FISDAP Medical Emergencies 3 — Questions and Answers
Question 1: A 62-year-old male presents with acute onset of right-sided facial droop, arm weakness, and slurred speech that began 45 minutes ago. Which action is the HIGHEST priority?
- Administer aspirin 324 mg
- Perform a 12-lead ECG
- Rapid transport to a stroke center (Correct answer)
- Establish IV access and administer dextrose
Correct answer: Rapid transport to a stroke center
Time-sensitive stroke care requires rapid transport to a stroke center capable of administering tPA; every minute of delay increases neuronal loss.
Question 2: Which of the following best describes Cushing's triad, indicating increased intracranial pressure?
- Tachycardia, hypotension, and irregular respirations
- Hypertension, bradycardia, and irregular respirations (Correct answer)
- Hypertension, tachycardia, and deep slow respirations
- Bradycardia, hypotension, and Cheyne-Stokes breathing
Correct answer: Hypertension, bradycardia, and irregular respirations
Cushing's triad consists of hypertension (widened pulse pressure), bradycardia, and irregular respirations, signaling herniation-level ICP.
Question 3: A 28-year-old female with known asthma presents with audible wheezing and is speaking in 2-word sentences. SpO2 is 91% on room air. After albuterol treatment, her SpO2 rises to 94% but wheezing persists. What is the next most appropriate intervention?
- Repeat albuterol treatment and consider ipratropium (Correct answer)
- Intubate immediately due to ongoing wheezing
- Switch to 100% oxygen via non-rebreather and transport
- Administer epinephrine 1:1,000 SubQ
Correct answer: Repeat albuterol treatment and consider ipratropium
Persistent bronchospasm after initial albuterol warrants a repeat dose combined with ipratropium bromide for additive bronchodilation.
Question 4: You are called to a nursing home for a 78-year-old with altered mental status. Staff reports she has been febrile, tachycardic, and confused for 2 hours. She has a Foley catheter in place. What is the MOST likely underlying cause?
- Acute MI
- Sepsis secondary to urinary tract infection (Correct answer)
- Hypertensive encephalopathy
- Hypoglycemia
Correct answer: Sepsis secondary to urinary tract infection
Fever, tachycardia, and altered mental status in an elderly patient with a urinary catheter strongly suggests sepsis from a urinary source.
Question 5: A patient in diabetic ketoacidosis (DKA) is breathing with deep, rapid, sighing respirations. What is the term for this breathing pattern?
- Cheyne-Stokes respirations
- Biot respirations
- Kussmaul respirations (Correct answer)
- Apneustic respirations
Correct answer: Kussmaul respirations
Kussmaul respirations are the deep, rapid, sighing breaths seen in metabolic acidosis as the body attempts to blow off CO2 and raise pH.
Question 6: Which of the following is a hallmark sign that distinguishes a hemorrhagic stroke from an ischemic stroke in the prehospital setting?
- Facial droop and arm drift
- Sudden onset of the worst headache of the patient's life (Correct answer)
- Slurred speech and confusion
- Unilateral leg weakness
Correct answer: Sudden onset of the worst headache of the patient's life
While both types share neurologic deficits, a sudden severe thunderclap headache is more associated with hemorrhagic stroke (subarachnoid or intracerebral hemorrhage).
Question 7: A 50-year-old male with end-stage renal disease missed his last two dialysis sessions. He presents with peaked T-waves on ECG, muscle weakness, and bradycardia. Which electrolyte abnormality is most likely responsible?
- Hyponatremia
- Hypocalcemia
- Hyperkalemia (Correct answer)
- Hypomagnesemia
Correct answer: Hyperkalemia
Missed dialysis leads to potassium accumulation; hyperkalemia causes peaked T-waves, muscle weakness, and potentially fatal dysrhythmias.
FISDAP Medical Emergencies 3
A 62-year-old male presents with acute onset of right-sided facial droop, arm weakness, and slurred speech that began 45 minutes ago.
Which action is the HIGHEST priority?