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Quiz Session - Attempts With Random Questions

IBSC CCP-C Exam Questions

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1.

You are treating a 19-year-old female patient from a multi-vehicle MVC. The patient was ejected from the vehicle and found approximately 20 yards from the vehicle in a grass field. While performing a neurological exam, you note the patient has a positive halo test. The patient most likely has sustained which of the following?

  • Basilar skull fracture

  • Subarachnoid hemorrhage

  • Tympanic membrane rupture

  • Le Fort II fracture

Correct answer: Basilar skull fracture

A positive halo test is indicative of a basilar skull fracture. A positive halo test occurs as a result of the leakage of CerebroSpinal Fluid (CSF). The healthcare provider can take a gauze pad and collect fluid escaping from the mouth, nose, or ear. If there is a halo appearance, described as a dark red circle surrounded by a yellow ring, this signifies there is a leak of CSF, and the patient most likely has a basilar skull fracture. Other signs and symptoms of a basilar skull fracture are Battle sign and raccoon eyes. 

CSF leakage is not associated with a subarachnoid hemorrhage, tympanic membrane rupture, or a Le Fort II fracture. 

2.

Ventilator-induced lung injury can occur in patients on mechanical ventilation. It is most common in patients with ARDS, COPD, and asthma, all of which are associated with high transpulmonary pressures (TPP). What is the formula for calculating transpulmonary pressure?

  • Alveolar pressure - pleural pressure = TPP

  • (PaCO2 - PECO2) / PaCO2 = TPP

  • Respiratory Rate x (Tidal Volume – Deadspace) = TPP

  • Change in pressure X change in volume = TPP

Correct answer: Alveolar pressure - pleural pressure = TPP

TransPulmonary Pressure (TPP) is calculated using the following formula: Alveolar Pressure (AP) - Pleural Pressure (PP). 

(PaCO2 - PECO2) / PaCO2 is the formula used to calculate dead space. 

Respiratory rate x (Tidal Volume - Deadspace) is the formula used to calculate alveolar minute ventilation. 

Change in pressure X change in volume is the formula to calculate the work of breathing. 

3.

The larynx consists of three single cartilages and six paired cartilages. Which of the single cartilages is formed by the fusing of two curving cartilage plates to make it the largest of the cartilages?

  • Thyroid cartilage

  • Cricoid cartilage

  • Epiglottis

  • Arytenoids

Correct answer: Thyroid cartilage

The three single cartilages of the larynx are the thyroid cartilage, the cricoid cartilage, and the epiglottis. The largest of the three single cartilages is the thyroid cartilage. It is nicknamed the Adam's Apple, and its primary job is to protect the vocal cords.

The cricoid cartilage is located below the thyroid cartilage and connected by the cricothyroid membrane. The cricoid cartilage is the location for a cricothyrotomy. 

The epiglottis is the third single cartilage and is located over the glottic opening. The epiglottis serves as a primary landmark when intubating. 

The arytenoids are a paired cartilage and provide an anchor for the vocal cords.

4.

You are treating a 50-year-old female patient with a severe traumatic brain injury in the intensive care unit. Her current measurements are a MAP 90 mmHg and ICP 25 mmHG. What is her Cerebral Perfusion Pressure (CPP), and why is it clinically significant?

  • 65 mmHg, ensuring adequate cerebral blood flow is crucial for brain function and preventing secondary injury

  • 115 mmHg, ensuring adequate cerebral blood flow is crucial for brain function and preventing secondary injury

  • 65 mmHg, as low CPP can lead to hyperperfusion and potential brain damage

  • 115 mmHg, as low CPP can lead to hyperperfusion and potential brain damage

Correct answer: 65 mmHg, ensuring adequate cerebral blood flow is crucial for brain function and preventing secondary injury

Cerebral Perfusion Pressure (CPP) is calculated using the formula:

CPP=MAP−ICP

So, 90 mmHg - 25 mmHg = 65 mmHg (CPP). Typically, a CPP of 60-70 mmHg is considered optimal for patients with TBI. If CPP falls below this range, there is a risk of insufficient blood flow to the brain, leading to ischemic damage. Conversely, excessively high CPP is less of a concern in this context than ensuring it does not drop too low.

115 mmHg is an incorrect CPP, as it does not follow the formula. Also, a low CPP does not lead to hypoperfusion. 

5.

You are treating a 12-year-old male with a chief complaint of hematuria with brown urine, pulmonary edema, and hypertension. The physician reports the patient recently was diagnosed with group A Streptococcus and missed a full week of school. The patient's lab work reveals a BUN 32 mg/dl, serum creatinine 2.5 mg/dl, and potassium 6.5 mEq/L. 

What should you suspect?

  • Acute postinfectious glomerulonephritis (APIGN)

  • Acute Tubular Necrosis

  • Hemolytic Uremic Syndrome

  • Diabetic Ketoacidosis

Correct answer: Acute postinfectious glomerulonephritis (APIGN)

Acute PostInfectious GlomeruloNephritis (APIGN) is a histopathologic disorder that commonly follows an acute infection, with the most typical cause being group A Streptococcus. APIGN is commonly seen in school-aged children and primarily in boys. The symptoms of APIGN typically present one to two weeks after the initial infection. Symptoms of APIGN include brown urine with gross hematuria, hyperkalemia, hyponatremia, elevated BUN and creatinine, and acidosis. Patients diagnosed with APIGN receive supportive treatment and IV fluid resuscitation. 

Acute Tubular Necrosis (ATN) causes tissue damage to the tubules of the kidneys, most commonly caused by renal ischemia secondary to hypovolemia. ATN occurs in three phases and is managed with fluid and electrolyte replacement. Signs and symptoms are severe oliguria in the first phase and ending with polyuria in the last phase. 

Hemolytic Uremic Syndrome causes Acute Kidney Injury (AKI) in infants and children under four years of age. It is characterized by a trio of symptoms, such as acute kidney injury, thrombocytopenia, and hemolytic anemia. Signs and symptoms are nausea and vomiting, bloody diarrhea, and abdominal pain. Treatment consists of fluids and blood pressure control. 

Diabetic KetoAcidosis (DKA) is an endocrine disorder, typically seen in Type I diabetic patients. Typical signs and symptoms of DKA are hyperglycemia, Kussmaul respirations, and fruity breath.

6.

You are treating a 5-month-old with difficulty breathing. The patient's mother states the child has been sick with an upper respiratory infection and fever for the past 36 hours. Upon inspection, you note intercostal retractions, auscultate wheezing, and observe that the patient’s nose is obstructed with mucus. 

Which of the following is your initial intervention?

  • Suction the patient's nose

  • Administer nebulized albuterol

  • Apply CPAP

  • Administer DuoNeb

Correct answer: Suction the patient's nose

It is important to suction the patient's nose and clear the mucus obstruction to improve tidal volume. Infants are primarily nose breathers, and any type of nasal obstruction can make breathing difficult. 

The patient may benefit from nebulized albuterol or DuoNeb, but the nose obstruction must be addressed first. 

CPAP would only be administered if the inhaled beta-agonists didn't improve the patient's symptoms. 

7.

Which of the following interventions is not an appropriate initial step in the management of idiopathic Persistent Pulmonary Hypertension of the Newborn (PPHN)?

  • Administer surfactant

  • Administer 100% oxygen via ventilator

  • Administer nitric oxide

  • Administer sedation agents

Correct answer: Administer surfactant

Surfactants are not routinely used to treat Persistent Pulmonary Hypertension of the Newborn (PPHN) unless the cause of the PPHN is known (in this scenario, it was idiopathic), such as meconium aspiration syndrome, parenchymal lung disease, pneumonia, or sepsis.

Persistent Pulmonary Hypertension of the Newborn (PPHN) is a syndrome in which the expected transition from fetal circulation to neonatal circulation fails to occur, resulting in right-to-left shunting of blood at the foramen ovale or the ductus arteriosus. This results in significant pulmonary hypertension and hypoxemia. PPHN treatment aims to maintain adequate oxygenation while waiting for pulmonary vascular resistance to decrease. Oxygen is often adequate initially, as it functions as a potent vasodilator. 

If the neonate is unable to maintain adequate oxygenation with the delivery of the 100% oxygen concentration, nitric oxide should be administered, as this also serves to decrease pulmonary vascular pressure. 

Sedation and neuromuscular blockade paralysis may also be considered to reduce oxygen consumption and pulmonary vascular resistance. High-frequency ventilation (oscillator, jet ventilator) should be used when possible if it is known the infant has parenchymal lung disease.

8.

You are treating a 23-year-old male with an acute severe asthma exacerbation. The patient is not responding to treatment with oxygen, albuterol, Solu-Medrol, and epinephrine and has persistent hypoxemia. What is your next step?

  • Administer a magnesium sulfate infusion

  • Administer a second dose of Solu-Medrol

  • Administer dexamethasone

  • Administer terbutaline

Correct answer: Administer a magnesium sulfate infusion

Magnesium sulfate is not recommended for routine use but may be used in those who fail to respond to initial treatment and remain hypoxemic. It can be effective in inducing bronchodilation and improving airflow. The recommended dosing is 40 mg/kg IV over 10 to 15 minutes, with a max dose of 2 g. 

A second dose of Solu-Medrol is not recommended for asthma exacerbation. 

Dexamethasone is a corticosteroid. Solu-Medrol has already been used and was unsuccessful. A second, different corticosteroid is not recommended. 

Albuterol was unsuccessful, so administering another beta-2 agonist, such as terbutaline, is not advisable. 

9.

You are treating a 45-year-old male complaining of severe chest pain and tearing pain in the upper back. Vital signs are BP 178/88 (right arm), BP 132/68 (left arm), P 118, R 20, and SpO2 92%. The 12-lead ECG reveals sinus tachycardia with no ST elevation noted. You should suspect which of the following?

  • A dissecting aortic aneurysm

  • A pulmonary embolism

  • A spontaneous pneumothorax

  • An NSTEMI

Correct answer: A dissecting aortic aneurysm

The patient is exhibiting classic signs and symptoms of a dissecting aortic aneurysm. Unequal blood pressure in each arm is indicative of a dissecting aortic aneurysm. This is secondary to the pseudohypotension located in the limb affected by the aneurysm. The chest pain and tearing pain to the upper back or between shoulder blades are also a hallmark of a dissecting aortic aneurysm. 

A pulmonary embolism, spontaneous pneumothorax, and an NSTEMI do not cause unequal blood pressure in each arm or tearing pain to the upper back or between shoulder blades. 

10.

Your adult patient has a central line placed, and you note there is an absence of the a-wave in the CVP tracing. What cardiac dysrhythmia do you suspect the patient is experiencing? 

  • Atrial fibrillation

  • Junctional tachycardia

  • Sinus tachycardia

  • 3° AV Block

Correct answer: Atrial fibrillation

In CVP tracing, the a-wave represents atrial contractions. If there is no a-wave, it means there are no atrial contractions or that the atria are beating so fast they are not recognized by the CVP tracing. This is typical of atrial fibrillation. 

The a-wave will appear in junctional tachycardia, sinus tachycardia, and 3° AV block. 

11.

You have just placed a chest tube in your adult male patient with a tension pneumothorax. You are setting up the Pleur-Evac pleural drainage system. What is the recommended initial setting for the pleural drainage system?

  • -20 cm H20

  • -10 cm H2O

  • +20 cm H2O

  • +10 cm H2O

Correct answer: -20 cm H2O

The Pleur-Evac pleural drainage system is connected to the chest tube to remove blood and other fluids and restore air pressure to the lungs. The first step is to connect suction. The initial setting for the Pleur-Evac is -20 cm H2O. The Pleur-Evac drainage system must be kept upright at all times to maintain drainage. It must be kept below chest level to maintain drainage by gravity. The tubing must be kink-free. 

The other answer options are incorrect.

12.

A 45-year-old male with a history of COPD is admitted to the ICU with severe pneumonia and ARDS. He is intubated and placed on mechanical ventilation. 

Which of the following is the most appropriate approach to setting PEEP on the ventilator for this patient?

  • Set PEEP based on the ARDSnet protocol, starting at 5 cm H2O and titrating upward

  • Set PEEP at 5 cm H2O to avoid barotrauma

  • Set PEEP at 10 cm H2O immediately to maximize alveolar recruitment

  • Avoid using PEEP to prevent hyperinflation in COPD

Correct answer: Set PEEP based on the ARDSnet protocol, starting at 5 cm H2O and titrating upward

Setting the appropriate PEEP on the ventilator is crucial for managing patients with ARDS, especially those with underlying conditions like COPD. The Acute Respiratory Distress Syndrome Network (ARDSnet) protocol provides evidence-based guidelines for optimizing PEEP to improve oxygenation and prevent ventilator-induced lung injury. The ARDSnet protocol recommends starting PEEP at 5 cm H2O and titrating based on oxygenation targets and patient response. Adjust PEEP to achieve optimal oxygenation with the lowest possible FiO2 (fraction of inspired oxygen), typically aiming for PaO2 of 55-80 mm Hg or SpO2 of 88-95%.

Starting at 5 cm H2O is reasonable, but avoiding titration upward based on patient response is not optimal for managing ARDS. 

While higher PEEP may be necessary, starting immediately at 10 cm H2O without titration could increase the risk of barotrauma. 

Avoiding PEEP entirely can worsen oxygenation and atelectasis. Careful titration is essential.

13.

You are treating a 17-year-old female who took an unknown amount of warfarin. What is the recommended antidote-reversal agent indicated? 

  • Vitamin K fresh frozen plasma

  • Benzodiazepines

  • Mucomyst

  • Deferoxamine

Correct answer: Vitamin K fresh frozen plasma 

The recommended reversal agent for warfarin (Coumadin) is vitamin K fresh frozen plasma. Prothrombin complex concentrate is also USD. IV vitamin K lowers the INR more quickly than oral vitamin K.

Benzodiazepines are the reversal agents for sympathomimetic, such as cocaine, amphetamine, and MDMA. They may also be used as the antidote for SSRIs. 

Mucomyst is the reversal agent for acetaminophen poisoning. 

Deferoxamine is the antidote for iron poisoning. 

14.

Which type of diabetes insipidus is caused by an increase in the breakdown of ADH and is common in pregnant women with eclampsia and preeclampsia?

  • Gestagenic DI

  • Neurogenic DI

  • Nephrogenic DI

  • Dipsogenic DI

Correct answer: Gestagenic DI

There are four types of diabetes insipidus. Gestagenic DI occurs in pregnant women with eclampsia, preeclampsia, multiple gestation, or liver complications. There is a decrease in ADH and an increase in vasopressinase, which is unresponsive to vasopressin. 

Neurogenic DI is caused by a decrease in ADH from the posterior pituitary gland. It is caused by bacterial meningitis, head trauma, chemical toxins, and autoimmune disease. 

Nephrogenic DI occurs when the kidneys are unable to concentrate the urine. 

Dipsogenic DI is caused by polydipsia. It is commonly called psychogenic polydipsia. 

15.

You are dispatched to an unresponsive adult found lying behind a convenience store. You find a 28-year-old male lying prone on the ground with empty alcohol bottles and evidence of cocaine lying beside him. The patient was in the store earlier complaining of chest pain and difficulty breathing. The patient is now unresponsive to verbal and painful stimuli, has a shallow respiratory rate of 8, and a blood pressure of 78/palpated.  Your partner provides positive pressure ventilation.

Which of the following should your next action be?

  • Intubate the patient

  • Assess blood glucose level

  • Administer IV naloxone

  • Administer IV thiamine

Correct answer: Intubate the patient

The patient's ventilatory status requires you to take immediate and aggressive action. The patient is in ventilatory failure. Assisted ventilations are being provided, so the next step is to intubate the patient. 

Assessing the patient's blood glucose will certainly be done in this patient, but it will not fix the patient's ventilatory problem. Address the respiratory failure and then look into assessing blood glucose. 

Naloxone will not reverse the effects of alcohol or cocaine. 

Thiamine is indicated in this patient but not before addressing the respiratory failure. 

16.

Your 23-year-old patient was hit in the chest by a baseball hit by another player. The patient is complaining of difficulty breathing. Auscultation reveals absent breath sounds to the left chest. The patient is apprehensive and anxious. You suspect pneumothorax and prepare to perform a pleural decompression. 

Which of the following is the best size to complete the needle decompression? 

  • 14 ga. 2.0 in.

  • 16 ga. 1.5 in.

  • 14 ga. 1.0 in.

  • 16 ga. 1.0 in.

Correct answer: 14 ga. 2.0 in.

A large-bore needle is required to perform a needle decompression. A 14 ga. or 16 ga. is preferred. Also, several of the commercial pneumothorax kits include a 10 ga. needle. The length should be at minimum 2.0 in. The 14 ga. 2.0 in. needle is the most appropriate to use. 

Needles less than 2.0 in. are not long enough to reach the pleural space and would be ineffective in relieving the tension pneumothorax. 

17.

You are treating a 19-year-old female in the field for pregnancy complications. The patient states she is unaware of how far along she is in her pregnancy and has not received any prenatal care. The patient states she thinks she may be between 36-38 weeks pregnant. You assess the fundal height to approximate the baby's gestational age. 

What measurement should the final height be for 36-38 weeks gestation?

  • 1 finger breadth below the the xiphoid process

  • Halfway between pubis and the umbilicus

  • 3-4 finger breadths above the umbilicus

  • 2-3 finger breadths below the xiphoid process

Correct answer: 1 finger breadth below the xiphoid process

Determining the fetal age is important when preparing to deliver a child. In the field, if the patient has not received prenatal care, it can be difficult to determine the fetal age. History provided by the patient can lead us to an assumption of age. In the field, the best way to to determine the fetus' age is to measure the fundal height. A gestational age of 36-38 weeks is measured by one finger breadth below the xiphoid process.

Halfway between the pubis and umbilicus is the fundal height measurement of a 16-week fetus. 

Three to four finger breadths above the umbilicus indicate 32 weeks, while two to three finger breadths below the xiphoid process indicate a fetus to be 40 weeks. 

18.

You are preparing to perform rapid sequence intubation on your 4-year-old male patient with respiratory failure. Which of the following medications is administered first?

  • Atropine

  • Fentanyl

  • Vecuronium

  • Lidocaine

Correct answer: Atropine

Rapid Sequence Intubation (RSI) is the treatment of choice in pediatric patients to facilitate intubation. The first line medication is atropine. Atropine blocks the vagal response in infants and children during the intubation procedure. 

Fentanyl may be used in the RSI procedure but is not the first-line medication. 

Vecuronium is a neuromuscular blocker administered after the patient has been intubated. It is a longer-acting paralytic medication. 

Lidocaine is not in the protocol for a typical RSI procedure. It is recommended in patients with increased intracranial pressure. 

19.

You are treating a 12-year-old male with vomiting and a decreased level of consciousness. The patient's respirations are rapid and deep, and he is lethargic and irritable in response to stimulation. He has poor skin turgor and dry mucous membranes. His mother states he has a one week history of polyuria and weight loss. The patient's ABG results are pH 7.25, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L.  

What do the ABG results show?

  • Partially compensated, metabolic acidosis

  • Uncompensated metabolic alkalosis

  • Uncompensated respiratory acidosis

  • Compensated respiratory acidosis

Correct answer: Partially compensated, metabolic acidosis

The patient is exhibiting signs and symptoms of diabetic ketoacidosis, and the ABG results show partially compensated metabolic acidosis. The patient's pH is 7.25, which is acidotic. The patient's HCO3 is considerably low, making this a metabolic issue, and the CO2 is low, representing partial compensation.

Uncompensated metabolic alkalosis would have an elevated pH and an elevated HCO3 with an abnormal PCO2. Uncompensated respiratory acidosis would have a lower pH, elevated PCO2, and a normal HCO3. Compensated respiratory acidosis would have an abnormal HCO3.

20.

You are working in the ER when a 26-year-old male patient is brought in by EMS with severe burns. The patient was pushed into a bonfire during an altercation and has partial thickness and full thickness burns noted to bilateral arms, neck, face, and chest. The patient is complaining of severe pain to his chest and arms. The patient is actively coughing up black soot. 

Which of the following is the priority?

  • Laryngeal swelling

  • Infection 

  • Hypothermia 

  • Pain management

Correct answer: Laryngeal swelling

With burn patients, the first priority is to stop the burning process. Secondly, the patient's airway must be addressed. Burn patients with burns to the face, neck, and chest are at high risk for airway burns, which cause severe laryngeal swelling. The patient is coughing up black soot, which should provide a high suspicion for airway burns and swelling. 

Infection is a major concern in burn patients but is not first priority in this patient. Although the CCP should complete measures to reduce the risk of infection, infection is not addressed in the primary assessment. 

Hypothermia is a real risk with burn patients, but airway management is the first priority. Hypothermia prevention will need to be addressed in this patient, but the laryngeal swelling is more important. 

Pain management is a concern with this patient but not first priority. 

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