Paramedics Exam Medical Emergencies and Obstetrics 4 — Questions and Answers
Question 1: A 52-year-old male with a history of CHF presents with severe dyspnea, pink frothy sputum, and crackles bilaterally to the apices. SpO2 is 82%. What is the MOST appropriate initial intervention?
- Furosemide 40 mg IV bolus
- CPAP or BiPAP application (Correct answer)
- Endotracheal intubation
- Nitroglycerin 0.4 mg SL
Correct answer: CPAP or BiPAP application
CPAP/BiPAP reduces the work of breathing, improves oxygenation, and decreases preload in acute pulmonary edema, often preventing the need for intubation.
Question 2: Which finding differentiates placenta previa from placental abruption?
- Painless bright red vaginal bleeding vs. painful dark bleeding (Correct answer)
- Presence of fetal heart tones
- Maternal blood pressure level
- Amount of blood loss visible externally
Correct answer: Painless bright red vaginal bleeding vs. painful dark bleeding
Placenta previa typically causes painless bright red bleeding, while placental abruption presents with painful dark bleeding often with a rigid uterus.
Question 3: A 42-year-old male presents with sudden onset crushing chest pain, diaphoresis, and nausea. His 12-lead ECG shows 2 mm ST elevation in leads II, III, and aVF. Which coronary artery is MOST likely occluded?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in leads II, III, and aVF (inferior leads) indicates an inferior wall MI, most commonly caused by right coronary artery occlusion.
Question 4: A patient with Type 1 diabetes is found unconscious with Kussmaul respirations and a fruity odor on breath. Blood glucose is 520 mg/dL. What acid-base disturbance is present?
- Metabolic alkalosis
- Respiratory alkalosis
- Metabolic acidosis (Correct answer)
- Respiratory acidosis
Correct answer: Metabolic acidosis
DKA causes metabolic acidosis from ketoacid accumulation, and Kussmaul respirations represent the respiratory compensation attempt.
Question 5: You are treating a 30-year-old female who is 38 weeks pregnant in active labor. The baby delivers but the placenta has not delivered after 30 minutes and the patient is bleeding heavily. What is this condition called?
- Placenta previa
- Uterine atony
- Retained placenta (Correct answer)
- Uterine inversion
Correct answer: Retained placenta
Retained placenta occurs when the placenta fails to deliver within 30 minutes of birth and can cause life-threatening postpartum hemorrhage.
Question 6: A 68-year-old male presents with sudden left-sided facial droop, arm weakness, and slurred speech that began 45 minutes ago. He is alert and has a BP of 178/98. What is the Cincinnati Prehospital Stroke Scale score?
- 0 — no stroke signs present
- 1 — one abnormal finding
- 2 — two abnormal findings
- 3 — all three findings abnormal (Correct answer)
Correct answer: 3 — all three findings abnormal
The Cincinnati Prehospital Stroke Scale assesses facial droop, arm drift, and abnormal speech; all three positive findings yields a score of 3, strongly suggesting stroke.
Question 7: A patient who overdosed on tricyclic antidepressants (TCAs) develops a wide QRS of 160 ms and hypotension. What is the MOST appropriate treatment?
- Flumazenil 0.2 mg IV
- Sodium bicarbonate 1-2 mEq/kg IV bolus (Correct answer)
- Activated charcoal via NGT
- Magnesium sulfate 2 g IV
Correct answer: Sodium bicarbonate 1-2 mEq/kg IV bolus
Sodium bicarbonate alkalinizes the blood and provides a sodium load that reverses TCA-induced sodium channel blockade and QRS widening.
Paramedics Exam Medical Emergencies and Obstetrics 4
A 52-year-old male with a history of CHF presents with severe dyspnea, pink frothy sputum, and crackles bilaterally to the apices.
SpO2 is 82%.
What is the MOST appropriate initial intervention?