Paramedics Exam Medical Emergencies and Obstetrics 3 — Questions and Answers
Question 1: A 28-year-old female at 20 weeks gestation complains of sudden, severe left lower quadrant pain and vaginal bleeding. Her HR is 124 and BP is 88/60. What is the most likely diagnosis?
- Placenta previa
- Placental abruption
- Ruptured ectopic pregnancy (Correct answer)
- Ovarian torsion
Correct answer: Ruptured ectopic pregnancy
Ruptured ectopic pregnancy presents at around 6-10 weeks but can occur up to 20 weeks; the hemodynamic instability and unilateral pain are hallmark signs.
Question 2: Which ECG finding is MOST associated with hyperkalemia in a patient with renal failure?
- ST depression with U waves
- Peaked T waves and widened QRS (Correct answer)
- Shortened PR interval with delta waves
- Prolonged QT interval
Correct answer: Peaked T waves and widened QRS
Hyperkalemia classically produces peaked/tall T waves early, followed by widened QRS and eventual sine-wave pattern as levels rise.
Question 3: During delivery, you note the umbilical cord is protruding from the vagina before the baby's head. What is the MOST appropriate immediate action?
- Attempt to push the cord back into the uterus
- Position the mother in knee-chest position and support the cord manually (Correct answer)
- Perform an immediate field C-section
- Apply gentle traction to expedite delivery
Correct answer: Position the mother in knee-chest position and support the cord manually
Cord prolapse is managed by relieving pressure on the cord with a gloved hand while positioning the mother knee-chest down to prevent fetal hypoxia.
Question 4: A patient with a known shellfish allergy receives a contrast dye injection during a CT scan and becomes hypotensive with bronchospasm. Which medication class is the LEAST helpful in reversing the acute physiological response?
- Epinephrine
- Corticosteroids
- Antihistamines
- Beta-blockers (Correct answer)
Correct answer: Beta-blockers
Beta-blockers can worsen anaphylaxis by blocking the therapeutic effects of epinephrine and promoting bronchospasm.
Question 5: A 60-year-old dialysis patient presents with peaked T waves, a HR of 38 bpm, and a wide QRS complex. After calcium gluconate, what is the next appropriate intervention?
- Sodium bicarbonate 50 mEq IV (Correct answer)
- Albuterol nebulizer
- Kayexalate (sodium polystyrene)
- Furosemide 40 mg IV
Correct answer: Sodium bicarbonate 50 mEq IV
Sodium bicarbonate temporarily shifts potassium into cells by alkalizing the blood, providing a rapid but temporary reduction in serum potassium.
Question 6: You respond to a call where a 35-year-old male took 30 acetaminophen tablets 2 hours ago. He is currently asymptomatic. Which intervention is MOST appropriate?
- Activated charcoal if airway is intact and no contraindications (Correct answer)
- Induce vomiting immediately
- Sodium bicarbonate infusion
- Begin N-acetylcysteine in the field
Correct answer: Activated charcoal if airway is intact and no contraindications
Activated charcoal administered within 1-2 hours of ingestion can reduce acetaminophen absorption significantly if the airway is protected.
Question 7: A neonate is delivered and is limp, apneic, and blue at 1 minute. Initial stimulation and positioning fail to elicit a response. What is the NEXT step?
- Chest compressions at 3:1 ratio
- Positive pressure ventilation via BVM (Correct answer)
- Epinephrine 0.01 mg/kg IV/IO
- Bulb suctioning of oropharynx for 30 seconds
Correct answer: Positive pressure ventilation via BVM
Positive pressure ventilation is the most critical initial intervention for a non-breathing or inadequately breathing neonate after initial steps fail.
Paramedics Exam Medical Emergencies and Obstetrics 3
A 28-year-old female at 20 weeks gestation complains of sudden, severe left lower quadrant pain and vaginal bleeding.
Her HR is 124 and BP is 88/60.
What is the most likely diagnosis?