Paramedic Cardiology & Resuscitation practice questions

Correct answer: A. sedation should be given where time and the patient's state allow it

The patient was unstable, so cardioversion was the right call, and it worked. But if they were awake enough to describe the shock, they were awake enough to sedate. When there's any time at all, sedation is part of the procedure, not an optional extra.

• A. Sedate whenever the patient's condition and the clock allow it.
• B. The distress came from having no sedation, not from the energy setting.
• C. Calling unsedated cardioversion always acceptable ignores suffering you could have prevented.
• D. Cardioversion is still the right treatment for an unstable tachycardia.

Correct answer: C. is not recommended as routine practice

The technique has been described and tested in trials, but the evidence hasn't shown enough benefit to recommend it routinely. Knowing what isn't recommended matters as much as knowing what is, especially when a plausible-sounding technique gets passed around informally.

• A. It does not replace antiarrhythmic therapy.
• B. No shock count triggers it in current recommendations.
• C. Insufficient evidence of benefit is the reason it is not recommended as routine practice.
• D. Calling it preferred in all refractory cases overstates a technique that's still under study.

Correct answer: C. an unstable tachycardia in a patient with a pulse

Synchronizing puts the shock on the R wave, so you don't deliver energy during the vulnerable repolarization period and set off ventricular fibrillation. That only matters when there's an organized rhythm to sync to, which means a patient with a pulse.

• A. Ventricular fibrillation has no organized complex to sync to.
• B. Pulseless ventricular tachycardia gets unsynchronized defibrillation.
• C. An organized tachycardia with a pulse is what synchronization needs and protects.
• D. Asystole isn't a shockable rhythm at all.

Correct answer: B. increases confidence that the ST elevation represents true infarction

Plenty of conditions raise the ST segment. Reciprocal depression in the opposite territory points to infarction, not a mimic. When you see it, you can be a lot more confident in the diagnosis.

• A. Reciprocal change doesn't date the infarct.
• B. Reciprocal change separates true infarction from the conditions that mimic it.
• C. It's the same infarct seen from the opposite direction.
• D. Pericarditis characteristically lacks reciprocal change.

Correct answer: C. atrial fibrillation with a rapid ventricular response

The atria are firing chaotically, so there are no organized P waves and conduction to the ventricles is irregular. That's your irregularly irregular pattern. Losing coordinated atrial contraction drops cardiac output, and the stasis it creates sets up clot formation.

• A. Third-degree block usually gives you a slow, regular escape rhythm.
• B. Ventricular tachycardia produces wide complexes at a regular rate.
• C. No P waves with an irregularly irregular ventricular response is the definition of atrial fibrillation.
• D. Sinus tachycardia is regular, with a clear P wave before each QRS.

Correct answer: D. repeat the 12-lead and treat the presentation, not the tracing

One normal tracing doesn't rule out an infarction, especially early, and changes can show up over the next few minutes. The patient in front of you with ongoing pain is the finding. The tracing is one test that hasn't caught up yet.

• A. A normal tracing doesn't exclude an infarction that's still evolving.
• B. Holding treatment until a tracing turns abnormal ignores the clinical picture.
• C. Ongoing chest pain gets transported, whatever the first tracing shows.
• D. Serial tracings catch changes that one early tracing misses.

Correct answer: D. exertional collapse with a family history of sudden death

Fainting during exertion is how the cardiomyopathies that kill young athletes show up. A first-degree relative dying suddenly young is the strongest clue in the history. Looking well now doesn't make either one reassuring.

• A. A normal blood pressure doesn't rule out structural heart disease.
• B. Being well conditioned doesn't explain fainting during exertion.
• C. A normal rate after the episode doesn't lower the concern.
• D. Exertional syncope with a family history of sudden death is the classic warning pattern.

Correct answer: D. consider aortic dissection and avoid treatments that assume a coronary cause

A big difference between the arms suggests a dissection flap involving the origin of one subclavian artery. Why does that matter so much? Anticoagulants and antiplatelets help in infarction but can be catastrophic in dissection.

• A. Writing off a reproducible difference as error misses a lethal diagnosis.
• B. Picking one reading throws away the difference, and the difference is the finding.
• C. Carrying on unchanged risks giving anticoagulation to a dissecting aorta.
• D. An interarm difference suggests dissection, where standard coronary treatment can do harm.