Paramedics Exam Medical Emergencies 4 — Questions and Answers
Question 1: A 72-year-old female presents with syncope, severe lightheadedness, and bradycardia at 38 bpm. She is pale and diaphoretic with a BP of 80/50. The ECG shows complete heart block. What is the first-line treatment?
- Adenosine 6 mg rapid IV push
- Transcutaneous pacing (Correct answer)
- Amiodarone 300 mg IV
- Atropine 0.5 mg IV
Correct answer: Transcutaneous pacing
Transcutaneous pacing is the first-line treatment for symptomatic third-degree (complete) heart block because atropine is often ineffective at this level of block.
Question 2: A patient presents with urticaria, laryngeal edema, bronchospasm, and hypotension after eating shellfish. Which medication is the cornerstone of treatment?
- Diphenhydramine 50 mg IV
- Methylprednisolone 125 mg IV
- Epinephrine 0.3 mg IM (1:1,000) (Correct answer)
- Albuterol 2.5 mg nebulized
Correct answer: Epinephrine 0.3 mg IM (1:1,000)
Epinephrine 1:1,000 administered IM into the lateral thigh is the first-line and potentially life-saving treatment for anaphylaxis, addressing bronchospasm and hypotension simultaneously.
Question 3: A 45-year-old male presents with profound weakness, hypotension, hyponatremia, hyperkalemia, and hyperpigmentation of the skin. He reports he stopped taking his steroid medication. What is the diagnosis?
- Cushing's syndrome
- Addisonian crisis (adrenal crisis) (Correct answer)
- Hypothyroid storm
- Pheochromocytoma
Correct answer: Addisonian crisis (adrenal crisis)
Adrenal crisis presents with hypotension, electrolyte disturbances (hyponatremia, hyperkalemia), weakness, and skin hyperpigmentation, often precipitated by abrupt steroid discontinuation.
Question 4: You are treating a patient with narrow-complex tachycardia at 180 bpm who is hemodynamically stable. Vagal maneuvers have failed. What is the next appropriate intervention?
- Synchronized cardioversion at 50J
- Adenosine 6 mg rapid IV push followed by saline flush (Correct answer)
- Amiodarone 150 mg IV over 10 minutes
- Verapamil 5 mg IV slow push
Correct answer: Adenosine 6 mg rapid IV push followed by saline flush
Adenosine is the first-line pharmacologic treatment for stable narrow-complex SVT after failed vagal maneuvers, as it temporarily blocks the AV node to terminate reentrant rhythms.
Question 5: A 60-year-old male with CHF presents with severe dyspnea, pink frothy sputum, SpO2 of 86%, bilateral crackles, and hypertension at 200/110 mmHg. What is the best prehospital treatment?
- Normal saline 500 mL IV bolus to maintain preload
- CPAP and nitroglycerin per protocol (Correct answer)
- Furosemide 40 mg IV and oxygen via NRB
- Morphine 2-4 mg IV for anxiolysis
Correct answer: CPAP and nitroglycerin per protocol
CPAP improves oxygenation and reduces preload, while nitroglycerin reduces afterload and preload; both are evidence-based prehospital treatments for acute pulmonary edema with hypertension.
Question 6: A patient presents with confusion, seizures, and a history of recent excessive water intake after a marathon. Serum sodium is 118 mEq/L. What condition does this represent?
- Hypernatremia
- Hyponatremia (dilutional) (Correct answer)
- Syndrome of inappropriate ADH (SIADH)
- Heat stroke
Correct answer: Hyponatremia (dilutional)
Excessive free water intake causing severe dilutional hyponatremia (sodium <120 mEq/L) leads to cerebral edema, manifesting as confusion and seizures.
Question 7: Which finding best differentiates neurogenic shock from hypovolemic shock?
- Altered level of consciousness
- Hypotension and tachycardia
- Bradycardia with warm, dry, flushed skin below the injury level (Correct answer)
- Narrow pulse pressure and cool, clammy skin
Correct answer: Bradycardia with warm, dry, flushed skin below the injury level
Neurogenic shock characteristically presents with bradycardia and warm, dry, flushed skin below the spinal injury due to loss of sympathetic tone, distinguishing it from hypovolemic shock.
Paramedics Exam Medical Emergencies 4
A 72-year-old female presents with syncope, severe lightheadedness, and bradycardia at 38 bpm.
She is pale and diaphoretic with a BP of 80/50.
The ECG shows complete heart block.
What is the first-line treatment?