×

Quiz Session - Attempts With Random Questions

IBSC CCP-C Exam Questions

Page 2 of 20

21.

Your patient has second- and third-degree burns to a total of 45% TBSA. The patient was burned in a house fire approximately three hours ago and was taken to a small rural ED. The patient was transported to your facility for specialized care. The patient is exhibiting symptoms of burn-induced Systemic Inflammatory Response Syndrome (SIRS). 

All the following are symptoms of SIRS except which of the following?

  • Decreased metabolism

  • Increased gut mucosal permeability

  • Decreased renal blood flow

  • Immunosuppression

Correct answer: Decreased metabolism

Decreased metabolism is not a symptom of burn-induced Systemic Inflammatory Response Syndrome (SIRS). 

Burn-induced SIRS typically occurs within hours of a burn affecting 30% or more TBSA. During SIRS, the body releases inflammatory and vasoactive mediators. 

These are the symptoms of burn-induced SIRS:

  • Decreased renal blood flow
  • Immunosuppression
  • Increased gut mucosal permeability
  • Increased metabolism
  • Increased metabolism
  • Altered hemodynamics
  • Vascular permeability and edema

22.

 You have arrived at a small rural hospital to transport a patient who presented with severe chest pain and signs of acute myocardial infarction. The hospital is unequipped to provide specialized cardiac care, and the patient requires urgent intervention. 

Which of the following actions is most appropriate for you to take under the Emergency Medical Treatment and Labor Act (EMTALA)?

  • Immediately transfer the patient to a nearby tertiary care center with cardiac catheterization capabilities

  • Provide emergency stabilization and treatment to the patient at the rural hospital until they are stable for transfer

  • Consult with an on-call cardiologist at the rural hospital and follow their guidance for management

  • Request a helicopter transport to transfer the patient to a tertiary care center with cardiac services

Correct answer: Immediately transfer the patient to a nearby tertiary care center with cardiac catheterization capabilities

Under the Emergency Medical Treatment and Labor Act (EMTALA), when a patient presents to a hospital with an emergency medical condition that the hospital is not capable of treating, the hospital is required to provide an appropriate transfer to another facility that can provide the necessary care. Given the patient's condition with signs of acute myocardial infarction, immediate transfer to a nearby tertiary care center with cardiac catheterization capabilities is warranted.

While providing emergency stabilization and treatment at the rural hospital may be necessary initially, EMTALA requires timely transfer to a higher level of care when the hospital does not have the capabilities to manage the patient's condition. 

While consulting with an on-call cardiologist may be part of the management plan, EMTALA mandates transfer to a facility capable of providing definitive care for the patient's condition when the presenting hospital lacks the necessary resources. 

While helicopter transport may be an option for expedited transfer to a tertiary care center, the primary consideration under EMTALA is to ensure appropriate transfer to a facility capable of providing the required medical services. Helicopter transport should be arranged as part of the transfer process, not as the primary intervention.

23.

You are dispatched to a residence for a child having a seizure. You arrive to find a lethargic, slightly responsive three-year-old female lying in her mother's arms. The mother states the patient has been sick for the past two days and had a seizure that lasted approximately one minute. She states the patient does not have a history of seizures. The patient has a fever of 102°. While assessing the patient, she begins to seize again. 

You should do which of the following?

  • Administer diazepam rectally

  • Begin cooling measures

  • Administer Tylenol orally

  • Administer a fluid bolus

Correct answer: Administer diazepam rectally

Due to no history of seizures and the patient's high fever, it is likely she is suffering from febrile seizures. Because the patient is actively seizing, the priority is to treat the seizure to stop it. The priority in seizure management is managing the airway, keeping the patient safe, and stopping the seizure. Diazepam is indicated for seizures, whether they are febrile or epileptic. In the pediatric patient, rectal administration is quick and effective. 

Cooling measures and Tylenol administration are indicated for this patient but are not the priority. The seizure must be treated immediately, and then you can begin cooling off the patient and administer Tylenol. 

A fluid bolus is not recommended for this patient. 

24.

What is the most common cause of respiratory distress in preterm infants that presents with progressive respiratory distress, accessory muscle use, retractions, and increased oxygen support?

  • Surfactant deficiency

  • Aspiration pneumonia

  • Pneumonia

  • Pulmonary hypertension

Correct answer: Surfactant deficiency

Respiratory Distress Syndrome (RDS) is hallmarked by the deficiency of surfactant in the lungs of the preterm infant. Surfactant deficiency results in poor lung compliance and causes atelectasis. There is a deficiency in surfactant production secondary to the immature development of type II pneumocytes. That lack of surfactant reduces surface area, which leaves little room for effective gas exchange. Typical signs and symptoms of surfactant deficiency are progressive respiratory distress, nasal flaring, grunting, accessory muscle use, retractions, and poor lung compliance. 

Aspiration pneumonia is caused by the aspiration of meconium, amniotic fluid, or blood. Aspiration pneumonia is more common in term and post-term infants. 

Pneumonia typically occurs in the neonate acquired from the mother and is not the number one cause of neonatal respiratory distress. 

Pulmonary hypertension causes a right-to-left shunting at the ductus arteriosus and leads to hypoxemia. PPHN, or Persistent Pulmonary Hypertension in the Newborn, is typically seen in near-term infants with meconium staining or sepsis. 

25.

Which of the following types of myocardial infarctions typically causes bradycardia or a first- or second-degree heart block?

  • Inferior MI

  • Anterior MI

  • Lateral MI

  • Posterior MI

Correct answer: Inferior MI

An inferior MI is diagnosed by ST elevation noted in the inferior leads of an ECG (II, III, and aVF). An inferior MI can cause bradycardia and a first- or second-degree heart block. An inferior MI is caused by the blockage of the right coronary artery, which supplies blood to the SA and AV node. The absence of blood flow to these areas can cause the bradycardia and heart blocks. 

Anterior MI is caused by an occlusion of the Left Anterior Descending (LAD) artery. The LAD supplies blood to the left ventricle. 

A lateral MI is caused by the occlusion of the LAD or Left CircumfleX (LCX).

A posterior MI is typically caused by an LCX occlusion.

26.

The body's respiratory centers are located in the brainstem, specifically the medulla and the pons. Which of the following controls expiratory muscles and the intrinsic pattern of breathing? 

  • Ventral respiratory group

  • Dorsal respiratory group

  • Pontine respiratory group

  • Medulla respiratory group

Correct answer: Ventral respiratory group

The Ventral Respiratory Group (VRG) is located within the medulla oblongata, and it controls expiratory muscles, upper airway muscles, and the intrinsic pattern of breathing. The VRG causes accessory muscles to contract and can stimulate muscles to force the air from the lungs. 

The Dorsal Respiratory Group (DRG) is also located in the medulla. The DRG works by maintaining a constant respiratory pattern but is not active during exhalation. 

The Pontine Respiratory Group (PRG) is located within the pons. The PRG adjusts breathing patterns for various activities, such as sleep and exercise.

The medulla respiratory group is a fabricated term. 

27.

You have just delivered a full-term infant in the field. The baby is crying, moving all extremities, and skin is pink. The temperature outside is 43° F, and you have wrapped the infant in the only blanket you have in your unit. 

You are concerned about hypothermia, which can lead to which of the following?

  • Metabolic acidosis

  • Decreased oxygen demand

  • Vasodilation

  • Decreased glucose demand

Correct answer: Metabolic acidosis

Infants born in the field are at a greater risk of hypothermia. Infants have a large surface area to body mass ratio and poor thermal insulation. Hypothermia causes an increase in metabolism and peripheral vasoconstriction. In response, peripheral perfusion is decreased, which leads to metabolic acidosis.

Hypothermia leads to an increase in oxygen consumption, vasoconstriction, and increased glucose demand. Infants with the greatest risk of hypothermia are pre-term, neonates with prolonged resuscitation, and any neonate requiring surgical intervention. 

28.

A patient with severe cardiogenic shock secondary to acute myocardial infarction is receiving intra-aortic balloon pump (IABP) therapy. What is the primary mechanism of action of the IABP in this patient?

  • Augmentation of coronary blood flow

  • Reduction of myocardial oxygen demand

  • Enhancement of systemic vascular resistance

  • Improvement of left ventricular contractility

Correct answer: Augmentation of coronary blood flow

The primary mechanism of action of the Intra-Aortic Balloon Pump (IABP) is augmentation of coronary blood flow during diastole. The balloon inflates during diastole, increasing aortic pressure and improving coronary perfusion.

The IABP does not directly reduce myocardial oxygen demand. It indirectly reduces myocardial oxygen demand by decreasing afterload and improving coronary perfusion. 

The IABP reduces systemic vascular resistance by deflating during systole, leading to decreased afterload and improved left ventricular ejection. 

The IABP does not directly improve left ventricular contractility but indirectly improves left ventricular function by decreasing afterload and increasing coronary perfusion.

29.

A 16-year-old male was thrown from his ATV and now has paralysis in his lower extremities. Assessment reveals a lack of sensory and motor function below the neckline. Vital signs are P 48,  R 16, and BP 76/34. Of the following, what should you administer first?

  • Levophed

  • Mannitol

  • Dexamethasone

  • Atropine

Correct answer: Levophed

With bradycardia, hypotension, and paralysis, the patient is exhibiting symptoms of neurogenic shock. A vasopressor is indicated to correct the hypotension. In neurogenic shock, the MAP should be maintained between 85-90 mmHg. The first step would be to administer a fluid bolus and then administer a vasopressor, such as Levophed. Other vasopressor choices are dopamine and phenylephrine. 

Mannitol is a diuretic and is not indicated for neurogenic shock. 

Dexamethasone is a corticosteroid and not a first-line medication in neurogenic shock. 

Atropine is indicated in bradycardia, but this patient's bradycardia is not cardiac-related. 

30.

You are transporting a 55-year-old female with complications associated with Crohn's disease. The patient is complaining of severe abdominal pain and a four-day stent of nausea, vomiting, and diarrhea. Vital signs are BP 102/78, P 94, R 16, and SpO2 97%. ECG reveals sinus rhythm with multiple, multifocal PVCs and a prolonged QT interval. 

What should you suspect?

  • Hypokalemia

  • Hyperkalemia

  • Hypercalcemia

  • Hyponatremia

Correct answer: Hypokalemia

Hypokalemia is commonly caused by chronic steroid therapy and GI loss. Both of these are common in patients with Crohn's disease. Multiple PVCs of unknown etiology and a prolonged QT interval are indicative of hypokalemia. Hypokalemia prolongs the repolarization of the ventricles. 

Hyperkalemia is not represented with multiple PVCs and QT prolongation on the ECG. Hyperkalemia can be seen on an ECG with hyperacute T waves. It is caused by renal failure, beta blockers, ACE inhibitors, trauma, and crush injuries. 

Hypercalcemia is often caused by an increase in calcium uptake, bone tumors, and parathyroid disease. It causes a shortened QT interval because of the shortened ventricular repolarization. 

Hyponatremia is caused by water gain or a loss of sodium. It does not commonly cause abnormalities in the ECG. 

31.

You are treating a four-year-old female in respiratory distress. She has a pulse oximetry of 90% and a fever of 101°. The patient is lethargic and responsive only to verbal stimuli. Which of the following would cause suspicion of a lower airway obstruction?

  • Bronchovesicular wheezes

  • Stridor

  • Drooling

  • Vesicular breath sounds

Correct answer: Bronchovesicular wheezes

Bronchovesicular wheezes are indicative of lower airway obstruction, most commonly bronchospasm. The patient may have a history of asthma, which makes her susceptible to respiratory infections. 

Stridor and drooling are both related to upper airway sounds. Stridor is common in pediatric patients with croup or a foreign body airway obstruction. 

Vesicular breath sounds are normal breath sounds. Inspiratory sounds are longer than expiratory sounds. 

32.

Which of the following ventilator modes can help reduce the risk of Ventilator Induced Lung Injury (VILI) during air medical transport?

  • Pressure-controlled ventilation

  • Pressure-regulated volume-controlled ventilation

  • Volume-controlled pressure-variable ventilation

  • Pressure-support ventilation

Correct answer: Pressure-controlled ventilation

In pressure-controlled ventilation mode, the ventilator delivers an inspiratory breath to the patient but only to a preset level of pressure. In addition, the healthcare provider is responsible for setting the rate of ventilations delivered by the ventilator as well as the length of time it will take for the ventilator to deliver the ventilation. Once the interval time of inspiration (rise time) has been met, the ventilator ceases delivery of the breath and exhalation begins. 

The Tidal Volume (Vt) delivered is dependent upon the patient's lung compliance and resistance. The main advantage of using a pressure-controlled ventilation mode is that it can prevent the development of barotrauma, as the pressure limits that are set can obviously be set using lower pressure parameters

In pressure-regulated volume-controlled ventilation, the ventilator works to achieve a tidal volume at the lowest possible airway pressure. 

In volume-controlled pressure-variable ventilation, airway pressure increases in response to reduced compliance. 

In pressure-support ventilation, spontaneous breaths are matched or supported. 

33.

All the following are components of EMTALA, except which one?

  • Transport team members must undergo mandatory HIPAA training

  • All patients who present to an ED should receive a nondiscriminatory medical screening

  • A patient with a medical emergency must be stabilized within the capabilities of the transferring hospital

  • The referring hospital must send all copies of medical records, diagnostic studies, and informed consent documents with the patient

Correct answer: Transport team members must undergo mandatory HIPAA training

The provision of transport team members undergoing mandatory HIPAA training is an implication of HIPAA. 

The essential components of EMTALA include the following:

  1. All patients who present to an ED should receive a nondiscriminatory medical screening.
  2. A patient with a medical emergency must be stabilized within the capabilities of the transferring hospital prior to transfer.
  3. If the patient must be transferred for further care, there must be a receiving physician at the receiving hospital.
  4.  The referring hospital must send all copies of medical records, diagnostic studies, and informed consent documents, and the patient must be transferred with the appropriate vehicle and personnel. 

34.

You are treating a 16-year-old male who was burned in a house fire. The patient has second degree burns to the right arm circumferentially, anterior chest, and right thigh. What is the TBSA percentage?

  • 22.5%

  • 36.5%

  • 18%

  • 38%

Correct answer: 22.5%

The Rule of Nines divides the body into multiples of nines. This patient has a TBSA of 22.5%. The right arm is 9%, the anterior chest is 9%, and the right thigh is 4.5% for a total of 22.5%. 

35.

You are treating a 22-year-old male involved in a roll-over MVC. The patient is suffering from multi-system trauma. All the following are complications of trauma except which one? 

  • MERS

  • SIRS

  • MODS

  • ARDS

Correct answer: MERS

MERS is Middle Eastern Respiratory Syndrome and is a severe respiratory infection. It is zoonotic and linked to dromedary camels. MERS is not a complication of trauma.

SIRS, MODS, and ARDS are all complications of trauma. 

36.

You are treating a 26-year-old female who is 31 weeks pregnant, complaining of excessive urination and thirst, dizziness, and fatigue. The patient states she drinks 8 to 10 bottles of water per day and continually feels thirsty. You should suspect:

  • Gestagenic diabetes insipidus

  • Dipsogenic diabetes insipidus

  • Myxedema coma

  • Acute adrenal insufficiency 

Correct answer: Gestagenic diabetes insipidus

This patient is experiencing signs and symptoms of gestagenic diabetes insipidus. Gestagenic DI develops in the third trimester and is caused by the breakdown of ADH. The condition typically resolves after the delivery of the placenta. 

Dipsogenic diabetes insipidus is caused by excessive fluid intake caused by primary polydipsia. Dipsogenic DI is the result of a psychological disorder. 

Myxedema coma is an extreme case of hypothyroidism. 

Acute adrenal insufficiency is a rare condition and is caused by a depletion of adrenal glucocorticoids and mineralocorticoids and is not typically found in pregnant patients. 

37.

You are treating an infant with persistent pulmonary hypertension of the newborn (PPHN) who is receiving ECMO support. While reassessing the infant's condition, the patient deteriorates with increasing oxygen requirements and signs of inadequate tissue perfusion. What is the most appropriate management strategy?

  • Preparing for emergent cannulation for venoarterial ECMO

  • Increasing the sweep gas flow rate on the ECMO machine

  • Administering inhaled nitric oxide therapy

  • Checking the circuit for any signs of malfunction

Correct answer: Preparing for emergent cannulation for venoarterial ECMO

Persistent Pulmonary Hypertension of the Newborn (PPHN) is a life-threatening condition characterized by elevated pulmonary vascular resistance leading to right-to-left shunting of blood through fetal circulatory pathways. ECMO provides support while allowing for time to resolve the pulmonary hypertension. Preparing for emergent cannulation for venoarterial ECMO may be necessary if the infant's condition continues to deteriorate despite ongoing support with venovenous ECMO. Venoarterial ECMO provides both cardiac and respiratory support and can be rapidly initiated in critically ill patients with PPHN who develop cardiogenic shock or severe cardiovascular compromise.

Increasing the sweep gas flow rate on the ECMO machine may improve oxygenation by enhancing gas exchange within the ECMO circuit. However, if the infant's condition is deteriorating rapidly, simply adjusting the sweep gas flow rate may not address the underlying cause of the deterioration. 

Administering inhaled nitric oxide (iNO) therapy is a standard treatment for PPHN, as it selectively vasodilates the pulmonary vasculature, improving oxygenation. However, if the infant's condition is deteriorating despite ongoing ECMO support, iNO therapy may not be sufficient. 

Malfunctioning of the ECMO circuit, including issues with oxygenator function, pump failure, or circuit clotting, can lead to inadequate support and worsening clinical status. However, checking the circuit is not the immediate primary management strategy. 

38.

You are assessing a two-year-old male who was brought into the ED for breathing difficulty. He has rapid and shallow respirations with an altered mental status. He has a carotid pulse of 56. You should do which of the following?

  • Immediately begin chest compressions

  • Provide assisted ventilations via bag-mask device

  • Provide oxygen at 15 lpm via non-rebreather

  • Perform immediate orotracheal intubation

Correct answer: Immediately begin chest compressions

This is a pediatric patient, so chest compressions are initiated if the heart rate is below 60. Because this patient's heart rate is only 56, chest compressions should be immediately initiated. Once this is done, airway and breathing may be addressed. 

Bag-mask ventilations are indicated in this patient, but the chest compressions come first because of the severe bradycardia. 

Oxygen via non-rebreather only addresses oxygenation and will not address the failure of ventilation in this patient. 

Intubation is not the first step in treatment for this patient. 

39.

You are transporting an adult female patient with an arterial line in place that you must monitor throughout transport. As the aortic semilunar valve closes, what feature is created on the arterial waveform? 

  • A dicrotic notch

  • An anacrotic notch

  • A QRS complex

  • A diastolic runoff

Correct answer: A dicrotic notch

When the semilunar valves close, particularly the aortic semilunar valve, a dicrotic notch is created on the arterial waveform. The dicrotic notch marks the end of systole and the beginning of diastole. 

An anacrotic notch presents at the systolic upstroke and is a sign of wave reflection. 

A QRS complex is a feature representing ventricular depolarization on an ECG. 

A diastolic runoff represents volume within the large arteries during systole and flowing to the arterioles. 

40.

You are treating a 48-year-old male with right-sided hemiparesis and left-sided facial drooping. Which of the following would exclude the patient from fibrinolytic therapy?

  • Left hip surgery two months ago

  • SBP greater than 140

  • History of diabetes

  • Recent syncopal episode

Correct answer: Left hip surgery two months ago

Every patient with stroke symptoms must go through a checklist to determine eligibility for fibrinolytic therapy. Surgery or trauma in the previous three months exclude a patient from fibrinolytic. Other exclusions are pregnancy, SBP greater than 180, history of ICP or aneurysm, history of recent stroke, current anticoagulant therapy, and bleeding concerns, such as a bleeding disorder. 

History of diabetes and a recent syncopal episode does not exclude a patient from fibrinolytic therapy. 

×