Paramedics Exam Medical Emergencies and Obstetrics 2 — Questions and Answers
Question 1: A 58-year-old male presents with sudden onset tearing chest pain radiating to the back. BP is 190/110 in the right arm and 160/90 in the left arm. What is the most likely diagnosis?
- Acute MI
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Esophageal rupture
Correct answer: Aortic dissection
Unequal blood pressures between arms combined with tearing back pain strongly suggests aortic dissection.
Question 2: A patient in status epilepticus has failed to respond to two doses of lorazepam. What is the next appropriate pharmacological intervention?
- Phenobarbital
- Fosphenytoin (Correct answer)
- Propofol
- Haloperidol
Correct answer: Fosphenytoin
Fosphenytoin (or phenytoin) is the second-line agent after benzodiazepines fail in status epilepticus management.
Question 3: A 32-year-old female at 36 weeks gestation has a BP of 160/110, severe headache, and 3+ proteinuria. She then has a generalized tonic-clonic seizure. How should you manage this?
- Administer diazepam 5 mg IV
- Administer magnesium sulfate 4-6 g IV bolus (Correct answer)
- Perform immediate field delivery
- Administer labetalol 10 mg IV
Correct answer: Administer magnesium sulfate 4-6 g IV bolus
Eclampsia is treated with magnesium sulfate as the drug of choice to terminate seizures and prevent recurrence.
Question 4: Which finding is MOST consistent with distributive (septic) shock?
- Cool, clammy skin with narrow pulse pressure
- Warm, flushed skin with wide pulse pressure (Correct answer)
- Distended neck veins with hypotension
- Muffled heart sounds with pulsus paradoxus
Correct answer: Warm, flushed skin with wide pulse pressure
Septic shock causes massive vasodilation resulting in warm, flushed skin and a wide pulse pressure in the early hyperdynamic phase.
Question 5: A 45-year-old male presents with wheezing, urticaria, hypotension (BP 70/40), and stridor after eating shellfish. What is the FIRST drug to administer?
- Diphenhydramine 50 mg IV
- Methylprednisolone 125 mg IV
- Epinephrine 0.3-0.5 mg IM (Correct answer)
- Albuterol via nebulizer
Correct answer: Epinephrine 0.3-0.5 mg IM
Epinephrine IM is the first-line treatment for anaphylaxis due to its immediate alpha and beta adrenergic effects.
Question 6: You arrive at a scene where a 70-year-old female is unresponsive with a blood glucose of 28 mg/dL. IV access cannot be established. What is the next best intervention?
- Oral glucose gel under the tongue
- Glucagon 1 mg IM (Correct answer)
- Dextrose 50% via IO access
- Thiamine 100 mg IV
Correct answer: Glucagon 1 mg IM
Glucagon IM is the preferred alternative when IV access is unavailable in a hypoglycemic patient who cannot take oral glucose.
Question 7: A patient presents with acute altered mental status, fever of 40.2°C, muscle rigidity, and diaphoresis. She was recently started on haloperidol. What condition is MOST suspected?
- Serotonin syndrome
- Neuroleptic malignant syndrome (Correct answer)
- Malignant hyperthermia
- Heat stroke
Correct answer: Neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) presents with hyperthermia, rigidity, altered mental status, and autonomic instability after antipsychotic use.
Paramedics Exam Medical Emergencies and Obstetrics 2
A 58-year-old male presents with sudden onset tearing chest pain radiating to the back.
BP is 190/110 in the right arm and 160/90 in the left arm.
What is the most likely diagnosis?