EMT Medical Practice Test 1
You arrive on scene to find a patient with an altered mental status. You quickly scan the scene. Which of the following items will help to point you in the right direction in finding a cause of the altered mental status?
The scene survey can lead to some very important clues as to what might be going on with your patient. Medications for specific medical conditions can lead you in the correct direction. Not only does it give you the patient’s past medical history, but it tells where to start your assessment and investigation of the patient’s signs and symptoms. An unkempt house and smells can provide an indication of a patient’s lifestyle and ability to care for themselves.
Your neuro assessment of an unresponsive patient reveals pin point pupils. What is your primary field diagnosis?
Narcotics will cause pupils to constrict making them the classic pin point. All of the other medications mentioned here do not affect the pupils, even though they may cause an altered mental status.
You find that your diabetic patient is hypoglycemic. You have oral glucose to give to the patient. You will give 15 grams of instant glucose to the patient except if they are ___________?
The clinician should never give any patient who cannot swallow anything by mouth because aspiration is a real risk. A patient with an altered mental status with a blood sugar of 80mg/dl should be given glucose to correct the mental status.
A medical condition where the patient sometimes suffers convulsions or seizure activity is known as?
Epilepsy is medical condition where the patient often suffers seizures. Tonic-clonic and focal motor are types of seizure activity and a postictal state is the period of time after a seizure where the patient is slow to respond and is possibly unresponsive where the brain is resetting and resting.
When assessing a patient complaining of depression, which of the following would be most suggestive that the patient is at risk for suicide?
A previous attempt at suicide is highly suggestive of a patient's risk for suicide. This is compounded by the depression, which can exacerbate suicidal feelings and willingness to carry out the act to finality. Persons contemplating suicide typically give possessions away and do not store them. Hostility towards family members in and of itself is not an indication of the potential for suicide. While a diagnosis of medical condition can predispose one to consider suicide, these conditions are generally terminal (e.g., cancer, HIV infection). Hypertension is generally treatable with lifestyle modification and medications.
To assess a patient with a stroke, there are two major assessment tools: the Cincinnati Stroke Scale and the Los Angeles Prehospital Stroke Screen. Which one of these two tools uses arm drift as a diagnostic tool?
The Cincinnati stroke scale uses arm drift as a diagnostic tool. Ask the patient to lift both arms up in front of them, close their eyes and watch for an arm to drift downward. If there is a drift downward on one arm then assess for a CVA on that side.
Your patient is a known diabetic who takes up to four insulin injections a day. Today he is found unresponsive, diaphoretic, and tachycardic. He is also only breathing 18 times a minute. What is likely the patient’s chief medical issue?
A known insulin dependent diabetic with the above symptoms is most likely suffering from hypoglycemia. The tachycardia and diaphoresis is from a catecholamine release trying to mobilize more glucose. This patient may very well have hypertension; it just is not the reason for the unresponsiveness.
The clinician's best role in the assessment and treatment of a stroke patient is rapid recognition and transport to a stroke center. What is the window of opportunity from the onset of symptoms until treatment?
Anytime there is a restriction of blood flow, the quicker blood flow is returned the better the results. It is well established that if tPa is infused within three hours of the onset of symptoms, there is a greater chance that all deficits will resolve without lasting effects.
There are two types of cerebral vascular accidents (i.e., strokes). The most common is an ischemic stroke. What is the other type?
The second type of cerebral vascular accident is a hemorrhagic stroke, also known as a bleed. Thrombotic and embolic strokes are types of ischemic strokes where the blood flow is stopped by a clot. A transient ischemic attack is most often referred as a mini stroke, a prelude to a full on CVA.
Your patient is not responding to your loud verbal stimuli. You find the following medications: Glucophage and Lipitor. What is the likely cause of the patient’s problem?
Glucophage is a diabetic medication. You may not be able to identify what type of reaction your patient is having without more diagnostic testing but it puts you looking in the correct direction. The Lipitor may come into play later on in long term care but high cholesterol generally has no effect on mental status the way hypo or hyperglycemia will.
Stroke symptoms often present the same as other medical problems. To prevent improper treatment for the signs and symptoms, working through the differentials is a must. Hypoglycemia is often mistaken for a CVA. How can a clinician rule in or out this differential?
One of the easiest and most often over looked diagnosis tools is the use of glucometer to check the blood sugar. The other screening info in this question do not rule in or out hypoglycemia.
Which of the following is an often fatal complication of diabetes and is also the first indication of diabetes in many young patients?
Often the first signs and symptoms of diabetes onset is diabetic Ketoacidosis. When there is no fuel (i.e., glucose) for the cells to burn, the cells will burn fat and protein which does not burn clean. The incomplete combustion produces acids which are not cleared. These acids will build up and can be fatal if not treated aggressively. Hypertension and cardiovascular disease are long term complications of diabetes.
Diabetic Ketoacidosis (DKA) has the following signs and symptoms; Acetone on breath, dry skin, poor skin turgor, altered mental status, confusion, thirst, and frequent urination. What other symptoms are associated with DKA?
Due to the hyperglycemic state, the kidneys try to diereses the glucose out of the blood stream causing the patient to become more dehydrated. As the blood becomes thicker and thicker, the cardiac output lowers and the heart has to work harder. With the excess glucose and incomplete combustion from other fuel sources, the brain is impaired as if the patient is intoxicated.
For a condition to be diagnosed as a transient ischemic attack (TIA), the symptoms must be resolved in 24 hours ______________?
Most TIAs will resolve within 15 minutes, however for it to be diagnosed as a TIA all signs and effects must be resolved within 24 hours after onset. TIA's are often the precursor to a major stroke.
Statements from patients are used as assessment tools. Which of the following statements about stroke symptoms should cause the clinician to use a higher index of suspicion?
"This is the worst headache I have ever had." This statement should not be ignored or considered to the dramatic, it should cause the clinician to modify their assessment to include a hemorrhagic stroke in their differential. All of the other statements do classify the intensity of their headache and may not rule out a stroke, however, the statement of the worst headache should alert you to the possibility of more acute findings.
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