Paramedics Exam Medical Emergencies 5 — Questions and Answers
Question 1: A patient taking lithium presents with coarse tremor, confusion, ataxia, and vomiting. His lithium level is elevated. Which finding would indicate severe toxicity requiring immediate intervention?
- Fine hand tremor at rest
- Nausea and mild diarrhea
- QRS widening and seizures (Correct answer)
- Polyuria and polydipsia
Correct answer: QRS widening and seizures
QRS widening and seizures indicate severe lithium toxicity with cardiac and neurological compromise, requiring immediate aggressive supportive care and hospital management.
Question 2: A 68-year-old female presents with acute confusion, fever of 104°F, and thyroid storm is suspected. Which finding best supports this diagnosis?
- Bradycardia and hypothermia
- Tachycardia, hyperthermia, and agitation with recent thyroid history (Correct answer)
- Hypotension and bradypnea
- Hyponatremia and weakness
Correct answer: Tachycardia, hyperthermia, and agitation with recent thyroid history
Thyroid storm presents with extreme tachycardia, high fever, and agitation in a patient with a history of hyperthyroidism or recent thyroid surgery/illness.
Question 3: A 25-year-old male presents with altered mental status, hyperthermia of 106°F, muscle rigidity, diaphoresis, and clonus after starting a new antidepressant. What syndrome is most likely?
- Neuroleptic malignant syndrome (NMS)
- Serotonin syndrome (Correct answer)
- Anticholinergic toxidrome
- Malignant hyperthermia
Correct answer: Serotonin syndrome
Serotonin syndrome is characterized by the triad of mental status changes, autonomic dysfunction, and neuromuscular abnormalities (clonus, hyperreflexia) precipitated by serotonergic drugs.
Question 4: A 78-year-old nursing home patient presents with confusion, hypotension, fever of 103°F, tachycardia, and tachypnea after a urinary catheter change. What is the most likely diagnosis?
- Pulmonary embolism
- Septic shock (Correct answer)
- Hypovolemic shock from dehydration
- Heat stroke
Correct answer: Septic shock
The combination of infection source (urinary catheter), systemic inflammatory response (fever, tachycardia, tachypnea), and hypotension meets criteria for septic shock.
Question 5: A patient with end-stage renal disease presents with altered mental status, vomiting, and severe hypertension at 240/130 mmHg. Fundoscopic signs suggest papilledema. What is the priority concern?
- Hypertensive emergency with end-organ damage (Correct answer)
- Hypertensive urgency without organ damage
- Hyperkalemia-induced encephalopathy
- Uremic pericarditis
Correct answer: Hypertensive emergency with end-organ damage
Papilledema, altered mental status, and severely elevated BP define hypertensive emergency (malignant hypertension) with active end-organ damage requiring controlled BP reduction.
Question 6: A 55-year-old male presents with sudden onset severe flank pain radiating to the groin, nausea, and hematuria. Vital signs are stable. What is the most likely diagnosis?
- Abdominal aortic aneurysm
- Acute appendicitis
- Renal colic (nephrolithiasis) (Correct answer)
- Ectopic pregnancy
Correct answer: Renal colic (nephrolithiasis)
Sudden severe colicky flank pain radiating to the groin with hematuria is the classic presentation of renal colic caused by a kidney stone obstructing the ureter.
Question 7: A 33-year-old female with a history of lupus presents with fever, pleuritic chest pain, and a pericardial friction rub on auscultation. What is the most likely complication?
- Myocardial infarction
- Pericarditis (Correct answer)
- Aortic stenosis
- Pulmonary hypertension
Correct answer: Pericarditis
Pericarditis, an inflammation of the pericardial sac, presents with pleuritic chest pain, fever, and a friction rub and is a known complication of autoimmune diseases like lupus.
Paramedics Exam Medical Emergencies 5
A patient taking lithium presents with coarse tremor, confusion, ataxia, and vomiting.
His lithium level is elevated.
Which finding would indicate severe toxicity requiring immediate intervention?