IBSC FP-C Exam Questions

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41.

Which of the following signs and symptoms is not associated with organophosphate poisoning?

  • Hyperthermia 

  • Salivation

  • Vomiting

  • Lacrimation

Correct answer: Hyperthermia 

Organophosphate poisoning results in acetylcholinesterase inhibition, and the decrease of degradation results in an excess of acetylcholine, leading to a cholinergic crisis and characteristic toxidrome due to muscarinic, nicotinic, and CNS stimulation. Muscarinic effects are contained in the pneumonic "SLUDGE" and include salivation, lacrimation, urinary incontinence, defecation, GI symptoms, and emesis. They can also include bronchorrhea, bronchospasm, bradycardia, and hypotension. Nicotinic effects include muscle fasciculations, seizures, and paralysis, which can lead to respiratory failure. 

Hyperthermia is not a part of the toxidrome.

42.

What term is used to refer to the practice of comparing and contrasting a service's quality assurance and improvement program findings against those of others in the industry?

  • Benchmarking

  • Thresholds

  • Metrics

  • Analyzation 

Correct answer: Benchmarking

Benchmarking is the last of three steps and is a process in which the agency in question compares its data to other programs.

Quality Assurance and Improvement programs (QA&I) are used by critical care services to improve the quality of the care and services provided. When creating a QA&I program, the first step is to define what quality means to the service in question. This is often done as a reflection of the mission statement or values of a service. The second step is to collect data from multiple sources and analyze it to see how it can be applied to the specific agency's program. The third step utilizes data analysis and understanding of issues to improve quality. This step is often done utilizing benchmarking, a process in which the agency in question compares its data to other programs. This is often done using metrics or databases of statistics, such as GAMUT or NEMSQA.

Thresholds are the level at which performance is considered unacceptable or noncompliant. 

43.

Which of the following most accurately reflects normal intracranial pressure?

  • 5-15 mmHg

  • 60 mmHg

  • 10-20 mmHg

  • 40 mmHg

Correct answer: 5-15 mmHg

Intracranial Pressure (ICP) describes the pressure within the cranial vault exerted by the presence of blood, Cerebrospinal Fluid (CSF), and the brain. According to the Monro-Kellie Doctrine, expansion of any of these three components must result in depletion of one or both of the others in order to maintain appropriate ICP levels. Increases in ICP can occur due to edema, changes in CSF production or drainage, masses, and changes in vessel size.

Normal Cerebral Perfusion Pressure is 60 mmHg.

44.

What is the single most important monitored predictor of fetal well-being?

  • Fetal monitoring variability

  • Mother’s GTPAL History (Gravidity, Term births, Preterm births, Abortions, Living children)

  • Regular prenatal care

  • Fetal movement

Correct answer: Fetal monitoring variability

Fetal monitoring is done using Electronic Fetal Monitoring (EFM) to record tracings of fetal heart rate and uterine contractions. Variability can be seen on the fetal heart tracing and is the best predictor of fetal distress and well-being during transport. Fetal movement is the most important nonmonitored indicator of fetal well-being.

Mother’s GTPAL score gives the provider a good history but does not actually identify fetal stress. Prenatal care is not a good indication of current fetal well-being.

45.

What does the A in the Diversity Practice Model stand for?

  • Assumption

  • Awareness

  • Alignment

  • Agender

Correct answer: Assumption

The A in the Diversity Practice Model is Assumption—What do we assume about this individual or their community?

The Diversity Practice Model was created by the Emergency Nurses Association as a tool to help guide providers in obtaining additional patient information to assist in patient care. It helps providers to recognize what makes us the same and different from our patients and uses this information to improve care of these patients. 

The model is broken down as follows:

  • A: Assumption. What do we assume about this individual or their community?
  • B: Beliefs or behaviors. How do my beliefs affect my patient care and are they reflected in my patient care?
  • C: Communication. How does my patient communicate and what tools can be used to improve communication?
  • D: Diversity and how the patient differs from the provider in skin color, sexual orientation, age, etc. 
  • E: Education and Ethics. Education and personal ethics are influenced by one's diversity and their understanding of others' diversity. 

46.

You and your partner are transporting an 82-year-old female three hours across state lines via fixed-wing aircraft. Two hours into the transport, the patient goes into cardiac arrest. The patient does not have a Do Not Resuscitate order, and no family was able to be reached prior to transport. Your service does not allow for death pronouncement while the aircraft is in the air. There is enough medication on board to perform CPR for approximately thirty minutes, and an automatic chest compression device has already been placed on the patient. There is a hospital twenty minutes away off of the scheduled transport route. 

What is the next best course of action?

  • Divert to the hospital twenty minutes away and call for ground transport to meet you upon landing

  • Continue to the receiving hospital, performing CPR without medication once it runs out

  • Pronounce the patient deceased and withhold all CPR efforts, continue to the receiving hospital

  • Turn back to the sending hospital, continuing CPR during transport until medication runs out

Correct answer: Divert to the hospital twenty minutes away and call for ground transport to meet you upon landing

Cardiac arrest during transport can be a complicated issue and a unique challenge. There are many factors that critical care providers must consider before making a decision about what to do with patient care when CPR is necessary during transport. The policies and procedures of the service must be considered first. Many services do not allow pronouncement of death while in the air due to some areas requiring pronouncement of death be performed by someone who is provincially licensed and recognized. As stated in the question, the providers in this situation cannot pronounce death due to service policy. 

Considerations must also be made for distance and time to the receiving hospital. This can help determine what the most appropriate action is. In this scenario, the transport service is closer to the receiving hospital than the sending one, so turning back would not be the most viable option. That being said, equipment and supplies are another critical consideration. If supplies will be exhausted prior to arrival at the receiving facility, then the aircraft should consider diverting to the closest appropriate facility per agency protocol. 

47.

While transporting an intubated patient, you begin to notice a curare cleft on the end tidal waveform. What is the next most appropriate treatment for this patient?

  • Resedate and reparalyze with Etomidate and Rocuronium

  • Extubate the patient and begin positive pressure ventilation

  • Increase the rate and PEEP on the ventilator

  • Increase the FiO2 and tidal volume on the ventilator

Correct answer: Resedate and reparalyze with Etomidate and Rocuronium

A curare cleft on the end tidal waveform is seen as a tick mark, or cleft, on the plateau of the wave. These tick marks indicate that the patient is choking or coughing on the tube, typically meaning they require repeat doses of sedatives and paralytics. 

While extubation would correct a curare cleft, it is not the most appropriate treatment or necessary for this patient. Changing the settings of the ventilator also will not help this patient, as the issue is not with the ventilator but with the patient's reaction to the tube.

48.

Which of the following statements most accurately reflects a gastroschisis defect?

  • Gastroschisis may result in the infant being born with adhesions of the intestines.

  • A gastroschisis defect most commonly occurs to the left of the umbilicus.

  • A gastroschisis defect involves the herniation of abdominal contents outside the abdomen and is covered by an amniotic-peritoneal membrane.

  • Gastroschisis occurs when the abdominal contents fail to return to the abdominal cavity in the 12th week of gestational development.

Correct answer: Gastroschisis may result in the infant being born with adhesions of the intestines.

The neonate may be born with the Gastrointestinal (GI) conditions gastroschisis or omphalocele. Gastroschisis occurs when there is a disruption in formation of the abdominal wall between the 4th and 8th weeks of gestation, most often resulting in a defect that presents to the right of the abdominal umbilical cord insertion site. The defect results in evisceration of the abdominal contents without any membrane covering the intestines; this often results in the eviscerated intestines appearing edematous and with the presence of adhesions due to "free-floating" in the amniotic fluid for many weeks. Gastroschisis typically occurs as a stand-alone disorder, without any association with other chromosomal disorders.

An omphalocele occurs during the 12th week of gestational development when the abdominal contents—which had previously protruded into the umbilical cord—fail to return to the abdominal cavity and remain outside, covered by an amniotic-peritoneal membrane into which the umbilical cord inserts. This GI defect has a strong association with other syndromes or chromosomal disorders.

49.

A 67-year-old male patient’s chest X-ray shows an enlarged heart that is more than half the width of the chest. Which condition is the patient most likely suffering from?

  • Congestive heart failure

  • Aortic dissection

  • Pericarditis

  • Pulmonary embolism

Correct answer: Congestive heart failure 

A chest X-ray with a cardiac shadow greater than one-half of the chest cavity is a common sign of Congestive Heart Failure (CHF). 

A patient with pericarditis will have a chest X-ray that reveals pleural effusions without heart enlargement.  

Aortic dissection or pulmonary embolisms are not likely to cause an enlarged heart in a chest X-ray. 

50.

A patient who is 38 weeks pregnant presents with painless, bright red bleeding. The patient is most likely experiencing which of the following complications?

  • Placenta previa

  • Abruptio placenta

  • Retained placenta

  • Placenta accreta

Correct answer: Placenta previa 

Pregnant women who experience placenta previa are likely to present with painless, bright red bleeding unrelated to the presence of uterine contractions. The medical transport team member who encounters a woman experiencing bleeding due to placenta previa should make every effort to keep the patient calm, minimizing her movement, and avoid vaginal examinations. Unless there is obvious hemorrhage, bleeding from placenta previa is not an emergency, although the patient should be evaluated as soon as possible. 

While the exact cause of placenta previa is unknown, it is believed to occur as a result of perfusion defects in the uterine decidua which contributes to implantation of the placenta in the lower segment of the uterus. In an attempt to compensate for the decrease in perfusion, the placenta increases its perfusion by thinning out and growing larger over a more extensive area of the uterus, partially or fully covering the uterine os. The cervical changes that occur in preparation for labor—thinning, softening, and dilating—result in a tearing of the placental attachments, causing the painless bright red bleeding. Typically, the initial episode of bleeding results in less than 250 mLs of blood loss. If there is further bleeding, these episodes tend to be much larger.

Abruptio placenta presents as very painful bright red bleeding. Retained placenta often presents as painless postpartum bleeding that does not decrease in volume as expected over the first few days or weeks following delivery. Placenta accreta is a rare complication of placenta previa in which the placenta attaches to the myometrium versus the endometrium.

51.

A ventilated patient takes a breath, causing the alveoli to open, but then the alveoli collapse with exhalation. This is known as:

  • Cyclic atelectasis

  • Auto-PEEP

  • Physiological atelectasis

  • Pathological atelectasis

Correct answer: Cyclic atelectasis

Cyclic atelectasis is the condition during which a patient takes an inspiratory breath, causing the alveoli to open, but the alveoli are unable to maintain their open position with exhale, immediately collapsing. This cycle occurs over and over again with each breath, and can ultimately lead to both local and systemic inflammation within the lung. In ventilated patients, Positive End Expiratory Pressure (PEEP) is used to prevent the alveoli from collapsing with expiration, and is best utilized in ventilator modes that also employ a set tidal volume in order to maintain alveolar recruitment during the exhale.

Auto-Positive End Expiratory Pressure (auto-PEEP) is a physiologic event that is common to mechanically ventilated patients. Auto-PEEP is commonly found in acute severe asthma, chronic obstructive pulmonary disease, or patients receiving inverse ratio ventilation. Physiological atelectasis is not a bodily process, as atelectasis is not physiological. Pathological atelectasis would be any atelectasis caused by a disease process or bodily change.

52.

A 70-year-old, 80 kg patient diagnosed with aspiration pneumonia after AMI is being transferred to a specialty care hospital. The patient is intubated, on the ventilator with vitals of BP 110/60, HR 110, R 16 (assisted). they have no spontaneous respirations, with GCS 3. Current vent settings AC Vt 550, f 16, FiO2 0.6 PEEP 5.0. ABG’s pH 7.34 PaCO2 50, HCO3 19, PaO2 78, SaO2 90%. Dopamine is infusing at 10 mcg/kg/min. What should your next treatment priority be?

  • Increase PEEP to 7.5 mmHg.

  • Adjust dopamine to 7.5 mcg/kg/min.

  • Increase FiO2 to 100%.

  • Initiate fluid bolus of 250 mL.

Correct answer: Increase PEEP to 7.5 mmHg

The patient is mildly hypoxic due to inadequate gas exchange in the alveoli. Increasing the PEEP would help oxygenate this patient and wash out dead space. This will be more effective than simply increasing FiO2. Changing the dopamine may reduce cardiac output. A fluid bolus will not be of benefit to this patient. 

53.

A patient with Marfan’s syndrome presents with sudden onset pain in the interscapular region that radiates into his legs. Patient has a history of hypertension and is non-compliant with his medications. Patient’s blood pressure is 185/95. You recheck the blood pressure in the other arm and find a blood pressure of 160/93. What is the probable cause of the patient’s symptoms?

  • Aortic dissection

  • GI bleed

  • Cardiac tamponade

  • Pulmonary embolism

Correct answer: Aortic dissection

Marfan’s syndrome is a disorder of the connective tissue where connective tissue degenerates. A common place for this to occur is the elastic fibers of the aortic media. This breakdown allows for dissection to occur. This information, along with history of hypertension and differing blood pressures in each arm, leads us to believe aortic dissection is the cause of the patient's symptoms. 

54.

Which of the following is used in the treatment of Group 4 pulmonary hypertension?

  • Blood thinners

  • Calcium channel blockers

  • Postanoids

  • Antibiotics

Correct answer: Blood thinners

Pulmonary hypertension occurs when the mean pulmonary arterial pressure is greater than 25 mmHg while at rest as confirmed by right heart catheterization. The World Health Organization has divided pulmonary hypertension into five groups based on pathology, hemodynamic characteristics, and appropriate management. Group 4 is pulmonary hypertension sufferers who have chronic thromboembolism, meaning they are treated with blood thinners.

All 5 groups are listed as follows:

  • Group 1 is considered to be pulmonary artery hypertension caused by narrowing of the vessels to the lungs, caused by genetics, drugs or toxins, connective tissue disorders, and others. Group 1 pulmonary hypertension is treated with calcium channel blockers, postanoids, phsophdiesterase-5 inhibitors, and endothelin receptor agonists. 
  • Group 2 pulmonary hypertension involves the left ventricle and is therefore treated by managing preload, afterload, and cardiac contractility.
  • Group 3 involves hypoxia and chronic lung disease and is treated by managing hypoxia. 
  • Group 4 pulmonary hypertension sufferers have chronic thromboembolism, meaning they are treated with blood thinners.
  • Group 5 pulmonary hypertension can have many unspecific causes and is treated by managing the underlying cause. 

55.

Which of the following is false regarding the use of CPAP?

  • It is most appropriately used for patients with ventilation problems as in COPD or asthma

  • The same pressure is maintained through the entire respiratory cycle

  • CPAP can be used in neonates with respiratory failure

  • It is most appropriately used for patients with oxygenation problems as in pulmonary edema or pneumonia

Correct answer: It is most appropriately used for patients with ventilation problems as in COPD or asthma

Bilevel Positive Airway Pressure, or BiPAP, is similar to CPAP in that pressure is delivered to the airway throughout the respiratory cycle but differs in that the pressure is different during inspiration and expiration. This makes BiPAP well suited for patients with ventilation issues, such as those suffering from COPD or asthma exacerbation. 

Continuous Positive Airway Pressure, or CPAP, is a form of noninvasive positive pressure ventilation that uses a tightly fitted mask to deliver continuous pressure to the airway. The pressure used is the same throughout the entire respiratory cycle, aiding in alveolar recruitment and oxygenation. It is often used in neonates with respiratory failure or in patients with a failure to oxygenate. 

56.

You are the flight paramedic caring for a 24-year-old female patient who has just delivered her baby. You note that the patient has soaked through several chux pads and is still bleeding. You estimate the amount of blood loss is over 500 mL. In addition to Pitocin, what other drug should be administered? 

  • Methergine

  • Tranexamic Acid (TXA)

  • Terbutaline

  • Glucocorticoids

Correct answer: Methergine

Postpartum hemorrhage can have several causes. One way to help stop bleeding is to make the uterus contract. Pitocin is naturally released during childbirth and while nursing the child. Pitocin along with methergine causes uterine contraction. 

TXA does not cause uterine contraction; while it does help prevent the breakdown of blood clots, the need here is to cause uterine contraction. Terbutaline is given to postpone preterm labor. Glucocorticoids are given to stimulate lung development. 

57.

Which type of pelvic fracture carries the highest risk for massive hemorrhage?

  • Posterior fractures

  • Anterior fractures

  • Lateral fractures

  • All have equal risk

Correct answer: Posterior fractures

Pelvic fractures are one of the most serious injuries that a patient can suffer from due to the risk of arterial injury and other large venous structures within and around the pelvis. Fatal hemorrhage can often result from pelvic fractures. Arteries and veins may be torn away due to fracture, with posterior fractures carrying a higher risk for hemorrhage than anterior or lateral. Fractures that maintain stability of the pelvic ring may be minor and require no hospitalization. Pelvic fractures that result in separation in two or more places, or of one or both sacroiliac joints are often seen in multisystem trauma. Immediate bleeding control through the use of a commercial pelvic binder or sheet should be top priority. These devices reduce the size of the pelvic ring space and decrease the space available for blood loss. Caution should be made not to overtighten when binding the pelvis and causing over-reduction.

58.

FAR Part 135 states that an air medical pilot's maximum duty day is: 

  • 14 hours

  • 12 hours 

  • 24 hours 

  • 16 hours 

Correct answer: 14 hours 

Federal Aviation Regulation (FAR) Part 135 addresses pilots who are flying passengers for money, and restricts a duty day to 14 hours. 

59.

A patient presents with altered mental status, dilated pupils, hot flushed skin, and dry mucous membranes. Which of the following drugs did the patient most likely overdose from?

  • Anticholinergics

  • Sympathomimetics

  • Benzodiazepines

  • Organophosphates

Correct answer: Anticholinergics

Anticholinergic effects range from mild sedation to delirium. Peripheral manifestations may include dry mouth and skin, blurred vision, urinary retention, constipation, paralytic ileus, cardiac dysrhythmias, and exacerbation of angle-closure glaucoma. Central anticholinergic syndrome is characterized by dilated pupils, dysarthria, and agitated delirium. Treatment is discontinuation of antipsychotics, and supportive measures. The phrase, “Mad like a hatter, blind as a bat, red as a beet, hot like a hare, and dry as a bone” is a way to remember the symptoms of anticholinergic overdose. These drugs block ACh from muscarinic receptors and, as such, stop the parasympathetic nervous system. 

Benzodiazepine overdose is often complicated by overdose of other substances such as alcohol, complicating the course of treatment and presentation. Presentation is often nonspecific with signs and symptoms ranging from drowsiness to coma. Sympathomimetics include cocaine, amphetamines, and ecstasy. Overdose of these drugs causes hyperactivity, hypertension, malignant cardiac arrhythmias, metabolic acidosis, hyperthermia, and seizures. Organophosphate poisoning is characterized by the SLUDGE acronym; salivation, lacrimation, urination, defecation, GI upset, and emesis.

60.

According to the National Fire Protection Agency, designated signage is used to identify the type and severity of hazards at a site. Signage that has a 1 in the blue section and a W in the white section indicates what?

  • Slight health hazard and water reactive risk

  • Slight health hazard and corrosive risk

  • Water-contact stable and slight health hazard risk

  • Unstable when heated

Correct answer: Slight health hazard and water reactive risk

The National Fire Protection Agency developed signage used today to aid in identifying the characteristics of potentially hazardous materials located at a site. The sign involves a diamond shape comprised of four different colored squares — red, yellow, white, and blue — and then further designation within each square with letter or number designations.

The red square represents any fire hazard presented by the substance, the yellow square represents the reactivity of the substance, the blue square represents any health hazards posed by the substance, and the white square represents any additional specific hazards presented by the substance. Risk of fire hazard is rated from 0 to 4, with 0 indicating the substance will not burn, and 4 indicating the substance is highly flammable and will burn below a level of 73 degrees Fahrenheit. Reactivity of the substance is also rated from 0 to 4, with a 0 rating indicating that the substance is stable, and 4 indicating the substance will detonate. A health hazard rating of 0 indicates that the substance is a normal substance and poses no health risk, while a rating of 4 indicates the substance is deadly to human health.

Finally, additional specific hazards which may be posed include radiation hazard, acid or alkaline designation, identification as an oxidizer or as a corrosive material, and as a substance which will react when in contact with water (indicated by the presence of a capital "W" with a strike through it).