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FPC / CFRN - REVIEW EXAM - VERSION
B 2024
Myxedema coma is also known as... A. Thyroid storm B. Adrenal insufficiency C. Hypothyroidism D. Hyperaldosteronism - correct answer✔✔ Hypothyroidism Most common presentation of a patient with hypothyroidism are all of the following, Except... A. Cold intolerance with coarse hair B. Almost exclusively over the age of sixty C. >90% of cases occur in the winter D. Primarily in men - correct answer✔✔ Primarily in men Hypothroidism occurs primarily in women, almost exclusively over the age of sixty, with 90% of the cases occurring in the winter months. Your patient presents with following parameters: CVP 0, CI 1, PA S/D 8/4, wedge 3, and SVR 1,800. What is your diagnosis? A. Hypovolemic shock B. Right ventricular infarction C. CHF D. Sepsis - correct answer✔✔ Hypovolemic shock
Careful interpretation of the CVP is important! Central venous pressure (CVP) describes the pressure of blood in the thoracic vena cava, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system. Drug of choice for profound hypotension in septic shock is? A. Isotonic crystalloid solution B. Levophed C. Nipride D. Dobutamine - correct answer✔✔ Levophed Sepsis is by far the most common cause of distributive shock. The average normal ICP range is... A. 0-10 mmHg B. 10-20 mmHg C. 20-30 mmHg D. >30 mmHg - correct answer✔✔ Normal ICP range is 0-10 mmHg, but range can go as high as 15 mmHg. The formula to calculate MAP is A. 2/3 DBP × SBP B. 2 × DBP + SBP divided by 3 C. 2 × SBP + DBP
D. Sinus Brady - correct answer✔✔ V-Fib Severe: 20-28 (coma, VF common) The drug of choice for a patient exhibiting signs and symptoms of malignant hyperthermia is: A. Anectine B. Sodium bicarbonate C. Dantrolene D. Glucagon - correct answer✔✔ Dantrolene Malignant hyperthermia: Characteristic signs are muscular rigidity, followed by a hypercatabolic state; with increased oxygen consumption, increased carbon dioxide production (hypercapnea, usually measured by capnography), tachycardia (fast heart rate), and an increase in body temperature (hyperthermia) at a rate of up to ~2°C per hour, temperatures up to 42°C (108°F) are not uncommon. Induction agent of choice with bronchospastic patients - correct answer✔✔ Ketamine (ketalar) Ativan: indication dose, max - correct answer✔✔ Lorazepam, seizures, 1-2 mg, max 4 mg Mannitol dose - correct answer✔✔ 1-2 g/kg Mannitol: an osmotic diuretic, acts by osmosis to ensure urine production and may prevent heme deposition in the kidney. Can be administered to avoid acute renal failure when fluid administration has been ineffective. Drug choice for cyclic antidepressant OD - correct answer✔✔ Sodium bicarbonate Drug choice for beta-blocker OD - correct answer✔✔ Glucagon
Fentanyl dose - correct answer✔✔ Sublimaze (3 μg/kg) Treatment for malignant hyperthermia - correct answer✔✔ Dantrium (dantrolene) Drug for GI bleeds - correct answer✔✔ Sandostatin (octreotide) You have been requested to transport a twenty-year-old female from an ICU with a history of TCA overdose two hours prior to your arrival at the sending facility. Your cardiovascular assessment of the patient would most likely include all of the following with this type of toxicity, EXCEPT... A. Early sinus bradycardia B. Widening QRS C. Prolonged QT and PR interval D. Early tachycardia - correct answer✔✔ Early sinus bradycardia Sinus tachycardia is the most common cardiac disturbance seen following TCA overdose. Rhabdomyolysis treatment - correct answer✔✔ - preventing shock and preserving kidney fxn
- NS with sodium bicarbonate Your patient presents with ABG's of pH 7.39, pCO2 68 HCO3 32, pO2 82. He has history of COPD and weighs 65 kg. He presents with a history of SOB for 3 days with a RR 20 and is on 4 L/minute of oxygen by NC. He speaks in four- to five-word sentences. What acid-base disorder is present? A. Metabolic acidosis with partial compensation B. Respiratory acidosis with complete compensation C. Metabolic alkalosis with no compensation D. Respiratory alkalosis with no compensation - correct answer✔✔ Respiratory acidosis with complete compensation.
A. Meningitis B. Splenic injury C. Retroperitoneal bleed D. Gallbladder - correct answer✔✔ Retroperitoneal bleed Grey Turner's sign refers to bruising of the flanks and can indicate retroperitoneal or intraabdominal bleeding, which can take up to 24-48 hours to show up on assessment. It can be caused by acute pancreatitis, blunt abdominal trauma, ruptured abdominal aortic aneurysm, or ruptured/hemorrhagic ectopic pregnancy. Most commonly seen injuries with side impact or "lay it down" motorcycle crashes include all of the following, EXCEPT: A. Open fracture of the femur B. Pelvic fractures C. Abrasions to the affected side D. Tibia/fibula or malleolus fractures - correct answer✔✔ Pelvic fractures Your patient was struck from behind while driving. The most common area of injury from a rear-end collision is: A. Ankle fracture B. Coup Contrecoup injury pattern C. C2 fracture D. T12-L1 injuries - correct answer✔✔ T12-L1 injuries Dry chemicals such as lime should be... A. Brushed off before irrigation
B. Neutralized with a special agent before irrigation C. Irrigated immediately with water or physiologic saline D. Wrapped in a dressing and not irrigated - correct answer✔✔ Brushed off before irrigation Chemical burns differ from thermal burns in that the burning process continues until the agent is inactivated by reaction of tissues: neutralized or diluted with water. Dry chemicals, such as lime, should be brushed off before irrigation. Water and physiologic saline are fluids of choice for wound irrigation. Hamman's sign may indicate which of the following? A. Tension pneumothorax B. Tracheobronchial injury C. Aortic rupture D. Cardiac tamponade - correct answer✔✔ Tracheobronchial injury Hamman's sign is a crunching sound heard with auscultation and may be synchronized with the patient's heart beat. This sign is associated with tracheobronchial injury. Recommended urinary output when managing a burn patient without an electrical injury is: A. 100 mL/hr B. 10-20 mL/hr C. 30-50 mL/hr D. >100 mL/hr - correct answer✔✔ 30-50 mL/hr Hydrofluoric burns can be managed with copious amounts of water and... A. Calcium gluconate B. Osmotic diuretics C. Glucagon
You are transporting a patient with a spinal cord injury above T6 level. His baseline vital signs prior to lift off: BP 160/80, HR 62, RR 20. During transport, the patient begins to complain of a throbbing headache with nasal stuffiness. Your assessment reveals that the patient is becoming increasingly agitated. His skin color is flushed and profusely diaphoretic. Repeat vital signs are a BP 206/100, HR 52, RR 26. Your initial management of the patient would be... A. Insert a foley catheter B. Administer nitroglycerin to help reduce blood pressure C. Hang a Nipride drip if diastolic is greater than 130 mmHg D. Do nothing because increased HTN is expected with altitude and spinal cord injuries. - correct answer✔✔ Insert a foley catheter Autonomic dysreflexia (AD), also known as "autonomic hyperreflexia or hyperreflexia," is a potentially life-threatening condition, which can be considered a medical emergency requiring immediate attention. AD occurs most often in spinal cord-injured individuals with spinal lesions above the T6 spinal cord level. Acute AD is a reaction of the autonomic (involuntary) nervous system to overstimulation. Your patient presents with motor loss, numbness to touch, vibration on the same side of the spinal injury, loss of pain, and temperature sensation on the opposite side. You suspect that the most likely spinal cord syndrome present is: A. Brown-Séquard B. Central cord C. Anterior cord syndrome D. Neurogenic shock - correct answer✔✔ Brown-Séquard Any presentation of spinal injury that is an incomplete lesion can be called a partial Brown-Séquard or incomplete Brown-Séquard syndrome, so long as it has characterized by features of a motor loss and numbness to touch and vibration on the same side of the spinal injury and loss of pain and temperature sensation on the opposite side. Most often occurs from a penetrating injury that has damaged one side of the spinal cord.
Blood supply to the anterior portion of the spinal cord is interrupted, causing a complete motor paralysis below the level of the lesion due to interruption of the corticospinal tract. Loss of pain and temperature sensation at and below the level of the lesion due to interruption of the spinothalamic tract. Retained proprioception and vibratory sensation due to intact dorsal columns. Most often occurs after hyperflexion injury - correct answer✔✔ "Anterior cord" syndrome It is characterized by disproportionately greater motor impairment in upper compared to lower extremities and variable degree of sensory loss below the level of injury. Most often occurs after hyperextension injury. - correct answer✔✔ "Central cord" syndrome Sinusoidal patterns are commonly associated with all of the following, EXCEPT: A. Fetal hypovolemia or anemia B. Accidental tap of the umbilical cord during amniocentesis C. Pregnancy-induced hypertension (PIH) D. Placental abruption - correct answer✔✔ Pregnancy-induced hypertension A uniform sine wave pattern indicates fetal hypovolemia or anemia and may occur in cases of erythroblastosis fetalis, accidental tap of the umbilical cord during amniocentesis, fetomaternal transfusion, placental abruption, or another type of accident. Diving injuries - 1 ATM for every ??? feet descent - correct answer✔✔ 1 ATM for every 33 feet descent You will be transporting a stable twenty-seven-year-old man with nontraumatic pneumocephalous secondary to gas producing necrotizing bacteria from rural hospital at 8,500 feet elevation to a local hospital at 1,200 feet sea level. What might be the best transport option? What gas law will most affect this patient negatively? A. Ground; Boyle's law B. Fixed wing transport pressurized to 9,000 AGL; Charles' law C. Rotor transport; Boyle's law D. Rotor transport; Charles' law - correct answer✔✔ Ground; Boyle's law
A. Increase FIO2 and apply/or increase PEEP B. Increase Vt and apply/or increase PEEP C. Increase FIO D. Increase Vt - correct answer✔✔ Increase FIO2 and apply/or increase PEEP You are transporting a seventy-five-year-old man with a diagnosis of inferior wall MI. During the flight you note V-Tach. Vital signs are: 70/palp, HR 150, RR 24, SpO2 94% on high flow oxygen with NRM at 15 L/min. He is awake and complains of chest pain and SOB. How will you manage this patient? A. Administer lidocaine and nitroglycerin B. Administer normal saline bolus C. Consider sedation and synchronize cardiovert at 100 joules D. Have the patient cough forcefully - correct answer✔✔ Consider sedation and synchronize cardiovert at 100 joules. The patient you are transporting reveals the following ABG: pH 7.51, pCO2 28, HCO3 24, pO2 110. He is a 60-kg male patient with Vt 650, F14, FIO2 0.21, I:E 1:2, PIP 46, Pplat 42, and PEEP 0. What is your ABG interpretation, and how will you correct it? A. Respiratory acidosis; increase respiratory rate (F) B. Respiratory alkalosis; decrease Vt C. Metabolic alkalosis; increase FIO D. Respiratory alkalosis; increase PEEP - correct answer✔✔ Respiratory alkalosis; decrease Vt The pCO2 is decreased and the pH is increased, indicating a respiratory alkalosis. The HCO3 is normal, indicating there is no compensation. Minute ventilation is... A. RR × weight in kg B. RR × SPO
C. Vt × weight in kg D. Vt × RR - correct answer✔✔ Vt × RR Tidal volume times the respiratory rate equal minute ventilation. Minute ventilation is defined as the total volume of air (gas) moved into and out of the lungs each minute. The formula is known as VE = Vt × f. VE signifies minute ventilation; Vt signifies tidal volume and f signifies respiratory rate. Alveolar minute volume is the amount of gas that reaches the alveoli for gas exchange in one minute. The formula is VAmin = (VT-VD) × Respiratory Rate. High-pressure alarms can be caused by all of the following, EXCEPT: A. Hypovolemia B. Connections C. Pneumothorax D. Obstructions - correct answer✔✔ Hypovolemia Low-pressure alarms can be caused by all of the following, EXCEPT: A. Hypovolemia B. Leaks in ventilator tubing C. Pneumothorax D. Connections - correct answer✔✔ Pneumothorax Pneumothorax can trigger high-pressure alarms when resistance to ventilation is too high. You are managing a four-year-old boy who is requiring intubation. The appropriate size ET tube for this patient would be... A. 3.
A. pO2 <60 mmHg and pCO2 > B. pO2 <80 mmHg and pCO2 > C. pO2 <60 mmHg and pCO2 > D. pO2 <90 mmHg and pCO2 >50 - correct answer✔✔ pO2 <60 mmHg and pCO2 > Acute respiratory failure (ARF) exists when breathing fails in its ability to maintain arterial blood gases within a normal range. By definition, ARF is present when the blood gases demonstrate a pO2 < 60 mmHg (hypoxic respiratory failure) and a pCO2 > 50 mmHg (ventilatory respiratory failure), which is usually accompanied by fall in the pH < 7.3. What personal protective equipment (PPE) should be worn when transporting a patient with bacterial meningitis? A. Mask, gloves, gown, and eye protection B. Gloves only C. Mask and gloves D. Gloves and eye protection - correct answer✔✔ Mask, gloves, gown, and eye protection The most common type of decompression sickness typically seen diving emergencies is: A. Musculoskeletal B. Pulmonary C. Arterial gas embolism D. Cutaneous - correct answer✔✔ Pulmonary Decompression Sickness (DCS) Musculoskeletal decompression illness (Type I DCS), better known as the "bends," is the most common type of DCS, which may comprise limb or joint pain (shoulder and elbow pain most common), skin rash, pruritus, and joint swelling ("skin bends"). Type II DCS comprises more serious manifestations such as headache, fatigue, visual disturbances, motor/sensory neurologic impairment/deficits, confusion, seizures, coma, and death
Situations that involve a LEFT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypocapnia C. Hypothermia D. Increased levels of 2,3-DPG - correct answer✔✔ Increased levels of 2,3-DPG The oxyhemoglobin dissociation curve describes the relation between the partial pressure of oxygen and the oxygen saturation. The effectiveness of hemoglobin-oxygen binding can be affected by several factors. Situations that involve a RIGHT shift in the oxygen-hemoglobin dissociation curve are all of the following, EXCEPT: A. Alkalosis B. Hypercapnia C. Hyperthermia D. Increased level of 2,3-DPG - correct answer✔✔ Alkalosis Alkalosis causes a left shift. A scaphoid abdomen, unequal breath sounds, dyspnea, and a shift in the PMI are a classic presentation of which of the following in the neonate patient? A. Tension pneumothorax B. Diaphragmatic hernia C. Aspiration pneumonia D. RDS, formerly known as hyaline membrane disease - correct answer✔✔ Diaphragmatic hernia
Common cause of seizures = hypoglycemia < 40 mg/dL and hypoxia Repeated doses of etomidate can cause: A. Increased ICP B. Acute adrenal insufficiency C. AMI D. Pulmonary edema - correct answer✔✔ Acute adrenal insufficiency Etomidate (Amidate), which is classified as a sedative-hypnotic can block the adrenal gland's production of cortisol and other steroid hormones, possibly resulting in temporary adrenal gland failure. This may cause abnormal salt and water balance, lowered blood pressure, and, ultimately, shock. Patients with known Addison's disease (acute renal insufficiency) should not be given etomidate. Coronary Perfusion Pressure (CPP) is calculated how? PCWP (pulmonary capillary wedge pressure) A. DBP - PCWP B. DBP + PCWP C. SBP - DBP D. SBP - PCWP - correct answer✔✔ CPP = DBP-PCWP (normal 50-60 mmHg) "Cerebral" perfusion pressure which can be calculated by using the following formula: MAP − ICP. Normal range for cerebral perfusion pressure is 70-90 mmHg. Remember that your HEAD is higher than your HEART.
Inferior wall MI is caused by an occlusion of which coronary artery? A. LAD B. RCA C. Circumflex D. Inferior vena cava - correct answer✔✔ Right coronary artery (RCA) "Lateral Wall" ST elevation in... - correct answer✔✔ I, aVL, V5, V "Septal Wall" ST elevation in... - correct answer✔✔ V1, V "Anterior Wall" ST elevation in... - correct answer✔✔ V3, V "Inferior Wall" ST elevation in... - correct answer✔✔ II, III, and aVF Normal CVP/RAP pressures are... A. 15 - 25 mmHg B. 8 - 12 mmHg C. 2 - 6 mmHg D. 8 - 15 mmHg - correct answer✔✔ 2 - 6 mmHg Central venous pressure (CVP and Right atrial pressure (RAP) - Reflection of right atrial pressure preload. PCWP (pulmonary capillary wedge pressure) evaluates... A. Right arterial pressures B. Right and left sided heart pressures
