Free IBSC CCP-C practice questions with answers

Twenty-five original, source-verified IBSC CCP-C questions with full answers and rationale below, free to read, no account required. A new set every day.

1. Question 1

   A patient with a large pituitary tumor has lost the outer (temporal) half of the visual field in each eye. Which anatomic fact explains why a midline lesion at the optic chiasm produces that pattern?

   • Fibers from the nasal half of each retina cross at the chiasm while temporal fibers do notCorrect
   • Fibers from the temporal half of each retina cross at the chiasm while nasal fibers do not
   • All retinal fibers cross at the chiasm, so any chiasmal lesion causes complete blindness
   • No retinal fibers cross at the chiasm, so the field loss must reflect optic nerve compression

   Why: At the optic chiasm the fibers arising from the nasal half of each retina decussate while those from the lateral or temporal half pass straight through, so a mass compressing the midline of the chiasm interrupts only the crossing nasal fibers. Because the nasal retina views the temporal field, the result is loss of the outer half of each visual field. Reversing the crossing fibers, claiming that all fibers cross, or claiming that none do would each predict a different pattern that does not match the finding. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Neurologic Emergencies, p. 1367.

2. Question 2

   A spontaneously breathing patient with morbid obesity and known sleep apnea must be moved to your stretcher for a 90-minute ground transfer. Which positioning plan is preferred?

   • Supine with a cervical collar to maintain a neutral airway
   • Left lateral recumbent with the head of the stretcher flat
   • Trendelenburg to improve venous return before departure
   • Semi-Fowler or a ramped position rather than flatCorrect

   Why: The weight of chest wall and abdominal tissue restricts diaphragmatic movement and reduces lung capacity, so breathing difficulty increases markedly when the bariatric patient is laid flat, and these patients desaturate faster than patients at ideal body weight, leaving a much shorter window to intervene once they become hypoxic. Transporting in a semi-Fowler or ramped position preserves functional residual capacity and improves the laryngeal view should intubation become necessary. Supine positioning, whether or not a collar is applied, is precisely what should be avoided. Lateral recumbency does not relieve the abdominal load on the diaphragm as reliably and complicates monitoring, and head-down positioning increases it. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Bariatric and Special Situations, p. 3327. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Patient Assessment and Preparation for Transport, p. 437.

3. Question 3

   A patient with a suspected pulmonary embolism is tachypneic, anxious and obviously hyperventilating, yet remains hypoxemic on supplemental oxygen. Why does the hyperventilation fail to correct the hypoxemia?

   • The work of the increased respiratory rate itself consumes all the oxygen reaching the alveoli
   • The obstructed segments are unperfused, so extra ventilation reaches units with no blood flowCorrect
   • Hyperventilation shifts the oxyhemoglobin dissociation curve so far to the right that saturation cannot rise
   • The embolus mechanically obstructs the large conducting airways as well as the pulmonary artery branch

   Why: Gas exchange requires ventilation and perfusion in the same unit. An embolus removes perfusion from segments that remain fully ventilated, so the additional minute ventilation the patient generates is spent on dead space and adds nothing to arterial oxygen content, while the blood that does flow is diverted to units it overwhelms. This is why the patient can look like a hyperventilating anxious patient and still have a low arterial oxygen tension, and it is a trap for the unwary. Breathing work does raise oxygen consumption, but that is not the mechanism; the curve does not shift far enough to prevent saturation; and an embolus does not obstruct the airways. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Pulmonary Emergencies, p. 1105.

4. Question 4

   A 5-year-old being transferred for suspected sepsis has a white blood cell differential reporting 14% band forms. How should the CCTP interpret this single finding?

   • It is a normal proportion of immature neutrophils for a school-age child and carries no interpretive weight on its own.
   • It indicates bone marrow suppression, which is conventionally defined by a band proportion above 10% of the total white cell count.
   • It represents an excess release of immature white cells into the circulation, a recognized marker of the systemic inflammatory response.Correct
   • It is almost always a processing artifact of a delayed specimen and should be disregarded unless the total white cell count is also abnormal.

   Why: The primary text lists bandemia, defined as immature band forms exceeding 10% of the white cell population, alongside altered thermoregulation, tachycardia, tachypnea and age-specific white cell derangement as a hallmark of the systemic inflammatory response syndrome. A 14% band fraction is therefore abnormal, not a normal pediatric baseline. Marrow suppression in this text is signalled by leukopenia and neutropenia rather than by a high band fraction. Dismissing the value as an artifact discards a genuine early marker of severe infection. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Pediatric Emergencies, p. 3253.

5. Question 5

   A golfer struck by lightning is confused and reports that he cannot hear from one side. What mechanism best explains the auditory finding?

   • Cerebrospinal fluid otorrhoea from an undetected basilar skull fracture
   • Ototoxicity from catecholamine release during the strike
   • Thermal burn of the ossicles from current conducted along the canal
   • Tympanic membrane rupture from the pressure wave of rapidly heated airCorrect

   Why: Lightning heats the surrounding air explosively, and the resulting pressure wave commonly ruptures the eardrum; the same pressure gradient can displace the lens of the eye, which is why an early ocular examination matters as well. Catecholamine release does not cause acute hearing loss. Current conducted along the canal to burn the ossicles is not the described mechanism, and the cutaneous injuries of lightning are typically superficial fern-like markings. A basilar skull fracture is possible if the patient was thrown, but the hearing loss characteristic of a lightning strike is the barotraumatic tympanic rupture, and otorrhoea is not described here. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Burns, p. 1616. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Burn Trauma, p. 882.

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7. Question 6

   A transport monitor offers only two pressure channels, and the patient has both a pulmonary artery catheter and an arterial line. Which pressure must be continuously displayed, and why?

   • The proximal right atrial port, because central venous pressure is what guides fluid therapy during transport.
   • The distal pulmonary artery port, because unrecognized spontaneous wedging can cause pulmonary infarction.Correct
   • Either port, because a sutured catheter cannot migrate once the introducer is secured.
   • The proximal right atrial port, because pulmonary artery pressure is calculated from that value.

   Why: The text states that any patient with a pulmonary artery catheter must have the distal pulmonary artery port continuously monitored, because the catheter can migrate into a wedged position on its own and unmonitored or undetected spontaneous wedging can result in pulmonary infarction. Central venous pressure is useful but is a static measurement that does not carry this hazard. A sutured catheter can still migrate, which is why the insertion depth is documented. Pulmonary artery pressure is transduced directly, not derived from the right atrial value. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Hemodynamic Monitoring, p. 1967. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Mechanical Circulatory Support Devices in Transport, p. 1020.

8. Question 7

   Which statement reflects the reference's comparison of the head tilt-chin lift and the jaw-thrust maneuvers?

   • Evidence suggests the head tilt-chin lift is less effective than the jaw thrust.Correct
   • The head tilt-chin lift is the more effective of the two in the unconscious patient.
   • The jaw thrust is contraindicated in patients without suspected cervical injury.
   • The two are equivalent, so the choice rests entirely on provider preference.

   Why: The head tilt-chin lift remains the most widely known manual maneuver for the unconscious nontrauma patient, but the reference notes that the evidence suggests it is not as effective as the jaw thrust at opening the airway. The jaw thrust is not restricted to trauma patients; in the nontrauma patient it may be combined with a slight head tilt to improve the opening still further. Treating the two maneuvers as interchangeable ignores that difference in effectiveness, and neither maneuver removes the need for an adjunct in the deeply obtunded patient. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Respiratory Emergencies and Airway Management, p. 442.

9. Question 8

   A patient with a documented history of severe allergic transfusion reactions is to receive red cells. The blood bank supplies a washed product. What has washing done to the unit, and what secondary benefit does it confer?

   • The non-cellular fluid has been replaced with saline, removing plasma proteins and potassium, which lowers allergic reaction and hyperkalaemia risk.Correct
   • The white cells and platelet fragments have been filtered out, which lowers the risk of febrile non-haemolytic reactions and of HLA alloimmunization.
   • The unit has been exposed to radiation, which limits lymphocyte replication and prevents transfusion-associated graft-versus-host disease in at-risk recipients.
   • About 250 mL of platelet-rich plasma has been extracted and preservative added, concentrating the red cells and extending the shelf life to 42 days.

   Why: Washed red cell and platelet products have the small amount of non-cellular fluid replaced, typically with saline; this removes all of the plasma proteins including antibodies and cytokines, along with electrolytes and preservative solution, which decreases the risk of severe allergic reactions, and in paediatric recipients the removal of potassium specifically reduces the risk of hyperkalaemia. Filtration of white cells and platelet fragments describes leuko-reduction, which targets febrile non-haemolytic reactions and HLA alloimmunization. Radiation exposure describes irradiated products and graft-versus-host disease. Extraction of platelet-rich plasma with an added anticoagulant preservative describes how ordinary packed red blood cells are made. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Resuscitation, Shock, and Blood Products, p. 1051.

10. Question 9

    A patient with five unilateral rib fractures and no flail segment is splinting, hypoventilating and desaturating on a nonrebreathing mask. What is the correct order of management?

    • Intubate first, then titrate analgesia once the airway is secured
    • Apply a rib belt to stabilize the segment, then reassess the need for analgesia
    • Withhold opioids because of the respiratory depression risk and proceed straight to noninvasive ventilation
    • Achieve adequate analgesia first; reserve ventilatory support for persistent insufficiency after pain is controlledCorrect

    Why: The goal in rib fractures is analgesia sufficient that the patient stops self-splinting, because pain rather than mechanics is usually what limits inspiration, and adequate analgesia should be achieved before any airway intervention; ventilatory assistance is reserved for the minority who remain insufficient afterward. Intubating first skips the intervention most likely to fix the problem. Strapping or belting the chest has been shown ineffective and has been abandoned. Withholding opioids guarantees continued splinting, and analgesia is in fact described as a major determinant of the patient's ability to ventilate unassisted. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Trauma, p. 1268.

11. Question 10

    Which finding does the primary text list as a contraindication to applying PEEP, rather than merely a reason for caution?

    • Hypovolemia with a borderline blood pressure
    • An untreated pneumothorax or a bronchopleural fistulaCorrect
    • An elevated intracranial pressure after traumatic brain injury
    • Reduced renal and portal blood flow from a low cardiac output

    Why: Hypovolemia, raised intracranial pressure, and reduced splanchnic and renal perfusion are listed among the detrimental effects that make PEEP hazardous and demand close monitoring, but they are hazards to be managed rather than bars to its use. An untreated pneumothorax or a bronchopleural fistula is named as a contraindication, because positive end-expiratory pressure will preferentially drive gas through the defect and can convert a simple pneumothorax into a tension pneumothorax. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Ventilation, p. 635.

12. Question 11

    A crew is about to depart with a critically ill patient when the family asks for a moment at the bedside and requests a brief prayer with a clergy member who has just arrived. What does the text advise?

    • Defer the request until the patient arrives at the receiving facility
    • Decline politely, because bedside time is capped at twenty minutes
    • Permit it only if the patient is awake and able to take part in it
    • Honour the request and allow the family brief time with the patientCorrect

    Why: The text is explicit that requests for a brief prayer by clergy or others should be honoured, and that providers should give family members time to speak with the patient and answer their questions before departure. It acknowledges the tension directly, noting that every second counts in a critical transport and arguing that these brief moments of family involvement still carry value beyond what words convey. Deferring the request to the receiving facility, refusing on the basis of a bedside time target, or conditioning it on the patient's alertness all subordinate the family to the clock in a way the text does not support. The twenty-minute figure is a general expectation for packaging a patient, not a prohibition. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Introduction and Overview of Critical Care Transport, p. 72.

13. Question 12

    Which adverse events does the primary text identify as most common during pediatric interfacility transport, and what effect does the composition of the transport team have on the rate?

    • Seizure and hypoglycemia predominate, and rates are the same whichever team performs the transport.
    • Unplanned extubation and pneumothorax predominate, and rates rise when a specialized transport team is used.
    • Hypertension and bradycardia predominate, and team composition has not been shown to matter.
    • Hypothermia, drug errors and tachycardia are among the most common, and specialized teams lower the rate.Correct

    Why: The events named for pediatric transport are hypothermia, drug errors, tachycardia, procedure error, loss of intravenous access and cyanosis, a profile that reflects a small patient's thermal vulnerability and the weight-based dose calculations that drive pediatric medication error. The text adds that the adverse event rate in this population was lower when specialized teams performed the transport, which is the opposite of the second option and rules out the two options that deny any team effect. Seizure, hypoglycemia, hypertension and bradycardia are not the events reported as most frequent here. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Patient Safety, p. 179.

14. Question 13

    A critical care transport paramedic reviewing a noise-exposure table asks at what sound level hearing damage becomes an immediate danger rather than a cumulative one. Which level does the primary text give as causing pain and signalling immediate risk of hearing loss?

    • Approximately 90 dB
    • Approximately 140 dBCorrect
    • Approximately 105 dB
    • Approximately 70 dBA

    Why: The text separates two distinct thresholds. Cumulative unprotected exposure at comparatively ordinary levels can produce irreversible loss over time, but sound at 140 dB causes pain and indicates the danger of immediate hearing loss whatever the duration. The intermediate figures correspond to sources with a tolerable exposure window rather than an instantaneous hazard, and the lowest figure is the cumulative threshold rather than the pain threshold, so none of them marks the point at which damage stops depending on how long the exposure lasts. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Aircraft Fundamentals and Flight Physiology, p. 229.

15. Question 14

    A patient being transported with a known simple pneumothorax deteriorates suddenly. Which cluster of findings should prompt the CCTP to treat the problem as a tension pneumothorax?

    • Bilateral crackles, frothy pink sputum, a rising jugular venous pressure and a third heart sound
    • Bradycardia, flat neck veins, symmetrical chest movement and breath sounds equal at both bases
    • Tracheal deviation, jugular distention, absent breath sounds and no chest movement on that sideCorrect
    • A pleural friction rub, fever, and pain reliably reproduced by palpation of the chest wall itself

    Why: Sudden deterioration in a patient with a pneumothorax should trigger a deliberate look for tension physiology, and the findings that define it are tracheal deviation away from the affected side, distended jugular veins as venous return is obstructed, and absent breath sounds together with absent chest movement on that side. Bilateral crackles with frothy sputum describe pulmonary edema. Flat neck veins with symmetrical movement argue against tension. A friction rub with reproducible chest wall pain points to pleural inflammation or a musculoskeletal cause rather than to accumulating pleural pressure. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Pulmonary Emergencies, p. 1101.

16. Question 15

    A transport service still records the bipolar MCL1 lead on its three-lead monitors as a stand-in for V1. What does the textbook say about that practice?

    • MCL1 is preferred over a true V1 during transport because it is far less prone to motion artifact
    • MCL1 and V1 record the same QRS morphology, so the substitution carries no interpretive penalty
    • QRS morphology differs between the two in about 38% of cases, so a true V1 should be obtainedCorrect
    • MCL1 is an acceptable substitute except in patients already known to have a bundle branch block

    Why: When V1 and MCL1 are recorded at the same moment, the QRS morphology is different in a significant share of patients, reported as 38%, so MCL1 is no longer recommended wherever a true V1 can be placed. Because so much of critical care interpretation turns on the V1 morphology, from right bundle branch block to wide complex tachycardia, a substituted lead can change the reading. The two leads are therefore not interchangeable, the substitution is not made for artifact reasons, and the mismatch is not confined to patients with a known conduction defect. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Electrophysiology, Pacemakers, and Defibrillators, p. 1670.

17. Question 16

    When sizing a nasopharyngeal airway for an adult, how should the CCTP select the diameter?

    • Use the smallest diameter that will pass, so that mucosal contact is avoided.
    • Match the diameter to the width of the patient's little finger.
    • Use the largest diameter that does not blanch the naris.Correct
    • Use a diameter one size smaller than the endotracheal tube planned.

    Why: Length is chosen by measuring from the tip of the nose to the tragus of the ear, and diameter is chosen as the largest the naris will accept without blanching, since blanching signals that the mucosa is being compressed hard enough to threaten its blood supply. A deliberately undersized tube adds resistance and is more likely to be obstructed by secretions than to protect the mucosa. The little finger comparison is an estimate used for pediatric endotracheal tube size, not for a nasal airway, and no relationship to a planned endotracheal tube size is described. Placement is never forced, because the nasal mucosa lacerates easily and bleeds freely. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Respiratory Emergencies and Airway Management, p. 445.

18. Question 17

    A runner having seizures attributed to exercise-associated hyponatremia is being prepared for interfacility transfer, and the sending physician orders 3% sodium chloride. Which administration pattern matches the approach described for severe symptomatic hyponatremia?

    • A continuous infusion of 3% sodium chloride at 0.5 to 3 mL/kg/h with no ceiling on total volume
    • Boluses of 100 mL over about 10 minutes, repeated to clinical improvement, to roughly 300 mL totalCorrect
    • A single 500-mL bolus given over 30 minutes, with reassessment 2 hours later
    • One litre of 3% sodium chloride over the first hour, followed by isotonic maintenance fluid

    Why: Severe symptomatic hyponatremia is corrected in small aliquots because overcorrection of serum sodium is itself devastating to the brain, and a rise of only 4 to 6 mmol/L usually relieves symptoms. The 0.5 to 3 mL/kg/h infusion is the regimen described for moderate, not severe, hyponatremia, and the large single-bolus options exceed any described ceiling. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Environmental Emergencies, p. 2512.

19. Question 18

    A hypotensive, obtunded patient with known Wolff-Parkinson-White syndrome is in atrial fibrillation with a very rapid ventricular response. The referring physician suggests amiodarone. What does the textbook say about that combination, and what is the safest option?

    • Amiodarone is safe here; electrical cardioversion is held back until two drug trials have failed
    • Amiodarone has precipitated ventricular fibrillation in this setting, and cardioversion is safestCorrect
    • Amiodarone is safe if it is infused slowly rather than pushed, with cardioversion as a last resort
    • Amiodarone is favored over cardioversion because an accessory pathway resists an external shock

    Why: The textbook flags the common assumption that amiodarone is safe in atrial fibrillation with pre-excitation as wrong, citing a small case series in which seven of twelve patients who received it went into ventricular fibrillation. For an unstable pre-excited tachyarrhythmia the safest treatment is electrical cardioversion, not a trial of a drug that may accelerate conduction down the accessory pathway. The three distractors all delay or replace cardioversion, and an accessory pathway does not make an external shock ineffective. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Electrophysiology, Pacemakers, and Defibrillators, p. 1734.

20. Question 19

    A patient on high-dose dexamethasone for cerebral oedema has a white blood cell count of 17,400 per microlitre with a neutrophil predominance and no fever or localizing signs. How should this be interpreted?

    • A neutrophil-predominant leukocytosis is specific for bacterial infection, so occult sepsis must be assumed and broad-spectrum antibiotics started.
    • A neutrophil predominance in a steroid-treated patient indicates a viral process, because corticosteroids suppress the bacterial response selectively.
    • Corticosteroid therapy itself can raise the neutrophil count with no infection present, so the differential must be read against the medication list.Correct
    • Any white cell count above 15,000 per microlitre is diagnostic of infection, regardless of the medications the patient happens to be receiving.

    Why: The primary text notes that a leukocytosis predominated by neutrophils is often associated with bacterial rather than viral infection and that relatively elevated lymphocyte counts typically accompany viral infection, but it explicitly adds that corticosteroid therapy can cause elevated neutrophil counts in the absence of any infection or other potential cause. Treating the count as specific for bacterial infection ignores that caveat, as do the other listed non-infectious causes such as haematologic malignancy, autoimmune disease and inflammatory conditions. Steroids do not convert a bacterial pattern into a viral one. No absolute white cell threshold is diagnostic of infection; the same chapter lists leukocytosis with trauma, pulmonary embolism, myocardial infarction and deep vein thrombosis. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Laboratory Analysis and Diagnostic Studies, p. 886.

21. Question 20

    A quality committee compares outcomes for pneumonia acquired in the community with pneumonia acquired in a medical facility. According to the primary reference, how do the mortality rates compare?

    • The two are essentially identical once patient age and comorbid burden are accounted for.
    • Nosocomial mortality is the lower of the two because the infection is recognised immediately.
    • Community-acquired mortality runs about 5% to 14%; nosocomial mortality reaches as high as 40%.Correct
    • Community-acquired mortality runs about 30% to 40%; nosocomial mortality stays below about 10%.

    Why: The primary reference gives a mortality rate of 5% to 14% for community-acquired pneumonia against as high as 40% for pneumonia acquired in a medical facility, and separately notes that hospital-acquired pneumonia is the leading cause of death among nosocomial infections. The reversed figures in the second option contradict that. The reference explicitly separates the two categories precisely because prognosis differs, so equivalence is wrong. Earlier recognition does not make facility-acquired pneumonia less lethal; the responsible organisms are more resistant and the hosts are sicker. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Infectious and Communicable Diseases, p. 2631.

22. Question 21

    Which analgesic approach is preferred for the pain of symptomatic gallstone disease, and why?

    • Morphine, because opioids relax the sphincter of Oddi
    • Nonsteroidal anti-inflammatory drugs, because opioids can raise sphincter of Oddi pressureCorrect
    • Acetaminophen alone, because nonsteroidal agents are thought to precipitate ascending cholangitis
    • No analgesia until surgical review, because relieving the pain masks evolving peritonitis

    Why: Evidence that opioids increase pressure at the sphincter of Oddi makes nonsteroidal anti-inflammatory drugs the analgesic of choice in gallstone disease, with escalation to opioids reserved for patients who cannot take nonsteroidal agents or who get inadequate relief from them. Morphine does not relax that sphincter. Nonsteroidal agents do not cause cholangitis, which arises from bacterial infection above a biliary obstruction. Withholding analgesia altogether is neither humane nor necessary, since serial examination remains possible in a treated patient. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Gastrointestinal and Genitourinary Emergencies, p. 2311.

23. Question 22

    A patient is receiving a magnesium sulfate infusion during a two-hour interfacility transfer. Which set of parameters should the CCTP follow in order to detect toxicity early?

    • Serum potassium, capillary refill time, and end-tidal carbon dioxide
    • Blood glucose, pupillary size, and core temperature by continuous probe
    • Patellar reflexes, respiratory effort, and urine output of at least 25 mL/hCorrect
    • Fundal height, cervical dilation, and cumulative estimated blood loss

    Why: Magnesium is cleared renally and the dose needed for effect sits close to the toxic range, so bedside monitoring rests on three things: patellar reflexes, which diminish first; respiratory effort, since depression and then arrest follow; and urine output, which should stay at or above 25 mL/h because falling output lets the level climb. If any sign of toxicity appears the infusion is stopped, calcium gluconate is given, and medical control is contacted. The other option sets track unrelated problems and would miss the classic reflex-then-respiration progression. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Obstetric and Gynecologic Emergencies, p. 2953. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), The Pregnant Patient, p. 1430.

24. Question 23

    On the motor strip of the frontal lobe, the size of the cortical area devoted to a given body part is proportional to what?

    • The mass of the muscle group that moves that body part
    • The distance of that body part from the spinal cord
    • The degree of dexterity required of that body partCorrect
    • The number of dermatomes that supply that body part

    Why: The motor area contains pyramidal cells controlling voluntary movement on the opposite side of the body, and parts demanding fine dexterity such as the thumb and tongue occupy a disproportionately large share of cortex compared with the shoulder or trunk. Muscle mass is not the organizing principle, which is why the bulky trunk musculature has a small representation. Distance from the cord and dermatomal supply describe peripheral sensory and segmental anatomy and have no bearing on how motor cortex is apportioned. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Neurologic Emergencies, p. 1325.

25. Question 24

    Maternal oxygen delivery to the placenta is abruptly interrupted during a maternal arrest. Roughly how long is the fetus's own oxygen reserve, and why is it so short?

    • About 10 minutes, because fetal hemoglobin carries a large stored reserve of oxygen for the fetus
    • About 30 minutes, because the fetal metabolic rate is far below the mother's per unit of weight
    • About 1 to 2 minutes, because fetal oxygen consumption per unit weight is nearly twice the mother'sCorrect
    • About 5 minutes, because the amniotic fluid acts as a secondary reservoir of dissolved oxygen

    Why: The fetus holds only a small oxygen reserve, on the order of one to two minutes, if the maternal supply is cut off or diminished. The reason is metabolic: fetal oxygen consumption per unit of weight is close to double the mother's, even though fetal blood carries a lower oxygen content than maternal blood. Fetal hemoglobin binds oxygen more avidly, which aids placental transfer but creates no reservoir, so the ten-minute option misreads that advantage. Fetal metabolic rate is high rather than low, and amniotic fluid stores no oxygen. This is why restoring maternal perfusion, not any fetal intervention, is the priority. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Obstetric and Gynecologic Emergencies, p. 2905. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), The Pregnant Patient, p. 1375.

26. Question 25

    A gastrostomy tube placed three weeks ago is accidentally pulled out of an 18-month-old during a transfer from bed to stretcher. Why is this urgent, and what is the appropriate interim measure if protocol allows?

    • The risk is peritoneal soiling rather than closure, so the stoma should be packed with sterile gauze and feeds restarted through a nasogastric tube en route.
    • The risk is hemorrhage from the gastric wall, so the stoma should be occluded with firm direct pressure for the duration of the transport.
    • The tract is immature and can close in as little as four hours, so an indwelling urinary catheter may be placed in the stoma to keep it patent.Correct
    • The tract is mature at three weeks and will stay open for days, so the stoma may simply be covered with a dressing until the child reaches the receiving hospital.

    Why: The primary text treats loss of a gastrostomy tube as urgent when the surgical tract is immature, which it defines as placement less than six weeks earlier, and notes the classic teaching that such tracts can close in as little as four hours. Where protocol allows, an indwelling urinary catheter is placed into the abdominal stoma to hold it open until the tube can be replaced, and position must be confirmed radiographically before feeds or medication are resumed. A three-week-old tract is therefore immature, not mature. Gauze packing and direct pressure both work against maintaining patency, which is the immediate goal. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Bariatric and Special Situations, p. 3407.