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Quiz Session - Attempts With Random Questions

IBSC CCP-C Exam Questions

Page 7 of 20

121.

A 27-year-old female with a history of depression is brought to the ED after being found unresponsive with an empty bottle of amitriptyline nearby. She is hypotensive and tachycardic with dilated pupils. You note a widened QRS complex on her ECG. 

Which of the following is the most appropriate initial treatment for this patient?

  • Administer sodium bicarbonate

  • Administer flumazenil

  • Initiate hemodialysis

  • Administer intravenous magnesium sulfate

Correct answer: Administer sodium bicarbonate

The patient is suffering from TriCyclic Antidepressant (TCA) toxicity. Signs and symptoms are hypotension, tachycardia, widened QRS complex, arrhythmias, seizures, altered mental status, coma, dilated pupils, dry mouth, urinary retention, and hyperthermia. The antidote is sodium bicarbonate. It works by alkalinizing the blood (raising pH) and increasing plasma sodium levels, which helps to narrow the QRS complex and counteract the cardiotoxic effects of TCAs. It also reduces the binding of TCAs to sodium channels in the heart, thereby improving cardiac conduction and contractility.

Flumazenil is a benzodiazepine antagonist and is not indicated in TCA overdose. In fact, it can precipitate seizures in patients with TCA toxicity. 

TCAs have a large volume of distribution and are highly protein-bound, making hemodialysis ineffective in removing the drug from the body. 

Magnesium sulfate is used for specific arrhythmias like torsades de pointes, but it is not the primary treatment for TCA overdose. 

122.

You are treating an 18-month-old male with severe diarrhea and vomiting. The mother states the patient had only one wet diaper in the past two days and has been unable to eat or drink anything without vomiting. The patient weighs 12 kg. 

Which of the following is the correct dosage for a fluid bolus and maintenance infusion for this patient?

  • 240 mLs; 44 mLs/hour

  • 360 mLs; 36 mLs/hour

  • 120 mLs;  24 mLs/hour

  • 480 mLs; 22 mLs/hour

Correct answer: 240 mLs; 44 mLs/hour

Fluid boluses should first be administered using an isotonic crystalloid. Fluid boluses are administered at a dose of 20 mL/kg of body weight. The patient weighs 12 kg, so the child would receive an IV bolus of normal saline of 240 mLs. 

Maintenance fluids are calculated using the 4-2-1 method: 4 mL/kg/hr for every kilogram of body weight between 1 to 10 kg. 2 mL/kg/hr for every kilogram between 10 to 20 kg of body weight. 1 mL/kg/hr for every kilogram over 20 kg of body weight. 

Based on the weight of 12 kg for the infant, the patient should be started on a maintenance infusion at a rate of 44 mLs/hour.

123.

The Monro-Kellie Doctrine states that the total volume of the brain must always remain constant. Which of the following is not considered cranium volumes?

  • Pons and medulla oblongata

  • Brain and medulla spinalis

  • Blood vessels and blood

  • The CSF space

Correct answer: Pons and medulla oblongata

The pons and medulla oblongata are not components of the cranial vault involved directly with the Monro-Kellie Doctrine. 

The Monro-Kellie Doctrine states that the cranial vault consists of three components and each component must remain constant to maintain perfusion pressure. The three components, or cranium volumes, are as follows:

  1. Brain and medulla spinalis
  2. Blood vessels and blood
  3. The CSF space

If any of these components increased in volume or size, the other two would compensate by decreasing. 

124.

While reviewing the ECG of a chest pain patient, you note the patient is experiencing an inferior wall acute myocardial infarction. Which leads must have ST elevation?

  • II, III, aVF

  • I, II, III

  • V1 - V2

  • I, aVL

Correct answer: II, III, aVF

Leads II, III, and aVF are inferior leads. When there is ST elevation, they indicate an inferior wall Acute Myocardial Infarction (AMI). An inferior AMI indicates an occlusion in the right coronary artery.

Lead I views the high lateral wall. V1 - V2 are septal leads, and aVL is a lateral lead. 

125.

You are working in the ED and treating a 72-year-old female with a history of chronic bronchitis. ABGs are pH of 7.34, PaCO2 47 mmHg, PaO2 90 mmHg, and HCO3- 29 mEq/L. Which of the following do these values represent?

  • Compensated respiratory acidosis

  • Compensated respiratory alkalosis

  • Decompensated respiratory acidosis

  • Decompensated metabolic acidosis

Correct answer: Compensated respiratory acidosis

The patient's disease process will cause acidosis to progress over time. Respiratory acidosis is represented by a decreased pH and an increased PaCO2. It is compensated with the increased HCO3-. 

Compensated respiratory alkalosis has an increased pH, a decreased PCO2, and decreased HCO3. 

Decompensated respiratory acidosis is represented by a low pH, high PaCO2, and a low HCO3-. 

Decompensated metabolic acidosis is characterized by a low pH, a low HCO3-, and a low CO2. 

126.

You are dispatched to a local restaurant for an adult male choking. You arrive to find the patient unresponsive and lying supine on the floor. Your partner attempts to ventilate the patient via a bag-mask device but is unsuccessful. You re-open the airway and ensure the correct position but are still unsuccessful with assisted ventilations.

You should do which of the following?

  • Begin chest compressions and visualize the airway with direct laryngoscopy

  • Provide abdominal thrusts and manual ventilations

  • Suction the airway and begin chest compressions

  • Perform a needle cricothyrotomy and ventilate

Correct answer: Begin chest compressions and visualize the airway with direct laryngoscopy

When a patient is suffering from a foreign body airway obstruction, it is important to follow AHA guidelines for the choking adult. Once the patient becomes unresponsive and not breathing, you must begin chest compressions. If chest compressions are not successful, the airway must be visualized via direct laryngoscopy in hopes of removing the foreign body with Magill forceps. 

Abdominal thrusts are not indicated because the patient is unresponsive. 

Suctioning the airway will not work, as the foreign body is obviously further down in the airway. 

A needle cricothyrotomy is a last-ditch effort intervention, which is not indicated in this patient because the next step is direct laryngoscopy. 

127.

A 58-year-old female with a history of systemic sclerosis presents to the emergency department with increasing shortness of breath, fatigue, and chest discomfort. Physical examination reveals jugular venous distention, a loud P2 on cardiac auscultation, and peripheral edema. An echocardiogram shows signs consistent with pulmonary hypertension. 

Which of the following is the most appropriate initial treatment for this patient in the acute setting?

  • Administer high-flow oxygen therapy

  • Administer intravenous fluids

  • Administer oral sildenafil

  • Administer inhaled nitric oxide

Correct answer: Administer high-flow oxygen therapy

Pulmonary Hypertension (PH) is a complex and serious condition characterized by elevated pressures in the pulmonary arteries. It can lead to right ventricular failure and significant morbidity. Acute management focuses on stabilizing the patient and optimizing oxygenation and hemodynamics. Oxygen can reduce pulmonary vasoconstriction and improve oxygenation. It is particularly beneficial if the patient is hypoxic, which is common in pulmonary hypertension.

Intravenous fluids are generally avoided in pulmonary hypertension unless there is clear evidence of hypovolemia, as fluid overload can worsen right ventricular failure.

A phosphodiesterase-5 inhibitor can be useful in chronic management of Pulmonary Arterial Hypertension (PAH) but is not the immediate treatment in an acute setting.

Potent pulmonary vasodilator can acutely lower pulmonary artery pressures. It is used in specific settings like the ICU but is not typically the first-line treatment in the emergency department.

128.

You are treating a patient in the ED with the following ABG results: pH: 7.50, PaCO2 44 mmHg, HCO3 33 mEq/L. Which of the following do the results represent?

  • Acute metabolic alkalosis

  • Compensated metabolic alkalosis

  • Acute respiratory alkalosis

  • Compensated respiratory acidosis

Correct answer: Acute metabolic alkalosis

Normal pH ranges from 7.35-7.45. Since this patient's pH is above 7.45, the patient is alkalotic. Normal CO2 is 35-45, and normal HCO3 is 22-26. The component that matches the pH is the system controlling the ABG. The pH and bicarbonate levels are both alkalotic, so the primary mechanism is metabolic alkalosis. 

The pH is high, but the CO2 levels are still within normal range, so there is no indication that the respiratory system is compensating. Therefore, it cannot be respiratory acidosis or respiratory alkalosis. 

129.

Which of the following interventions is a cornerstone in the management of a patient with esophageal varices?

  • Initiation of beta-blockers to reduce portal pressure

  • Administering high doses of antacids to reduce gastric acid secretion

  • Performing a liver biopsy to confirm the diagnosis

  • Surgical resection of the varices for immediate symptom relief

Correct answer: Initiation of beta-blockers to reduce portal pressure

Esophageal varices are a serious complication of portal hypertension, often associated with liver cirrhosis. The primary goal in managing esophageal varices is to prevent bleeding episodes and reduce the risk of mortality. Beta blockers help to reduce portal pressure by decreasing cardiac output and splanchnic blood flow. 

Reducing gastric acid secretion does not improve esophageal varices.

Performing a liver biopsy is not indicated, as an ultrasound is used to measure scarring in the liver in conjunction with esophageal varices. 

Surgical resection of the varices is not a treatment priority. Beta blockers and possible endoscopic band ligation are the treatment priorities in the management of esophageal varices. 

130.

You are assessing a 59-year-old female who presents with confusion, disorientation, right-sided weakness, and left facial droop. Her BP is 218/126 mmHg, HR 118 bpm, and R 20; SpO2 is 94% on room air. You should do which of the following?

  • Assess the patient's blood glucose

  • Administer nitroglycerin 0.4 mg SQ

  • Administer oxygen 15 lpm via NRB

  • Administer oral glucose

Correct answer: Assess the patient's blood glucose

Any patient experiencing an altered mental status must have their blood glucose level assessed. Hypoglycemia can mimic a stroke and must be ruled out in all patients exhibiting signs and symptoms of a stroke. 

Even though the patient is hypertensive, nitroglycerin is not recommended due to the probability of a stroke. Labetalol and sodium nitroprusside are better choices for blood pressure management in the presence of a stroke. 

The patient is not complaining of shortness of breath, and her SpO2 is 94%, which can be easily managed with oxygen via nasal cannula. Oxygen at 15 lpm via NRB is not indicated in this patient. 

Oral glucose is not recommended in this patient. 

131.

A 6-year-old male has fallen from the top of the tall playground slide. He presents to the ED ambulatory but crying loudly. The patient states his stomach hurts, but he feels fine other than that. Upon examination, you note diffuse tenderness in his abdomen and mild distension. His vital signs are P 118, R 28 (crying), BP 92/70. 

What is your priority?

  • Administer a 20 ml/kg fluid bolus

  • Administer Fentanyl for pain

  • Obtain parent's permission to treat patient

  • Provide oxygen via non rebreather

Correct answer: Administer a 20 ml/kg fluid bolus

The patient has a combination of a major mechanism of injury, abdominal tenderness and distention, and vital signs that all point to compensated shock. It's important to begin treatment quickly and aggressively. Your first priority is to administer a saline bolus or 20 ml/kg. 

Fentanyl would also be important, but the treatment of the compensated shock should come first. 

The patient is exhibiting a life-threatening condition, so you do not have to wait for parental permission. Waiting would delay definitive care. 

Oxygen via non rebreather is not indicated at this time. 

132.

Orotracheal intubation is a reliable and effective means of airway management in pediatrics. Which of the following is not a reason for intubation in the pediatric patient?

  • The need for lower inspiratory pressures

  • Improved control of inspiratory times

  • Route for resuscitation medications prior to IV access

  • Loss of airway protective reflexes

Correct answer: The need for lower inspiratory pressures

There are an array of reasons for intubating a pediatric patient. The need for lower inspiratory pressures is not a reason. Instead, it is the need for higher inspiratory pressures or PEEP.

Other reasons for pediatric intubation are: 

  • Route for resuscitation medications prior to IV access
  • Loss of protective airway reflexes
  • To isolate the airway for effective oxygenation and ventilation
  • Decrease the risk of aspiration
  • Improved control of inspiratory times
  • To deliver PEEP
  • To coordinate chest compressions
  • Anatomical or foreign airway obstruction
  • Inadequate oxygenation or ventilation
  • Need for mechanical ventilatory support
  • The patient is expected to deteriorate in transport

133.

The anion gap (AG) is used to classify the cause of metabolic acidosis in pediatrics. The AG is found by calculating the difference between sodium (Na+) and which of the following two measured anions?

  • Chloride and bicarbonate

  • Chloride and potassium

  • Potassium and bicarbonate

  • Chlorine and bicarbonate

Correct answer: Chloride and bicarbonate

Metabolic acidosis is common in pediatric patients. To classify causes of metabolic acidosis, the Anion Gap (AG) is used, and causes are categorized into large anion gap, normal anion gap, and small anion gap. To determine the AG, a calculation of the difference between sodium and chloride and bicarbonate is used. The formula is AG (mEq/L ) = (Na+) - (Cl- + HCO3-).

Potassium is a major anion but is not used to classify causes of metabolic acidosis. 

Chlorine is not a major anion. 

134.

You are treating a 63-year-old female with known liver failure. The patient has an increased PA pressure and a wedge pressure of 10. Her BUN and creatinine are elevated, and the patient's urinary output is 0.30 ml/kg/hr. Which of the following should you suspect? 

  • Hepatopulmonary syndrome

  • Cardiogenic shock

  • Pancreatitis

  • Cholecystitis

Correct answer: Hepatopulmonary syndrome

Hepatopulmonary syndrome is caused by renal failure and portal hypertension that leads to breathing difficulty and right-sided heart failure symptoms. With the syndrome, the patient will have a normal wedge pressure and an increased PA pressure. 

In cardiogenic shock, the patient will typically have an increased wedge pressure and no elevation in BUN and creatinine. 

Pancreatitis will cause elevation in BUN and creatinine but may possibly cause an increased wedge pressure. 

Elevated BUN and creatinine are not associated with cholecystitis but will elevate if there is renal failure secondary to cholecystitis. 

135.

You are treating a 72-year-old female complaining of a sudden onset of chest pain that began 20 minutes ago. She points to her right axillary area and tells you the pain is in that spot and very sharp. She is on her second round of antibiotics due to a post-hip surgery infection. The surgical incision site is red with no swelling noted and no drainage. Vital signs are BP 150/90, P 118, and R 16.  

What should you suspect?

  • Pulmonary embolism

  • Myocardial infarction

  • Sepsis

  • Pulmonary edema

Correct answer: Pulmonary embolism

The patient is exhibiting signs and symptoms of a pulmonary embolism. The patient had a sudden onset of pleuritic chest pain, sharp in nature, and a history of recent surgery. Signs and symptoms of a pulmonary embolism are tachycardia, tachypnea, dyspnea, pleuritic pain, lightheadedness, JVD, and dependent edema. 

The pain from a myocardial infarction is seldom sharp in nature. Sharp is more indicative of pleuritic pain. 

Sepsis is a possibility, but the patient has no fever and the incision site is not swollen and has no drainage. 

The patient has no complaints of shortness of breath or wet lung sounds, so this rules out pulmonary edema. 

136.

During a patient flight, in an unpressurized cabin, the temperature continues to drop as the aircraft climbs higher in elevation. Because of this, patients may need extra blankets to maintain normal body temperature. This is expressed by which gas law?

  • Gay-Lussac's Law

  • Fick's Law

  • Henry's Law

  • Graham's Law

Correct answer: Gay-Lussac's Law

Gay-Lussac's Law is expressed as P1/T1 = P2/T2, where V and n are always constant. Gay-Lussac's Law refers to pressure and temperature and states that the pressure of a gas is directly proportional to the absolute temperature for a constant amount of gas. As the aircraft climbs higher, the temperature tends to drop and become cooler.

Fick's Law is commonly used in ventilator management in reference to oxygenation. It states that the diffusion rate of a gas is proportional to the concentration gradient. 

Henry's Law refers to the solubility of gases in liquids. The law states the quantity of gas dissolved in liquid is proportional to the partial pressure of the gas in contact with the liquid. 

Graham's Law is another law of diffusion. It states that lower molecular weights will dissolve faster and gases with higher solubility remain in liquids longer. 

137.

A 17-year-old male has been rescued from the river after a prolonged submersion. You arrive on the scene as bystanders are pulling the young man from the water. The patient is cold to the touch, cyanotic, and not breathing. You are unable to feel a carotid pulse. You should first do which of the following?

  • Open the airway and provide two rescue breaths

  • Call medical control for the time of death

  • Begin chest compressions and prepare to defibrillate

  • Immediately perform gastric decompression

Correct answer: Open the airway and provide two rescue breaths

Typical cardiac arrest patients are treated by the CAB approach. But, patients in cardiac arrest following submersion should be treated with the ABC approach. 

Not attempting cardiac resuscitation is not recommended for this patient. 

Once airway and breathing have been addressed, you should begin chest compressions and provide defibrillation if the patient is in a shockable rhythm. 

Gastric decompression can be performed by inserting a nasogastric or orogastric tube after the patient has been intubated. 

138.

You are treating a 48-year-old male with a history of coronary artery disease, who presents with a new onset of severe difficulty breathing. His respirations are labored with accessory muscle use and a respiratory rate of 60/min. When assessing waveform capnography you note very low amplitude waves at a value of 10 mmHg. 

What should you suspect?

  • Pulmonary embolism

  • Tension pneumothorax

  • Asthma exacerbation

  • Respiratory alkalosis

Correct answer: Pulmonary embolism

Low amplitude waveforms and very low ETCO2 should alert you to obstructed alveolar blood flow from a pulmonary embolism. 

A tension pneumothorax is associated with increased levels of carbon dioxide. Asthma exacerbation would cause a shark-fin appearance of the capnography waves. Respiratory alkalosis is associated with low levels of ETCO2 but would not include respiratory distress. 

139.

Which of the following does not meet the criteria for a failed airway as defined by The Difficult Airway course?

  • Inability of an experienced intubator to perform a successful orotracheal intubation after 2 failed attempts

  • Failure to maintain adequate SpO2 during or after a failed laryngoscopic attempt

  • Inability of an experienced intubator to perform a successful orotracheal intubation after 3 failed attempts

  • The "best attempt" at orotracheal intubation fails in the "forced to act" situation

Correct answer: Inability of an experienced intubator to perform a successful orotracheal intubation after 2 failed attempts

A failed airway is defined as "a failure to ventilate or oxygenate the patient," according to The Difficult Airway course. If the clinician is unable to secure a difficult airway, the clinician must enact the failed airway algorithm. 

The Difficult Airway course defines a failed airway as meeting the following three criteria:

  1. Failure to maintain adequate SpO2 during or after a failed laryngoscopic attempt.
  2. Inability of an experienced intubator to perform a successful orotracheal intubation after 3 failed attempts.
  3. The "best attempt" at orotracheal intubation fails in the "forced to act" situation.

140.

You are reviewing the ECG of a severely hypothermic patient and note an extra deflection at the junction of the QRS and ST segment. What is the term for this finding?

  • J wave

  • F wave

  • J point

  • Delta wave

Correct answer: J wave

In severely hypothermic patients, at a core temperature of 77°, a J wave (Osborne wave) is clearly seen. It is described as an extra deflection at the junction of the QRS and ST segments. The origin is unknown. 

F waves are fibrillation waves that are seen in atrial fibrillation. 

The J point is the first upward deflection from the S to ST segment to identify ST elevation in STEMIs. 

The Delta wave is seen in WPW. 

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