Paramedics Exam Medical Emergencies 3 — Questions and Answers
Question 1: A 40-year-old female presents with sudden dyspnea, pleuritic chest pain, and tachycardia after a long flight. Her SpO2 is 91% and she has a swollen left calf. What is the most likely diagnosis?
- Spontaneous pneumothorax
- Pulmonary embolism (Correct answer)
- Acute myocardial infarction
- Pleural effusion
Correct answer: Pulmonary embolism
Pulmonary embolism is strongly suspected given the triad of dyspnea, pleuritic chest pain, and tachycardia combined with DVT risk factors (immobility, unilateral leg swelling).
Question 2: A 28-year-old known diabetic is found unresponsive. Blood glucose reads 32 mg/dL. You have IV access. What is the appropriate intervention?
- Administer glucagon 1 mg IM
- Administer dextrose 50% IV push (25g) (Correct answer)
- Administer normal saline 500 mL bolus
- Administer insulin per protocol
Correct answer: Administer dextrose 50% IV push (25g)
With confirmed IV access, D50W (25g dextrose) administered IV is the fastest and most effective treatment for severe hypoglycemia in an unresponsive patient.
Question 3: You are treating a seizing patient. After 5 minutes of continuous seizure activity with no IV access, which medication and route is most appropriate?
- Lorazepam 2 mg IV
- Diazepam 5 mg PR (rectal)
- Midazolam 10 mg IM (Correct answer)
- Phenytoin 20 mg/kg IV
Correct answer: Midazolam 10 mg IM
IM midazolam (typically 10 mg for adults) has been shown to be as effective as IV lorazepam and is the preferred route when IV access is unavailable for status epilepticus.
Question 4: A patient presents with fever, stiff neck, photophobia, and a petechial/purpuric rash. What is the most critical prehospital consideration?
- Administer acetaminophen to reduce fever
- Isolate the patient and use BSI precautions for suspected bacterial meningitis (Correct answer)
- Perform a lumbar puncture to confirm diagnosis
- Administer IV penicillin immediately in the field
Correct answer: Isolate the patient and use BSI precautions for suspected bacterial meningitis
The presentation is classic for bacterial meningitis/meningococcemia, which is contagious via droplets, making patient isolation and strict BSI precautions the immediate priority.
Question 5: A 65-year-old male has a blood glucose of 820 mg/dL, Kussmaul respirations, and fruity breath odor. He is alert but confused. Which condition does this presentation represent?
- Hyperosmolar hyperglycemic state (HHS)
- Diabetic ketoacidosis (DKA) (Correct answer)
- Addisonian crisis
- Hyperglycemic hyperosmolar nonketotic coma
Correct answer: Diabetic ketoacidosis (DKA)
Kussmaul respirations (deep, labored breathing) and fruity breath (ketones) combined with marked hyperglycemia indicate DKA, typically seen in Type 1 diabetics.
Question 6: A 55-year-old presents with sudden onset of tearing chest pain radiating to the back between the scapulae, with unequal blood pressures in both arms. What is the most likely diagnosis?
- Aortic dissection (Correct answer)
- STEMI
- Esophageal rupture
- Cardiac tamponade
Correct answer: Aortic dissection
Tearing or ripping chest/back pain with pulse or blood pressure differential between extremities is the classic presentation of aortic dissection.
Question 7: During assessment of a patient with altered mental status, you note his breath smells like ammonia. He has a distended abdomen, jaundice, and spider angiomas. What metabolic emergency is most likely?
- Uremic encephalopathy
- Hepatic encephalopathy (Correct answer)
- Diabetic ketoacidosis
- Wernicke's encephalopathy
Correct answer: Hepatic encephalopathy
Ammonia breath with signs of liver disease (jaundice, spider angiomas, ascites) and altered mental status indicates hepatic encephalopathy from liver failure.
Paramedics Exam Medical Emergencies 3
A 40-year-old female presents with sudden dyspnea, pleuritic chest pain, and tachycardia after a long flight.
Her SpO2 is 91% and she has a swollen left calf.
What is the most likely diagnosis?