Paramedics Exam Special Patient Populations 3 — Questions and Answers
Question 1: An elderly patient on warfarin fell and struck his head but appears asymptomatic. What is the most critical concern?
- Vertebral compression fracture
- Delayed intracranial hemorrhage due to anticoagulation (Correct answer)
- Subdural hygroma from chronic alcoholism
- Concussion with rapid recovery
Correct answer: Delayed intracranial hemorrhage due to anticoagulation
Anticoagulated patients are at high risk for delayed intracranial hemorrhage after head trauma even when initially asymptomatic.
Question 2: Which presentation is MOST consistent with epiglottitis in a pediatric patient?
- Barking cough, low-grade fever, gradual onset
- High fever, drooling, tripod positioning, muffled voice (Correct answer)
- Sudden onset wheezing with unilateral decreased breath sounds
- Productive cough with bilateral crackles and nasal flaring
Correct answer: High fever, drooling, tripod positioning, muffled voice
Epiglottitis classically presents with high fever, drooling, tripod positioning, and a muffled (not barking) voice due to supraglottic swelling.
Question 3: A patient with autism spectrum disorder becomes combative when you attempt to place an oxygen mask. The BEST approach is to:
- Restrain the patient immediately to ensure oxygen delivery
- Offer blow-by oxygen and reduce sensory stimulation in the environment (Correct answer)
- Administer IM sedation to facilitate treatment
- Abandon oxygen therapy and focus only on transport
Correct answer: Offer blow-by oxygen and reduce sensory stimulation in the environment
Blow-by oxygen and minimizing sensory stimulation reduces distress in patients with autism while still providing supplemental oxygen.
Question 4: You are called for a 28-week pregnant patient in active labor. On delivery, the neonate is born limp and apneic. Your FIRST action is to:
- Begin chest compressions at 3:1 ratio
- Administer epinephrine via umbilical vein
- Warm, dry, stimulate, and position the airway (Correct answer)
- Immediately intubate with a 2.5 mm ETT
Correct answer: Warm, dry, stimulate, and position the airway
The initial steps of neonatal resuscitation are warming, drying, stimulating, and positioning the airway before any advanced intervention.
Question 5: Which physiologic change in pregnancy increases the risk of aspiration during airway management?
- Increased lower esophageal sphincter tone
- Decreased gastric motility and elevated intra-abdominal pressure (Correct answer)
- Reduced progesterone levels relaxing the diaphragm
- Increased tidal volume compressing the stomach
Correct answer: Decreased gastric motility and elevated intra-abdominal pressure
Pregnancy delays gastric emptying and increases intra-abdominal pressure, raising aspiration risk during any airway intervention.
Question 6: A geriatric patient with dementia is agitated and combative. His daughter states he is normally calm. What condition should be ruled out FIRST?
- Progression of underlying dementia
- Medication non-compliance
- Acute delirium from infection, hypoxia, or metabolic cause (Correct answer)
- Psychiatric emergency requiring psychiatric evaluation
Correct answer: Acute delirium from infection, hypoxia, or metabolic cause
Acute delirium superimposed on dementia—often from UTI, hypoxia, or metabolic disturbance—must be ruled out before attributing behavior to dementia alone.
Question 7: A home ventilator-dependent patient has a high-pressure alarm sounding and increasing respiratory distress. After checking the circuit for leaks, your next step is to:
- Increase the FiO2 setting on the ventilator
- Switch the patient to a bag-valve-mask and investigate the cause (Correct answer)
- Decrease the tidal volume setting to lower airway pressures
- Administer a bronchodilator via the in-line nebulizer
Correct answer: Switch the patient to a bag-valve-mask and investigate the cause
When a ventilator alarms and the patient deteriorates, removing the patient from the vent and manually ventilating with BVM ensures oxygenation while the problem is identified.
Paramedics Exam Special Patient Populations 3
An elderly patient on warfarin fell and struck his head but appears asymptomatic.
What is the most critical concern?