FISDAP MEDICAL EXAM 2 LATEST VERSIONS A & B ACTUAL
EXAM 220 QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES
When you arrive at a residence for a man who is "not acting right," you enter the
house and find him sitting on his couch. Which of the
following findings would be MOST indicative of an altered mental status?
A) Odor of alcohol
B) Closed eyes
C) Tired appearance
D) Slurred speech - ANSWER: D) Slurred speech
Often, an altered mental status can be difficult to assess, especially if you do not
know how the patient normally acts. However, there are key findings that
should increase your index of suspicion. An abnormal speech pattern, such as
slurring or incoherent words, can be the result of a diabetic problem, alcohol
intoxication, or drug ingestion. All of these can cause an altered mental status. The
odor of alcohol suggests intoxication as a potential cause of his problem,
but cannot be quantified. Just because the patient's eyes are closed or he has a
tired appearance, does not necessarily indicate that he has an altered mental
status.
A young woman reports significant weight loss over the last month, persistent fever,
and night sweats. When you assess her, you note the
presence of dark purple lesions covering her trunk and upper extremities. You should
suspect:
A) HIV infection.
B) tuberculosis.
C) rheumatic fever.
D) end-stage cancer. - ANSWER: A) HIV infection.
Weight loss, fever, and night sweats could indicate tuberculosis or HIV infection
that has progressed to acquired immunodeficiency syndrome (AIDS);
however, the dark purple lesions on the skin, which are called Kaposi's sarcoma,
are malignant skin tumors and are a classic finding in patients in the later
stages of AIDS.
A 19-year-old man is experiencing hallucinations and paranoia after abusing an
unknown substance. His heart rate is 170 beats/min, he
complains of a headache, and he is experiencing muscle twitching. Which of the fo
llowing substances would MOST likely explain his
presentation?
A) Heroin
B) Bath salts
C) Ketamine
,D)Valium - ANSWER: B) Bath salts
Of the drugs listed, the patient's clinical presentation is the most consistent with
use of synthetic cathinones (bath salts). Bath salts, not to be confused with
products such as Epsom salt, are a class of drugs similar to MDMA (ecstasy). Cloud
Nine and Ivory Wave are common streets names for bath salts. Bath salts
produce euphoria, increased mental clarity, and sexual arousal. Most users snort
the drug. Adverse effects include teeth grinding, loss of appetite, muscle
twitching, lip -smacking, confusion, paranoia, headache, tachycardia, and
hallucinations. Heroin (an opioid) and Valium (a benzodiazepine) are both central
nervous system depressant drugs; therefore, they would not explain the patient's
presentation. Ketamine (Ketalar) is a sedative-hypnotic drug; it would not
explain the patient's signs and symptoms.
Unresponsiveness, shallow breathing, and constricted pupils are indicative of which
type of drug overdose?
A) Narcotic
B) Marijuana
C) Barbiturate
D) Amphetamine - ANSWER: A) Narcotic
Signs of a narcotic (opiate/opioid) overdose from drugs such as heroin, morphine
(Astromorph, Duramorph), meperidine (Demerol), and codeine include
altered mental status; slow, shallow breathing; pupillary constriction (miosis),
hypotension; and bradycardia. Narcotics are central nervous system
depressants that, when taken in excess, suppress the vital functions necessary for
life, such as breathing, heart rate, and blood pressure. Barbiturates
produce the same effects; however, the pupils are typically dilated (mydriasis), not
constricted. Marijuana and amphetamine drugs are central nervous system
stimulants and, therefore, would cause the patient to become restless or even
combative.
A man is experiencing a severe allergic reaction after being stung by a scorpion. He
does not have his own epinephrine; however, his wife is allergic to bees and has a
prescribed epinephrine auto-injector. You should:
A) provide rapid transport and consider an ALS intercept.
B) assist the patient with the wife's prescribed epinephrine.
C) administer an oral antihistamine and transport without delay.
D) request an ALS unit to respond to the scene to administer epinephrine. -
ANSWER: A) provide rapid transport and consider an ALS intercept.
If a patient does not have a prescribed epinephrine auto-injector and is
experiencing a severe allergic reaction, you should administer supplemental
oxygen,
assist the patient's ventilations if needed, and transport without delay. Closely
monitor the patient's airway and breathing status en route and coordinate an
,ALS intercept if possible. If you carry an epinephrine auto-injector on your
ambulance and your protocols allow you to administer it, do so without delay.
Otherwise, the ALS unit will be able to administer epinephrine via the
intramuscular or intravenous route. Never assist a patient with a medication that is
not
prescribed to him or her specifically. Antihistamines are given after epinephrine; in
most systems, EMTs are not authorized to dispense oral medications
other than glucose and aspirin.
You are dispatched to a residence for a 20-year-old man with respiratory distress.
When you arrive, you find that the patient has a
tracheostomy tube and is ventilator dependent. His mother tells you that he was
doing fine, but then suddenly began experiencing
breathing difficulty. You should:
A) remove him from the mechanical ventilator and ventilate him manually.
B) check the settings on the ventilator to ensure that it is functioning properly.
C) detach the ventilator, suction the tracheostomy tube, and reassess the patient.
D) remove the ventilator tubing and place an oxygen mask over the tracheostomy
tube. - ANSWER: A) remove him from the mechanical ventilator and ventilate him
manually.
If a ventilator-dependent patient experiences a sudden onset of respiratory distress,
you should first remove him or her from the mechanical ventilator and
begin manual ventilation with a bag-mask device; attach the bag directly to the
tracheostomy tube. If the patient improves, you will know that the problem
was a malfunction with the mechanical ventilator. If the patient does not improve,
the tracheostomy tube is likely plugged with thick mucus secretions and
requires suctioning. Unless you are familiar with the mechanical ventilator (most
EMTs are not), do not attempt to troubleshoot the device by checking the
settings; this simply wastes time and could harm the patient if you do not know what
you are doing.
When treating an unresponsive man who was struck by lightning, you should:
A) begin CPR at once if he is apneic and pulseless.
B) apply full spinal precautions before moving him.
C) ensure that you and the patient are in a safe place.
D) manually stabilize his head and open his airway. - ANSWER: C) ensure that you
and the patient are in a safe place.
Contrary to popular belief, lightning can (and does) strike in the same place twice.
After lightning strikes, the ground remains electrically charged for a period
of time; this increases the chance of a second strike within a short period of time.
You must first ensure that you and the patient are safe by moving to a
sheltered area, preferably indoors. After you have ensured the safety of yourself and
the patient, begin treatment as dictated by the patient's condition. Do
not let the life you save, or attempt to save, TAKE your own!
, A 23-year-old woman with sickle cell disease reports a sudden onset of severe pain
in her lower extremities. Which of the following is the
MOST likely cause of her symptoms?
A) Red blood cells are being destroyed at an abnormal rate.
B) Spontaneous bleeding is occurring within the muscles.
C) Blood flow is diminished because of vascular occlusion.
D) Blood clots have formed because of excessive platelets. - ANSWER: C) Blood flow
is diminished because of vascular occlusion.
Sickle cell disease is an inherited blood disorder in which the red blood cells are
misshapen and take on a sickle appearance. The sharp and misshapen red
blood cells lead to dysfunction in oxygen binding and unintentional clot formation.
These unintentional clots may lead to a condition called vasoocclusive
crisis. The patient's symptoms indicate that this is what has happened in her lower
extremities. The blood clots in her lower extremities did not form because
of an excessive platelet count (thrombocythemia) because sickle cell disease is not a
condition of excessive platelet production. Spontaneous bleeding is not the cause of
her symptoms because sickle cell disease is not a condition of low platelets
(thrombocytopenia). Sickle cell disease is not a condition of abnormal red blood cell
destruction.
You are at the scene where a man panicked while swimming in a small lake. Your
initial attempt to rescue him should include:
A) throwing a rope to the victim.
B) rowing a small raft to the victim.
C) swimming to the victim to rescue him.
D) reaching for the victim with a long object. - ANSWER: D) reaching for the victim
with a long object.
General rules to fo llow when attempting to rescue a patient from the water include
"reach, throw, row, and then go." In this case, you should attempt to reach
the victim by having him grab hold of a long object, such as a stick or pole. If this is
not possible or unsuccessful, throw the victim a rope or flotation device (if available).
If these are not available, row to the patient in a small raft (if available). Going into
the water to retrieve the victim is a last resort. The rescuer must
be a strong swimmer because patients who are in danger of drowning are in a state
of blind panic and will make every attempt to keep themselves afloat,
even if it means forcing the rescuer underwater.
Which of the following is a later sign of hepatitis?
A) Fatigue
B) Jaundice
C) Loss of appetite
D) Fever and vomiting - ANSWER: B) Jaundice
Early signs and symptoms of viral hepatitis include loss of appetite (anorexia),
vomiting, fever, fatigue, and muscle and joint pain. Jaundice (yellow sclera and
EXAM 220 QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES
When you arrive at a residence for a man who is "not acting right," you enter the
house and find him sitting on his couch. Which of the
following findings would be MOST indicative of an altered mental status?
A) Odor of alcohol
B) Closed eyes
C) Tired appearance
D) Slurred speech - ANSWER: D) Slurred speech
Often, an altered mental status can be difficult to assess, especially if you do not
know how the patient normally acts. However, there are key findings that
should increase your index of suspicion. An abnormal speech pattern, such as
slurring or incoherent words, can be the result of a diabetic problem, alcohol
intoxication, or drug ingestion. All of these can cause an altered mental status. The
odor of alcohol suggests intoxication as a potential cause of his problem,
but cannot be quantified. Just because the patient's eyes are closed or he has a
tired appearance, does not necessarily indicate that he has an altered mental
status.
A young woman reports significant weight loss over the last month, persistent fever,
and night sweats. When you assess her, you note the
presence of dark purple lesions covering her trunk and upper extremities. You should
suspect:
A) HIV infection.
B) tuberculosis.
C) rheumatic fever.
D) end-stage cancer. - ANSWER: A) HIV infection.
Weight loss, fever, and night sweats could indicate tuberculosis or HIV infection
that has progressed to acquired immunodeficiency syndrome (AIDS);
however, the dark purple lesions on the skin, which are called Kaposi's sarcoma,
are malignant skin tumors and are a classic finding in patients in the later
stages of AIDS.
A 19-year-old man is experiencing hallucinations and paranoia after abusing an
unknown substance. His heart rate is 170 beats/min, he
complains of a headache, and he is experiencing muscle twitching. Which of the fo
llowing substances would MOST likely explain his
presentation?
A) Heroin
B) Bath salts
C) Ketamine
,D)Valium - ANSWER: B) Bath salts
Of the drugs listed, the patient's clinical presentation is the most consistent with
use of synthetic cathinones (bath salts). Bath salts, not to be confused with
products such as Epsom salt, are a class of drugs similar to MDMA (ecstasy). Cloud
Nine and Ivory Wave are common streets names for bath salts. Bath salts
produce euphoria, increased mental clarity, and sexual arousal. Most users snort
the drug. Adverse effects include teeth grinding, loss of appetite, muscle
twitching, lip -smacking, confusion, paranoia, headache, tachycardia, and
hallucinations. Heroin (an opioid) and Valium (a benzodiazepine) are both central
nervous system depressant drugs; therefore, they would not explain the patient's
presentation. Ketamine (Ketalar) is a sedative-hypnotic drug; it would not
explain the patient's signs and symptoms.
Unresponsiveness, shallow breathing, and constricted pupils are indicative of which
type of drug overdose?
A) Narcotic
B) Marijuana
C) Barbiturate
D) Amphetamine - ANSWER: A) Narcotic
Signs of a narcotic (opiate/opioid) overdose from drugs such as heroin, morphine
(Astromorph, Duramorph), meperidine (Demerol), and codeine include
altered mental status; slow, shallow breathing; pupillary constriction (miosis),
hypotension; and bradycardia. Narcotics are central nervous system
depressants that, when taken in excess, suppress the vital functions necessary for
life, such as breathing, heart rate, and blood pressure. Barbiturates
produce the same effects; however, the pupils are typically dilated (mydriasis), not
constricted. Marijuana and amphetamine drugs are central nervous system
stimulants and, therefore, would cause the patient to become restless or even
combative.
A man is experiencing a severe allergic reaction after being stung by a scorpion. He
does not have his own epinephrine; however, his wife is allergic to bees and has a
prescribed epinephrine auto-injector. You should:
A) provide rapid transport and consider an ALS intercept.
B) assist the patient with the wife's prescribed epinephrine.
C) administer an oral antihistamine and transport without delay.
D) request an ALS unit to respond to the scene to administer epinephrine. -
ANSWER: A) provide rapid transport and consider an ALS intercept.
If a patient does not have a prescribed epinephrine auto-injector and is
experiencing a severe allergic reaction, you should administer supplemental
oxygen,
assist the patient's ventilations if needed, and transport without delay. Closely
monitor the patient's airway and breathing status en route and coordinate an
,ALS intercept if possible. If you carry an epinephrine auto-injector on your
ambulance and your protocols allow you to administer it, do so without delay.
Otherwise, the ALS unit will be able to administer epinephrine via the
intramuscular or intravenous route. Never assist a patient with a medication that is
not
prescribed to him or her specifically. Antihistamines are given after epinephrine; in
most systems, EMTs are not authorized to dispense oral medications
other than glucose and aspirin.
You are dispatched to a residence for a 20-year-old man with respiratory distress.
When you arrive, you find that the patient has a
tracheostomy tube and is ventilator dependent. His mother tells you that he was
doing fine, but then suddenly began experiencing
breathing difficulty. You should:
A) remove him from the mechanical ventilator and ventilate him manually.
B) check the settings on the ventilator to ensure that it is functioning properly.
C) detach the ventilator, suction the tracheostomy tube, and reassess the patient.
D) remove the ventilator tubing and place an oxygen mask over the tracheostomy
tube. - ANSWER: A) remove him from the mechanical ventilator and ventilate him
manually.
If a ventilator-dependent patient experiences a sudden onset of respiratory distress,
you should first remove him or her from the mechanical ventilator and
begin manual ventilation with a bag-mask device; attach the bag directly to the
tracheostomy tube. If the patient improves, you will know that the problem
was a malfunction with the mechanical ventilator. If the patient does not improve,
the tracheostomy tube is likely plugged with thick mucus secretions and
requires suctioning. Unless you are familiar with the mechanical ventilator (most
EMTs are not), do not attempt to troubleshoot the device by checking the
settings; this simply wastes time and could harm the patient if you do not know what
you are doing.
When treating an unresponsive man who was struck by lightning, you should:
A) begin CPR at once if he is apneic and pulseless.
B) apply full spinal precautions before moving him.
C) ensure that you and the patient are in a safe place.
D) manually stabilize his head and open his airway. - ANSWER: C) ensure that you
and the patient are in a safe place.
Contrary to popular belief, lightning can (and does) strike in the same place twice.
After lightning strikes, the ground remains electrically charged for a period
of time; this increases the chance of a second strike within a short period of time.
You must first ensure that you and the patient are safe by moving to a
sheltered area, preferably indoors. After you have ensured the safety of yourself and
the patient, begin treatment as dictated by the patient's condition. Do
not let the life you save, or attempt to save, TAKE your own!
, A 23-year-old woman with sickle cell disease reports a sudden onset of severe pain
in her lower extremities. Which of the following is the
MOST likely cause of her symptoms?
A) Red blood cells are being destroyed at an abnormal rate.
B) Spontaneous bleeding is occurring within the muscles.
C) Blood flow is diminished because of vascular occlusion.
D) Blood clots have formed because of excessive platelets. - ANSWER: C) Blood flow
is diminished because of vascular occlusion.
Sickle cell disease is an inherited blood disorder in which the red blood cells are
misshapen and take on a sickle appearance. The sharp and misshapen red
blood cells lead to dysfunction in oxygen binding and unintentional clot formation.
These unintentional clots may lead to a condition called vasoocclusive
crisis. The patient's symptoms indicate that this is what has happened in her lower
extremities. The blood clots in her lower extremities did not form because
of an excessive platelet count (thrombocythemia) because sickle cell disease is not a
condition of excessive platelet production. Spontaneous bleeding is not the cause of
her symptoms because sickle cell disease is not a condition of low platelets
(thrombocytopenia). Sickle cell disease is not a condition of abnormal red blood cell
destruction.
You are at the scene where a man panicked while swimming in a small lake. Your
initial attempt to rescue him should include:
A) throwing a rope to the victim.
B) rowing a small raft to the victim.
C) swimming to the victim to rescue him.
D) reaching for the victim with a long object. - ANSWER: D) reaching for the victim
with a long object.
General rules to fo llow when attempting to rescue a patient from the water include
"reach, throw, row, and then go." In this case, you should attempt to reach
the victim by having him grab hold of a long object, such as a stick or pole. If this is
not possible or unsuccessful, throw the victim a rope or flotation device (if available).
If these are not available, row to the patient in a small raft (if available). Going into
the water to retrieve the victim is a last resort. The rescuer must
be a strong swimmer because patients who are in danger of drowning are in a state
of blind panic and will make every attempt to keep themselves afloat,
even if it means forcing the rescuer underwater.
Which of the following is a later sign of hepatitis?
A) Fatigue
B) Jaundice
C) Loss of appetite
D) Fever and vomiting - ANSWER: B) Jaundice
Early signs and symptoms of viral hepatitis include loss of appetite (anorexia),
vomiting, fever, fatigue, and muscle and joint pain. Jaundice (yellow sclera and
