A patient in significant respiratory distress with agonal respirations or apnea requires immediate support. Which device is indicated in this situation rather than any passive oxygen delivery device alone?

Bag-mask ventilation with supplemental high-flow oxygen

An older patient with pre-existing cervical spondylosis sustains a hyperextension injury during a fall and now has much greater weakness in the hands and arms than in the legs, with variable loss of pain and temperature sensation but sacral sparing. Which syndrome is most likely, and what is the typical prognosis?

Central cord syndrome; prognosis is generally good, often with substantial motor recovery

What is a key difference between the King LT airway's design and that of the classic laryngeal mask airway (LMA) that affects how each achieves an airway seal?

The King LT uses a single inflation port for its two cuffs and ventilates through orifices between them, while the classic LMA uses one elliptical cuff placed over the larynx

A bougie is being used to facilitate a difficult intubation. What tactile finding as the bougie is advanced confirms that it has entered the trachea rather than the esophagus?

A series of 'clicks' as the coude tip passes over the tracheal rings, or 'hold-up' when it reaches the carina or a mainstem bronchus

A patient develops confusion and asterixis several weeks after placement of a transjugular intrahepatic portosystemic shunt (TIPS) for variceal bleeding. What complication does this most likely represent, and roughly how common is it?

Hepatic encephalopathy, occurring in up to 35% of patients because the shunt bypasses hepatic parenchymal clearance

According to the effective-performance-time (EPT) table for altitude exposure, a crew member exposed to sudden hypoxia at 43,000 feet has an average EPT of only 9 to 12 seconds. What happens to EPT as altitude increases further, to above 50,000 feet?

It stays essentially the same, about 9 to 12 seconds

A patient's PAC-derived hemodynamic values include an elevated pulmonary artery diastolic pressure. Which acute condition is this finding most likely to reflect, absent chronic pulmonary hypertension?

Tachycardia (typically greater than 120 beats/min) or pulmonary emboli

A newborn has uncovered, edematous loops of intestine protruding through a defect just to the right of an intact umbilical cord. Which condition does this describe, and what immediate management step is indicated?

Gastroschisis; place the exposed bowel in a clear sterile bag and minimize handling

A 12-lead ECG on a patient with chest pain shows a failure of the R wave to grow normally in amplitude from V1 through V4, but no significant Q waves are present. Which conclusion is most accurate?

This poor R-wave progression can, by itself, signify an anterior MI, but it is nonspecific and can also occur with right ventricular hypertrophy, chronic lung disease, or improper precordial lead placement

A flight crew is transporting a patient with progressive, symmetric ascending muscle weakness that began in the legs several days ago, now with depressed deep tendon reflexes and wide swings in blood pressure and heart rate. No structural lesion is suspected. Which diagnosis best fits, and what proportion of these patients are reported to require ventilator support?

Guillain-Barre syndrome; ventilator support is required in as many as 30% of patients

During transport of a patient with suspected ongoing intra-abdominal hemorrhage before definitive surgical control is available, damage-control resuscitation principles favor which blood pressure target rather than pursuing full normalization with aggressive fluids?

Systolic blood pressure of approximately 80-90 mm Hg (mean arterial pressure approximately 60-65 mm Hg)

Immediately after a caustic oral ingestion, what simple first step is recommended, and what two interventions should specifically be avoided?

Give the patient a small amount of water or milk to drink; do not induce vomiting and do not attempt neutralization

An FAA Advisory Circular describes how, in the events preceding a crash, 'one bad decision often leads to another.' What does this describe about the nature of most air medical crashes, according to the text?

Crashes are rarely caused by a single event; instead, a series of contributing factors compounds until few safe alternatives remain, a progression sometimes called the accident chain

A patient with a traumatic head injury and no prior endocrine history develops unexplained refractory hypotension despite adequate volume resuscitation. Which endocrine consideration does the text specifically flag for this population?

Approximately 50% of patients with moderate to severe traumatic brain injury develop some form of adrenal insufficiency

Critical incident stress debriefing (CISD) was widely favored from the 1980s to manage psychological aftereffects in emergency personnel, but the text notes it has now largely been replaced by a different approach. What is the primary reason given for this shift?

CISD requires a specially trained team and carries the potential to create iatrogenic harm from mandatory attendance, practitioner error, and mixing of groups

Shortly after fibrinolysis for STEMI a patient develops a run of accelerated idioventricular rhythm and brief ventricular ectopy. What mechanism does the textbook give for these reperfusion arrhythmias?

Rapid return of potassium into the intracellular space as the ischemic myocardium is reperfused

A blood bank is preparing platelets for transport to support a patient with thrombocytopenic bleeding. Which storage practice is correct for platelet concentrate?

Stored at room temperature under constant agitation, with a shelf life of about 5 days

Compared with an adult's epiglottis, a child's epiglottis is best described as which of the following?

Large, floppy, U-shaped, and angled about 45 degrees to the pharyngeal wall

An intubated 5-year-old has a stable waveform capnography reading of 40 mm Hg. How should this ETCO2 value be interpreted relative to normal pediatric ventilation?

It falls within the normal 35 to 45 mm Hg range and correlates well with arterial PaCO2

When selecting a laryngoscope blade size for a pediatric patient, what should primarily guide the CCTP's choice?

The child's physical size, since blade size selection depends on size rather than age

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Free IBSC FP-C practice questions with answers

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

Question 1
A patient in significant respiratory distress with agonal respirations or apnea requires immediate support. Which device is indicated in this situation rather than any passive oxygen delivery device alone?
- A simple nasal cannula
- Bag-mask ventilation with supplemental high-flow oxygenCorrect
- A nonrebreathing mask at low flow
- Blow-by oxygen held near the face
Why: Patients with agonal respirations or who are apneic require active positive-pressure support via bag-mask ventilation with supplemental high-flow oxygen, since passive oxygen delivery devices cannot generate the ventilation these patients lack. A nasal cannula, low-flow nonrebreathing mask, and blow-by oxygen are all passive devices intended for patients who are breathing adequately on their own, not for agonal or apneic patients. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Respiratory Emergencies and Airway Management, p. 456.
Question 2
An older patient with pre-existing cervical spondylosis sustains a hyperextension injury during a fall and now has much greater weakness in the hands and arms than in the legs, with variable loss of pain and temperature sensation but sacral sparing. Which syndrome is most likely, and what is the typical prognosis?
- Central cord syndrome; prognosis is generally good, often with substantial motor recoveryCorrect
- Anterior cord syndrome; prognosis is generally poor
- Brown-Sequard syndrome; prognosis is generally poor
- Complete spinal cord injury; no recovery is expected
Why: Central cord syndrome typically follows a hyperextension injury to the cervical spine, often in older patients with underlying cervical spondylosis and stenosis, and produces disproportionately greater weakness in the upper extremities than the lower extremities with variable loss of pain and temperature sensation and possible sacral sparing; the prognosis is typically good, with many patients regaining most motor function or having only residual hand weakness. This contrasts with anterior cord syndrome (motor and pain/temperature loss from anterior artery disruption) and Brown-Sequard syndrome (hemisection pattern), and this presentation does not represent a complete injury given the described sparing. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Neurologic Emergencies, p. 1489.
Question 3
What is a key difference between the King LT airway's design and that of the classic laryngeal mask airway (LMA) that affects how each achieves an airway seal?
- The King LT has two separate inflation ports for its two cuffs, while the LMA has none
- The King LT uses a single inflation port for its two cuffs and ventilates through orifices between them, while the classic LMA uses one elliptical cuff placed over the larynxCorrect
- The King LT does not require any cuff inflation
- The LMA can only be used in cardiac arrest, while the King LT cannot
Why: The King LT has proximal and distal cuffs inflated through a single port, with ventilation occurring through orifices between the two cuffs, whereas the classic LMA relies on one elliptical cuff that covers the supraglottic area directly over the larynx. The King LT does require cuff inflation, and neither device is restricted to cardiac arrest only, both being indicated more broadly for failed intubation or the inability to intubate. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Respiratory Emergencies and Airway Management, p. 515. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Airway Management, p. 511.
Question 4
A bougie is being used to facilitate a difficult intubation. What tactile finding as the bougie is advanced confirms that it has entered the trachea rather than the esophagus?
- A complete absence of any resistance as it is advanced its full length
- A series of 'clicks' as the coude tip passes over the tracheal rings, or 'hold-up' when it reaches the carina or a mainstem bronchusCorrect
- A whistling sound produced by airflow
- Immediate visualization of the carina without any tactile feedback needed
Why: As the introducer's angled coude tip is advanced, the operator feels a series of clicks as it passes over the tracheal cartilaginous rings, or encounters hold-up when the tip reaches the carina or a mainstem bronchus and can be advanced no further; either finding confirms tracheal placement, whereas passage of the entire device with no clicks or hold-up suggests esophageal placement. A whistling sound describes a different adjunct (the airway whistle/BAAM), not the bougie, and the bougie is specifically valued because it provides tactile, not visual, confirmation. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Respiratory Emergencies and Airway Management, p. 476. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Airway Management, p. 505.
Question 5
A patient develops confusion and asterixis several weeks after placement of a transjugular intrahepatic portosystemic shunt (TIPS) for variceal bleeding. What complication does this most likely represent, and roughly how common is it?
- Hepatic encephalopathy, occurring in up to 35% of patients because the shunt bypasses hepatic parenchymal clearanceCorrect
- Acute shunt thrombosis, occurring in nearly 100% of cases
- A normal, expected finding unrelated to the shunt
- Bacterial peritonitis, occurring in 90% of TIPS patients
Why: TIPS creates a shunt between the hepatic venous circulation and systemic venous return, effectively bypassing hepatic parenchymal filtration; because ammonia and other gut-derived toxins normally cleared by the liver reach the systemic circulation unprocessed, up to 35% of patients develop hepatic encephalopathy after the procedure. TIPS otherwise has a greater than 95% success rate at reducing bleeding recurrence while the shunt remains patent, so encephalopathy, not shunt failure, is the described trade-off. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Gastrointestinal and Genitourinary Emergencies, p. 2259.
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Question 6
According to the effective-performance-time (EPT) table for altitude exposure, a crew member exposed to sudden hypoxia at 43,000 feet has an average EPT of only 9 to 12 seconds. What happens to EPT as altitude increases further, to above 50,000 feet?
- It stays essentially the same, about 9 to 12 secondsCorrect
- It drops further, to roughly 2 to 3 seconds
- It lengthens slightly because the air is less dense
- It becomes unmeasurable because oxygen delivery is no longer possible at any altitude
Why: EPT falls sharply as altitude increases through the 20s and 30s of thousands of feet, but by the low 40,000s the reserve of available oxygen is already so small that further pressure loss produces little additional practical change; the reference table lists the same 9- to 12-second range at both 43,000 feet and above 50,000 feet. This plateau matters operationally because it means there is no meaningfully greater margin to react to a decompression at extreme cruise altitudes than at the lower end of that range -- donning oxygen within the first few seconds is equally critical either way. The other distractors either invent a further decline, reverse the physiology, or overstate the effect. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Aircraft Fundamentals and Flight Physiology, p. 248.
Question 7
A patient's PAC-derived hemodynamic values include an elevated pulmonary artery diastolic pressure. Which acute condition is this finding most likely to reflect, absent chronic pulmonary hypertension?
- Hypovolemia
- Tachycardia (typically greater than 120 beats/min) or pulmonary emboliCorrect
- Isolated bradycardia
- Third-degree AV block alone
Why: Acute elevations in pulmonary artery diastolic pressure, absent chronic disease, most often result from tachycardia (usually greater than 120 beats/min in adults) or pulmonary emboli, which increase flow or resistance in the pulmonary circuit. Hypovolemia is instead associated with a decrease in pulmonary artery diastolic pressure. Bradycardia and isolated third-degree AV block are not the mechanisms described for an acute elevation in this specific parameter. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Hemodynamic Monitoring, p. 2022.
Question 8
A postpartum patient presents with right upper quadrant pain, malaise, and laboratory results showing hemolysis, an elevated AST, and a platelet count of 85,000/uL. Which condition best explains this presentation?
- Acute fatty liver of pregnancy
- HELLP syndromeCorrect
- Uncomplicated preeclampsia without severe features
- Disseminated intravascular coagulation from trauma
Why: HELLP syndrome is named for its defining triad: hemolysis, elevated liver enzymes, and low platelet count, and classically presents with right upper quadrant pain and malaise, often in the postpartum period. Hypertension and proteinuria may be present in most, but not all, cases, so the diagnosis is supported by the lab triad shown here rather than by a separate condition. Preeclampsia without severe features does not include thrombocytopenia and elevated liver enzymes as core features. There is no trauma history given to suggest DIC from an unrelated cause. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Obstetric and Gynecologic Emergencies, p. 1220. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), The Pregnant Patient, p. 1933.
Question 9
A newborn has uncovered, edematous loops of intestine protruding through a defect just to the right of an intact umbilical cord. Which condition does this describe, and what immediate management step is indicated?
- Omphalocele; leave the intact protective membrane undisturbed and transport
- Gastroschisis; place the exposed bowel in a clear sterile bag and minimize handlingCorrect
- Diaphragmatic hernia; begin needle decompression of the chest
- Meconium ileus; begin rectal irrigation
Why: A full-thickness abdominal wall defect to the right of an intact umbilical cord with uncovered, edematous bowel describes gastroschisis; because there is no protective membrane, the exposed bowel should be placed in a clear sterile bag to limit fluid, protein, and heat loss, with handling minimized to avoid vascular compromise. Omphalocele, by contrast, involves herniation into the cord base beneath an intact membrane, which is not what is described here. Diaphragmatic hernia presents with respiratory findings and a scaphoid abdomen, not exposed bowel. Meconium ileus is an intraluminal obstruction, not an abdominal wall defect. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Neonatal Emergencies, p. 1269.
Question 10
A 12-lead ECG on a patient with chest pain shows a failure of the R wave to grow normally in amplitude from V1 through V4, but no significant Q waves are present. Which conclusion is most accurate?
- This poor R-wave progression can, by itself, signify an anterior MI, but it is nonspecific and can also occur with right ventricular hypertrophy, chronic lung disease, or improper precordial lead placementCorrect
- The absence of Q waves definitively rules out any infarct, so poor R-wave progression can be ignored
- Poor R-wave progression is diagnostic of an acute inferior wall infarct
- Poor R-wave progression only occurs after thrombolytic therapy and never before it
Why: Even without significant Q-wave formation, poor R-wave progression across the precordial leads may signify an anterior wall MI, but the finding by itself is not specific for that diagnosis because it can also be produced by right ventricular hypertrophy, chronic lung disease, or improperly placed precordial electrodes. The absence of Q waves does not rule out infarction, poor R-wave progression is a precordial (anterior) finding rather than a marker of inferior infarction, and it is not specific to a post-thrombolytic state. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Electrophysiology, Pacemakers, and Defibrillators, p. 1777.
Question 11
A crew is briefed that a patient's noncontrast head CT shows an area that 'appears off-white.' What does this finding most likely represent?
- BloodCorrect
- Normal brain tissue
- CSF
- Air
Why: On a normal noncontrast CT scan of the head, density corresponds to brightness: bone appears white, blood appears off-white, brain tissue appears shaded gray, CSF appears off-black, and air appears black. Recognizing this density scale allows the CCTP to interpret a radiology report or images in transit and anticipate the clinical significance of a described finding, such as an off-white area representing hemorrhage rather than normal parenchyma, CSF, or air. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Neurologic Emergencies, p. 1397.
Question 12
A flight crew is transporting a patient with progressive, symmetric ascending muscle weakness that began in the legs several days ago, now with depressed deep tendon reflexes and wide swings in blood pressure and heart rate. No structural lesion is suspected. Which diagnosis best fits, and what proportion of these patients are reported to require ventilator support?
- Guillain-Barre syndrome; ventilator support is required in as many as 30% of patientsCorrect
- Central cord syndrome; ventilator support is required in nearly all patients
- Autonomic dysreflexia; ventilator support is essentially never required
- Todd paralysis; ventilator support is required in the majority of cases
Why: Guillain-Barre syndrome is an immune-mediated polyneuropathy producing progressive, usually symmetric muscle weakness that typically begins in the legs, with depressed or absent deep tendon reflexes and prominent autonomic nervous system dysfunction causing wide swings in blood pressure and heart rate; ventilator support is required in as many as 30% of patients and is highly likely in those with acute, severe presentations. Central cord syndrome is a spinal cord injury syndrome with a different mechanism and distribution of weakness, autonomic dysreflexia is a hypertensive complication of chronic SCI rather than a primary weakness syndrome, and Todd paralysis is transient postictal weakness following a seizure, not a progressive ascending polyneuropathy. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Neurologic Emergencies, p. 1514.
Question 13
A rotor-wing program operates strictly under visual flight rules (VFR). What is a commonly cited minimum flight visibility required to legally continue operating under VFR?
- 1 mile (1.6 km)
- 3 miles (5 km)Correct
- 5 miles (8 km)
- 10 miles (16 km)
Why: Programs operating under visual flight rules generally must maintain a visibility minimum of about 3 miles (5 km), along with appropriate clearance from clouds; falling below this threshold requires either aborting the flight or being qualified and cleared to continue under instrument flight rules. One mile is too low a threshold for basic VFR operations, and 5 and 10 miles overstate the commonly cited minimum. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Aircraft Fundamentals and Flight Physiology, p. 237. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Safety and Survival, p. 300.
Question 14
Above roughly 10,000 feet, an aircraft occupant enters a zone where barometric pressure has fallen enough that hypoxic hypoxia and trapped or evolved gas problems become significant unless protective measures are used. This zone is called the:
- Physiologic zone
- Physiologically deficient zoneCorrect
- Space-equivalent zone
- Troposphere
Why: The physiologically deficient zone begins around 10,000 feet, where barometric pressure has fallen enough to cause hypoxic hypoxia and to allow trapped and evolved gases to expand meaningfully; pressurized cabins, supplemental oxygen, and protective equipment become necessary within this zone. This is distinct from the physiologic zone below it, where unaided function is normally adequate, and from the space-equivalent zone above it, where oxygen alone is no longer sufficient. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Aircraft Fundamentals and Flight Physiology, p. 206. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Transport Physiology, p. 133.
Question 15
During transport of a patient with suspected ongoing intra-abdominal hemorrhage before definitive surgical control is available, damage-control resuscitation principles favor which blood pressure target rather than pursuing full normalization with aggressive fluids?
- Systolic blood pressure of approximately 80-90 mm Hg (mean arterial pressure approximately 60-65 mm Hg)Correct
- Systolic blood pressure greater than 160 mm Hg
- Mean arterial pressure of 100-110 mm Hg
- No blood pressure target is used; fluids should be maximized until vital signs are fully normal
Why: For a patient with suspected ongoing intra-abdominal hemorrhage awaiting surgical control, blood pressure is deliberately maintained at approximately 80-90 mm Hg systolic (roughly 60-65 mm Hg MAP) rather than driven to normal, because over-resuscitation with crystalloid can worsen bleeding before the source is controlled. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Trauma, p. 1242. Cross-reference: ATLS: Advanced Trauma Life Support, Student Course Manual (10th Edition, American College of Surgeons), Shock, p. 106.
Question 16
Immediately after a caustic oral ingestion, what simple first step is recommended, and what two interventions should specifically be avoided?
- Give the patient a small amount of water or milk to drink; do not induce vomiting and do not attempt neutralizationCorrect
- Induce vomiting immediately and give an oral acid to neutralize an alkali ingestion
- Give activated charcoal immediately and avoid all fluids
- No intervention is needed until the patient reaches the emergency department
Why: Immediately after an oral caustic exposure, patients should be given a small amount of water or milk to drink to help remove the caustic agent from the upper airway; providers should not induce vomiting or attempt any neutralization, since re-exposing already injured tissue to vomited caustic material or to an exothermic neutralization reaction can worsen the injury. The airway should be secured early with an ET tube if there are signs of airway injury, because such injury may progress quickly. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Toxicologic Emergencies, p. 2840.
Question 17
An FAA Advisory Circular describes how, in the events preceding a crash, 'one bad decision often leads to another.' What does this describe about the nature of most air medical crashes, according to the text?
- Crashes are almost always caused by a single sudden mechanical failure that pilot training cannot prevent
- Crashes result primarily from patient acuity overwhelming the medical crew, independent of flight operations
- Crashes are attributable to a single regulatory violation identified after the fact by investigators
- Crashes are rarely caused by a single event; instead, a series of contributing factors compounds until few safe alternatives remain, a progression sometimes called the accident chainCorrect
Why: The NTSB has found that aircraft crashes are rarely caused by a single event; rather, they culminate from a series of contributing factors, with each decision narrowing the alternatives for continued safe flight, a progression the FAA and NTSB describe as the accident chain. This contradicts the idea that crashes are typically due to one mechanical failure, patient acuity alone, or a single identified violation, since real crash investigations typically find multiple compounding contributing factors. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Aircraft Fundamentals and Flight Physiology, p. 273. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Safety and Survival, p. 300.
Question 18
A patient with a traumatic head injury and no prior endocrine history develops unexplained refractory hypotension despite adequate volume resuscitation. Which endocrine consideration does the text specifically flag for this population?
- Approximately 50% of patients with moderate to severe traumatic brain injury develop some form of adrenal insufficiencyCorrect
- Traumatic brain injury always causes diabetes insipidus, never adrenal insufficiency
- Adrenal insufficiency cannot occur after trauma, only after surgery
- This presentation should prompt suspicion for pheochromocytoma rather than adrenal insufficiency
Why: The text specifically notes that approximately 50% of patients with moderate or severe traumatic brain injury present with some form of adrenal insufficiency, and that patients receiving high-dose pentobarbital, propofol, or vasopressors for blood pressure management should be carefully monitored for it, since unrecognized AI is a potentially fatal cause of refractory hypotension. It does not state that DI is the only possible endocrine complication, nor does it exclude AI after trauma without surgery. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Endocrine Emergencies, p. 2457.
Question 19
Critical incident stress debriefing (CISD) was widely favored from the 1980s to manage psychological aftereffects in emergency personnel, but the text notes it has now largely been replaced by a different approach. What is the primary reason given for this shift?
- CISD was found to be more expensive than its replacement
- CISD requires a specially trained team and carries the potential to create iatrogenic harm from mandatory attendance, practitioner error, and mixing of groupsCorrect
- CISD was replaced simply because it became outdated technology
- CISD was banned by federal regulation
Why: The text explains that CISD has largely been replaced by psychological first aid (PFA) because CISD requires a specially trained team and carries the potential to create iatrogenic harm from mandatory attendance, practitioner error, mixing of groups, and preexisting conditions unknowingly present in participants; PFA, by contrast, is implemented within the workplace by management and coworkers with an emphasis on personal resilience. Cost, obsolescence, and federal prohibition are not the reasons given in the text for this shift. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Introduction and Overview of Critical Care Transport, p. 68.
Question 20
Shortly after fibrinolysis for STEMI a patient develops a run of accelerated idioventricular rhythm and brief ventricular ectopy. What mechanism does the textbook give for these reperfusion arrhythmias?
- Catecholamine surge from pain
- Fibrinolytic-induced hypocalcemia
- Air embolism from the infusion line
- Rapid return of potassium into the intracellular space as the ischemic myocardium is reperfusedCorrect
Why: During ischemia potassium leaves the cells; when flow is restored by fibrinolysis or PCI the potassium rapidly moves back into the intracellular space, producing rhythm disturbances that are usually short lived but occasionally serious. The crew also monitors for bleeding, including retroperitoneal or femoral hematomas and headache with altered consciousness, stopping heparin for severe bleeding. Pain-related catecholamines, hypocalcemia and air embolism are not the described mechanism. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Electrophysiology, Pacemakers, and Defibrillators, p. 1763.
Question 21
A blood bank is preparing platelets for transport to support a patient with thrombocytopenic bleeding. Which storage practice is correct for platelet concentrate?
- Stored at room temperature under constant agitation, with a shelf life of about 5 daysCorrect
- Stored on wet ice identical to packed red blood cells
- Frozen solid at -18°C for indefinite storage
- Refrigerated at 1-6°C without agitation
Why: Platelets are most commonly stored at room temperature under constant agitation to prevent aggregation, giving them a shelf life of about 5 days; refrigeration or freezing platelets impairs their function unlike red cells. Wet-ice storage is used for whole blood and PRBCs, not platelets. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Resuscitation, Shock, and Blood Products, p. 1052.
Question 22
Compared with an adult's epiglottis, a child's epiglottis is best described as which of the following?
- Flat and flexible, lying parallel to the base of the tongue
- Large, floppy, U-shaped, and angled about 45 degrees to the pharyngeal wallCorrect
- Absent until approximately 8 years of age
- Fused to the vallecula, preventing direct elevation with a laryngoscope blade
Why: A child's epiglottis is proportionally larger, floppier, and U-shaped, and it sits at roughly a 45-degree angle to the anterior pharyngeal wall rather than lying parallel to the tongue base as in the adult; this often requires directly lifting the epiglottis with the laryngoscope blade tip. It is present from birth and is not fused to the vallecula. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Respiratory Emergencies and Airway Management, p. 393. Cross-reference: ASTNA Patient Transport: Principles and Practice (Mosby, 4th Edition), Airway Management, p. 523.
Question 23
An intubated 5-year-old has a stable waveform capnography reading of 40 mm Hg. How should this ETCO2 value be interpreted relative to normal pediatric ventilation?
- It is far below normal and indicates severe hyperventilation
- It falls within the normal 35 to 45 mm Hg range and correlates well with arterial PaCO2Correct
- It is elevated and indicates the child is hypoventilating
- ETCO2 values cannot be interpreted in pediatric patients under 8 years old
Why: Normal ETCO2 in a ventilated patient is 35 to 45 mm Hg, and these values correlate well with the partial pressure of carbon dioxide on an arterial blood gas, making capnography a reliable trend tool for ventilation adequacy. A reading of 40 mm Hg is squarely within this normal range, so it indicates neither hyperventilation nor hypoventilation, and the tool is applicable across pediatric age groups. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Pediatric Emergencies, p. 3192.
Question 24
Which organ is identified as the one most frequently injured in penetrating abdominal trauma, found in as many as 96% of penetrating trauma cases in one cited study, with gunshot wounds accounting for the large majority of these injuries?
- Liver
- Spleen
- Large intestine (colon)Correct
- Kidney
Why: The large intestine (colon) is identified as the organ most frequently injured by penetrating trauma, found in 96% of penetrating trauma cases in one study, with gunshot wounds accounting for more than 90% of those injuries; colon and rectal injuries are particularly prone to sepsis and peritonitis. The liver, spleen, and kidney are injured less frequently by penetrating mechanisms in this data. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Trauma, p. 1257. Cross-reference: ATLS: Advanced Trauma Life Support, Student Course Manual (10th Edition, American College of Surgeons), Abdominal and Pelvic Trauma, p. 136.
Question 25
When selecting a laryngoscope blade size for a pediatric patient, what should primarily guide the CCTP's choice?
- The child's chronological age in years
- The child's physical size, since blade size selection depends on size rather than ageCorrect
- The child's weight in kilograms only, using a fixed age-independent formula
- Blade size is standardized and identical for all pediatric patients
Why: The text is explicit that actual blade size selection depends on the child's size, as opposed to age, reflecting the wide variation in body size among children of the same chronological age; a table of size-based guidance supports this selection. This means age alone, a weight-only formula, or a one-size-fits-all approach are all less reliable than assessing the individual child's physical size directly. Primary reference: Critical Care Transport (Jones & Bartlett, 3rd Edition), Pediatric Emergencies, p. 3215.

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