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Quiz Session - Attempts With Random Questions

IBSC CCP-C Exam Questions

Page 10 of 20

181.

Your adult patient has a history of Graves disease. The patient presents to the ED with agitation and tremors. Vital signs are BP 182/94, P 138, R 22, with a temperature of 102° F. You should suspect:

  • Thyrotoxicosis

  • Myxedema coma

  • Acute adrenal insufficiency 

  • Diabetes insipidus

Correct answer: Thyrotoxicosis

Patients with Graves disease account for 60%-80% of all thyrotoxicosis patients, also known as thyroid storm. Thyroid Storm is caused by an excessive release of thyroid hormones. Common signs and symptoms of thyrotoxicosis are hyperthermia, agitation, tremors, tachydysrhythmias, and dehydration. It is important to be aggressive in your treatment of a thyroid storm. 

Myxedema coma is a form of hypothyroidism and is commonly caused by Hashimoto's disease. 

Acute adrenal insufficiency, also known as addisonian crisis, is caused by a lack of glucocorticoids and mineralocorticoids. 

Diabetes Insipidus (DI) is caused by inadequate ADH, and there are 4 types of DI. 

182.

You are treating a 60-year-old male patient who presents to the ED in cardiogenic shock. The patient is hypotensive, tachycardic, and experiencing significant respiratory distress. The patient has a history of coronary artery disease and is post AMI of two weeks. Arterial blood gas analysis is performed, revealing the following results:

  • pH: 7.25
  • PaO2: 60 mmHg
  • PaCO2: 50 mmHg
  • HCO3-: 24 mEq/L
  • SaO2: 90%
  • Lactate: 4 mmol/L

Based on the blood gas analysis, which of the following interpretations is most accurate regarding the patient's status?

  • Respiratory acidosis with compensated metabolic alkalosis

  • Respiratory alkalosis with uncompensated metabolic acidosis

  • Respiratory acidosis with uncompensated metabolic acidosis

  • Respiratory alkalosis with compensated metabolic acidosis

Correct answer: Respiratory acidosis with compensated metabolic alkalosis

The pH value of 7.25 indicates acidemia, suggesting an acid-base imbalance. The PaCO2 of 50 mmHg is elevated, indicating respiratory acidosis, which is consistent with hypoventilation commonly seen in cardiogenic shock due to pulmonary edema. The HCO3- level is within the normal range, suggesting a compensated metabolic status. The presence of metabolic alkalosis would typically be characterized by an elevated HCO3- level. Therefore, the patient's acid-base status can be interpreted as respiratory acidosis with compensated metabolic alkalosis. 

This interpretation reflects the respiratory compromise leading to acidosis and compensatory mechanisms maintaining the pH within a near-normal range. The lactate level of 4 mmol/L suggests tissue hypoperfusion and anaerobic metabolism, consistent with cardiogenic shock.

183.

You are transporting a 22-year-old female with chest pain and dizziness. The ECG reveals SVT at a rate of 165. You note a delta wave in leads II and V1. The patient states that she feels like her heart is "fluttering," and it causes her to feel short of breath. You should suspect:

  • Wolff-Parkinson White

  • Hypothermia

  • Pulmonary embolism

  • Cardiac tamponade

Correct answer: Wolff-Parkinson White

Wolff-Parkinson White (WPW) is a pre-excitation syndrome that occurs when an accessory pathway is created in the heart, known as the bundle of Kent, which allows the electrical current to bypass the AV node and enter the ventricles. The hallmark ECG sign of WPW is a delta wave. A delta wave is a slurring of the upstroke of the QRS complex. 

The hallmark of an ECG on a hypothermic patient is an Osborne wave. 

A pulmonary embolism does not create a delta wave. The amplitude of the QRS is decreased in a pulmonary embolism. 

A cardiac tamponade causes a trio of events, which are tachycardia, low QRS voltage, and electrical alternans. 

184.

A patient is brought to the ED following a stabbing injury to the spinal cord. Upon your assessment, the patient exhibits ipsilateral weakness and loss of proprioception below the level of injury along with contralateral loss of pain and temperature sensation. Of the following, what is your priority? 

  • Immobilizing the spine and providing supportive care

  • Administering a bolus of intravenous fluids

  • Placing the patient in Trendelenburg position

  • Administering high-dose corticosteroids

Correct answer: Immobilizing the spine and providing supportive care

Immobilizing the spine and providing supportive care is the most appropriate immediate management strategy for a patient with suspected Brown-Sequard syndrome. Immobilization of the spine helps prevent further damage to the spinal cord and surrounding structures.

Administering a bolus of intravenous fluids is not the immediate management strategy for Brown-Sequard syndrome. 

Placing the patient in the Trendelenburg position is not indicated for Brown-Sequard syndrome. 

Administering high-dose corticosteroids has been studied in the management of acute spinal cord injury, including BSS. However, the evidence supporting the use of corticosteroids in this context is controversial, and their routine administration remains debated.

185.

You are treating a 56-year-old female in the ED with a subarachnoid hemorrhage (SAH) and increased intracranial pressure. Which of the following interventions should be prioritized in the management of this patient?

  • Administering Mannitol IV 

  • Elevating the head of the bed

  • Performing a lumbar puncture

  • Initiating hyperventilation to lower PaCO2 levels

Correct answer: Administering Mannitol IV

Administering mannitol is a common intervention to reduce IntraCranial Pressure (ICP) in patients with SubArachnoid Hemorrhage (SAH) and increased ICP. Mannitol is an osmotic diuretic that works by drawing water out of brain tissue and reducing cerebral edema. It can help lower ICP and improve cerebral perfusion pressure.

Elevating the head of the bed is a standard measure to optimize cerebral venous drainage and reduce ICP in patients with SAH but will not effectively or quickly address the increased ICP as Mannitol will. 

Performing a lumbar puncture is contraindicated in patients with suspected or confirmed SAH and increased ICP.  

Hyperventilation induces cerebral vasoconstriction, leading to a decrease in cerebral blood flow and ICP.  However, it should be used judiciously to avoid excessive vasoconstriction and ischemia and is not a priority over Mannitol. 

186.

A 19-year-old male presents to the ED following a severe head injury from a motorcycle accident. He is initially responsive but begins to exhibit signs of deteriorating neurological status. 

Which of the following clinical features is most indicative of rising IntraCranial Pressure (ICP)?

  • Irregular respirations, bradycardia, and hypertension

  • Hypotension and bradycardia

  • Rapid, shallow breathing and hypertension

  • Tachycardia and hypotension

Correct answer: Irregular respirations, bradycardia, and hypertension

The classic triad of symptoms associated with rising IntraCranial Pressure (ICP) includes irregular respirations, bradycardia, and hypertension known as Cushing's Triad. This is the result of the body's attempt to maintain cerebral perfusion.

The combination of hypotension and bradycardia is not typical of rising ICP and can be seen in other conditions such as neurogenic shock. 

While hypertension is part of Cushing's triad, rapid, shallow breathing is not specific for increased ICP. It may indicate respiratory distress or other conditions. 

The combo of tachycardia and hypotension suggests hypovolemic shock or other forms of shock but is not characteristic of increased ICP.

187.

You are treating a patient with a traumatic brain injury. Your goal is to maintain cerebral perfusion pressure. What is the minimum pressure required to perfuse the brain?

  • 70 mmHg

  • 50 mmHg

  • 90 mmHg

  • 80 mmHg

Correct answer: 70 mmHg

Normal cerebral perfusion pressure is 70-90 mmHg. The formula for CPP is MAP - ICP. The minimum perfusion required to maintain brain perfusion is 70 mmHg.

A CPP below 70 can lead to hypoxic-ischemic damage and can increase cerebral edema. 

188.

A 32-year-old male who had a gunshot to the chest two years ago is complaining of shortness of breath. Auscultation reveals abnormal breath sounds in the right upper lobe. His vital signs are P 88, R 22, and BP 130/86, and SpO2 is 92% on room air. 

You should suspect which of the following?

  • Spontaneous pneumothorax

  • Costochondritis

  • Pleural effusion

  • Bacterial pneumonia

Correct answer: Spontaneous pneumothorax

Spontaneous pneumothoraces are not just seen in tall, slender men or patients with chronic lung diseases. They also occur in patients with previous lung injuries. The patient is experiencing symptoms in line with a spontaneous pneumothorax, and his history makes it more plausible.

Costochondritis is the inflammation of the cartilage that connects the ribs to the breastbone. It does not produce abnormal breath sounds. 

The patient does not have the history or symptoms of a pleural effusion. 

The patient's history does not match up to bacterial pneumonia. 

189.

Critical care air transport provides many benefits for patients, but there is also a list of relative contraindications that accompany air transport. Which of the following patients is a relative contraindication to air transport? 

  • 64-year-old male with unstable atrial fibrillation uncontrolled with diltiazem

  • 24-year-old female, 22 weeks pregnant, with a hypertensive crisis

  • 46-year-old female 3-weeks post-Chiari malformation decompression surgery

  • 55-year-old male, intubated and in left-sided heart failure

Correct answer: 64-year-old male with unstable atrial fibrillation uncontrolled with diltiazem

Recent history has proven that air medical transport has been shown to decrease mortality rates and provide access to more specialized medical facilities for patients who would otherwise not have access. Even with all the benefits of air medical transport, there are a handful of relative contraindications that require a risk-benefit analysis. 

  • Severe anemia
  • Uncontrolled, unstable arrhythmias
  • Recent optical globe surgery
  • Pregnancies further than 24-weeks gestation
  • Nonacute hypovolemia
  • Recent MI within 10 days or MI complications within five days of the flight

The patients described in the other answer options may benefit from air medical transport.

190.

You are treating an adult patient suffering from a traumatic brain injury. As you are assessing the patient's cranial nerves, you ask the patient to move their eyes up and down. Which cranial nerve are you assessing?

  • IV, Trochlear

  • II, Optic 

  • V, Trigeminal

  • IX, Glossopharyngeal

Correct answer: IV, Trochlear

Assessment of the cranial nerves can provide information about intracranial pressure and its effect on the brainstem. Cranial nerve IV, the trochlear nerve, is tested by having the patient move their eyes up and down. 

The optic nerve, nerve II, is tested through a patient's field of vision or visual acuity test. 

Nerve V, the trigeminal, is tested using jaw movement and sensation in the face, scalp, cornea, nasal cavity, and oral cavity. 

The glossopharyngeal nerve, nerve IX, is tested through swallowing and the gag reflex

191.

You are transferring a critical pediatric patient to a specialized pediatric trauma center. According to EMTALA, the sending physician is in charge of the patient until which of the following?

  • The patient arrives at the next facility

  • The transport team leaves the sending facility

  • The transport team travels past the halfway point to the next facility

  • The patient is turned over to the transport team

Correct answer: The patient arrives at the next facility

Emergency Medical Treatment and Active Labor Act (EMTALA) is a part of COBRA and states that an emergency physician must act if someone requires emergency care to sustain life or is actively giving birth. On patient transfers, EMTALA requires and states that the sending physician is responsible for the patient being transferred until the patient arrives at the next facility. 

If the transfer team needs to contact medical control, it is recommended to call the sending physician.

 If the transport team needs to detour to another hospital due to a patient emergency, the sending physician is responsible for the patient until the patient arrives at the new facility. 

192.

Which type of aortic stenosis is the least common?

  • Supravalvular stenosis

  • Valvular stenosis

  • Subvalvular stenosis

  • Pulmonic stenosis

Correct answer: Supravalvular stenosis

Aortic stenosis is the narrowing of the aortic valve. Supravalvular stenosis is the least common form of aortic stenosis. It is the narrowing of the aorta above the aortic valve and coronary arteries. 

Valvular stenosis is the most common form of aortic stenosis caused by the creation of a bicuspid valve instead of the normal tricuspid valve. 

Subvalvular stenosis occurs due to lesions or congenital heart anomalies. 

Pulmonic stenosis is not a form of aortic stenosis. It is an obstruction of blood flow from the right ventricle to the pulmonary artery. 

193.

You are transporting a 45-year-old female patient with a high fever, difficulty swallowing, drooling, and a muffled voice. During transport, the patient becomes lethargic, with shallow respirations at 10 breaths/minute. You elect to perform rapid sequence intubation (RSI). 

Which combination of medications is most appropriate for facilitating intubation in this patient?

  • Ketamine and succinylcholine

  • Versed and rocuronium

  • Etomidate and lidocaine

  • Lidocaine and succinylcholine

Correct answer: Ketamine and succinylcholine

The patient is exhibiting signs and symptoms of epiglottitis. Because of its nature, epiglottitis is a life-threatening emergency. To facilitate intubation in this patient, the best choice will be ketamine and succinylcholine. Ketamine is a dissociative anesthetic and provides analgesia and amnesia. It has a unique ability to preserve spontaneous ventilation and airway reflexes while providing adequate sedation. Succinylcholine is the paralytic of choice in rapid sequence intubation. Its rapid onset and short duration make it perfect for this patient. 

Versed is a common benzodiazepine used in inducing sedation in the Rapid Sequence Intubation (RSI) sequence. 

Rocuronium is not indicated as an induction medication. Rocuronium is a nondepolarizing neuromuscular blocker. It has an onset of one to two minutes and a duration of 20-40 minutes. It is not appropriate for induction. 

Etomidate is a barbiturate-like derivative often used in RSI induction. 

Lidocaine is only indicated in RSI of patients with increased intracranial pressure. 

194.

A 24-year-old male is pulled from a lake after being submerged for several minutes. Upon arrival, he is unresponsive and not breathing. He has a weak, rapid pulse. 

Which of the following is the most appropriate immediate intervention?

  • Begin ventilations with a bag-valve-mask

  • Administer intravenous fluids

  • Perform abdominal thrusts to expel water

  • Administer naloxone

Correct answer: Begin ventilations with a bag-valve-mask

In a near-drowning scenario where the patient is experiencing respiratory arrest, the primary focus is on restoring adequate ventilation and oxygenation. Immediate and effective airway management is crucial. Providing positive pressure ventilation with 100% oxygen helps to correct hypoxia, which is the most immediate threat to the patient’s life. This intervention is critical in patients with respiratory arrest.

IV fluids may be needed later for resuscitation or to address hypovolemia, but the immediate focus should be on ventilation and oxygenation. 

Abdominal thrusts are not recommended, as they can induce vomiting and aspiration. It is a myth that large amounts of water need to be expelled from the lungs; the primary issue is hypoxia. 

Narcan is only indicated in opioid overdoses. 

195.

You are treating a 74 year-old-female who is complaining of fatigue, blurred vision, and seeing a yellow-green halo in her vision. Vital signs are BP 90/46, P 42, R 14, SpO2 94%. The ECG reveals a sinus bradycardia. Which medication is likely the cause of the patient's symptoms?

  • Digoxin

  • Metoprolol

  • Doxepin

  • Midazolam

Correct answer: Digoxin

Digoxin is prescribed for the treatment of heart failure and atrial arrhythmias. Toxicity presents with cardiac or noncardiac symptoms. Cardiac symptoms include braydysrhythmias and hyperkalemia. Noncardiac symptoms include nausea, vomiting, fatigue, anorexia, insomnia, drowsiness, hallucinations, and yellow-green halos in the visual fields. Treatment includes digoxin-specific antibody fragments, supportive care, and correction of hyperkalemia. 

The most likely signs and symptoms to be expected with metoprolol overdose are respiratory distress, bradycardia, and hypotension. 

Signs and symptoms of doxepin overdose include abnormally low blood pressure, confusion, convulsions, dilated pupils and other eye problems, disturbed concentration, drowsiness, hallucinations, impaired heart function, rapid or irregular heartbeat, reduced body temperature, stupor, unresponsiveness or coma. 

Midazolam overdose causes drowsiness, coma, and other nonspecific symptoms in an overdose.

196.

You respond to a 22-year-old male, with a tracheostomy, in respiratory distress. When you arrive, you find the patient lying semi-fowlers in bed, with shallow respirations. You note mottling to the patient's extremities. The patient's mother states the home health nurse replaced the patient's tracheostomy tube about 30 minutes ago before she left their house. 

You should do which of the following?

  • Ventilate the patient with a bag-mask device

  • Suction the tracheostomy

  • Contact the home health agency

  • Administer oxygen via a tracheostomy mask

Correct answer: Ventilate the patient with a bag-mask device

The patient is experiencing ventilatory failure. The first thing you must do is ventilate the patient with a bag-mask device. Shallow respirations and mottling are signs of respiratory failure. 

The tracheostomy tube was just placed, and there is no mention of gurgling heard in the tracheostomy. Suctioning is not indicated. 

Contacting the home health agency will not correct the problem at hand. 

Administering oxygen via a tracheostomy mask will aid in oxygenation but not correct the ventilatory failure. 

197.

Crew Resource Management (CRM) began in the 1970s in the airline industry. One safety concept of CRM, in which all crew members must play an equal role, is the decision of:

  • Flight acceptance

  • To hot fuel or cold fuel

  • Landing zone quality

  • Flight altitude increase

Correct answer: Flight acceptance

Crew resource management began in 1977 in response to the crash of a Pan American commercial flight in the Canary islands. CRM focuses on the interpersonal and cognitive skills of maintaining a safe flight and the concept of maintaining situational awareness. CRM allows for all crew members to play an active role in the decision-making process, although it does not imply that all decisions are made without rank consideration. 

Of the following, all crew members must play an active role in the decision on whether to accept a flight. The pilot must perform weather checks and completely assess the situation prior to flight acceptance, but medical crew members also play an active role in flight acceptance. The term all to go, one to say no is a common rule followed by most flight medical providers when determining flight acceptance.

The decision to hot fuel or cold fuel, landing zone quality, and altitude of flight are all decisions made by the pilot. The pilot may converse with the crew members about these decisions, but the ultimate decision is made by the pilot. 

198.

A 32-year-old male was thrown from his ATV when he drove into a wire fence with the wire hitting him across the throat. The patient was not wearing a helmet and was thrown several feet from the ATV. The patient is unresponsive with shallow respirations. You manually open the airway and begin manual ventilations but meet resistance with each breath. You perform direct laryngoscopy and are unable to recognize landmarks. 

You should do which of the following?

  • Perform a surgical cricothyrotomy 

  • Forcefully ventilate with the BVM

  • Place an iGel and ventilate

  • Place an NPA and ventilate 

Correct answer: Perform a surgical cricothyrotomy 

When a patient cannot be ventilated and oxygenated by other means, then surgical cricothyrotomy is indicated. Indications for a surgical cricothyrotomy are inability to ventilate or oxygenate by other means, unrecognizable airway anatomy landmarks due to trauma or anatomical obstruction, and inability to visualize the vocal cords and glottic opening.

It is not indicated to forcefully ventilate with the BVM. In the case of a laryngeal spasm, two to three forceful ventilations may be required initially to adequately ventilate the patient. 

This patient is not exhibiting signs of a laryngeal spasm. An iGel is contraindicated because of the airway trauma noted in this patient. 

Placing an NPA will not improve the ventilation of this patient, as the airway would still be blocked by the trauma. 

199.

Your patient is a two-month-old infant with a history of Tetralogy of Fallot. The patient presents with cyanosis and respiratory distress. Pulse oximetry is 75% on room air. What is the most appropriate initial management strategy?

  • Initiating bag-mask ventilation with 100% oxygen

  • Administering supplemental oxygen via nasal cannula

  • Placing the infant in a knee-to-chest position

  • Administering a dose of sublingual nitroglycerin

Correct answer: Initiating bag-mask ventilation with 100% oxygen

Tetralogy Of Fallot (TOF) is a congenital heart defect characterized by four anatomical abnormalities: pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy. Bag-mask ventilation helps improve oxygenation and correct hypoxemia, providing immediate support while additional interventions are considered. However, it is important to be cautious with ventilation strategies in infants with TOF to avoid exacerbating right-to-left shunting of blood.

Supplemental oxygen helps improve oxygen saturation and alleviate hypoxemia, although it may not fully correct the underlying physiological abnormalities in TOF.  

Positioning maneuvers can sometimes alleviate symptoms in infants with certain congenital heart defects, but they are unlikely to have a significant impact on the underlying cyanosis and respiratory distress associated with TOF. 

Administering a dose of sublingual nitroglycerin is not indicated in the management of an infant with TOF.

200.

You are treating an adult patient in the neurocritical care unit with a traumatic brain injury (TBI) who has an intracranial pressure (ICP) monitoring system in place. The patient's ICP readings have been consistently elevated, and adjustments have been made to optimize cerebral perfusion pressure (CPP).

Based on the management of the ICP monitoring system, which of the following actions is most appropriate to ensure accurate and reliable ICP measurements?

  • Leveling the external transducer system at the level of the patient's tragus

  • Zeroing the pressure monitoring system at the level of the external auditory canal

  • Routinely calibrating the ICP monitoring system every 24 hours

  • Ensuring that the patient's head is maintained in a neutral position to prevent fluctuations in ICP

Correct answer: Leveling the external transducer system at the level of the patient's tragus

Leveling the external transducer system at the level of the patient's tragus ensures that the pressure transducer is zeroed to atmospheric pressure and referenced to the level of the brain, providing accurate IntraCranial Pressure (ICP) measurements. This position helps compensate for variations in intracranial pressure due to changes in body position or intrathoracic pressure. 

Zeroing the pressure monitoring system at the level of the external auditory canal is not recommended, as this reference point may not accurately reflect the level of the brain and could lead to erroneous readings. 

Routinely calibrating the ICP monitoring system every 24 hours is important for accuracy but does not directly address the positioning of the transducer. 

Ensuring that the patient's head is maintained in a neutral position is essential for preventing fluctuations in ICP but is not specifically related to the proper positioning of the external transducer system. Therefore, leveling the external transducer system at the level of the patient's tragus is the most appropriate action to ensure accurate and reliable ICP measurements.

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