You are called to transport a 67 year old male with a diagnosis of cardiogenic shock. Although the flight crew recognizes the patients suffer from a combination of hypoxia types, the most likely type of hypoxia this patient will suffer from is:

a. Hypoxic hypoxia

b. Histotoxic hypoxia

c. Hypemic hypoxia

d. Stagnant hypoxia

Complications of intubation include all of the following except:

a. Gastric distention

b. Identification of known difficult airway

c. Bronchospasm

d. Inability to identify landmarks

You are transporting a patient with a differential diagnosis of decreased level of consciousness. ABG's show pH .7.06, CO2 of 45 and a HCO3 of 10. Lab results show potassium of 6.9, sodium of 145, calcium of 10, and chloride of 102. The patient is profoundly hypotensive and you are considering a Dopamine drip. What acid base imbalance does this patient have?

a. Respiratory acidosis

b. Respiratory alkalosis

c. Metabolic acidosis

d. Metabolic alkalosis

In metabolic acidosis , what electrolyte becomes falsely elevated due to the acid-base imbalance?

a. Potassium

b. Sodium

c. Calcium

d. Chloride

Complications of PEEP are:

a. Increased cardiac output, decreased 02 sats, increased venous return

b. Decreased cardiac output, subcutaneous emphysema, pneumothorax

c. Increased cardiac output, increased 02 sats, increased renal perfusion

d. Decreased intracranial pressure, decreased CO2 levels, increased venous returns

Indications for intubation of the asthmatic patient include:

a. Vital capacity above the level of tidal volume

b. pH above 7.2

c. pPgreaterthan5SinmHg

d. p02 less than 80 mmHg

There are two common types of ventilators used in the transport setting, volume cycled ventilators and pressure cycled ventilators. When using a pressure cycled ventilator, the flight crew knows:

a. The ventilator triggers until a preset pressure limit is reached.

b. The ventilator triggers until a preset volume is reached.

c. Pressure cycled ventilators are preferred with ARDS patients.

d. The ventilator delivers a consistent Vt while adhering to pressure limits.

Cerebral Perfusion Pressure (CPP) is calculated from which of the following:

a. Mean Arterial Pressure (MAP) and intracranial pressure (ICP)

b. Systolic blood pressure (SBP) and ICP

c. Diastolic blood pressure (DBP) and ICP

d. The SBP and DBP

Normal adult CPP range is:

a. 40 to 60 mmHg

b. 50 to 70 mmHg

c. 60 to 80 mmHg

d. 70 to 90 mmHg

Diffuse Axonal Injury (DAI) is defined as:

a. Prolonged post-traumatic coma that is not due to a mass lesion or ischemic insults
b. A prolonged hypoxic episode
c. A venous bleed in the Circle of Willis
d. An injury that results in transient alterations of consciousness

When monitoring invasive intracranial pressure lines, the zero line of the transducer should be leveled at the:

a. Foramen of Kellie, level with the 4th ICS, mid-axillary
b. Foramen of Monro, level with the auditory meatus
c. Foramen of Magnum, level with the basilar portion of the skull

d. Foramen of Ovale, level with the auditory meatus

Calculate the following patient's cerebral perfusion pressure:

BP = 150/75 HR= 140 RR=28 Sa02=100% CVP=2 ICP=25

a. 98
b. 125
c. 65
d. 75

In addition to glucose, which electrolyte must be maintained within normal limits for the head injured patient?

a. Calcium
b. Magnesium
c. Potassium
d. Sodium

Myoglobinuria if left untreated will result in what condition?

a. Polycystic kidney disease
b. Cardiomyopathy
c. Acute tubular necrosis
d. Hyperkalemic crisis

Massive hemothorax in an adult is defined as a rapid accumulation of more than:

a. 500 mL of blood
b. 750 mL of blood
c. 1500 mL blood
d. 2000 mL of blood

Beck's triad is defined as:

a. Narrowed pulse pressure, positive JVD and orthopnea
b. Widened pulse pressure, tachycardia and muffled heart tones
c. Widened pulse pressure, positive JVD and a friction rub
d. Narrowed pulse pressure, positive JVD. muffled heart tones

Appropriate placement for a needle thoracostomy is:

a. 2nd intercostal space, mid-clavicular line, superior to the 3rd rib

b. 4th intercostal space, mid-clavicular line, superior to the 5th rib
c. 3rd intercostal space, mid-axillary line, inferior to the 3rd rib

d. 6th intercostal space, mid-axillary line, inferior to the 5th rib

Fractures of the first through third ribs should indicate a high index of suspicion for which injury:

a. Esophageal rupture
b. Great vessel injury
c. Pulmonary contusion
d Internal mammary artery laceration

When transfusing a patient with multiple units of blood, the flight crew knows this may result in citrate toxicity. What electrolyte is indicated to counteract citrate toxicity?

a. Calcium
b. Magnesium
c. Potassium
d. Sodium

Which key sign differentiates a tension pneumothorax from a simple pneumothorax?

a. Hyperresonance on the injured side
b. Decreased or absent breath sounds on the injured side
c. Dyspnea, tachypnea
d. Tracheal deviation with a shift towards the uninjured side

Complications of pericardiocentesis include all of the following except:

a. Laceration of coronary artery or vein
b. Pneumothorax
c. Left mainstem bronchial perforation
d. Ventricular fibrillation

When faced with intubating a 4 year old patient, the flight crew calculates the appropriate uncuffed ETT size to be:

a. 4.0 ETT
b. 4.5 ETT
c. 5.0 ETT
d. 5.5 ETT

Steeple sign on the AP neck film indicates what pediatric respiratory problem?

a. Croup
b. Epiglottitis
c. Bronchiolitis
d. Foreign body obstruction

Cardiac conduction abnormalities associated with hyperkalemia include all of the following except:

a. Peaked T wave
b. Absent P wave
c. Appearance of a U wave
d. Prolonged PR interval

EKG abnormalities associated with an anterior wall MI include:

a. Bradycardia
b. First Degree AV block
c. Second Degree AV block
d. Right Bundle Branch Block

Pulmonary capillary wedge pressure is reflective of:

a. Left ventricular end diastolic pressure
b. Afterload of the heart
c. Right sided preload
d. Right ventricular pressures

A murmur associated with mitral valve regurgitation is associated with all of the following except:

a. Pansystolic murmur
b. Blowing quality, high pitched
c. Loudest at the second intercostal space, right sternal border
d. Radiates to the left axilla

The dicrotic notch on the arterial waveform is reflective of what mechanical event in the heart?

a. Aortic valve closure
b. Mitral valve closure
c. Pulmonic valve closure
d. Tricuspid valve closure

On 12 lead EKG's, posterior wall MI's manifest as:

a. ST elevation in II, III and AVF
b. ST depression in II, III and AVF
c. ST depression In V1-V4 with abnormal to R waves
d. ST elevation in V1-V4 with abnormal tall R waves

Inferior wall MI's are the result of obstruction of what coronary vessel?

a. LCX
b. LAD
c. RCA
d. LCX and RCA

Which of the following is the best definition of shock?

a. Impaired metabolism
b. Impaired tissue perfusion
c. Impaired oxygen transport
d. Impaired oxygen diffusion

A positive plantar's reflex in an adult indicates:

a. Upper motor neuron lesion
b. Peripheral neurovascular disease
c. Lower motor neuron lesion
d. Meningeal irritation

Which of the following is an acute reaction to stress while working in the air medical environment?

a. Chronic illness
b. Negative patient interactions
c. Chronic failure to meet financial obligations
d. Nightmares

Which values would indicate acute respiratory failure in a patient with normal lung function?

a. PCO2 above 40 mmHg, P02 below 40 mmHg
b. PCO2 less than 20 mmHg, P02 below 60 mmHg
c. PCO2 above 50 mmHg. P02 below 60 mmHg
d. PCO2 below 60 mmHg, P02 below 70 mmHg

You are caring for a 52 year old female patient with a history of pulmonary hypertension. There are invasive hemodynamic monitoring lines in place. You would expect increases in all of the following measurements due to the pulmonary hypertension except:

a. PCWP
b. PAP
c. PVR
d. RVP

The 12 lead EKG is used to evaluate all of the following except:

a. Pulse rate
b. Valvular dysfunction
c. Conduction abnormalities
d. To isolate waveforms indicative of AMI

Symptoms in the early stages of septic shock include:

a. Warm. flushed moist skin
b. Weak thready pulses with hypotension
c. Decreased urine output with elevated BUN
d. Bilateral crackles

In a two year old child with vomiting, fever and irritability, the flight crew should immediately examine for:

a Fluid behind the tympanic membrane
b. Abdominal tendernes
c. Respiratory wheezing
d. Skin rash

The goal in ICP management in the head injured patient is to maintain:

a. ICP below 40 mmHg
b. MAP above 120 mmHg
c. CPP above 75 mmHg
d. DBP below 90 mmHg

What is the most common cause of esophageal varices?

a. Pulmonary hypertension
b. NSAID misuse
c. Pancreatic trauma
d. Hepatic congestion

Which chamber of the heart is susceptible to myocardial contusion?

a. Right atrium
b. Left ventricle
c. Right ventricle
d. Left atrium

You are preparing to transport a 28 year old female from Costa Rica to Houston, Texas. The report from the patient's nurse advises the patient was struck by a car, fell off her motorcycle and struck her head on the pavement She had initial loss of consciousness, but was awake, alert and oriented upon EMS arrival. Approximately twelve minutes into the transport the patient became unresponsive to verbal stimuli. Pupils were unequal, with the right 6mm/unreactive, left 3mm/sluggish. Sternal rub elicited decorticate posturing. Which type of ICB does this presentation indicate?

a. Subdural hematoma
b. Intercerebral hemorrhage
c. Subarachnoid hemorrhage
d. Epidural hematoma

Which of the following is NOT an uncommon sequelae of cardiac surgery?

a. Pneumonia
b. Pericarditis
c. Hypokalemia
d. Hyperkalemia

Widened pulse pressure, increased systolic blood pressure and bradycardia is known as:

a. Cushing's triad
b. "Steeple" sign
c. Oslo's response
d. Kehr's triad

Which of the following is commonly associated with bacterial meningococcal meningitis?

a. Petechiae
b. Hemoptysis
c. Nystagmus
d. Severe hypertension

What is the pathophysiology behind cardiogenic shock?

a. Impaired pumping action of the heart
b. Viral infection
c. Decreased intravascular volume
d. Bacterial infection

A 24 year old patient took an unknown amount of Elavil and Paxil. Which of the following would notbe a sign of tricyclic antidepressant toxicity?

a. Seizures
b. Hypothermia
c. Urinary incontinence
d. Sinus tachycardia

The gas law that has the most impact on care of a patient with compromise of the gastrointestinal system is:

a. Vance's law
b. Dalton's law
c. Boyle's law
d. Charles' law

You are transporting a 22 year old male whose house caught fire after he fell asleep while smoking. Yesterday, he sustained 35% deep thermal partial thickness burns to the arms and torso. Which lab value would be the best indication that the patient has received adequate fluid resuscitation in the last 24 hours?

a. Sodium 139 mEq/L
b. Cardiac index 2.2 L/min/mL
c. HCT 63%
d. Urine output 42mL/hr

Which form of shock includes hypotension and bradycardia?

a. Anaphylactic shock
b. Cardiogenic shock
c. Neurogenic shock
d. Septic shock

Shock produces an increase in

a. Lactic acid
b. Hemodynamic parameters
c. Oxygen metabolism
d. Alkalosis

What is the most common prequel to pediatric cardiac arrest?

a. Electrical injury
b. Penetrating trauma
c. Congenital heart defects
d. Respiratory arrest

In a 12 lead EKG, ST segment elevation is an indicator of:

a. Myocardial injury
b. Myocardial ischemia
c. Hypermagnesemia
d. Cardiomyopathy

While packaging an ARDS patient for transport you notice that the ventilator has been set on inverse ratio ventilation. Which complication should you monitor for?

a. Air trapping
b. Tracheal deviation
c. Hemothorax
d. Microbarotrauma

Which of the following would NOT be an indication for intubation in the patient with an acute asthma attack?

a. Respiratory fatigue
b. ABG results of pH 7.36. P02 70, PCO2 45
c. Inability of patient to speak in sentences
d. Confusion and/or agitation

Which of the following is NOT a causative factor for hypovolemia in the setting of septic shock?

a. Increased insensible fluid loss
b. Plasma fluid trapped in the interstitial space
c. Increased capillary permeability
d. Increased vascular resistance

PEEP causes an increase in:

a. Pulmonary vascular resistance
b. Mean arterial pressure
c. Preload
d. Cardiac output

What type of abnormal metabolism occurs during shock?

a. Krebian metabolism
b. Aerobic metabolism
c. Anaerobic metabolism
d. Hypoxic metabolism

An S3 is indicative of:

a. Epicarditis
b. Mitral valve prolapse
c. Congestive heart failure
d. Hypovolemia

In the presence of midface trauma with instability, which airway maneuver would be contraindicated?

a. Nasotracheal intubation
b. Oral intubation
c. Oropharyngeal suctioning of foreign bodies
d. Digital intubation

You are evaluating a patient who is s/p blunt abdominal trauma after being struck multiple times with a crowbar. On review of the patient's X-ray, an elevated right diaphragm is noted. What injury should you be suspicious of, based on this X-ray finding?

a. Pneumothorax
b. Hemothorax
c. Ruptured spleen
d. Diaphragmatic rupture or tear

Which type of facial fracture is pyramidal, involving the middle facial area?

a. LeFort I
b. LeFort II
c. LeFort III
d. Orbital

When administering PEEP, it is important to monitor for this common side effect:

a. Hypertension
b. Hypotension
c. Hearing loss
d. Hyperkalemia

Which intervention would be inappropriate for the patient in cardiogenic shock?

a. Furosemide 1.5 times daily dose IVP
b. Dobutamine titrated to maintain SBP > 100 mmHg
c. NS 150 mL/hr continuous
d. Oxygen 6 LPM via NC, humidified

c. NS 150 mL/hr continuous

Which of the following is NOT a sign of increased intracranial pressure?

a. Hypotension

b. Vomiting

c. Bradycardia

d. Irritability

Dysfunction of which organ can lead to clotting abnormalities?

a. Liver

b. Bone marrow

c. Thyroid

d. Spleen

Raccoon's eyes (periorbital ecchymosis) is a sign of:

a. Middle fossa fracture

b. Posterior fossa fracture

c. Anterior fossa fracture

d. Temporal fracture

What is the advantage of an intraventricular catheter in monitoring intracranial pressure?

a. Infection risk is low

b. Allows cerebrospinal fluid drainage

c. Very low complication rates
d. Easily inserted

Which of the following may reduce a trauma patient's risk for fat embolus?

a. Monitoring compartment pressures

b. Oxygen via NRB

c. Ice and passive ROM exercises

d. Immobilizing and splinting extremity fractures

For any patient with an altered level of consciousness, which nursing diagnosis must be addressed?

a. Risk for decreased cardiac output

b. Risk for ineffective airway clearance

c. Risk for hypothermia

d. Risk for noncompliance

The most common reperfusion dysrhythmia is:

a. Ventricular tachycardia

b. Atrioventricular block

c. Sinus bradycardia

d. Accelerated idioventricular

Which of the following would NOT be indicated before transport of a patient in neurogenic shock?

a. Administration of corticosteroids

b. Elevating head of the stretcher

c. Insertion of a urinary catheter

d. Serial Glasgow Coma Scale scores

The most common form of shock is:

a. Distributive

b. Cardiogenic

c. Septic

d. Hypovolemic

Typical systolic blood pressure of a 6 year old child (50th percentile) is:

a. 100 mmHg

b. 110 mmHg

c. 102 mmHg

d. 92 mmHg

Fluid resuscitation in the profoundly hypothermic patient needs to be initiated to reduce the risk of acute tubular necrosis. Which is the best parameter to monitor and assess the effectiveness of the fluid resuscitation?

a. Increases in CVP and urinary output

b. Increase in peripheral pulses

c. Increase in mental status

d. Increase in core body temperature

In a 17 year old male involved in a motorcycle accident, priapism would indicate:

a. Transection of the urethra

b. Testicular trauma

c. Neurological or spinal trauma

d. Cranial nerve disruption

Select the normal range for central venous pressure:

a. 5-15 mmHg

b. 3-10 mmHg

c. 20-30 mmHg

d. 0-7 mmHg

The spleen performs the hematologic function of:

a. Stimulating erythrocyte formation

b. Producing antibodies

c. Forming clotting factors

d. Producing leukocytes

During pericardiocentesis, the flight crew should:

a. Have the patient perform the Valsalva maneuver

b. Monitor the patients EKG in a V lead

c. Place the patient flat

d. Collect the pericardial fluid in a Sagstenmore tube

When evaluating a c-spine film, how many cervical vertebrae should be seen?

a. 5

b. 6

c. 7

d. 8

Which test shows the functioning of the intrinsic clotting mechanism?

a. PTT

b. PT

c. INR

d. Platelet count

When turning over care of a trauma patient with a chest tube, you note a member of the trauma team clamping the chest tube. What complication may occur due to damping a chest tube?

a. Pericardial tamponade

b. Hemothorax

c. Tension pneumothorax

d. Hemopneumothorax

Airway obstruction is most often caused by:

a. Bronchospasm

b. Relaxation of the tongue

c. Foreign body

d. Aspiration

Which of the following is NOT an organism that commonly causes bacterial meningitis?

a. Haemophilus influenza

b. Streptococcus pneumonia

c. Staphylococcus klebsiella

d. Neisseria meningitidis

You are transporting a 36 year old female who recently started developing blood in her stools. She has been on Coumadin for years and presented to the hospital with bright red blood in her stools. Which of the following is NOT an appropriate intervention?

a. Volume replacement
b. Whole blood
c. Protamine sulfate
d. FFP

In the pediatric patient, blood pressure changes may not be evident until the loss of what percentage of blood?

a. 5%

b. 10%

c. 15%

d. 25%

During which phase of the cardiac cycle does coronary perfusion take place?

a. Depolarization
b. Systole
c. Repolarization
d. Diastole

Rapid SVT that may develop in the immediate post resuscitation period should be addressed by:

a. Medicating with beta blockers
b. Continued monitoring
c. Administering digoxin
d. Utilizing vagal maneuvers

Patients who experience an inferior wall Ml are also at significant risk for:

a. Left ventricular infarction
b. Fluid overload
c. Septal wall infarction
d. Right ventricular infarction

ST segment elevation in V1 through V6 is suspicious for:

a. LAD occlusion
b. Inferior wall infarct
c. Circumflex occlusion
d. RCA occlusion

Which nursing diagnosis would be appropriate for the spinal cord injury patient with poikilothermy?

a. Pain
b. Knowledge deficit
c. Ineffective thermoregulation
d. Decreased cardiac output

Acute spinal cord injury will cause respiratory paralysis at and above the level of

a. C6
b. C4
c. T1
d. C7

Mediastinal widening, presence of apical cap, extrapleural hematoma, loss of aortic knob and left pleural effusion are all signs of:

a. Aortic trauma
b. Abdominal aortic aneurysm
c. Pericardial effusion
d. Myocardial contusion

Which of the following is a sign of renal trauma?

a. Dysuria
b. Oliguria
c. Positive Berwick's sign
d. Hematoma over flank

All of the following are likely causes of mental confusion in the septic patient except:

a. Alkalosis resulting from hyperventilation
b. Decreased cerebral perfusion
c Accumulation of metabolic waste products
d. Endotoxins affecting the CNS

Your patient's EKG is demonstrating sinus tachycardia at 124 with peaked T waves and an ABG indicates a pH of 7.2, PCO2 13, HCO3 10 and P02 104. The patient's CMP reveals NA+ 132, K+ 2.5, Cl- 97, HCO3- 10, BUN 44, Creat 2.0 and glucose of 685. The most appropriate diagnosis would be:

a. Primary hypokalemia

b. ARDS

c. Asthma

d. DKA

Your patient's peripheral arterial line is showing a very sharp waveform with readings that appear to

be "exaggerated". This may be due to:

a. Catheter embolus formation

b. Catheter "whip"

c. Over-damping of the pressure system

d. Kinking of the pressure tubing

When assessing CVP or PA pressures on a mechanically ventilated patient, the pressures should be assessed at:

a. Beginning inhalation

b. Beginning exhalation

c. End inhalation

d. End exhalation

In a healthy adult patient, normal cardiac output is:

a. 4-8 liters/mm

b. 2-4 liters/mm

c. 8-10 liters/mm

d. 4-6 liters/mm

Your patient is most likely to experience barotitis media on:

a. Ascent

b. Descent

c. Cruise flight

d. Ground taxi

You notice that the waveform on your patient's arterial line is over dampened. The most likely cause of this is:

a. Fluid in the system

b. Air in the system

c. Patient needs to be in prone position for accurate reading

d. Pressure bag has less than 300 mmHg

Your patient has significant hypemic hypoxia. Which of the following is NOT likely a cause?

a. Hemorrhage

b. Anemia

c. Drugs (i.e. nitrates)

d. Pulmonary embolus

The percentage of oxygen at 25,000 MSL is:

a. 4%

b. 16%

c. 21%

d. 27%

Which of the following represents normal mixed venous blood gas?

a. pH 7.25-7.35, CO2 40-50, HCO3 22-26, Pa02 40-60, Sa02 70-75%, BE -2- +2

b. pH 7.31-7.41, CO2 35-45, HCO3 22-26, Pa02 80-100, Sa02 >95%, BE -2 - +2

c. pH 7.31-7.41, CO2 40750, HCO3 22-26, Pa02 3540, Sa02 70-75%. BE -2- +2

d. pH 7.35-7.45, CO2 35-45, HCO3, 22-26, Pa02 80-100, Sa02 >95%, BE -2- +2

Your patient presents with the following ABG's: pH7.30LPCO2 26, HCO3 12 and P02 126. Which of the following acid-base balance does this patient have based off ABG’s?

a. Metabolic acidosis

b. Respiratory acidosis

c. Metabolic alkalosis

d. Respiratory alkalosis

Which of the following represents normal ventilator settings for an adult patient?

a. Vt 6-10 cc/kg, Rate 8-20 min- LE ratio 1:2 or 1:3, F102 0.21-1.00, Pplat <35

b. Vt 2-6 cc/kg, Rate 8-20 mm, I:E ratio 1:4 or 1:5, F102 0.21-0.31, Pplat >80

c. Vt 10-20 cc/kg, Rate 8-20 min, l:E ratio 1:10, F102 0.21-1.00, Pplat <2

d. Vt 12-20 cc/kg, Rate 8-20 min, LE ratio 1:1 or 1:2, F102 0.21-0.50, Pplat 100

Which of the following correctly illustrates the flow of blood through the heart?

a. Right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary vein, lungs, pulmonary artery, left atrium, mitral valve, left ventricle, aortic valve, aorta

b. Right atrium, mitral valve, right ventricle, pulmonic valve, pulmonary artery, lungs, pulmonary vein, left atrium, tricuspid valve, left ventricle, aortic valve, aorta

c. Right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, lungs, pulmonary vein, left atrium, mitral valve, left ventricle. aortic valve, aorta

d. Right atrium, mitral valve, right ventricle, aortic valve, aorta, pulmonary artery, lungs, pulmonary vein, left atrium, tricuspid valve, left ventricle

The LCX supplies which part of the heart with blood?

a. Primarily lateral wall of the left ventricle

b. Anterior surface of the heart, part of the lateral wall

c. Right atrium, right ventricle

d. Inferior and posterior walls of the left ventricle

Your patient has a chief complaint of dyspnea and weakness with the following vitals: HR 112, BP 72/64, RR 28, Sp02 88%, temperature 99.1 F. He is on 6 LPM via NC, EKG shows sinus tachycardia with frequent PVC's. Physical exam reveals profound vesicular rales and bronchial wheezing. Your most likely diagnosis is:

a. CHF

b. ARDS

c. Asthma

d. Cardiogenic shock

Increased PA pressures would be seen in all the following except:

a. Fluid overload

b. Hepatic congestion

c. Atrial or ventricular defects

d. Mitral stenosis/regurgitation

Which of the following is NOT a cause of Syndrome of Inappropriate AntiDiuretic Hormone (SLADH)?

a. Oat cell carcinoma

b. Dilantin

c. Head injury

d. Viral pneumonia

Your patient has been diagnosed with Hyperglycemic Hyperosmolar NonKetotic Coma (HHNC). Which of the following is characteristic of this condition?

a. No ketones in urine

b. Insulin therapy guided by serial BGL's

c. Decreased BUN

d. Hyponatremia

Dramatic weight loss, fever, chest pain, difficulty in breathing, palpitations, tremors and marked tachycardia (atrial fibrillation common) are all characteristic of:

a. Myxedema coma/Hypothyroidism

b. Cushing's syndrome/Hyperaldosteronism

c. Addison's disease/Adrenal insufficiency

d. Grave's disease/Thyrotoxicosis ('Thyroid storm)

In pediatric hyperthermia, for every 1 degree Celsius that the temperature rises above 37 degrees Celsius, which of the following physiologic responses happens?

a. Heart rate increases 20 BPM, respiratory rates increases 10 BPM

b. Heart rate decreases 20 BPM, respiratory rate decreases 10 BPM

c. Heart rate increases 10 BPM, respiratory rate increases 5 BPM

d. Heart rate decreases 10 BPM, respiratory rate decreases 5 BPM

Your pediatric patient had a VP shunt placed 4 weeks ago. The flight crew knows that the shunt originates where and terminates where?

a. Originates in ventricles of brain, terminates in thoracic cavity

b. Originates in subdural space, terminates in peritoneal cavity

c. Originates in ventricles of brain, terminates in peritoneal cavity

d. Originates in subarachnoid space, terminates in thoracic cavity

From the question above, which of the following are NOT signs of a shunt malfunction?

a. Signs of increasing ICP

b. Fever

c. Profound hypotension

d. Seizures

Before packaging a patient for a 20 hour flight, the patient's physician decides to place a subclavian central line due to poor peripheral access. Which of the following must be done prior to using the central line?

a. Aspiration of blood and able to easily infuse fluids.

b. Confirmation of placement via X-ray

c. Confirmation of placement via CT scan

d. Line must be transduced and CVP waveform documented

Which of the following are the normal parameters for Pulmonary Artery Pressures (PAP)?

a. 15-30 mmHg /6-12 mmHg

b. 100-130 mmHg/60-90 mmHg

c. 100-130 mmHg/4-12 mmHg

d. 25-30 mmHg/0-8 mmHg

Which of the following abdominal organs are NOT hollow?

a. Stomach

b. Ovaries

c. Bladder

d. Uterus

Hematochezia is the presence of blood in:

a. Urine

b. Emesis

c. Cheese

d. Stool

The difference between FAR Part 135 vs FAR Part 91 is:

a. Part 135 is activated when a paying passenger is on board. Part 91 has no patient on board

b. Part 91 is activated when a paying patient is on board, Part 135 has no patient on board

c. Part 135 is only applicable in the continental United States, Part 91 refers to international

d. Part 91 is only applicable in the continental United States, Part 135 refers to international

CAMTS stands for:

a. Committee on Accreditation of Medical Transport Systems

b. Commission on Accreditation of Medical Transport Systems

c. Commission on Accreditation of Medical Transport Status

d. Committee on Accreditation of Multi Transport Systems

Normal adult male Hemoglobin values are:

a. 13.2-17.3 g/dL

b. 4.3-5.7 cells/mcl

c. 10.7-17.1 g/dL

d. 3.8-5.1 cells/mcl

While reviewing your patient's lab values, you notice that the patient has a decreased WBC count Which of the following is NOT a cause of decreased WBC's?

a. Hepatitis

b. Influenza

c. Leukemia

d. Mononucleosis

BUN/Creatinine ratio is used to evaluate:

a. Acid-base balance, electrolyte balance and fluid status

b. Renal and urinary tract function

c. Endocrine, calcium and renal disorders

d. Renal function (Pre-renal failure vs Acute Tubular Necrosis)

All of the following are common causes of pacemaker loss of capture except:

a. Dislodgement

b. Battery depletion

c. Variability in rate

d. Lead fracture

Aortic dissections are divided into how many different types?

a. 2

b. 3

c. 4

d. 5

Your patient is experiencing an acute inferior wall myocardial infarction. Which of the following is an appropriate initial intervention?

a. Right sided EKG

b. Support with vasopressor agents

c. Initiate interventions to decrease pre-load

d. Order a stat CBC

Which of the following best describes hypemic hypoxia?

a. Occurs when conditions exist that reduce cardiac output, pool blood in certain regions of the body, or decrease/resist blood flow

b. Reduction in the oxygen carrying capacity of the blood

c. Tissue poisoning that occurs when metabolic disorders or poisoning results in the cell's inability to use molecular oxygen

d. Deficiency in alveolar oxygen exchange

Increased pain during ascent, and relieved on descent, your patient is most likely to experience:

a. Barotitis Media

b. Barosinusitis

c. Barodontalgia

d. Tinnitus

Your patient has been diagnosed with an epidural hematoma. The flight crew knows that the difference between acute and sub-acute bleeds is:

a. Acute is arterial in nature, sub-acute is venous in nature

b. Acute is venous in nature, sub-acute is arterial in nature

c. Acute primarily affects patients >70 years old due to cerebral atrophy, sub-acute affects primarily those <70 years old

d. There is no difference

One of the primary causes of Diabetes Insipidus (DI) is:

a. Obesity

b. Head injury

c. Hyperglycemia

d. Chronic pancreatitis

Which of the following are the correct hypothermic ranges:

a. Mild 32-36 C. Moderate 29-32 C. Severe <28 C

b. Mild 34-36 C, Moderate 30-34 C, Severe <29 C

c. Mild 31-35 C, Moderate 28-30 C, Severe <27 C

d. Mild 33-37 C, Moderate 27-32 C, Severe <26 C

The following are all presentations of pancreatitis except:

a. Elevation of left diaphragm

b. Renal failure

c. Cullen's sign (periumbilical bruising)

d. Hyperglycemia

Heat is transmitted in all of the following ways except:

a. Conduction

b. Evaporation

c. Suspension

d. Radiation

Which of the following is NOT a normal sequalae during pregnancy?

a. Increased blood volume

b. Increased respiratory rate

c. Decreased breath sounds

d. Decreased arterial pH

d. Decreased arterial pH

When assessing a pediatric blood pressure, the formula for a normal blood pressure is which of the following?

a. 90+ (2X the child's age in years)

b. 60+ (2 X the child's age in years)

c. 70 + (2 X the child's age in years)

d. 90 + (3 X the child's age in years)

a. 90+ (2X the child's age in years)

Your patient presents with inappropriate speech, abnormal flexion, and eye opening to pain. What is the patients GCS?

a. 7

b. 8

c. 6

d. 9

The major intracellular cation is:

a. Magnesium

b. Sodium

c. Potassium

d. Calcium

Which organ is the primary regulator of fluid and electrolyte balance in the body?

a. Kidneys

b. Bladder

c. Lungs

d. Intestines

You are transporting a patient from a third world country back to the United States. The patient was admitted to the hospital for shortness of breath. Only medical history is mild COPD. It is very obvious upon initial patient contact that the level and quality of care has been very poor. Your patient presents with altered mental status, intense thirst and fatigue. Physical assessment reveals peripheral and pulmonary edema, postural hypotension and tachycardia. Lab results are NOT available. Based solely on the above information, the flight crew would suspect this patient is suffering from:

a. Hyperkalemia

b. Hypocalcemia

c. Hypernatremia

d. Hypomagnesia

Which of the following medical conditions is most often seen in patients with chronic metabolic acidosis?

a. COPD

b. ARDS

c. CRF

d. Cystic Fibrosis

In a healthy adult, the approximate average daily urine output is:

a. 1500 ml

b. 2000 ml

c. 800 ml

d. 1000 ml

While evaluating your male patients' most recent lab results, you notice his hematocrit is 80%. Which of the following is a reasonable explanation for this?

a. Acute hemorrhage

b. Dehydration

c. Over-hydration

d. Acute Renal Failure

Approximately what percentage of potassium is located within the cells in the human body?

a. 2%

b. 26%

c. 72%

d. 98%

All of the following are stressors of altitude except:

a. Hypoxia

b. Dehydration

c. Vibration

d. Barometric pressure

All of the following are stressors of flight except:

a. Noise

b. Thermal changes

c. Gravitational forces

d. Third spacing

When preparing a patient for flight, all air filled balloons should be replaced with saline. The gas law which applies to the rationale behind this is:

a. Boyle's Law

b. Charles' Law

c. Henry's Law

d. Dalton's Law

Which of the following cations play a major role in muscle contraction as well as nervous impulse transmissions?

a. Calcium

b. Magnesium

c. Sodium

d. Chloride

All of the following are reasons for a hypochloremia value except:

a. Gastric suctioning

b. Renal failure

c. Diuretic use

d. Diarrhea

You are transporting a 34 year-old female who sustained multiple long bone fractures while hiking in Greece. She is being repatriated to the United States. Her only medical history is asthma, for which she has an extensive history of intubations due to status asthmaticus. During the flight, she has a severe asthma attack. Despite your aggressive treatments, she rapidly decompensates and you and your partner decide to intubate. She is successfully intubated via RSI with no complications. Which of the following represents the most appropriate vent settings for this 70 kg patient?

a. AC, Vt 700 mL, rate 16, Fi02 1.0, PEEP 10, I:E 1:2

b. SIMV, Vt 560 mL, rate 12-14, Fi02 0.30, PEEP 10, I:E 1:3

c. AC, Vt 500mL, rate 8-10, Fi02 1.0, PEEP none, I:E 1:4

d. SIMV, Vt 650 mL, rate 18, F102 0.60, PEEP 5, l:E 2:1

When auscultating heart sounds, the S1 sound is indicative of:

a. Mitral and tricuspid valve closure

b. Aortic and pulmonic valve closure

c. Mitral and tricuspid valve opening

d. Aortic and pulmonic valve opening

When auscultating the pulmonic area of the heart, you should place your stethoscope:

a. On the fifth ICS on the midclavicular line

b. On the fifth ICS to the left of the sternum

c. On the second ICS to the left of the sternum

d. On the second ICS to the right of the sternum

All of the following are dialysis related complications except:

a. Hyperkalemia

b. Fluid overload

c. Hypernatremia

d. Infection

All of the following are correct differences between pediatric and adult anatomic respiratory systems except:

a. Pediatrics are obligate mouth breathers

b. Pediatrics have a funnel shaped larynx

c. Pediatrics have a proportionately larger tongue

d. Pediatrics have a more "floppy" epiglottis

In order to get accurate readings from an invasive line, the transducer must be placed at a level corresponding to the __________. The phlebostatic axis is located at the, and is the correct location for placement.

a. left atrium, 4th ICS midaxillary line

b. right atrium, 6th ICS midclavicular line

c. right atrium, 4th ICS midaxillary line

d. left atrium, 6th ICS midclavicular line

1 Unit of PRBC's will produce a ____% rise in hematocrit.

a. 3

b. 5

c. 7

d. 9

For every 1,000 foot increase in altitude, the temperature drops _____degrees Celsius.

a. 1

b. 2

c. 3

d. 5

Adequate urinary output in an infant is ______mL/kg/hr while adequate urinary output in an older child is ______ mL/kg/hr.

a. 1-2, 0.5-1

b. 0.5-1, 1-2

c. 4-6, 5-7

d. 2-4, 2-3

The normal pulsation created by contraction of the left ventricle is called the point of maximum impulse (PMI). Normally, the PMI is located:

a. 2nd ICS, midclavicular line

b. 3rd ICS, midclavicular line

c. 4th ICS, midclavicular line

d. 5th ICS, midclavicular line

What term is used to describe worsening shortness of breath in the upright position?

a. Orthopnea

b. Platypnea

c. Apnea

d. Eupnea

Which of the following disorders is NOT likely to be associated with hemoptysis?

a. Esophageal varices

b. Pulmonary embolism

c. Bronchitis

d. Pericarditis

Which of the following conditions is LEAST likely to produce jugular venous distention?

a. Hypervolemia

b. Chronic left heart failure

c. Cardiac tamponade

d. Liver failure

Your patient, who has been immobilized in bed for the last 12 days s/p pelvic fracture, is complaining of an acute onset of pleuritic chest pain and shortness of breath. You suspect an acute pulmonary embolus. Which of the following laboratory tests would be most useful in helping to form your differential diagnosis?

a. PT

b. PTT

c. D-dimer

d. INR

Creatinine tests measure which of the following?

a. Waste product of skeletal muscle and is an indicator of renal function

b. The amount of urea nitrogen in the blood

c. Hydration status of the patient

d. Renal clearance time

You are reviewing your patient's latest BMP results. Which of the following laboratory values is NOT normally included in the panel?

a. Calcium

b. Phosphate

c. Chloride

d. Potassium

Your patient's chloride level is currently 87 mEq/L. The normal level is 100-108 mEq/L. Which of the following is NOT a cause of hypochloremia?

a. Renal failure

b. Diarrhea

c. Diuretic use

d. Vomiting

All of the following are causes of metabolic acidosis except:

a. Renal failure

b. Shock

c. Pulmonary edema

d. DKA

Which of the following should be your first priority in establishing after a crash in a remote area?

a. Shelter

b. Water

c. Fire

d. Food

Who has the responsibility of establishing safety in the aircraft?

a. PIC, pilot in command

b. FO, first officer

c. Everyone

d. Flight attendant

Oxygen can be stored in the peripheral tissues.

a. True

b. False

Systemic vascular resistance is decreased in all the following types of shock except:

a. Cardiogenic

b. Neurogenic

c. Anaphylactic

d. Distributive (septic)

The respiratory system utilizes chemical receptors in which part of the brain to aid in pH regulation?

a. Pons

b. Medulla

c. Cerebellum

d. Cerebrum

Serum amylase and lipase can be used as sole indicators to diagnose pancreatitis.

a. True

b. False

Your patient has a one week history of hematochezia and melena. The patient also has an accompanying history of weakness and dizziness. These findings would be most indicative of:

a. Peptic ulcer disease

b. Lower GI bleed

c. Esophageal varices

d. Mallory-Weiss syndrome

In which of the following structures does the regulation of arterial blood pressure by altering sodium excretion occur?

a. Kidneys

b. Liver

c. Small intestine

d. Heart

Your patient has a history of severe asthma with numerous intubations. The physical state of the lungs in between attacks, when there are no respiratory issues, is:

a. Chronic bronchoconstriction

b. Chronic bronchodilation

c. No pathological changes

d. Increased PAP

The contraction of a skeletal muscle begins with the release of:

a. Norepinephrine

b. Acetylcholine

c. n-Acetylsistine

d. Calcium

b. Acetylcholine

The patient you are caring for has suffered significant second degree burns on both arms and stomach. All of the following systemic changes occur as a result of burns with the exception of:

a. Increase in intracapillary colloid osmotic pressure

b. More severe the burn, the more protein is lost

c. Increased capillary permeability around the burn site

d. Leaking of colloids from damaged capillaries and into interstitial spaces

Your patient has been diagnosed with a decubitus ulcer. Upon examining the ulcer, it is noted the entire dermis is affected. It has distinct edges, shallow full-thickness, early fibrosis, and skin color changes. You would classify this as a:

a. Stage I

b. Stage II

c. Stage III

d. Stage IV

b. Stage II

The area of contact between neurons in nervous tissue is the:

a. Dendrite

b. Axon

c. Synapse

d. Golgi apparatus

There are how many cranial nerves?

a. 9

b. 33

c.18

d. 12

All of the following can cause cerebral vasodilatation except:

a. Hypercapnia

b. Hypoxia

c. Carbon dioxide

d. Respiratory alkalosis

Which of the following is true regarding chest tube obstruction?

a. Stripping the tube is acceptable

b. Milking the tube is acceptable

c. Stripping the tube decreases intrathoracic pressure

d. Milking the tube requires squeezing its length without releasing it

Initial ABG's done on a PT with a pneumothorax will reveal:

a. Respiratory acidosis

b. Respiratory alkalosis

c. Metabolic acidosis

d. Metabolic alkalosis

The TUC, time of useful consciousness, is defined as the time from initial exposure to an oxygen deficient environment until useful consciousness is lost The TUC is affected at various altitudes and is rapidly decreased as altitude decreases. You are currently at 35,000 and experience a rapid cabin depressurization. What is the TUC at this altitude?

a. 3-5 minutes

b. 1.0-1.5 minutes

c. < 15 seconds

d. 30-60 seconds

You are transporting a patient from Hawaii to Nevada. The patient suffered a TBI after being thrown from a horse. The patient is intubated, although not sedated, and is not responsive. During the flight, the patient's arms are noted to be extended, adducted and hyperpronated. The legs are noted to be extended and feet are plantar flexed. You would document this as:

a. Decerebrate posturing

b. Decorticate posturing

c. Position in early hemiplegia

d. Hyperreflexia

Which of the following organs is the largest of the human body?

a. Liver

b. Lungs

c. Small intestine

d. Skin

A shift to the left on the oxyhemoglobin dissociation curve results in impaired dissociation of oxygen from hemoglobin. Which condition would result in a left shift on the oxyhemoglobin dissociation curve?

a. pH of 7.20

b. Pa02 of 95

c. CO2 of 55 mmHg

d. Temperature of 96.1 F

Which of the following is NOT an organism that commonly causes bacterial meningitis?

a. Haemophilus influenza

b. Streptococcus pneumonia

c. Staphylococcus klebsiella

d. Neisseria meningitidis

What is normal BUN/Creatinine?

a. 15-20

b. 10-15

c. 25-30

d. 20-25