, Question 1
A patient with severe asthma presents with diffuse expiratory wheezing,
accessory muscle use, and an SpO2 of 88% on room air. After two continuous
albuterol nebulizers and ipratropium, the wheezing becomes barely audible and
the patient's mental status declines. Which pathophysiologic process best
explains this change, and what is the most appropriate immediate intervention?
A. Improved airflow from bronchodilation; continue nebulized albuterol
and reassess in 10 minutes.
B. Progression to silent chest from severe bronchospasm and mucus
plugging; assist ventilations with a BVM and prepare for advanced
airway management.
C. Development of pulmonary edema from beta-agonist toxicity;
administer nitroglycerin and furosemide.
D. Anaphylaxis-induced laryngeal edema; administer intramuscular
epinephrine and observe.
Correct Answer: B - Progression to silent chest from severe
bronchospasm and mucus plugging; assist ventilations with a
BVM and prepare for advanced airway management.
RATIONALE
Loss of wheezing in a deteriorating asthmatic signals a 'silent chest'
due to extreme airflow limitation, not improvement. Immediate
assisted ventilation with a BVM and preparation for advanced airway
management is indicated. Beta-agonist toxicity does not cause
pulmonary edema, and anaphylaxis would present with other systemic
signs.
Page 2
, Question 2
A patient with a history of heart failure and an implanted
cardioverter-defibrillator (ICD) experiences multiple ICD shocks while
conscious. Which of the following is the most appropriate initial EMS
management?
A. Place a magnet over the ICD to deactivate it.
B. Administer amiodarone 150 mg IV bolus.
C. Assess for and treat reversible causes (e.g., hypoxemia, electrolyte
imbalance, ischemia) while providing supportive care and transport.
D. Perform immediate synchronized cardioversion.
Correct Answer: C - Assess for and treat reversible causes (e.g.,
hypoxemia, electrolyte imbalance, ischemia) while providing
supportive care and transport.
RATIONALE
Repeated ICD shocks in a conscious patient suggest recurrent
ventricular arrhythmias or device malfunction; EMS should focus on
correcting reversible triggers and supportive care. Magnet application
is not a field intervention, amiodarone may be considered but is not
the first step, and synchronized cardioversion is not indicated for a
conscious patient with a functioning ICD.
Question 3
Which of the following best describes the primary pathophysiologic
mechanism of neurogenic shock compared to spinal shock?
A. Neurogenic shock results from loss of sympathetic tone causing
vasodilation and bradycardia; spinal shock refers to transient loss of
motor and sensory function below the injury.
B. Neurogenic shock is caused by massive histamine release; spinal
shock is due to adrenal insufficiency.
C. Neurogenic shock presents with tachycardia and hypertension; spinal
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, shock presents with bradycardia and hypotension.
D. Neurogenic shock is a late complication of spinal injury; spinal shock
occurs immediately and resolves within 24 hours.
Correct Answer: A - Neurogenic shock results from loss of
sympathetic tone causing vasodilation and bradycardia; spinal
shock refers to transient loss of motor and sensory function below
the injury.
RATIONALE
Neurogenic shock is a distributive shock from sympathetic disruption,
leading to vasodilation, hypotension, and often bradycardia. Spinal
shock is a separate phenomenon of transient areflexia and
sensory/motor loss below the lesion. The other options incorrectly
describe mechanisms or vital sign patterns.
Question 4
A patient with a suspected opioid overdose presents with pinpoint pupils,
respiratory depression, and a respiratory rate of 6/min. After administering
naloxone 0.4 mg IV, the patient's respiratory rate improves to 12/min but the
patient remains unresponsive. What is the most appropriate next action?
A. Administer a second dose of naloxone 2 mg IV.
B. Begin assisted ventilation with a BVM and monitor for
renarcotization.
C. Insert an oropharyngeal airway and transport immediately.
D. Administer flumazenil 0.2 mg IV to reverse possible benzodiazepine
co-ingestion.
Correct Answer: B - Begin assisted ventilation with a BVM and
monitor for renarcotization.
Page 4
A patient with severe asthma presents with diffuse expiratory wheezing,
accessory muscle use, and an SpO2 of 88% on room air. After two continuous
albuterol nebulizers and ipratropium, the wheezing becomes barely audible and
the patient's mental status declines. Which pathophysiologic process best
explains this change, and what is the most appropriate immediate intervention?
A. Improved airflow from bronchodilation; continue nebulized albuterol
and reassess in 10 minutes.
B. Progression to silent chest from severe bronchospasm and mucus
plugging; assist ventilations with a BVM and prepare for advanced
airway management.
C. Development of pulmonary edema from beta-agonist toxicity;
administer nitroglycerin and furosemide.
D. Anaphylaxis-induced laryngeal edema; administer intramuscular
epinephrine and observe.
Correct Answer: B - Progression to silent chest from severe
bronchospasm and mucus plugging; assist ventilations with a
BVM and prepare for advanced airway management.
RATIONALE
Loss of wheezing in a deteriorating asthmatic signals a 'silent chest'
due to extreme airflow limitation, not improvement. Immediate
assisted ventilation with a BVM and preparation for advanced airway
management is indicated. Beta-agonist toxicity does not cause
pulmonary edema, and anaphylaxis would present with other systemic
signs.
Page 2
, Question 2
A patient with a history of heart failure and an implanted
cardioverter-defibrillator (ICD) experiences multiple ICD shocks while
conscious. Which of the following is the most appropriate initial EMS
management?
A. Place a magnet over the ICD to deactivate it.
B. Administer amiodarone 150 mg IV bolus.
C. Assess for and treat reversible causes (e.g., hypoxemia, electrolyte
imbalance, ischemia) while providing supportive care and transport.
D. Perform immediate synchronized cardioversion.
Correct Answer: C - Assess for and treat reversible causes (e.g.,
hypoxemia, electrolyte imbalance, ischemia) while providing
supportive care and transport.
RATIONALE
Repeated ICD shocks in a conscious patient suggest recurrent
ventricular arrhythmias or device malfunction; EMS should focus on
correcting reversible triggers and supportive care. Magnet application
is not a field intervention, amiodarone may be considered but is not
the first step, and synchronized cardioversion is not indicated for a
conscious patient with a functioning ICD.
Question 3
Which of the following best describes the primary pathophysiologic
mechanism of neurogenic shock compared to spinal shock?
A. Neurogenic shock results from loss of sympathetic tone causing
vasodilation and bradycardia; spinal shock refers to transient loss of
motor and sensory function below the injury.
B. Neurogenic shock is caused by massive histamine release; spinal
shock is due to adrenal insufficiency.
C. Neurogenic shock presents with tachycardia and hypertension; spinal
Page 3
, shock presents with bradycardia and hypotension.
D. Neurogenic shock is a late complication of spinal injury; spinal shock
occurs immediately and resolves within 24 hours.
Correct Answer: A - Neurogenic shock results from loss of
sympathetic tone causing vasodilation and bradycardia; spinal
shock refers to transient loss of motor and sensory function below
the injury.
RATIONALE
Neurogenic shock is a distributive shock from sympathetic disruption,
leading to vasodilation, hypotension, and often bradycardia. Spinal
shock is a separate phenomenon of transient areflexia and
sensory/motor loss below the lesion. The other options incorrectly
describe mechanisms or vital sign patterns.
Question 4
A patient with a suspected opioid overdose presents with pinpoint pupils,
respiratory depression, and a respiratory rate of 6/min. After administering
naloxone 0.4 mg IV, the patient's respiratory rate improves to 12/min but the
patient remains unresponsive. What is the most appropriate next action?
A. Administer a second dose of naloxone 2 mg IV.
B. Begin assisted ventilation with a BVM and monitor for
renarcotization.
C. Insert an oropharyngeal airway and transport immediately.
D. Administer flumazenil 0.2 mg IV to reverse possible benzodiazepine
co-ingestion.
Correct Answer: B - Begin assisted ventilation with a BVM and
monitor for renarcotization.
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