1. C. An anaphylactoid reaction is the most severe form of allergic reaction and is not mediated by an antigen-antibody reaction. A type I allergic reaction may lead to life-threatening anaphylaxis. Immunity can be natural or can be artificially induced through immunization.
2. D. Individuals in occupations that may involve prolonged exposure to latex, such as hairdressers, food handlers, healthcare workers, and tollbooth operators, are at high risk of latex allergy. Patients with asthma or with a genetic predisposition to allergies may also be at high risk; however, patients with allergic rhinitis are at no particular risk of latex allergy.
3. C. The first step in managing a patient with an anaphylactic reaction is to provide adequate airway support; the patient should be placed in a comfortable position and high-concentration oxygen should be administered. Intramuscular epinephrine may be given to patients with clinical signs of shock; however, intravenous epinephrine should only be given in rare instances and with authorization from medical direction. Saline is given only in the presence of hypotension or when the patient does not respond to epinephrine.
4. B. Beta-blockers can increase the severity of anaphylaxis and induce a severe reaction to epinephrine; however, beta agonists, antihistamines, corticosteroids, antiarrhythmics, and vasopressors may be given as additional drug therapy.
5. D. Signs of a mild allergic reaction include urticaria or hives, cramping or diarrhea, and bronchoconstriction; however, altered mental status, as indicated by a sense of impending doom, confusion, and agitation, is typically associated with anaphylaxis.
6. C. In performing defibrillation, paddles should not be placed over the sternum or over the generator of an implanted automatic defibrillator or pacemaker. Place one paddle to the right of the upper sternum below the clavicle and the other to the left of the left nipple immediately over the apex of the heart.
7. D. Various gels, creams, and pastes are useful in decreasing paddle-skin interface resistance; however, use only those made specifically for defibrillation and not for electrocardiogram monitoring. Pads soaked in saline are safe but those soaked in alcohol may ignite.
8. A. Nitroglycerin patches should be removed before defibrillation; placing paddles together can cause pitting, which may burn the patient. Alternating cardiopulmonary resuscitation with defibrillation may transfer gel from the patient’s chest to the paddle handles. To remove an unwanted charge, simply turn off the defibrillator.
9. C. Asynchronous pacing is used less often than demand pacing, usually as only a last resort. Asynchronous pacing may be used in cases of asystole, to control tachydysrhythmia such as torsades de pointes, and in cases when artifact on the electrocardiogram interferes with its ability to read the actual heartbeat.
10. B. Transcutaneous cardiac pacing is primarily used in cases of symptomatic bradycardia, heart block associated with reduced cardiac output, or pacemaker failure. Cardiac pacing is usually ineffective in cardiac arrest or pulseless electrical activity and is not recommended in patients with open wounds or burns.
11. D. Resuscitation should not be attempted in patients with a valid Do Not Attempt Resuscitation (DNAR) order, in cases when vital functions have deteriorated, such as in patients with septic or cardiogenic shock, or in patients with asystole; however, resuscitation may be indicated in special cases, such as in young children or in those with hypothermia, electrolyte abnormalities, toxin exposure, or drug overdose.
12. B. Initial defibrillation should be attempted at 360 J monophasic energy; initial defibrillation for pediatric patients is 2 J/kg, followed by 4 J/kg if necessary. Biphasic defibrillation of 115 J is as effective as monophasic defibrillation of 200 J; the optimal current for ventricular defibrillation is 30 to 40 A.
13. A. Patients with chronic obstructive pulmonary disease (COPD) typically have an acute episode of worsening dyspnea and may be leaning forward to aid breathing. These patients may use accessory muscles as well as pursed-lip breathing to aid in respiration.
14. C. The thin, barrel-chest appearance of this patient, as well as the presence of wheezing, rhonchi, and pursed-lip breathing, are indicative of emphysema.
15. C. Typical signs and symptoms of chronic bronchitis include chronic cyanosis, productive cough, and resistance on inspiration; pink or red complexion, nonproductive cough, and pursed-lip breathing are indicative of emphysema.
16. D. In all patients in respiratory distress, the paramedic should establish an IV line and apply a cardiac monitor. Pulse oximetry and administration of high-concentration oxygen are also indicated; however, oxygen should not be withheld to avoid reduction of the hypoxic drive.
17. B. In the acronym OPQRST, used in obtaining a focused history in patients with respiratory distress, O = onset, P = provocation, Q = quality, R = region and radiation, S = severity, and T = time.
18. C. Conditions indicative of a perfusion problem include shock, anemia, pulmonary embolism, and trauma; asthma is indicative of a ventilation problem and atherosclerosis and carbon dioxide poisoning of diffusion problems.
19. A. Patients with chronic bronchitis and emphysema, known together as chronic obstructive pulmonary disease (COPD), may have both COPD and asthma at the same time but in varying degrees of severity. Patients with emphysema are referred to as “pink puffers” due to increased production of red blood cells; those with bronchitis are referred to as “blue bloaters” because they often appear cyanotic. In contrast to adult-onset asthma, childhood asthma usually improves or resolves with age.
20. B. The primary goal in managing an acute asthma attack is to ensure an adequate airway and reverse the bronchospasm. After administering high-concentration oxygen and consulting medical direction, the next step is usually to administer a fast-acting bronchodilator such as albuterol. Continuous positive airway pressure (CPAP) and biphasic positive airway pressure (BiPAP) should only be used if the patient has adequate spontaneous respirations; ketamine is used to sedate a patient before endotracheal intubation.
21. C. Inspiratory wheezing may indicate the presence of secretions in the large airways but does not necessarily indicate upper airway occlusion.
22. C. Peak expiratory flow rate (PEFR) tests are used in patients experiencing an acute asthma attack to determine baseline airflow before drug administration. PEFR tests are not useful in children less than 5 years of age or in patients in severe respiratory distress. Positive end-expiratory pressure (PEEP) is often used in patients with adult respiratory distress syndrome (ARDS).
23. B. Initial management of a stroke patient should include providing life support, confirming signs and symptoms, and establishing the time of stroke onset to determine whether fibrinolytic therapy should be administered; the patient should then be transported to the hospital as soon as possible for definitive care. Management of hypertension is not indicated in the initial treatment of stroke.
24. D. Both the Cincinnati Prehospital Stroke Scale (CPSS) and the Los Angeles Prehospital Stroke Screen (LAPSS) are useful in diagnosing stroke; if the patient is conscious, obtaining a medical history may also be useful. 50% dextrose is administered during glucose analysis only when indicated.
25. C. Transient ischemic attacks (TIAs) present with the same signs and symptoms as those of stroke; thus, assessment of a patient with a TIA is the same as that for a patient with stroke. TIAs are important predictors of brain infarction; however, they are not associated with permanent neurological deficits.