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Quiz Session - Attempts With Random Questions

BCEN CFRN CTRN Exam Questions

Page 2 of 50

21.

You and your medical air rescue crew are en route to a wilderness location to aid in the rescue and transport of victims of an avalanche. Which of the following mnemonic devices should be considered as an aid to planning and safety when taking part in wilderness rescues?

  • TOMAS

  • ROMAN

  • THREAT

  • TAWS

Correct answer: TOMAS

At times, the medical air rescue crew may be called upon to aid in the rescue and transport of individuals involved in critical incidents in wilderness areas. The air medical rescue crew should have an already established safety plan for their role in assisting in wilderness incidents prior to acceptance of an assignment in wilderness transport. The mnemonic TOMAS can be utilized to help in preparation of the plan and ensuring of safety in wilderness locations.

T: Terrain (consider exposure to the elements, and the presence of cliffs, water, forest, vegetation, hiking terrain, possible presence of snow)

O: Obstacles (consider what may inhibit rescue/transport, including trees, loose rocks, debris, wires, daylight, rotor wash, and blade clearance issues)

M: Method (how will the air transport crew insert themselves into the location, possible landing zone sites, hover load)

A: Alternatives (wait for certified search and rescue (SAR) personnel or ferry SAR personnel, relocate the patient prior to attempting transport, abort the mission)

S: Safety (which should be first, last, and always)

The ROMAN mnemonic is used when determining if a patient potentially has a difficult airway.

The THREAT mnemonic is used for outlining the critical actions needed during an active shooter incident.

TAWS is an abbreviation which stands for "terrain awareness and warning systems."

22.

The patient you are transporting is displaying symptoms of myxedema madness. Which of the following is the most likely cause of her symptoms?

  • Hypothyroidism

  • Hyperosmolar hyperglycemic state

  • Thyroid storm

  • Acute adrenal insufficiency

Correct answer: Hypothyroidism

Myxedema madness, also referred to as myxedema psychosis, is a potential component of myxedema coma that manifests with symptoms of hallucinations, paranoia, depression, combativeness, agitation, and lack of attention to personal hygiene. The myxedema conditions result as a severe complication of hypothyroidism, primarily in individuals who are 60 years old or older. If medical air transport is required for patients who are experiencing myxedema madness, the transport team must make preparations to protect their own safety as well as the safety of the patient. Treatment of the underlying hypothyroid condition should result in resolution of the psychosis symptoms.

23.

All the many operational stresses of transport may induce fatigue to some degree for a CFRN/CTRN. Which of the following is not a common symptom of acute fatigue related to transport? 

  • Depression and/or anxiety 

  • Lack of awareness

  • Loss of coordination

  • Lack of energy

Correct answer: Depression and/or anxiety 

Fatigue is an inherent stress of transport duties and the end product of all the physiologic and psychological stresses of flight associated with exposure to altitude. Erratic schedules, hypoxic environments, noise and vibration, and imperfect environmental systems eventually take their toll; fatigue is always a potential threat to safety. 

Signs and symptoms of acute fatigue include lack of awareness, loss of coordination, lack of energy, and increased risk of medical errors. 

24.

You are the CFRN/CTRN called for the emergent transfer of a 30-year-old female who was the victim of an assault. The patient presented to the sending facility's ER with signs of shock. The sending RN states the patient is 36 weeks pregnant. Upon your initial assessment, while examining the abdomen, you note what appears to be fetal parts underneath the patient's skin. What do you suspect?

  • Uterine rupture

  • Diaphragmatic rupture

  • Ruptured liver

  • Placenta abruptio

Correct answer: Uterine rupture 

When able to palpate fetal parts underneath the mother’s skin, the uterus has ruptured. 

Diaphragmatic rupture would result in tachypnea from decreased tidal volume, and the auscultation of bowel sounds in the lung fields. Ruptured liver would not cause the presence of fetal parts to be felt. Placenta abruptio would result in painful bleeding from the vagina.

25.

All of the following statements regarding toxic shock syndrome (TSS) are false, except:

  • Twenty-five percent of TSS cases occur in males

  • Most cases of TSS are result from Group B streptococcus infection

  • A small percentage of women develop antibodies to the organism responsible for causing TSS

  • Twenty-five percent of TSS cases are associated with the use of long-absorbing tampons

Correct answer: Twenty-five percent of TSS cases occur in males

Toxic shock syndrome (TSS) is an uncommonly occurring but potentially deadly complication of a bacterial infection caused by the presence of toxin-producing Staphylococcus aureus (S. aureus) or Streptococcus pyogenes (S. pyogenes). Mortality from TSS remains high at approximately 10% of individuals, with 50% of cases resulting from the use of long-absorbing tampons. S. aureus occurs naturally in the vagina in just under 10% of women, and most women develop antibodies to the organism. And while TSS is most often associated with women experiencing menstrual cycles, 25% of cases of TSS occur in males. Five percent of asymptomatic males have S. aureus present in urethral cultures. TSS may also occur with septic abortion, postpartum wound infections, chorioamnionitis, infected skin lesions, osteomyelitis, and periodontal abscess, among others.

26.

The Intra Aortic Balloon Pump (IABP) is a device that improves coronary artery perfusion and cardiac output while decreasing the workload on the heart. During which phase does the IABP balloon inflate?

  • Beginning of diastole

  • Beginning of systole

  • Just before the end of systole

  • Just before the end of diastole

Correct answer: Beginning of diastole

The balloon improves cardiac output and coronary artery perfusion by counter flow. At the beginning of diastole, as the heart relaxes, the balloon inflates, thus pushing blood back into the coronary arteries. At the very moment systole begins, the balloon deflates, creating negative pressure allowing the heart to work less to pump blood into systemic circulation.

27.

All of the following statements regarding shock state in a patient are accurate except:

  • Patients with hypertension can maintain adequate perfusion in a shock state

  • In patients with hypertension, the development of hypotension may be ignored or missed

  • Changes to the patient's vital signs reflects the body's attempt to compensate

  • Uncompensated shock is defined by a decrease in blood pressure

Correct answer: Patients with hypertension can maintain adequate perfusion in a shock state

Patients can experience a shock state as a result of any number of different insults, including hypovolemia, vasomotor dysfunction, sepsis, anaphylaxis, or acute spinal cord injury (among others), but overall, the effect of shock is the same. The physical signs, including changes in vital signs, exhibited by a patient in shock are a reflection of the compensation attempts of the body, as well as a result of hypoxia. If the shock state is not treated rapidly, hypotension will ensue, indicating a failure of the body's compensatory mechanisms; this is typically referred to as "uncompensated shock." 

In patients with an underlying history of hypertension, the development of a hypotensive state may be ignored or missed, and while it may be assumed that adequate perfusion is being maintained due to what appears to be normal systemic blood pressures, this may not be the case. Often, hypertensive patients in a shock state are ultimately grossly underperfused as a result of decreases in arterial blood pressure, due to their already dysfunctional blood pressure state.

28.

A 10-month-old desert-dwelling male child sustained a bark scorpion bite and is now experiencing seizure activity. Which of the following statements regarding scorpion stings and their treatment is most accurate?

  • Severe scorpion stings should be treated with benzodiazepines and atropine

  • Most individuals, including infants and children, who sustain scorpion stings do not experience severe symptoms

  • Scorpion stings, like venomous snake bites, are treated with an antivenin manufactured from horse serum

  • The administration of scorpion antivenin can produce positive results in as soon as 8 to 12 hours

Correct answer: Severe scorpion stings should be treated with benzodiazepines and atropine

Scorpion stings from the bark scorpion are extremely common in the southwest areas of the United States. Most scorpion stings produce only mild symptoms of localized pain and paresthesias, and can be safely treated at home with the application of cool compresses, taking acetaminophen or ibuprofen for the pain, and elevating the bitten area, after cleaning the area with soap and water. Severe symptoms most often occur in infants, children, and the elderly, and require immediate treatment at the hospital. Symptoms are neurologic in nature, and include seizures, cranial nerve dysfunction, and neuromuscular dysfunction. 

Anascorp, the antivenin for scorpion stings, should be administered to individuals experiencing severe symptoms as a result of the sting. Positive results are typically experienced in up to 4 hours. If scorpion antivenin is not available, the victim should be treated with benzodiazepines and atropine. Anascorp is manufactured from horse serum, while the antivenin manufactured to treat venomous snake bites is made using sheep serum.

29.

A nurse is providing advanced airway management to a pediatric patient. A child's airway differs from an adult's until about the age of: 

  • 8 years.

  • 5 years.

  • 6 years.

  • 10 years.

Correct answer: 8 years.

Once a child is approximately 8 years of age, their larynx resembles that of an adult in structure and position. The greatest differences are in a child who is 2 years or younger and patients between the years of 2 and 8 (a transitional period). 

30.

You are the team leader transporting a pulseless, three-year-old male patient in Torsades de Pointes. High quality CPR is in progress. His baseline-corrected QT interval on a 12-lead ECG is prolonged, he has received one dose of epinephrine 0.01 mg/kg, but he remains in Torsades de Pointes.

What is the best next step?

  • Magnesium sulfate 25 to 50 mg/kg IV

  • Adenosine 0.1 mg/kg IV

  • Lidocaine 1 mg/kg IV

  • Epinephrine 0.1 mg/kg IV

Correct answer: Magnesium sulfate 25 to 50 mg/kg IV

Immediate defibrillation is the treatment of choice when Torsades is sustained or degenerates to VF. However, termination of Torsades by shock does not prevent its recurrence, which requires additional measures. In small case series, IV magnesium has been effective in suppressing and preventing recurrences of Torsades. Magnesium is believed to suppress early after-depolarizations, which are fluctuations in the myocardial action potential that can trigger the salvos of VT seen in Torsades. Magnesium is the initial treatment for Torsades de Pointes and dysrhythmias secondary to hypomagnesemia, cardiac arrest from QTc prolongation, or cardiac glycoside toxicity. Pacing is continued until the cause of QT prolongation (drug toxicity, electrolyte abnormality) is resolved.

31.

The medical air transport team that is providing care for an individual who intentionally ingested a toxic dose of acetylsalicylic acid is preparing to evaluate arterial blood gas (ABG) results. The team should expect to see which of the following most likely initial ABG results?

  • Respiratory alkalosis

  • Metabolic acidosis

  • Metabolic alkalosis

  • Respiratory acidosis

Correct answer: Respiratory alkalosis

Acetylsalicylic acid poisoning (aspirin) occurs with ingestion of greater than 150 mg/kg of aspirin, and can cause mild to severe symptoms which are dependent upon the amount of aspirin ingested. Mild intoxication results in symptoms of headache, vertigo, ringing in the ears (tinnitus), confusion, diaphoresis, hyperventilation, drowsiness, and nausea and vomiting. Patients with severe intoxication also experience these symptoms, as well as electrolyte and acid-base imbalance, and may also experience seizures and ultimately, coma. 

The initial arterial blood gas (ABG) results in aspirin toxicity typically reveal a state of respiratory alkalosis, as a result of the direct stimulation of the respiratory center by the salicylates. Without intervention, the acid-base imbalance will ultimately progress to a severe metabolic acidosis.

32.

You are the CFRN/CTRN transporting a burn patient to the regional burn center. While en route, the patient’s EKG begins to show tall peaked T waves. What is the possible cause?

  • Hyperkalemia

  • Hyponatremia

  • Hypothermia

  • Myocardial infarction

Correct answer: Hyperkalemia 

Burn patients can experience electrolyte changes due to destruction of cells. Most commonly, intracellular electrolytes such as potassium are released causing hyperkalemia. Evidence of hyperkalemia is seen on the EKG first as a tall peaked T waves. If the hyperkalemia is not corrected, the QRS will widen and, eventually, the rhythm will look sinusoidal. 

Hyponatremia generally does not reveal EKG changes. Hypothermia could produce an Osborn wave, not tall peaked T waves. Myocardial infarction would produce ST segment elevation.

33.

Falls from what distance are associated with severe injury?

  • Falls greater than 15-20 feet (3x standing height)

  • Falls from standing (same level falls)

  • Falls 5-10 ft

  • Falls 10-15 ft

Correct answer: Falls greater than 15-20 feet (3x standing height)

Any height greater than one story (15 feet) is associated with severe injuries. Also, falls 3x the height of the patient is a good estimation for severity in pediatric patients.

34.

What does the dicrotic notch of an arterial waveform represent?

  • Closing of the aortic valve 

  • Opening of the aortic valve 

  • Closing of the tricuspid valve

  • Opening of the tricuspid valve 

Correct answer: Closing of the aortic valve

The CFRN/CTRN should know what the dicrotic notch is and what it represents. Even if you do not remember this information, we can use critical thinking to solve the problem, given the answer choices. First, we know that an arterial waveform reads pressure in the arteries. The dicrotic notch is a small upward rise on the downward slope of the waveform. So what would cause a small rise in pressure? Given the answer choices, the closing of the aortic valve would cause a small increase in pressure of circulatory system. This occurs because the forward flow of blood during systole momentarily flows backward (this is how the coronary arteries are filled). The elastic walls of the aorta rebound to this increase in backward pressure and we see a small “blip” in the arterial waveform.

35.

The medical transport provider who has been called to the scene of a motor vehicle accident is using the Revised Trauma Score tool to aid her in determining the severity of the patient's injuries. All of the following assessment components are included in the Revised Trauma Score tool, except:

  • Capillary refill

  • Systolic blood pressure

  • Glasgow Coma Scale (GCS) score

  • Respiratory rate

Correct answer: Capillary refill

The Revised Trauma Score tool, as its name suggests, is a trauma scoring tool that was developed through revision of the original Trauma Score physiologic index used to help determine the severity of traumatic injury. The original Trauma Score index includes assessment of five patient parameters, including systolic blood pressure, capillary refill, respiratory rate, respiratory expansion (any use of accessory muscles or presence of intercostal retractions), and the Glasgow Coma Score (GCS). The Revised Trauma Score excludes scoring of the subjective components of the assessment, the capillary refill and respiratory expansion, as these two parameters can be scored differently simply due to difference in the person assessing the patient. 

Regardless of which of these tools is used to determine severity of traumatic injury, what needs to be kept in mind is that both of these tools measure the patient's physiologic response; patients who are compensating for the injury and patients being supported by mechanical ventilation will demonstrate more positive scores (indicating less severe injury), without the actual severity of their condition being accurately reflected.

36.

Within the first 24 hours of extrauterine life, all of the following health complications are listed among the top killers of neonates except:

  • Gastroschisis

  • Sepsis

  • Meconium aspiration

  • Persistent pulmonary hypertension

Correct answer: Gastroschisis

In the first 24 hours of extrauterine life, the neonate is most likely to die from complications related to sepsis, cardiac problems, and issues with respiration than any other cause. Sepsis most often results from maternal infection with Group B Streptococcus (GBS) despite the now routine evaluation for GBS at the end of the third trimester. Respiratory complications may arise from meconium aspiration, respiratory distress syndrome (seen in preterm neonates due to deficiency of surfactant), or other disorders such as choanal atresia. Congenital cardiac conditions such as cyanotic heart lesions or congenital heart disease may contribute to cardiac arrhythmias or poor perfusion, while bradycardia may present as a result of intrauterine hypoxia.

37.

A medical air transport crew is en route to pick up a patient who has been diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) for transport. Which of the following laboratory findings is consistent with this diagnosis? 

  • Hyponatremia 

  • Increased osmolality 

  • Increased blood urea nitrogen (BUN) 

  • Hyperkalemia 

Correct answer: Hyponatremia 

SIADH occurs when the pituitary gland releases excessive amounts of ADH, which originates in the hypothalamus and is stored in the pituitary gland. Increased production of antidiuretic hormone (ADH) causes decreased urinary output and fluid overload, resulting in hyponatremia. 

Fluid overload causes hypokalemia (not hyperkalemia) and low osmolality (<275 mOsm/L). Blood urea nitrogen (BUN) is normal or decreased. 

38.

You performing a neurological examination of a patient with a potential head injury, and you apply painful stimuli to the nail bed, resulting in extensor rigidity in all four extremities. Your patient is exhibiting:

  • Decerebrate posturing

  • Decorticate posturing

  • Flaccid paralysis

  • Normal posturing to pain

Correct answer: Decerebrate posturing

Decerebrate posturing is extensor rigidity of all four extremities in response to painful stimuli.

Damage to lower midbrain and upper pons causes decerebrate posturing in which lower extremities are extended with toes pointed inward and upper extremities extended with fingers flexed and forearms pronated. Neck and head are extended. 

Damage to upper midbrain may cause decorticate posturing in which upper limbs are flexed, lower limbs are extended with toes pointed slightly inward, and head is extended. Flaccid paralysis is a condition characterized by extreme weakness of muscles and loss of muscle tone.

39.

Which of the following is a common cause of upper airway obstruction in children?

  • Foreign body aspiration

  • Bronchiolitis

  • Botulism

  • Pneumothorax

Correct answer: Foreign body aspiration

All of the answer choices are common causes of respiratory distress in children. Upper airway obstruction is a common result of croup, epiglottitis, and foreign body aspiration. 

Bronchiolitis is a cause of lower airway obstruction; botulism and pneumothorax can affect ventilation, but are not obstructive.

40.

While packaging a patient for medical air transport from the scene of crime during which the patient was shot in the head, you discover a handgun. What is the next best step in this scenario?

  • Leave the weapon where it is, notify law enforcement, and then transport the patient around the location of the weapon

  • Take a photo of the weapon in the location where it was found ensuring that reference points can be identified in the photo

  • Remove the ammunition from the weapon and ask a crew member to position the weapon in a neutral position for photographing

  • Notify law enforcement of the weapon, then pick up the weapon using the grips and move it into a neutral location so the patient can be safely transported

Correct answer: Leave the weapon where it is, notify law enforcement, and then transport the patient around the location of the weapon

Members of medical air transport crews may at times encounter firearms (or other weapons) at the scene of the transport site. When at all possible, the weapon should be left in place and law enforcement should be notified. 

The medical air transport crew should always assume firearms are loaded and able to operate correctly, even if the weapon appears to be damaged or is not fully intact. If the weapon needs to be relocated in order to provide medical care to the victim or in order to ensure safe transport of the victim, the weapon should be photographed in place, making sure to include as many of the details of the surrounding environment as possible. Do not attempt to remove ammunition from firearms, but a count of any ammunition visible in the cylinder chamber or the presence and location of any expended ammunition should be made. Only one individual should be responsible for the actual touching of the firearm, and should pick up the weapon using the grips held between the fingers, without concern of obscuring any possible fingerprints.

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