Patient Assessment Basics [ 2 ] Quiz

Quiz Answer Key and Fun Facts

1. A stethoscope can be used to listen to breath sounds, heart sounds, and bowel sounds.

Answer: True

A stethoscope is one of the tools I'd prefer not to do my job without. I use it on almost every patient I see. I use it to take a blood pressure, listen to breath sounds, and I've listened to heart sounds. It takes practice to use a stethoscope correctly, and to be able to identify correctly the sounds that I am listening to.

2. I've been called to a patient with abdominal pain, who states that the pain has been getting worse all day. When I examine their stomach, they tell me that the pain was originally all over their stomach, however is now only on their right side. Their Right Lower Quadrant (RLQ) is rigid and tender. It is still exceptionally painful, and they feel very nauseous. Which of the following is the patient likely to be suffering from?

Answer: Acute appendicitis

The most likely cause is acute appendicitis. It is quite common for the pain to be generalised at first, then it locates to the Right Lower Quadrant (RLQ) where the appendix is located. Nausea commonly accompanies appendicitis, as does rigidity of the muscles over the area of inflammation.
It is important that the person with appendicitis goes to the hospital for a surgical consult. A ruptured appendix causes a severe infection called peritonitis, which can be fatal.

3. It's a busy night tonight. After I take my patient with abdominal pain to the hospital, we get a call to a child with breathing difficulties. The child looks incredibly unwell and is drooling more than I consider to be usual. His mother states that he won't go a lie down, as he wants to sit up all the time. Which of the following is this child likely to have?

Answer: Epiglottitis

Epiglottitis is a potentially life-threatening condition - it is caused by a bacterial infection. The epiglottis is a little flap-valve that moves between the trachea and the oesophagus (wind-pipe and food-pipe respectively). The infection causes the epiglottis to swell, blocking both of these pipes.

It is very important that the throat is not examined in any patient suspected of having epiglottitis, as severe laryngospasm can occur, completely occluding the patient's airway. Generally, the patient is transported in a position of comfort (on a parent or carer's lap), with high-flow oxygen as close as the patient will tolerate. It is also important not to allow these patients to become upset, as this will also compromise their airway.

4. I spent many a sleepless night trying to remember all the things I need to know about ECG's. An ECG is an ElectroCardioGraph (hence 'ECG'), and it records the electrical activity of the heart. The 'squiggles'on the paper are referred to as waves, and they have had letters assigned to them for no particular reason other than they needed a name. I know how hard this subject is, so I'll only ask one question on this topic - what does the QRS complex on an ECG represent?

Answer: Ventricular depolarisation

The QRS complex represents Ventricular depolarisation, and hopefully along with that goes Ventricular contraction. Ventricular repolarisation is represented by the T wave. Atrial depolarisation is represented by the P wave, and Atrial repolarisation is often 'lost' inside Ventricular depolarisation. It's not lost as such, it is just hidden within the QRS complex as this uses more electrical energy than Arial repolarisation.
For anybody just starting to learn about ECG's - good luck with it. It's a skill you need to practise all the time in order to get better and stay good at.

5. It is common for a paramedic to ask a patient about their medications, and for the patient to have a shopping bag full of medications that they don't know too much about. Should a paramedic bring all of the patient's medications to the hospital with them?

Answer: Yes

It is best if you can bring all of the patient's medications to the hospital with the patient. If you are taking someone to the hospital yourself, it is advisable to take all of their medications with them as well. It helps the doctors to understand what medical conditions the patient has, and what strength of drug was being used to treat it.

Many drugs look similar, or have similar sounding names, or come in different strengths or combinations. The safest thing for all patients is to bring their own medications with them.

6. I'm at the scene of a Motor Vehicle Crash (MVC). I'm presented with a single patient who is unconscious, is very stiff and has their arms and legs extended, and their head is tilted back (retracted). My training allows me to recognise this as decerebrate posturing. Decerebrate posturing indicates an injury to which area of the brain?

Answer: In the brainstem

Decerebrate posturing is an ominous sign and usually indicates an injury within the brainstem. Decorticate posturing indicates an injury at or above the upper brainstem and the patient presents with the legs extended also, but the arms are usually flexed (bent at the elbow and drawn up toward the body) with the fists clenched.

7. With any patient with a head injury, I try to ensure that their observations are taken at regular intervals, usually every 5 minutes. Which of the following is a collection of changes to a patient's vital signs that indicates the patients Intra Cranial Pressure (ICP) is increasing?

Answer: Cushing's reflex

Cushing's reflex is also known as Cushing's Triad, and it represents an increase in blood pressure, with a corresponding decrease in pulse and respiration. These three signs indicate that the patient has an increased, or increasing, ICP. To ensure that the patient is treated promptly and effectively, it is important that their vital signs are taken often so that a developing trend is identified early.

Cullen's sign is bruising (ecchymosis) around the navel or belly button (periumbilical area).
Grey-Turner's sign is bruising around the flank. Both Cullen's sign and Grey-Tuner's sign can indicate internal bleeding or fluid loss into the abdominal cavities.
Battle's sign is bruising behind the mastoid process, and is commonly associated with a base of skull fracture.

8. There is so much to remember in order to assess each and every patient properly. It should come as no surprise that many paramedics and first aid providers learn mnemonics to help them remember causes and symptoms of illnesses, injury patterns, and just about anything we need to remember. For which of the following is the mnemonic AEIOU-TIPS memorised?

Answer: Altered mental status

AEIOU-TIPS is used for remembering the myriad of causes as to why a patient may be unconscious, or have an altered mental status. It stands for the following:
A - Alcohol, Acidosis, Anoxia
E - Epilepsy
I - Infection
O - Overdose (of anything)
U - Uraemia (kidney failure)
T - Trauma, Tumour, Toxins
I - Insulin (hypoglycaemia, diabetic ketoacidosis)
P - Poison, Psychosis
S - Stroke, Seizure

So many things to remember, so little space in my memory banks!

9. On my way back to the ambulance station after my last call, I stop to talk with the local police officers who have pulled over to talk to a lady who appears to be intoxicated. She is clearly unsteady on her feet, states she has a headache, and is a little bit aggressive. She is arguing with the two male police officers, so I ask if I might speak with her to calm her down a little. I notice that she is clammy, and she claims to feel cold. She lets me take her pulse, and I observe that it is weak and rapid. I ask the lady if it might be okay with her if I take a little bit of blood out of her finger to check it for her, and she says that this will be okay. What am I concerned about for this patient?

Answer: Hypoglycaemia

My first thought is that the lady might be suffering with low blood sugar, technically called hypoglycaemia. 'Hypo' means low, 'glyc' refers to sugar, and the 'aemia' part refers to blood. A simple finger-prick test will allow me to test her blood sugar, and treat her if it is what I suspect. If a patient has low blood sugar, the correct treatment is to administer them sugar.

Some diabetics are able to tell when their sugar is getting low, and many carry sweets on them for that purpose. I prefer to give sugar to my patients intravenously, as they literally get better before your eyes, but you need to be careful. If it leaks out of the vein, the tissue around the leak can die.

It is imperative that the cannula is flushed with saline prior to administering IV dextrose so that you can check for extravasation (a leak in the vein) BEFORE administering dextrose this way.

10. I'm on my way home from work - finally my day is over. I work in a rural area though, so my day may not be over yet. I go home in the ambulance (I'm driving) because I work on-call. I complete my shift then I am available until the start of my next shift. Today, I want to be home as soon as possible because I have a birthday party to attend. I'm almost home when the people down the street flag me down and tell me that someone who is staying with them has collapsed in the bathroom. I radio to let my coordination staff know where I am, then I grab my gear and follow them into the house. I find a person who is unconscious on the floor, with a needle and a tourniquet by their side. I notice that their pupils are so small they are almost not there at all, and they are only breathing 4 times per minute. Their Glascow Coma Score (GCS) is 6, but I'm not going to intubate the patient straight away. What do I suspect is wrong with this patient?

Answer: Narcotic overdose

Generally the golden rule for intubation is "GCS less than 8, intubate", and this patient certainly fits that criteria. However, this particular scenario leads me to administer Naloxone to the patient as my first line of treatment (as I am allowed to administer this drug - if I wasn't, I'd ventilate the patient with 100% oxygen in this situation) and see if they respond to it. Narcotic (or opiate) overdose often presents with pinpoint pupils and lack of respiratory effort.

In these cases, the reason the person has become unconscious is because they are not breathing sufficiently to support consciousness. Oxygen administration will help the symptoms, but not reverse the cause. Naloxone (Narcan) administration blocks the action of the drug, and causes the patient to breathe again.

Many patients refuse transport to the hospital (some violently), however if they are willing to go they should be taken. The action of most narcotics is longer than that of Naloxone (2-4 hours as opposed to 40-45 minutes) so the patient is at risk of a relapse when the Naloxone wears off.

Source: Author ecnalubma

This quiz was reviewed by FunTrivia editor crisw before going online.
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I was lucky enough to receive a number of compliments on my first quiz on Patient Assessment Basics. Due to the kindness of these people, here is my second quiz on patient assessment.

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