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Chapters 21-24
Chapters 21-24
108
Medical
Professional
04/07/2013
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Term
The primary physiologic abnormality that causes diabetes is:
 Definition
ineffective action of insulin.
Term
Insulin is produced when:
 Definition
absorbed carbohydrates stimulate the beta cells of the pancreas.
Term
Circulating blood glucose levels typically range from:
 Definition
80 to 120 mg/dL.
Term
A 29-year-old male with a history of insulin-dependent diabetes presents with excessive urination and marked thirst. These signs indicate that the:
 Definition
renal system is excreting excess glucose.
Term
Kussmaul respirations indicate that the respiratory system is:
 Definition
excreting ketones from the blood.
Term
A 45-year-old female with insulin-dependent diabetes presents with an altered mental status. Her skin is pale and moist, and her respirations are rapid and shallow. You should:
 Definition
provide ventilatory assistance with 100% oxygen.
Term
Which of the following statements regarding diabetic coma is correct?
 Definition
It progresses slowly over a period of hours.
Term
In which of the following situations would a diabetic patient MOST likely develop insulin shock?
 Definition
Heavy exertion following a small meal
Term
A 72-year-old male with non-insulin dependent diabetes complains of “not feeling
well.” He is diaphoretic and his blood sugar reading is 110 mg/dL. You should be
MOST suspicious for:
 Definition
an acute myocardial infarction.
Term
A 39-year-old male with a history of insulin-dependent diabetes mellitus is found unresponsive by his wife. When obtaining information from the wife, which of the following questions would be LEAST pertinent?
 Definition
Was your husband hospitalized for this problem in the past?
Term
Fifty percent dextrose (D50) would be indicated in all of the following situations, EXCEPT:
 Definition
an asymptomatic patient with a blood glucose of 60 mg/dL.
Term
A common clinical finding in patients with either diabetic coma or insulin shock is:
 Definition
an altered mental status.
Term
You are dispatched to a residence for a 60-year-old diabetic male who is unresponsive. As you are assessing the patient, your partner attempts to obtain a blood glucose reading; however, the glucometer reads “error.” You should manage this patient's airway appropriately and then:
 Definition
start an IV and administer 50 mL of D50.
Term
In which of the following patients would it be MOST appropriate to administer oral glucose?
 Definition
Confused diabetic patient who is breathing adequately.
Term
Following the administration of one tube of oral glucose, your 20-year-old female diabetic patient's condition markedly improves. You should:
 Definition
transport her to the hospital and reassess her blood sugar en route.
Term
The primary fuels for cellular metabolism are:
 Definition
glucose and oxygen.
Term
Insulin maintains homeostasis by:
 Definition
facilitating cellular glucose uptake.
Term
Which of the following general statements regarding diabetes is correct?
 Definition
Insulin-dependent diabetes occurs most commonly in children.
Term
Diabetic ketoacidosis (DKA) occurs when:
 Definition
the body's cells metabolize fat as an immediate energy source.
Term
A 50-year-old male with a blood sugar level of 40 mg/dL would be expected to present with all of the following, EXCEPT:
 Definition
glucose in the urine.
Term
A 56-year-old male is found unresponsive by a neighbor. Your assessment reveals that he is diaphoretic, pale, and is breathing rapidly with reduced tidal volume. His blood glucose reading is 30 mg/dL. The MOST appropriate management for this patient includes:
 Definition
assisted ventilation, 25g of D50 IV, and cardiac monitoring.
Term
A potential complication associated with the administration of D50 is:
 Definition
tissue necrosis if it extravasates into the soft tissues.
Term
A 29-year-old confused female has a blood glucose reading of 50 mg/dL. After administering one tube of oral glucose, you note marked improvement in her mental status. As you are obtaining baseline vital signs, her level of consciousness suddenly decreases. You should:
 Definition
assess her airway and treat accordingly.
Term
Prior to administering D50 to an unresponsive patient with a blood glucose reading of 35 mg/dL, you should:
 Definition
ensure that the IV line is patent and running effectively.
Term
Which of the following conditions would result in the MOST rapid loss of consciousness?
 Definition
Acute hypoglycemia
Term
An allergic reaction is MOST accurately defined as a/an:
 Definition
exaggerated response of the body's immune system to a foreign stimulus.
Term
Following exposure to an allergen, an individual will MOST likely experience a severe allergic reaction if he or she:
 Definition
was previously exposed and sensitized to the allergen.
Term
A foreign substance that stimulates the body's immune response is called a/an:
 Definition
antigen.
Term
Allergic reactions to oral medications, which are slower in onset:
 Definition
may cause a severe reaction within 60 minutes of ingestion.
Term
You should attempt to remove an imbedded stinger from a patient who was stung by a bee because:
 Definition
it can inject venom for up to 20 minutes after the initial sting.
Term
Your assessment of a patient with an allergic reaction should focus on the:
 Definition
respiratory system, circulatory system, mental status, and skin.
Term
The MOST immediate threat to life that is associated with angioedema is:
 Definition
swelling of the upper airway.
Term
A 46-year-old female presents with respiratory difficulty, facial swelling, and widespread hives after she was stung by an unknown type of insect. Her blood pressure is 88/58 mm Hg; auscultation of her lungs reveals diffuse expiratory wheezing. The patient has a prescribed EpiPen, but has not used it. After administering 100% oxygen, you should:
 Definition
assist the patient with her EpiPen in accordance with your protocols.
Term
Decreases in cardiac output and blood pressure in a patient with anaphylactic shock are the result of:
 Definition
systemic vasodilation.
Term
You are assisting a 25-year-old male with his epinephrine auto-injector after he was stung multiple times by fire ants. The medication should be injected in the:
 Definition
lateral thigh, midway between the hip and knee.
Term
Shortly after administering epinephrine to a 49-year-old male with anaphylactic shock, he becomes unconscious. Your assessment reveals that he is pulseless and apneic. You should:
 Definition
begin CPR and apply the AED.
Term
The bite from a female black widow spider is MOST noted for:
 Definition
the intense muscle spasms it causes.
Term
You are dispatched for a 56-year-old female with “arm pain”. Your assessment reveals that she is conscious, alert, and in no respiratory distress. On her arm, you find a swollen, painful lesion that is surrounded by erythema and has a mottled center. The patient denies being bitten or stung by anything. You should suspect a:
 Definition
brown recluse spider bite.
Term
Which of the following clinical findings is a classic indicator of a pit viper snakebite?
 Definition
Two small puncture wounds with discoloration, swelling, and pain
Term
Appropriate management for a patient with a poisonous snakebite includes all of the following, EXCEPT:
 Definition
applying a chemical icepack directly over the bite.
Term
When caring for a conscious and alert 7-year-old male who was bitten by a stray dog, it is important to:
 Definition
report the bite to the appropriate authorities.
Term
A 37-year-old male was swimming in the ocean when he was stung on the leg by a jellyfish. He complains of dizziness and severe pain to the affected area. The MOST effective way to inactivate the nematocysts that remain in the patient's leg is to:
 Definition
apply isopropyl alcohol to the affected area.
Term
Which of the following chemicals that are released by the immune system are responsible for an allergic reaction?
 Definition
Histamines and leukotrienes
Term
In addition to widespread urticaria, _____________ is a common response in patients experiencing a severe allergic reaction.
 Definition
bronchospasm
Term
Assuming that previous exposure and sensitization has occurred, which of the following patients will likely experience the MOST severe allergic reaction?
 Definition
A 40-year-old female who was stung by a yellow jacket
Term
Unlike the sting of a honeybee, wasps and hornets:
 Definition
can sting a person repeatedly.
Term
A 29-year-old male experienced multiple fire ant bites to his lower extremities. He is conscious and alert, and denies respiratory distress. His skin is warm, dry, and without urticaria and his breath sounds are clear and equal bilaterally. Appropriate management for this patient includes:
 Definition
applying ice to the bites and observing for signs of an allergic reaction.
Term
While assessing a patient with signs and symptoms of anaphylactic shock, you notice angioedema of the face and neck. This is caused by:
 Definition
histamine release that results in an increase in vascular permeability.
Term
Epinephrine is a critical treatment for patients with severe allergic reactions (anaphylaxis) because it:
 Definition
works rapidly to raise the BP by constricting the vasculature and improves ventilation by dilating the bronchioles.
Term
A 50-year-old male was stung two times by a yellow jacket. He has a history of coronary artery disease and thinks that he is allergic to yellow jackets. Although slightly anxious, he is conscious and alert and in no respiratory distress. Your assessment reveals clear and equal breath sounds bilaterally, and stable vital signs. Treatment for this patient should include all of the following, EXCEPT:
 Definition
subcutaneous epinephrine.
Term
Potential side effects of epinephrine include which of the following?
 Definition
Hypertension
Term
In addition to epinephrine and antihistamines, other medications that can be administered to patients with an allergic reaction include:
 Definition
inhaled beta2 bronchodilators.
Term
While stacking wood on a woodpile, a 60-year-old male experienced immediate, severe pain on the back of his hand. He complains of abdominal pain, nausea, and dizziness. Your assessment reveals that he is conscious and alert, but has an extremely rigid abdomen. You should suspect a/an:
 Definition
black widow spider bite.
Term
Which of the following statements regarding the brown recluse spider is correct?
 Definition
Its venom is cytotoxic and causes severe local tissue destruction.
Term
You are assessing a 24-year-old male who was bitten by a rattlesnake while hiking in the woods. Which of the following clinical signs would be MOST indicative of envenomation?
 Definition
Progressive tissue swelling
Term
In addition to causing local tissue destruction, the venom from a rattlesnake also causes:
 Definition
spontaneous bleeding due to interference with the blood-clotting mechanisms.
Term
A human bite should be considered more serious than a dog bite because:
 Definition
human saliva contains a wide range of virulent bacteria and viruses.
Term
Which of the following scenarios is an example of an intentional poisoning?
 Definition
A 24-year-old female sprays mace into the eyes of a perpetrator during a burglary attempt.
Term
When responding to the scene of a patient who possibly overdosed on a drug, your primary responsibility is to:
 Definition
ensure that you are safe.
Term
A 32-year-old male ingested a large quantity of Dilaudid, a powerful opiate. Which of the following clinical signs would you MOST likely encounter during your assessment?
 Definition
Respiratory depression and bradycardia
Term
In addition to managing the ABCs of a patient who was exposed to a poisonous substance, the MOST important treatment that the EMT-I can provide in the prehospital setting is to:
 Definition
dilute or physically remove the poisonous agent from the patient.
Term
What is the mechanism of action of activated charcoal when administered to a patient who has ingested a poisonous substance?
 Definition
It absorbs the toxic substance and delays the digestive process
Term
Which of the following statements regarding ethyl alcohol (ETOH) is correct?
 Definition
It stimulates the CNS at low doses and depresses it in high doses.
Term
The presence of ________________ often contributes to the signs and symptoms of acute alcohol intoxication.
 Definition
hypoglycemia
Term
Patients with acute alcohol withdrawal commonly need:
 Definition
IV crystalloid fluid boluses to treat hypovolemia.
Term
In an attempt to kill herself, a 56-year-old female ingested a large quantity of Darvon. Your initial assessment reveals that she is semiconscious, has slow respirations with reduced tidal volume, and a heart rate of 40 beats/min. Further assessment reveals that her BP is 80/50 mm Hg. Initial management for this patient includes:
 Definition
positive-pressure ventilations with a BVM and 100% oxygen.
Term
Carbon monoxide (CO) causes severe tissue hypoxia because it:
 Definition
binds to the hemoglobin molecule and inhibits cellular oxygenation.
Term
Which of the following signs or symptoms is MOST suggestive of organophosphate poisoning?
 Definition
Pupillary constriction
Term
The misuse of a drug or other substance for the purpose of producing a desired effect is called:
 Definition
substance abuse.
Term
A 47-year-old male ingested an unknown type of medication. After ensuring scene safety, you approach the patient and begin to assess him. Which of the following questions would be of LEAST pertinence with regard to the acute management of this patient?
 Definition
Why did you take the medication?
Term
Upon entering the residence of a young female with a possible toxic exposure, you begin surveying the scene. Which of the following findings would provide you with the LEAST amount of information regarding the nature of the poison?
 Definition
General condition of the living area
Term
The vast majority of all poisonings, intentional and unintentional, occur via:
 Definition
ingestion.
Term
You and your partner are standing by at the scene of a structural fire when two firefighters carry a patient to you that they rescued from one of the rooms inside the house. The patient is not moving and has no obvious burns. You should:
 Definition
determine if the patient's airway is patent and then assess ventilatory effort.
Term
When caring for a patient who was exposed to a dry chemical, it is important to:
 Definition
remove all contaminated clothing and brush away the chemical prior to irrigating.
Term
A 3-year-old 15-kg female swallowed an unknown quantity of gasoline. Your assessment reveals that she is conscious, crying, and alert. Her airway is patent and her respirations are adequate. You should
 Definition
apply 100% oxygen as tolerated and promptly transport her.
Term
You respond to the residence of a 39-year-old male who, according to his wife, is not acting right. Law enforcement has secured the scene prior to your arrival. As you assess the patient, you find that he is confused, has a fever, and is agitated. The patient's wife states that he is an alcoholic and stopped drinking approximately 5 days ago. In addition to assessing and managing his airway, you should be MOST concerned with the potential for:
 Definition
seizures.
Term
A 20-year-old female has ingested an unknown quantity of oxycodone. Your assessment reveals that she is semiconscious, bradycardic, and hypotensive. Her respirations are slow and shallow. As your partner is assisting the patient's ventilations, you should
 Definition
start an IV and administer 1 to 2 mg of naloxone and reassess her clinical condition.
Term
In addition to cardiac monitoring and IV therapy, general management for a patient with a significant benzodiazepine overdose includes:
 Definition
maintaining airway patency, assisting ventilations, and transporting.
Term
A 67-year-old female complains of nausea, vomiting, and abdominal pain that woke her from her sleep. As you and your partner enter her residence, you immediately note the smell of natural gas. Suspecting carbon monoxide toxicity, you quickly remove the patient from her home and place her in the ambulance. When assessing her, you must keep in mind that:
 Definition
a pulse oximetry reading that is high does not rule out significant hypoxemia.
Term
A 27-year-old male ingested approximately 7g of Tylenol. If not promptly treated with a specific antidote, __________ failure will occur.
 Definition
liver
Term
________________ is a disorder of the brain, in which blood flow to a portion of the brain is suddenly disrupted, resulting in brain cell death.
 Definition
Cerebral infarction
Term
An ischemic stroke is MOST often the result of a/an:
 Definition
blocked cerebral artery.
Term
A 60-year-old male with a history of poorly-controlled hypertension complains of a sudden, severe headache. Within a few minutes, his level of consciousness rapidly deteriorates. This is MOST suggestive of a/an:
 Definition
ruptured cerebral artery.
Term
A transient ischemic attack (TIA) occurs when:
 Definition
the body's normal processes destroy a cerebral thrombus.
Term
Which of the following scenarios is MOST descriptive of an absence seizure?
 Definition
A 6-year-old male who is conscious, but will not respond to his mother; symptoms subside spontaneously within a few minutes.
Term
A space-occupying intracranial lesion is an example of a/an ______________ cause of a seizure.
 Definition
structural
Term
You are dispatched to a local convenience store for a 30-year-old male who is actively seizing. Upon your arrival, the patient is semiconscious and somewhat combative. This is MOST indicative of the ___________ phase.
 Definition
postictal
Term
A patient experiencing status epilepticus:
 Definition
is having a prolonged generalized motor seizure.
Term
You are assessing a 59-year-old male with an altered mental status. You should suspect an acute ischemic stroke versus hypoglycemia if the patient:
 Definition
attempts to communicate with you.
Term
A 69-year-old female is found to be semiconscious, hypertensive, and bradypneic. You should:
 Definition
assist ventilations and start an IV set to keep the vein open.
Term
With regard to potential treatment in the hospital, which of the following questions is MOST important to ask the spouse of a 66-year-old female who presents with signs and symptoms of an acute ischemic stroke?
 Definition
When did you first notice the symptoms?
Term
A 70-year-old male presents with acute aphasia, unilateral weakness, and confusion. In addition to administering 100% oxygen, it is important to:
 Definition
assess his blood glucose level to rule out hypoglycemia.
Term
You are assessing the arm drift of an elderly male with a suspected stroke and note that both of his arms drift toward the ground. You should:
 Definition
ensure the patient understood your instructions and repeat the test.
Term
A 20-year-old female with a history of chronic epilepsy, who is compliant with her anticonvulsant medication, experiences a “breakthrough” seizure. This usually happens when:
 Definition
a seizure occurs despite a therapeutic medication blood level.
Term
__________ brain cells receive a minimal supply of oxygen and are unable to function normally.
 Definition
Ischemic
Term
To minimize the amount of brain cell damage that occurs following a stroke, fibrinolytic therapy must be administered within:
 Definition
3 hours after the onset of symptoms.
Term
A hemorrhagic stroke occurs as a result of:
 Definition
a ruptured cerebral artery.
Term
A 57-year-old female with a history of peripheral vascular disease presents with an acute onset of confusion, aphasia, left-sided hemiparesis, and loss of muscle control to the right side of her face. You should suspect an:
 Definition
arterial blockage in the right cerebral hemisphere.
Term
Patients with a hemorrhagic stroke typically experience a rapidly declining level of consciousness because of:
 Definition
increasing intracranial pressure.
Term
A 68-year-old male presents with confusion, left-sided hemiparesis, and decreased muscle tone to the right side of his face. You administer oxygen, start an IV, and begin transport to the hospital. En route, the patient becomes more coherent and slowly regains use of his left arm. These findings are MOST suggestive of:
 Definition
temporary ischemia to the right side of the brain
Term
The clonic phase of a generalized motor seizure is characterized by:
 Definition
muscle contraction and relaxation occurring in rapid succession.
Term
Which of the following conditions would MOST likely mimic the signs and symptoms of an acute ischemic stroke?
 Definition
Decrease in blood glucose
Term
You are called to the county jail for a 50-year-old male who is “drunk”. When you assess him, you note the smell of alcohol on his breath and a markedly decreased level of consciousness. The sheriff's deputy tells you that this patient is a “regular”. On the basis of the information that you have obtained, you should:
 Definition
assess the patient's blood glucose and suspect intracranial bleeding.
Term
You respond to a call for a 39-year-old female with an altered mental status. Your initial assessment reveals that she is conscious but confused, has a heart rate of 88 beats/min, and respirations of 22 breaths/min with adequate tidal volume. After administering supplemental oxygen, you should:
 Definition
perform a focused history and physical exam.
Term
You are dispatched to an assisted living center for a 67-year-old male with “mental status changes”. You arrive at the scene and begin to assess the patient. He is responsive to painful stimuli only, has rapid and shallow breathing, and a slow radial pulse. You should:
 Definition
begin assisting the patient's breathing effort.
Term
When using the Cincinnati Stroke Scale to assess a 59-year-old female with a suspected stroke, you note a left-sided facial droop when you ask her to smile. You should:
 Definition
determine if the patient has dysarthria or is unable to speak.
Term
A patient with a possible stroke is a potential candidate for fibrinolytic therapy unless he or she:
 Definition
is experiencing an intracranial hemorrhage.
Term
Treatment for a patient who has just experienced a generalized tonic-clonic seizure and is postictal includes all of the following, EXCEPT:
 Definition
giving 5 mg of diazepam via intramuscular injection.
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