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Quiz Session - Attempts With Random Questions

IBSC CCP-C Exam Questions

Page 3 of 20

41.

You are treating a 58-year-old male found in the passenger seat of his car in a ditch of water. The temperature was 63°, and the patient's vehicle was partially submerged with the patient entrapped. The patient was reported missing by family four days ago. The patient's core temperature is 82.4°. 

Which of the following set of symptoms should you suspect to see in this patient?

  • Hypotension, loss of vasoconstrictive capabilities, v-fib if handled roughly, and increased myocardial irritability

  • Vasoconstriction, decreasing level of consciousness

  • Coma, pulmonary edema, and respiratory arrest

  • Maximal risk of v-fib, 75% decreased in oxygen consumption

Correct answer: Hypotension, loss of vasoconstrictive capabilities, v-fib if handled roughly, and increased myocardial irritability

With the patient's core temperature at 82.4°, the patient is classified as severe hypothermia. The patient would experience all the symptoms associated with mild and moderate hypothermia and hypotension, loss of vasoconstrictive capabilities, v-fib if handled roughly, and increased myocardial irritability.

Vasoconstriction and decreasing level of consciousness occur in moderate hypothermia at a temperature of 89.6. Coma, pulmonary edema, and respiratory arrest are indicative of severe hypothermia at a temperature of 75.2°. 

A maximal risk of v-fib and 75% decrease in oxygen consumption occur in severe hypothermia at a temperature of 71.6.

42.

You are transporting a five-year-old female cardiac patient via ground transport to a specialty pediatric facility for emergency heart surgery. Regarding patient safety, you should:

  • Ensure the patient is secured properly to the stretcher

  • Always hold onto the top safety bar while standing

  • Relay all important patient information to the family during transport

  • Ensure all equipment is at arm's length for quick access

Correct answer: Ensure the patient is secured properly to the stretcher

The Agency for Healthcare Research and Quality (AHRQ) provides the following definition for patient safety: Patient safety is a discipline in the health care sector that applies safety science methods toward the goal of achieving a trustworthy system of health care delivery. Patient safety is also an attribute of health care systems: it minimizes the incidence and impact of, and maximizes recovery from, adverse effects.

The Critical Care Transport Paramedic (CCTP) must ensure patient safety. Ensuring the patient is secured properly to the stretcher is of the utmost importance. 

It is recommended to secure yourself to the best of your ability while moving around during transport. Holding on to the top safety bar is a good choice but is not the top priority in addressing patient safety. 

Relaying patient information to the family is not the responsibility of the CCTP during patient transport. The CCTP may certainly share patient information if allowed and time permits. 

Ensuring all equipment is within arm's reach is a great idea but not a priority in patient safety. 

43.

Wilderness rescues require extra planning, training, and specialized equipment. When preparing to respond to a hiker down in the woods, it's good to review the mnemonic, TOMAS. What does the M stand for?

  • Method

  • Material

  • Mastery

  • Mentality

Correct answer: Method

Method consists of the type of location and insertion, landing near or far from the patient, and the hover load. 

The mnemonic TOMAS is helpful with planning and safety for a wilderness rescue. 

  • T - Terrain
  • O - Obstacles
  • M - Method
  • A - Alternatives
  • S - Safety

The other answer options are incorrect.

44.

A patient in the local hospital is evaluated for an abdominal aortic aneurysm. The patient is unstable and requires surgery, which is unavailable in the current hospital. The on-call physician refuses to come in to see the patient. When you arrive to transfer the patient to the receiving facility, the nurses share with you what happened and verbalize their disgust with their on-call physician. 

Under the rules of EMTALA, what must the hospital do?

  • Follow the remaining rules of EMTALA, complete the patient transfer, and follow up with an internal investigation

  • Contact the receiving hospital to cancel the patient transfer due to physician non-compliance

  • Cancel the patient transfer and continue contacting the on-call physician until the physician comes to evaluate the patient

  • Immediately contact the hospital CEO and demand an internal investigation of the on-call physician

Correct answer: Follow the remaining rules of EMTALA, complete the patient transfer, and follow up with an internal investigation

Several EMTALA investigations are initiated because on-call physicians refuse to come in person to evaluate a patient or negate to stabilize the patient prior to transfer. It is expected that on-call physicians physically evaluate and treat their patients, but if the physician refuses, the hospital must document the refusal in the patient's records and hospital transfer paperwork. If the on-call physician refuses to physically examine the patient, the hospital staff must continue to follow the remaining EMTALA regulations, complete the patient transfer, and then follow up with an internal investigation. 

Although the on-call sending physician has not physically evaluated the patient, the patient transfer process can still continue and does not have to be transferred due to physician non-compliance. 

Also, definitive patient care must not be delayed because of the on-call physician not being present physically. This patient requires surgical intervention and should not remain in a facility that cannot provide the surgery while waiting for the hospital to convince the physician to come in to evaluate the patient. 

The hospital must not delay the patient transfer to contact the CEO and complete an investigation. These actions can be performed after the patient transfer has been completed. 

45.

A 93-year-old male complains of chest pain, nausea, and vomiting. The ECG monitor shows an irregular, narrow complex rhythm at 48 beats/minute. You note increasing PR intervals with an eventual dropped QRS complex. You should suspect which of the following?

  • 2° AV block type I

  • 2° AV block type II

  • 3° AV block

  • 1° AV block

Correct answer: 2° AV block type I

The rhythm described is a 2° AV block type I. The electrical impulse is progressively being delayed at the AV junction longer and longer each time before being blocked completely. This is represented by increasing PR intervals until a QRS complex is dropped. 

A 2° AV block type II possibly indicates structural damage to the AV node. The rhythm is described as QRS complexes at a regular rate, normal PR intervals with more P waves than QRSs. 

A 3° AV block is life-threatening and consists of varying PR intervals throughout the rhythm with no relationship between the P wave and QRS complex. 

The 1° AV block is a regular rhythm with a prolonged PR interval throughout. 

46.

You are preparing to intubate your adult patient. Upon inspection of the oropharynx, you are only able to visualize the base of the uvula. What would this patient score on the Mallampati scale?

  • Mallampati III

  • Mallampati I

  • Mallampati II

  • Mallampati IV

Correct answer: Mallampati III

The Mallampati Score is a visual test to assess the patient's difficulty in oral intubation. Predicting the difficulty level in intubating a patient is an important aspect of the intubation process. Mallampati III predicts moderate difficulty and only the base of the uvula can be visualized.

Mallampati I predicts zero difficulty in intubation. You are able to see the soft palate, uvula, and the anterior/posterior tonsillar pillars. 

Mallampati II predicts zero difficulty. The tonsillar pillars are hidden by the tongue. 

Mallampati IV predicts a difficult airway and is commonly seen in patients with short or fat or muscular necks. The uvula cannot be seen.

47.

You are transferring a newborn with suspected hypoxic-ischemic encephalopathy (HIE). While en route, the patient experiences poor muscle tone, weak reflexes, and respiratory distress. What should you do first?

  • Administer therapeutic hypothermia

  • Initiate bag-mask ventilation with 100% oxygen

  • Administer intravenous fluid bolus

  • Place the newborn in a knee-to-chest position

Correct answer: Administer therapeutic hypothermia

Hypoxic-Ischemic Encephalopathy (HIE) in newborns results from perinatal asphyxia that places the newborn at significant risk of long-term neurologic deficits. Administering therapeutic hypothermia, also known as Targeted Temperature Management, is the most effective treatment for newborns with moderate to severe HIE. Hypothermia treatment involves reducing the newborn's core body temperature to 33-34°C for 72 hours, which has been shown to mitigate neuronal injury and improve neurological outcomes. It should be initiated as soon as possible, ideally within six hours of birth.

Adequate oxygenation is crucial to prevent secondary brain injury and support cellular metabolism. However, ventilation alone may not address the underlying cerebral hypoperfusion and neuronal injury associated with HIE. 

Administering intravenous fluid bolus is not typically indicated as the immediate management strategy for newborns with HIE. 

While positioning maneuvers can sometimes alleviate symptoms in newborns with certain conditions, such as improving lung expansion in infants with respiratory distress, they are unlikely to have a significant impact on the underlying neurological injury and respiratory distress associated with HIE.

48.

You are treating a 45-year-old male patient in severe respiratory distress. Despite initial interventions, including high-flow oxygen and non-invasive ventilation, the patient's oxygen saturation continues to decline rapidly. Arterial blood gas analysis reveals severe hypoxemia and hypercapnia. The attending physician places an order to initiate extracorporeal membrane oxygenation (ECMO) for the patient.

Based on your understanding of ECMO management, which of the following actions should you prioritize during the initiation of ECMO support?

  • Securing vascular access by placing large-bore cannulas into the femoral vessels for ECMO cannulation

  • Ensuring adequate anticoagulation therapy to prevent clot formation within the ECMO circuit

  • Administering inotropic support to maintain hemodynamic stability during ECMO initiation

  • Initiating a slow and gradual weaning of mechanical ventilation once ECMO support is established

Correct answer: Securing vascular access by placing large-bore cannulas into the femoral vessels for ECMO cannulation

During the initiation of ExtraCorporeal Membrane Oxygenation (ECMO) support, securing vascular access by placing large-bore cannulas into the femoral vessels is a critical step. Femoral cannulation allows for rapid initiation of ECMO support and provides adequate blood flow for oxygenation and carbon dioxide removal.

While anticoagulation therapy is necessary to prevent clot formation within the ECMO circuit, it is typically initiated after ECMO cannulation.

Administering inotropic support may be necessary to maintain hemodynamic stability but is not a primary consideration during ECMO initiation.

Weaning of mechanical ventilation should be approached cautiously and gradually once ECMO support is established and the patient's condition stabilizes.

49.

A young female is brought to the ED with multiple stab wounds. You note multiple superficial stab wounds to bilateral forearms, a stab wound to the neck with bubbles noted, and a stab wound to the right thigh with oozing blood. The patient is altered and complains of difficulty breathing. 

What should you do first?

  • Place an occlusive dressing over the neck wound

  • Assist ventilations with a BVM

  • Place a tourniquet distal to the right thigh wound

  • Administer high-flow oxygen via NRB

Correct answer: Place an occlusive dressing over the neck wound

The patient has multiple stab wounds, but the stab wound in the neck is the most concerning because it is allowing air to escape. This must be addressed in the primary assessment. You must place an occlusive dressing over the neck wound. 

Assisting ventilations is not indicated because there is no mention of ventilatory failure. 

No indication of bleeding requires a tourniquet. 

High-flow oxygen is indicated in this patient, but you must first place the occlusive dressing. 

50.

A 22-year-old male is brought into the ED via ambulance, unresponsive and with shallow respirations. During the paramedic's hand-off report, they state that the patient is taking pirfenidone and nintedanib. Which of the following is the patient suffering from? 

  • Idiopathic pulmonary fibrosis

  • Acute respiratory distress syndrome

  • Chronic obstructive pulmonary disease

  • Chronic bronchitis

Correct answer: Idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis is a respiratory condition that causes severe lung scarring. Pirfenidone and nintedanib are prescribed to slow the scarring process in the lungs. 

Medications used to treat Acute Respiratory Distress Syndrome (ARDS) are corticosteroids and angiotensin IIs. Chronic Obstructive Pulmonary Disease (COPD) and chronic bronchitis patients are on beta-agonists and corticosteroids. 

51.

Which of these is not a category of clinical practice used in EBM?

  • Blind studies

  • Systematic reviews

  • Clinical practice guidelines

  • Clinical evidence

Correct answer: Blind studies

Blind studies are a type of study and are analyzed during systematic review. Evidence-Based Medicine, or EBM, is the practice of using scientific knowledge as well as information about best practice to improve patient care. It is a problem-solving approach that utilizes the best evidence obtained from well-designed studies in addition to clinician expertise and experience coupled with the patient's individual values and beliefs. 

There are three categories of evidence when using the EBM process: systematic reviews, clinical evidence, and clinical practice guidelines. These categories are used to classify the strength of the evidence obtained and its pertinence to patient care.

52.

You are treating an unresponsive 23-year-old male patient who has a closed head injury secondary to a motorcycle accident. His vitals are P 42, R 8, BP 188/118, and SpO2 96%. What should you do first?

  • Assist ventilations with a BVM

  • Administer Labetalol 20 mg

  • Administer oxygen via non-rebreather

  • Administer atropine 1 mg

Correct answer: Assist ventilations with a BVM

The patient is exhibiting signs and symptoms of increased intracranial pressure. Your first step in treatment is to assist ventilations with a BVM. You will shoot for a target ETCO2 of 30-35 mmHg. 

The patient is hypertensive due to the increased ICP. Labetalol is indicated for blood pressure control in increased ICP patients, but it is not the first intervention to be completed with this patient. 

The patient has a failure to ventilate with a respiratory rate of 8, so administering oxygen with a non-rebreather would not improve the patient's ventilatory effort. 

The patient is bradycardic because of the increased ICP. Atropine is not indicated in this patient. 

53.

What is the primary cause of ARDS in the adult patient?

  • A loss of surfactant

  • Destruction of alveoli

  • Chronic bronchospasms

  • Pulmonary contusion

Correct answer: A loss of surfactant

ARDS is caused by a loss of surfactant, an increase in pulmonary vascular permeability, and the loss of aerated tissue. The primary treatment is mechanical ventilation There is no cure, but the symptoms can be treated.

Alveoli destruction, chronic broncho spasms, and pulmonary contusions are not causes of ARDS. 

54.

You have arrived at a small ER to transfer a 32-year-old female with a head injury. The patient has been intubated, and the ER staff have been providing positive pressure ventilations via bag-mask for 45 minutes prior to your arrival. While receiving the report from the RN, you note the ER staff member is ventilating the patient at a rate of 32 breaths/min. The patient's BP has decreased from 128/78 to 98/64, and the ETCO2 is 24 mmHg. 

Which of the following should you suspect may be happening? 

  • Auto-PEEP

  • Oxygen toxicity

  • Hemothorax

  • Ventilator-associated pneumonia

Correct answer: Auto-PEEP

Rapid ventilation is the primary cause of auto-PEEP. Auto-PEEP is caused by air-trapping from rapid ventilation preventing expiration before initiation of the next ventilation. A drop in blood pressure and decreasing ETCO2 are both signs of auto-PEEP. 

Oxygen toxicity is caused by the production of oxygen-free radicals and can occur with higher than normal FiO2 settings over a long period of time. 

A hemothorax would not occur spontaneously, such as a pneumothorax. A hemothorax is typically caused by blunt trauma. 

Ventilator-Associated Pneumonia (VAP) can occur after prolonged ventilation, which has not been achieved in 45 minutes. 

55.

The structures within the respiratory system are divided into the upper airway and the lower airway. All the following are structures of the lower airway, except:

  • Larynx

  • Epiglottis

  • Hyoid bone

  • Thyroid cartilage

Correct answer: Larynx

The upper airway consists of larynx, nasal passages, oral cavity, nasopharynx, oropharynx, and glottis. 

The lower airway consists of epiglottis, trachea (hyoid bone, thyroid cartilage, cricoid cartilage, cricothyroid membrane), vocal cords, and lungs. 

56.

Your adult patient diagnosed with acute respiratory distress syndrome (ARDS) is currently on a mechanical ventilator with the following setting: Vt 6 mL/kg of predicted body weight, PEEP 10 cmH2O, and FiO2 of 0.6. Despite these settings, the patient's oxygenation remains poor with a PaO2 of 55 mmHg. 

What is the most appropriate next step in managing this patient?

  • Increase the PEEP to 15 cmH2O

  • Increase the FiO2 to 1.0

  • Increase the tidal volume to 8 mL/kg of predicted body weight

  • Administer a recruitment maneuver

Correct answer: Increase the PEEP to 15 cmH2O

Acute Respiratory Distress Syndrome (ARDS) is a severe form of acute respiratory failure characterized by diffuse alveolar damage, leading to impaired gas exchange and severe hypoxemia. Management typically involves mechanical ventilation with lung-protective strategies to minimize ventilator-induced lung injury. Increasing the PEEP to 15 cmH2O helps recruit collapsed alveoli, improve lung compliance, and maintain alveolar recruitment.

Increasing the FiO2 to 1.0 may improve oxygenation temporarily; however, it is not the most appropriate next step, as the patient is already receiving a high FiO2. 

Increasing the tidal volume to 8 mL/kg of predicted body weight is not recommended in ARDS management. Increasing tidal volume may exacerbate lung injury and should be avoided. 

Administering a recruitment maneuver involves briefly increasing airway pressure to open collapsed alveoli and recruit additional lung volume. 

57.

You are treating a 17-year-old male patient who was rescued from a house fire. The patient is unresponsive with black soot noted to the mouth and nose. You note stridorous respirations at 10/min with diminished breath sounds bilaterally. What should you do first?

  • Perform immediate orotracheal intubation and transport

  • Place an oropharyngeal airway and ventilate with a BVM

  • Place the patient on CPAP and transport rapidly

  • Administer nebulized albuterol and oxygen via non-rebreather

Correct answer: Perform immediate orotracheal intubation

The patient has obvious smoke inhalation based on the mechanism of injury, noted stridor, and soot noted to mouth and nose. The patient requires immediate orotracheal intubation before the airway continues to swell and eventually occlude. Smoke inhalation and burns to the airway cause severe airway swelling that happens quickly and aggressively. 

Inserting an oropharyngeal airway could irritate the airway and increase swelling intensity and quality, which would prevent orotracheal intubation. 

CPAP is contraindicated because the patient is unresponsive. 

Albuterol may be indicated in this patient, but the first step is addressing the airway. Albuterol will not improve upper airway swelling. 

58.

During your transport of a two-day-old neonatal cardiac patient, the patient has a sudden change in mental status and a decrease in respirations and oxygen saturation. Current vital signs are RR 28 and shallow, HR 59, and SpO2 84%. After 30 seconds of positive pressure ventilations, the vitals remain the same. 

What should you do?

  • Begin chest compressions at a ratio of 3:1

  • Intubate the patient with a 2.5 ETT at a depth of 6.75 cm

  • Place a tibial IO and administer 0.03 mg epinephrine

  • Continue positive pressure ventilations, but increase the rate to 60-60 breaths/min

Correct answer: Begin chest compressions at a ratio of 3:1

Chest compressions should be administered in the neonatal patient if the heart rate remains below 60 beats/min after 30 seconds of positive pressure ventilation. Chest compressions should be performed at a ratio of 3:1 at a rate of 120/minute. Continue chest compressions for 60 seconds and then reevaluate. If the HR increases above 60 beats/min, then discontinue chest compressions. If it remains below 60/min, then continue compressions and administer epinephrine. 

The next step is not intubation, as the patient must be given chest compressions because the heart rate is below 60. If there is no improvement in patient status after PPV, chest compressions, and epinephrine, then the patient must be intubated. 

The correct dosage of epinephrine for neonates is 0.01 - 0.03 mg/kg. Epinephrine is administered after compressions have been performed for a minute with no clinical improvement. 

PPV should be performed at a rate of 40-60 breaths/min. 60-80 breaths/min is too high for neonatal resuscitation. 

59.

You are transporting a 28-year-old male who was injured while burning trash in his backyard. He was thrown backwards after a gas can exploded in his burn pile. He is complaining of chest pain and shortness of breath. The patient's skin is diaphoretic, and you note JVD. Vital signs are P 43, R 28, and BP 84/44. 

Of the following, what is the most likely cause?

  • Blunt cardiac injury

  • Tension pneumothorax

  • Cardiac tamponade

  • Commotio cordis

Correct answer: Blunt cardiac injury

The patient's symptoms of JVD, chest pain, shortness of breath, and bradycardia are indicative of a blunt cardiac injury. At times, the patient may also exhibit palpitations and symptoms of acute heart failure. 

A tension pneumothorax causes difficulty breathing, hypotension, unequal chest expansion, and diminished or absent breath sounds on the injured side. 

Cardiac tamponade causes JVD, muffled heart sounds, and hypotension. It typically causes tachycardia. 

Commotio cordis causes sudden cardiac arrest. 

60.

What is the hallmark sign of a patient taking ACE inhibitors? 

  • A dry cough

  • A productive cough

  • Cold hands or feet

  • Orthostatic hypotension

Correct answer: A dry cough

The hallmark sign of patients taking ACE inhibitors is a dry cough due to an increase in the cough reflex. 

A productive cough is not related to ACE inhibitors. Cold hands or feet are a side effect of beta blockers. Orthostatic hypotension is a side effect of alpha agonist medications. 

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