Paramedic Medical / OB / GYN practice questions

Correct answer: A. sodium channel blockade requiring alkalinization rather than rate control

A QRS of 0.16 with seizures and tachycardia after an overdose is sodium channel blockade, most often from a tricyclic. Sodium bicarbonate overcomes the blockade and narrows the complex. You titrate it to the QRS, not to a pH value.

• A. A widening QRS after overdose with seizures indicates sodium channel blockade.
• B. A pre-existing block would not appear alongside seizures and tachycardia after overdose.
• C. A wide complex from channel blockade is not treated by cardioversion.
• D. Seizure-related potassium change does not widen the QRS this way.

Correct answer: B. assessing for a source of the fever and transporting for evaluation

A simple febrile seizure in a child who's back to baseline is usually benign. The cause of the fever still needs evaluating, though, and meningitis has to be excluded. The seizure has stopped, so there's nothing for an anticonvulsant to treat.

• A. Being back to baseline doesn't rule out a serious cause of the fever.
• B. Looking for the fever source and transporting for evaluation addresses what actually matters here.
• C. Ice packs cause shivering, and shivering raises metabolic demand and core temperature.
• D. You don't give a benzodiazepine prophylactically after a seizure that's already over.

Correct answer: B. warmed before and during administration

Cold fluid in a cold patient drops the core temperature even further. A heart that cold is irritable, and that drop can tip it into arrest. Warm fluid gives you the volume without making the real problem worse.

• A. Ambient fluid is well below core temperature, so it cools the patient.
• B. Warmed fluid fixes the volume without dropping the core any further.
• C. Volume loss in hypothermia needs correcting now. It shouldn't be put off.
• D. Fast, cold fluid is the likeliest way to provoke an arrhythmia.

Correct answer: C. sodium channel blockade producing widened complexes and arrhythmia

Tricyclics kill through the heart, not through sedation. They block cardiac sodium channels, and the QRS width predicts the risk and guides the alkalinization that treats it.

• A. Renal injury isn't the primary concern.
• B. Sedation happens, but the cardiac effects are what kill.
• C. Sodium channel blockade widening the QRS is the lethal mechanism.
• D. Hepatic failure isn't the characteristic cause of death.

Correct answer: B. continuous seizure activity causes progressive neuronal injury and hypoxia

Past about five minutes, a seizure is unlikely to stop on its own, and the metabolic demand it creates outruns the supply. Hypoxia and hyperthermia pile on. The damage keeps building as long as the seizure goes on.

• A. A structural lesion is possible, but duration alone doesn't establish one.
• B. Continuous activity causes cumulative neuronal injury on top of the hypoxia and hyperthermia.
• C. Tachycardia is expected, and it isn't the immediate threat.
• D. The temperature rises from the muscle activity. It doesn't point to infection.

Correct answer: D. whether the effort is still maintaining oxygenation

In distress, the child is working hard and the work is still paying off. In failure, the compensation is running out. That's why effort alone is a poor guide: a quiet, tiring child with a falling rate is further along than a noisy one working hard.

• A. A falling rate in a tiring child is more ominous than a fast one.
• B. Crying means a patent airway and some reserve, not failure.
• C. Retractions show effort, not whether it's enough.
• D. Whether the effort is still succeeding is what separates distress from failure.

Correct answer: B. a ruptured ectopic pregnancy

Missed period, one-sided lower abdominal pain and an unstable patient: that's a ruptured ectopic until proven otherwise. She can bleed a lot into the peritoneum with almost nothing to see from outside, which is why the vital signs matter more than the belly exam.

• A. A urinary tract infection doesn't cause acute hemorrhagic shock.
• B. A missed period with one-sided pain and hypotension is the classic ruptured ectopic.
• C. A muscle strain doesn't explain hemodynamic instability.
• D. Simple ovarian cyst pain doesn't usually bring hypotension and tachycardia.

Correct answer: A. a subarachnoid hemorrhage

A headache that's at its worst the moment it starts is the classic story of a ruptured aneurysm bleeding into the subarachnoid space. The trap is focusing on how bad it hurts. Plenty of benign headaches hurt badly too, but they build gradually. The suddenness is what tells you.

• A. Abrupt onset, maximal within moments, is the hallmark of subarachnoid hemorrhage.
• B. Migraines usually build over minutes to hours and often come with warning features.
• C. Dehydration headaches come on gradually.
• D. Tension headaches build gradually and are rarely described as the worst ever.