FISDAP MEDICAL END OF COURSE QUESTIONS AND
ANSWERS MARKED A+
✔✔A 28-year-old woman has severe lower quadrant abdominal pain. When assessing
her abdomen, you should:
A) ask her where the pain is located and palpate that area first.
B) ask her where the pain is located and palpate that area last.
C) auscultate for bowel sounds for approximately 2 to 5 minutes.
D) encourage the patient to lie supine with her legs fully extended. - ✔✔B) ask her
where the pain is located and palpate that area last.
Assessment of a patient's abdomen includes asking where the pain is located and then
palpating that area last. Palpating the painful area first may interfere
with the rest of your assessment because of the significant pain the patient will be in.
Bowel sounds are of little value in the field and generally are not
included in the abdominal assessment. Patients with severe abdominal pain typically
prefer to lie on their side with their knees drawn up into their chest
(fetal position). Moving them from this position will aggravate their pain.
✔✔Which of the following complications would MOST likely occur if a patient with end-
stage renal disease missed several dialysis treatments?
A) Severe dehydration
B) Potassium depletion
C) Bacterial infection
D) Pulmonary edema - ✔✔D) Pulmonary edema
Dialysis removes waste products from the body when the patient's kidneys are unable
to do so on their own. If dialysis is not performed, everything that
should have been removed remains in the body. This can lead to myriad problems for
the patient. Potassium levels can rise to dangerous levels
(hyperkalemia), and the patient can develop volume overload; this can result in
pulmonary edema. Dehydration would be more likely to occur with aggressive dialysis,
not missing a treatment. Patients receiving dialysis are at increased risk for infection,
not because of the dialysis, but because of the underlying renal disease.
✔✔When insulin levels in the blood remain high:
A) a fruity odor can be detected on the patient's breath.
B) the cells starve for glucose and begin to metabolize fat.
C) the patient urinates excessively and becomes dehydrated.
D) glucose is rapidly taken out of the blood to fuel the cells. - ✔✔D) glucose is rapidly
taken out of the blood to fuel the cells.
Insulin is a hormone that promotes the cellular uptake of glucose from the bloodstream.
If insulin levels remain high, such as when a diabetic inadvertently
,takes too much insulin, glucose is rapidly taken out of the blood to fuel the cells. This
leads to low circulating blood glucose levels (hypoglycemia) and a
condition called insulin shock. By contrast, if insulin levels are too low, such as when a
diabetic forgets to take his or her insulin, glucose cannot enter the
cells and pools in the bloodstream (hyperglycemia). In the absence of glucose, the cells
begin to metabolize fat, which produces ketoacids (diabetic
ketoacidosis [OKA]). The respiratory system attempts to eliminate ketoacids from the
blood with an increased rate and depth of breathing (Kussmaul
respirations) that is accompanied by a fruity or acetone breath odor. Hyperglycemia
causes the patient to eliminate excess water from the body through
urination (diuresis), resulting in dehydration.
✔✔The signs and symptoms of an allergic reaction to a bee sting are caused by:
A) failure of the immune system to produce antibodies that render the bee's venom
inactive.
B) an inability of the immune system to recognize the bee's venom as being a foreign
substance.
C) the direct toxic effects of the bee's venom on the cardiovascular and respiratory
systems.
D) an exaggerated immune system reaction in which chemicals are released in
response to the venom. - ✔✔D) an exaggerated immune system reaction in which
chemicals are released in response to the venom.
An allergic reaction, an exaggerated immune response to any substance, is not caused
directly by an outside stimulus, such as venom released during a bite
or sting. Rather, it is a reaction that occurs when the immune system recognizes the
stimulus as being foreign; in response, the immune system releases
chemicals (histamines and leukotrienes) to combat the stimulus. An allergic reaction is
not caused by a failure of the immune system to produce antibodies;
rather, it occurs because the immune system produces them. A bee's venom does not
have a direct toxic effect on the body; the chemicals released in
response to the venom, however, can cause life-threatening conditions such as
respiratory failure and shock.
✔✔You receive a call to a restaurant where a 34-year-old man is experiencing
shortness of breath. When you arrive, you immediately note that
the man has urticaria on his face and arms. He is conscious, but restless, and is in
obvious respiratory distress. You should:
A) ask the patient if he has an epinephrine auto-injector.
B) remove the patient's shirt to inspect his chest for urticaria.
C) obtain vital signs and a SAMPLE history.
D) administer supplemental oxygen at 12 to 15 L/min. - ✔✔D) administer supplemental
oxygen at 12 to 15 L/min.
Initial management of a patient with a severe allergic reaction is to ensure a patent
airway and administer supplemental oxygen. Positive pressure ventilation
,may be required if the patient is breathing inadequately. After ensuring a patent airway
and adequate ventilation and oxygenation, you should inquirewhether the patient has a
prescribed epinephrine auto- injector. If so, you should contact medical control and
obtain permission (if required by local protocol) to assist the patient with the auto-
injector.
✔✔A 31-year-old man presents with uncontrolled twitching of his left arm that began
shortly after he experienced an odd taste in his mouth. He denies loss of
consciousness and states that this has happened to him before. What should you
suspect?
A) Absence seizure
B) Generalized seizure
C) Simple partial seizure
D) Complex partial seizure - ✔✔C) Simple partial seizure
Seizures are classified as being generalized or partial. Generalized seizures are further
classified as being tonic-clonic (formerly called grand mal) or absence (formerly called
petit mal) seizures. Generalized tonic-clonic seizures result from abnormal electrical
discharges from large areas of the brain, usually involving both hemispheres. They are
characterized by unconsciousness and generalized severe twitching of the body's
muscles; they last several minutes or longer. Absence seizures are characterized by a
brief lapse of consciousness in which the patient seems to stare and does not respond
to anyone. Absence seizures do not involve any changes in motor activity. Partial (focal)
seizures begin in one part of the brain and are classified as simple and complex. In a
simple partial seizure, no change occurs in the patient's level of consciousness. Patients
may report numbness, weakness, or dizziness. The senses may also be involved; the
patient may report visual changes and unusual smells or tastes. A simple partial seizure
may also cause twitching of the extremity muscles that spreads slowly from one part of
the body to another. In a complex partial seizure, the patient has an altered mental
status and does not interact normally with his or her environment. This type of seizure
results from abnormal discharges from the temporal lobe of the brain. Other signs may
include lip smacking, eye blinking, and isolated convulsions or jerking of the body or one
part of the body, such as the arm. The patient may experience unpleasant smells and
visual hallucinations, exhibit uncontrollable fear, or exhibit repetitive physical behavior
such as constant sitting or standing.
✔✔You receive a call for a 54-year-old woman who is having a seizure. When you
arrive at the scene, the patient is actively seizing. Her
husband tells you that she has a history of seizures and that she has been seizing
continuously for 20 minutes. It is MOST important for you
to recognize that:
A) her seizure could be the result of a low blood glucose level.
B) the patient may have stopped taking her seizure medication.
C) the patient is hypoxic and needs oxygen as soon as possible.
D) her husband's description is consistent with status epilepticus. - ✔✔C) the patient is
hypoxic and needs oxygen as soon as possible.
, There are many causes of seizures, including noncompliance with prescribed
anticonvulsant medications, hypoglycemia, stroke, head trauma, and poisoning, among
others. Regardless of the underlying cause, it is most important to recognize that
patients who are actively seizing, especially if the seizure is
prolonged, are hypoxic and need supplemental oxygen as soon as possible; in many
cases, it may be necessary to assist the patient's ventilations. The husband's
description of the seizure (eg, continuous for 20 minutes) is consistent with status
epilepticus, which is all the more reason to recognize that she is severely hypoxic.
Seizure-related deaths are the result of cerebral hypoxia.
✔✔After administering epinephrine to a woman in anaphylactic shock, her condition
improves. The EMT should recognize that her clinical
improvement is because epinephrine:
A) constricts the blood vessels and dilates the bronchioles.
B) decreases the heart rate, which improves cardiac output.
C) blocks histamine receptors and stops the allergic reaction.
D) causes fluid to shift back into the cells, which reduces edema. - ✔✔A) constricts the
blood vessels and dilates the bronchioles.
The life-threatening complications of anaphylactic shock are caused by vasodilation,
which results in hypo tension, and bronchoconstriction, which results in
respiratory failure. Epinephrine reverses these effects because it stimulates alpha and
beta receptors. Alpha receptor stimulation produces vasoconstriction,
which increases the blood pressure. Beta receptor stimulation causes bronchodilation,
which improves breathing. Epinephrine increases the heart rate, also
through its beta stimulation properties. Epinephrine does not stop the allergic reaction;
antihistamines (ie, diphenhydramine [Benadryl]), which bind to
histamine receptors, actually terminate the reaction. Antihistamines also reduce the
edema that occurs during a severe allergic reaction.
✔✔A patient with a core body temperature of 94°F would MOST likely present with:
A) decreased muscle activity.
B) an altered mental status.
C) joint and muscle stiffness.
D) shivering and pale skin. - ✔✔D) shivering and pale skin.
Mild hypothermia is defined as a core body temperature (CBT) between 93.2 degrees F
and 96.8 degrees F (34 degrees C and 36 degrees C). Mildly
hypothermic patients are usually alert and shivering in an attempt to generate heat
through muscular activity. Their skin is typically pale due to the body's
constriction of blood vessels at the skin to retain heat. In moderate hypothermia (CBT
between 86 degrees F and 93.2 degrees F [30 degrees C and 34 degrees
C]), shivering stops and muscular activity decreases. As the CBT falls further, all muscle
activity stops. In severe hypothermia (CBT 86 degrees F [30 degrees
ANSWERS MARKED A+
✔✔A 28-year-old woman has severe lower quadrant abdominal pain. When assessing
her abdomen, you should:
A) ask her where the pain is located and palpate that area first.
B) ask her where the pain is located and palpate that area last.
C) auscultate for bowel sounds for approximately 2 to 5 minutes.
D) encourage the patient to lie supine with her legs fully extended. - ✔✔B) ask her
where the pain is located and palpate that area last.
Assessment of a patient's abdomen includes asking where the pain is located and then
palpating that area last. Palpating the painful area first may interfere
with the rest of your assessment because of the significant pain the patient will be in.
Bowel sounds are of little value in the field and generally are not
included in the abdominal assessment. Patients with severe abdominal pain typically
prefer to lie on their side with their knees drawn up into their chest
(fetal position). Moving them from this position will aggravate their pain.
✔✔Which of the following complications would MOST likely occur if a patient with end-
stage renal disease missed several dialysis treatments?
A) Severe dehydration
B) Potassium depletion
C) Bacterial infection
D) Pulmonary edema - ✔✔D) Pulmonary edema
Dialysis removes waste products from the body when the patient's kidneys are unable
to do so on their own. If dialysis is not performed, everything that
should have been removed remains in the body. This can lead to myriad problems for
the patient. Potassium levels can rise to dangerous levels
(hyperkalemia), and the patient can develop volume overload; this can result in
pulmonary edema. Dehydration would be more likely to occur with aggressive dialysis,
not missing a treatment. Patients receiving dialysis are at increased risk for infection,
not because of the dialysis, but because of the underlying renal disease.
✔✔When insulin levels in the blood remain high:
A) a fruity odor can be detected on the patient's breath.
B) the cells starve for glucose and begin to metabolize fat.
C) the patient urinates excessively and becomes dehydrated.
D) glucose is rapidly taken out of the blood to fuel the cells. - ✔✔D) glucose is rapidly
taken out of the blood to fuel the cells.
Insulin is a hormone that promotes the cellular uptake of glucose from the bloodstream.
If insulin levels remain high, such as when a diabetic inadvertently
,takes too much insulin, glucose is rapidly taken out of the blood to fuel the cells. This
leads to low circulating blood glucose levels (hypoglycemia) and a
condition called insulin shock. By contrast, if insulin levels are too low, such as when a
diabetic forgets to take his or her insulin, glucose cannot enter the
cells and pools in the bloodstream (hyperglycemia). In the absence of glucose, the cells
begin to metabolize fat, which produces ketoacids (diabetic
ketoacidosis [OKA]). The respiratory system attempts to eliminate ketoacids from the
blood with an increased rate and depth of breathing (Kussmaul
respirations) that is accompanied by a fruity or acetone breath odor. Hyperglycemia
causes the patient to eliminate excess water from the body through
urination (diuresis), resulting in dehydration.
✔✔The signs and symptoms of an allergic reaction to a bee sting are caused by:
A) failure of the immune system to produce antibodies that render the bee's venom
inactive.
B) an inability of the immune system to recognize the bee's venom as being a foreign
substance.
C) the direct toxic effects of the bee's venom on the cardiovascular and respiratory
systems.
D) an exaggerated immune system reaction in which chemicals are released in
response to the venom. - ✔✔D) an exaggerated immune system reaction in which
chemicals are released in response to the venom.
An allergic reaction, an exaggerated immune response to any substance, is not caused
directly by an outside stimulus, such as venom released during a bite
or sting. Rather, it is a reaction that occurs when the immune system recognizes the
stimulus as being foreign; in response, the immune system releases
chemicals (histamines and leukotrienes) to combat the stimulus. An allergic reaction is
not caused by a failure of the immune system to produce antibodies;
rather, it occurs because the immune system produces them. A bee's venom does not
have a direct toxic effect on the body; the chemicals released in
response to the venom, however, can cause life-threatening conditions such as
respiratory failure and shock.
✔✔You receive a call to a restaurant where a 34-year-old man is experiencing
shortness of breath. When you arrive, you immediately note that
the man has urticaria on his face and arms. He is conscious, but restless, and is in
obvious respiratory distress. You should:
A) ask the patient if he has an epinephrine auto-injector.
B) remove the patient's shirt to inspect his chest for urticaria.
C) obtain vital signs and a SAMPLE history.
D) administer supplemental oxygen at 12 to 15 L/min. - ✔✔D) administer supplemental
oxygen at 12 to 15 L/min.
Initial management of a patient with a severe allergic reaction is to ensure a patent
airway and administer supplemental oxygen. Positive pressure ventilation
,may be required if the patient is breathing inadequately. After ensuring a patent airway
and adequate ventilation and oxygenation, you should inquirewhether the patient has a
prescribed epinephrine auto- injector. If so, you should contact medical control and
obtain permission (if required by local protocol) to assist the patient with the auto-
injector.
✔✔A 31-year-old man presents with uncontrolled twitching of his left arm that began
shortly after he experienced an odd taste in his mouth. He denies loss of
consciousness and states that this has happened to him before. What should you
suspect?
A) Absence seizure
B) Generalized seizure
C) Simple partial seizure
D) Complex partial seizure - ✔✔C) Simple partial seizure
Seizures are classified as being generalized or partial. Generalized seizures are further
classified as being tonic-clonic (formerly called grand mal) or absence (formerly called
petit mal) seizures. Generalized tonic-clonic seizures result from abnormal electrical
discharges from large areas of the brain, usually involving both hemispheres. They are
characterized by unconsciousness and generalized severe twitching of the body's
muscles; they last several minutes or longer. Absence seizures are characterized by a
brief lapse of consciousness in which the patient seems to stare and does not respond
to anyone. Absence seizures do not involve any changes in motor activity. Partial (focal)
seizures begin in one part of the brain and are classified as simple and complex. In a
simple partial seizure, no change occurs in the patient's level of consciousness. Patients
may report numbness, weakness, or dizziness. The senses may also be involved; the
patient may report visual changes and unusual smells or tastes. A simple partial seizure
may also cause twitching of the extremity muscles that spreads slowly from one part of
the body to another. In a complex partial seizure, the patient has an altered mental
status and does not interact normally with his or her environment. This type of seizure
results from abnormal discharges from the temporal lobe of the brain. Other signs may
include lip smacking, eye blinking, and isolated convulsions or jerking of the body or one
part of the body, such as the arm. The patient may experience unpleasant smells and
visual hallucinations, exhibit uncontrollable fear, or exhibit repetitive physical behavior
such as constant sitting or standing.
✔✔You receive a call for a 54-year-old woman who is having a seizure. When you
arrive at the scene, the patient is actively seizing. Her
husband tells you that she has a history of seizures and that she has been seizing
continuously for 20 minutes. It is MOST important for you
to recognize that:
A) her seizure could be the result of a low blood glucose level.
B) the patient may have stopped taking her seizure medication.
C) the patient is hypoxic and needs oxygen as soon as possible.
D) her husband's description is consistent with status epilepticus. - ✔✔C) the patient is
hypoxic and needs oxygen as soon as possible.
, There are many causes of seizures, including noncompliance with prescribed
anticonvulsant medications, hypoglycemia, stroke, head trauma, and poisoning, among
others. Regardless of the underlying cause, it is most important to recognize that
patients who are actively seizing, especially if the seizure is
prolonged, are hypoxic and need supplemental oxygen as soon as possible; in many
cases, it may be necessary to assist the patient's ventilations. The husband's
description of the seizure (eg, continuous for 20 minutes) is consistent with status
epilepticus, which is all the more reason to recognize that she is severely hypoxic.
Seizure-related deaths are the result of cerebral hypoxia.
✔✔After administering epinephrine to a woman in anaphylactic shock, her condition
improves. The EMT should recognize that her clinical
improvement is because epinephrine:
A) constricts the blood vessels and dilates the bronchioles.
B) decreases the heart rate, which improves cardiac output.
C) blocks histamine receptors and stops the allergic reaction.
D) causes fluid to shift back into the cells, which reduces edema. - ✔✔A) constricts the
blood vessels and dilates the bronchioles.
The life-threatening complications of anaphylactic shock are caused by vasodilation,
which results in hypo tension, and bronchoconstriction, which results in
respiratory failure. Epinephrine reverses these effects because it stimulates alpha and
beta receptors. Alpha receptor stimulation produces vasoconstriction,
which increases the blood pressure. Beta receptor stimulation causes bronchodilation,
which improves breathing. Epinephrine increases the heart rate, also
through its beta stimulation properties. Epinephrine does not stop the allergic reaction;
antihistamines (ie, diphenhydramine [Benadryl]), which bind to
histamine receptors, actually terminate the reaction. Antihistamines also reduce the
edema that occurs during a severe allergic reaction.
✔✔A patient with a core body temperature of 94°F would MOST likely present with:
A) decreased muscle activity.
B) an altered mental status.
C) joint and muscle stiffness.
D) shivering and pale skin. - ✔✔D) shivering and pale skin.
Mild hypothermia is defined as a core body temperature (CBT) between 93.2 degrees F
and 96.8 degrees F (34 degrees C and 36 degrees C). Mildly
hypothermic patients are usually alert and shivering in an attempt to generate heat
through muscular activity. Their skin is typically pale due to the body's
constriction of blood vessels at the skin to retain heat. In moderate hypothermia (CBT
between 86 degrees F and 93.2 degrees F [30 degrees C and 34 degrees
C]), shivering stops and muscular activity decreases. As the CBT falls further, all muscle
activity stops. In severe hypothermia (CBT 86 degrees F [30 degrees
