bargaining, depression, acceptance
Critical Incident Stress Management - answer A system used to deal with stress on the job by
educating and providing resources
What is the most effective way to control disease transmission? - answer Proper hand
washing
Standard Precautions - answer Assumes all body fluids are contaminated
Ryan White Act - answer Requires notification of EMS personnel if they are exposed to a
patient with a communicable/infectious disease
NHTSA and DOT require a minimum data set on PCR including; - answer Chief complaint,
Initial assessment with vitals, age, sex, race, times, unit number
Facilitation - answer Encourages the patient to give you informations. "Go on, I'm listening"
Reflection - answer Repeating what the patient says
Scope of Practice - answer State law defining the role of prehospital providers
Standard of Care - answer Following laws, rules, protocol, national curriculum
Plaintiff must have these 4 things to prove negligence - answer 1) paramedic had a duty to act
2)there was a failure to act/breach of duty 3) injury occured 4) injury was directly caused by
the provider
Res ipsa loquitur - answer The act speaks for itself
Sources of Errors - answer Skills based, Rules based, Knowledge based
Libel - answer False writing injuring one's reputation
Slander - answer False verbal statements injuring one's reputation
Landing zone size at night - answer 100 feet by 100 feet
When approaching air medical transport, you should; - answer Approach from the front after
being cleared by the pilot or crew.
In a Hazmat situation, the hot zone is; - answer A contaminated area
In a Hazmat situation, the warm zone is; - answer The decontamination area
In a Hazmat situation, the cold zone is; - answer The safe zone, prehospital workers work in
this area.
Multi Casualty Incident - answer any incident that put excessive demands on EMS workers
Sections of NIMS - answer Command, Finance/Admin, Logistics, Operations, Planning
Staging sector - answer where emergency vehicles wait to be assigned
In simple triage, a patient would be considered "Red" if; - answer Their airway is not open
requiring an NPA/OPA, respirations over 30, No radial pulses or delayed cap refill, cannot
follow simple commands
In an MCI, you are assigned to triage and come across a 34 year old female with a visible
fracture to her left femur, what would you categorize her as? - answer Priority 2 Yellow
In an MCI, a patient actively in cardiac arrest receives what color tag? - answer Black, cardiac
arrests are not treated in MCI
Using JUMP START Triage, a pediatric is considered "Red" if; - answer Their airway is not open
requiring an NPA/OPA, respirations less than 15 or over 45 (if not breathing, give 5 rescue
breaths, if breathing resumes; red tag. If breathing does not resume; black tag. No peripheral
pulses.