AMLS Post Test

1. A 45-year-old patient is found supine on the floor. Healthcare providers note pinpoint pupils, shallow respirations, and vomitus in and around the mouth. What course of action should be taken next?

b. Supplemental oxygen and suction

2. Patients with a history of COPD that present with an acute onset of shortness of breath are likely to have what condition?

a. Pulmonary embolism

3. During compensatory shock, the renin-angiotensin-aldosterone system is activated to cause a/an:

a. Increase in preload, afterload, and re-absorption of sodium

4. What clinical findings are most commonly associated with a pulmonary embolus?

a. Clear breath sounds with tachypnea

5. What condition is most likely to cause respiratory acidosis?

b. Narcotic overdose

6. A 55-year-old complains of an 'aching' chest discomfort that persists over several days. The patient has a temperature of 101F (38.3C). Which finding will help narrow the diagnosis to pericarditis?

d. ST-segment elevation in all leads

7. Anaphylaxis is most associated with which physiological event?

b. Vasodilation

8. Acute Respiratory Distress Syndrome (ARDS) is characterized by what pathological change?

c. Breakdown of the alveolar-capillary membrane

9. Continuous positive airway pressure would be most beneficial in treating which patient?

b. A 22yo with severe asthma who is not responding to nebulizer treatments

10. What is the initial treatment for a patient experiencing hyperosmolar hyperglycemic nonketotic coma (HHNC)?

a. Crystalloid IV fluid administration

11. Your patient has had a seizure secondary to a nerve agent exposure. What medication would be best to diminish the seizure?

c. Midazolam

12. Respiratory alkalosis may occur as a result of:

a. Fever and anxiety

13. An age-related change that increases the risk of respiratory compromise is:

c. Decrease in lung compliance

14. Paroxysmal nocturnal dyspnea is most common in patients with a history of:

a. Left-sided heart failure (?)

15. The patient presents with a history of fever and an upper respiratory infection. Historical information reveals increasing water intake, orthostatic hypotension, and an increase in urination. You suspect these symptoms are caused by:

a. Hyperglycemia

16. You are dispatched to the home of a 32yo patient with a history of Graves' disease. The patient was in the ER earlier today for some "tests for my ulcers." He received contrast and was discharged. He is now complaining of not feeling well, chest pain, and palpitations. You note an anxious patient with fine tremors. He is diaphoretic and has a temperature of 101.5F, BP 100/62, P 156 (sinus tach), R 30, glucose level 133. Which of the following are management considerations for this patient?

d. Beta Blockers

17. Metabolic acidosis is best described by which arterial blood gas interpretation?

b. pH decreased, pCO2 decreased, H2CO3 low (?)

18. The AMLS Assessment Pathway first advises safety and initial observations of the scene. The second process described in this pathway asks the healthcare provider to:

c. Identify and manage life threats

19. Observing a patient's body positioning can be an early indicator that the patient is:

a. Sick or not sick

20. Which assessment finding is crucial to obtain from a patient suspected of a stroke?

c. Onset of symptoms

21. A 62yo patient presents with a severe headache. It is described as a "thunderclap" accompanied with nausea, blurred vision, and an elevated blood pressure. What neurologic condition is most likely the cause of this patient's presentation?

d. Subarachnoid hemorrhage

22. A 38yo presents with mild chest tightness and urticaria after mowing the lawn. He felt a "sting" in his left lower leg and states the symptoms came on suddenly. BP 130/82, P 100, R 20 with a normal work of breathing and clear lung sounds. The healthcare provider should:

b. Initiate an IV with 0.09% NS and monitor the patient carefully

23. Healthcare providers are treating a patient complaining of substernal chest pain accompanied with nausea and one episode of vomiting. The patient has had two cardiac stents placed within the last year. He has a familial history of heart disease and takes a baby aspirin daily. What information is most concerning?

b. Recent stent placement

24. The patient complains of sharp chest pain that worsens when supine. He is bed ridden due to complications from a recent hip surgery. The patient is tachypneic and the ECG reveals sinus tachycardia. What is the patient's working diagnosis?

d. Pulmonary embolism

25. A patient is a resident in an assisted living facility to obtain physical therapy after a knee replacement surgery. She complains of a rash that is red and has small bumps. She has been feeling ill for several days. What is the most likely working diagnosis?

c. Methicillin-resistant Staphylococcus aureus

26. A foreign exchange university student is found by his roommate and EMS is dispatched. The patient presents with an unusual flat red rash on his chest and arms. He has been ill with fever, nausea, and vomiting. Physical exam reveals stiffness of the neck. The healthcare provider will anticipate which diagnosis?

b. Meningitis

27. Healthcare providers are treating a 49yo male complaining of diffuse abdominal cramping. He has been ill with vomiting for 3 days. What working diagnosis is most probable?

d. Gastroenteritis

28. While assessing your patient, you note he involuntary flexes the legs in response to flexing his neck. The patient is presenting with:

b. A positive Brudzinski's sign indicating possible meningitis

29. Healthcare providers are assessing an obese 49yo who is lethargic and has not been feeling well for several days. His family reports a history of extreme thirst. Vital sings are P 143, R 14, and BP 88/58. He takes medication for type 2 diabetes daily. What is the most probably working diagnosis?

d. Hyperosmolar hyperglycemic nonketotic coma

30. A firefighter has been working a fire for 4 hours on a humid, hot day. He suddenly becomes nauseated and restless. The provider observes pupil dilation and an almond odor to his breath. The vital signs are P 56, R 22, BP 140/86. The ECG reveals sinus bradycardia with occasional PACs. Which toxin exposure has occurred?

d. Cyanide poisoning

31. Healthcare providers are treating a patient that has taken an unknown amount of a prescribed pain medicine along with an OTC analgesic numerous times over the last 36 hours for chronic lumbar pain. The patient is experiencing abdominal pain, nausea, and vomiting. The providers note pallor and diaphoresis. Blood glucose is 42. What toxin overdose is suspected?

b. Acetaminophen

32. A patient complains of nausea and is passing black, tarry stools rectally. This patient is most likely suffering from:

c. Upper GI bleed

33. The provider assesses a patient suffering from fever, nausea, vomiting, and per-umbilical pain. Further evaluation reveals RLQ pain and lower back pain. A physical exam reveals an increase in RLQ pain when the patient's right leg is extended from the hip (Psoas Sign). Which working diagnosis is most appropriate?

d. Appendicitis

34. Intra-abdominal bleeds, like pancreatitis, often present with discoloration or bruising around the umbilicus. This physical exam finding is known as:

a. Cullen's sign

35. Which of the following is a hallmark sign of tricyclic antidepressant toxicity?

a. Dysrhythmias

36. A daughter states that her 72yo mother has a history of hypertension, high cholesterol, and rheumatoid arthritis. Daily medications include aspirin, Tenormin, Plaquenil, and Plavix. She is concerned as her mother has mixed up her medications and is now lethargic with diminished respirations. Vital signs are P 58 and regular, R 10 and shallow, and a BP of 90/74. Blood glucose is 52. Which medication toxicity would be indicative of this presentation?

c. Beta blocker

37. If untreated, a cardiac tamponade will present with signs and symptoms of which type of shock?

c. Obstructive

38. A patient presents anxious with difficulty in breathing and chest pain. An assessment reveals hypotension, muffled heart tones, and distended neck veins. There is a past medical history of pericarditis. The provider notes that there is a decrease in systolic blood pressure when the patient inhales. Which diagnosis would be considered with this presentation?

b. Cardiac tamponade (?)

39. The healthcare provider is assessing a 60yo female patient with complaints of indigestion and mild upper abdominal discomfort. This presentation should prompt the provider to:

a. Perform a 12-lead ECG

40. The most common underlying medical conditions found in patients with acute pancreatitis is:

a. Gall stones and heavy alcohol use

41. A patient complaining of a 3-day history of left lower abdominal pain describes it as sharp and, during the focused physical exam, the pain intensifies during palpation over the site. Differentials should include:

a. Ectopic pregnancy or diverticulitis

42. A 22yo male has recently undergone a surgical procedure to repair an injury to thoracic vertebrae T4-T6. Assessment indicates the patient is alert and oriented, bradycardic, hypotensive, and has warm, dry skin. Which type of shock is most likely occurring?

d. Neurogenic

43. A caregiver for a quadriplegic patient notes an onset of difficulty in breathing and anxiousness in her patient. Further assessment shows a temperature of 1011.2F, P 128, BP 86/68, and R 24. Physical exam reveals the skin is warm and urine in the catheter is dark yellow and cloudy. This patient is most likely experiencing which type of shock?

b. Septic

44. When assessing geriatric patients, infectious diseases are more difficult to identify for all of the following reasons EXCEPT:

d. Heightened immune response is common

45. A local business woman has returned from missionary work in South Africa. She is complaining of night sweats, chest discomfort, and a persistent cough for several weeks. Which underlying diagnosis is most likely causing these symptoms?

c. Tuberculosis

46. Healthcare providers are responding to a near-drowning at a local lake. The patient is experiencing uncontrolled shivering and complains of nausea and weakness. The patient had been treading water for 25 minutes and now presents with tachycardia and rapid respirations. Core body temperature is 93.2F (34C). Which diagnosis is most likely?

a. Mild hypothermia

47. An elderly patient is receiving nursing care at a home while recuperating from a recent knee surgery. A post-operative infection developed, and the patient has been on antibiotics for quite some time. She is complaining of a foul-smelling diarrhea, and abdominal cramping and loss of appetite. On the basis of this presentation, the provider should suspect:

b. Clostridium difficile

48. A 20yo female presents with a 2-day history of dyspnea, nonproductive cough, chest tightness, and audible wheezing. Further exam reveals no fever or stridor. The patient has rapid respirations with difficulty exhaling. Which diagnosis is most likely?

c. Asthma

49. An elderly patient with a 1-week history of productive cough and wheezing notices an increase in difficulty breathing when grocery shopping. Further assessment reveals pursed lip breathing, rhonchi, and minimal jugular vein distension. Which diagnosis should the provider suspect?

a. COPD

50. A 50yo female has called 9-1-1. She complains of shortness of breath and chest discomfort. Assessment reveals her skin is pale, moist, and cool. BP is 102/68, R 24 and labored with crackles, P of 130 and regular. Which type of shock is most likely occurring?

d. Cardiogenic