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DJTHEMAC
09-05-2007, 18:41
Howdy all! I am a newly registered EMT-B. I applied to work for a private ambulance transport company and was given a 30 question "entrance exam," which i failed. I guess you need 24/30 to pass. What irritates the heck out of me is that I passed my EMT class with 95%, and nailed the NREMT test the first time, yet I failed some dinky test. Anyhow, if anybody could help me rethink some of my answers, I can retest at a later date.

Q1. Your Patient has just had a seizure and has an altered LOC. His girlfriend is there and tells you that he has a history of seizures, and has been prescribed tegritol. The MOST appropriate question to ask is:
1. Is the patient an alcohol abuser? (my choice)
2. Describe the onset of the seizure
3. When was the last time he saw his physician
4. How long has this patient had a history of seizures?

Q2. What is the correct treatment for a child who has had a seizure?
1. Cool down with wash cloths
2. Rapid transport, calm the mother down enroute.

Q3. Your patient has chest pain and is breathing at 24times a minute adequately. The MOST correct treatment is
1. BVM/O2 assist vent (my choice, due to the 24 times a minute, but the question said some that the breaths were ADEQUATE meaning maybe a non rebreather is a better option)
2. Non-rebreather focused history/physical

Q4. You have an elderly patient who recent had a hip replacement. This patient wakes up in the middle of the night with dried blood around her mouth and chest pain. She most like has
1. COPD
2. Pulmonary Edema (my choice)
3. Spontaneous pnuemothorax
4. one other injury

Q5. What injury is most to present pain in the the Right Upper Quadrant
1. appendicitis
2. pancreatitis (my choice, but I had no idea)
3. Cholecysticitis
4. another injury with an "itis" in it.

Q6. What disease might a patient with a "barrel chest" have?

4095fanatic
09-05-2007, 19:10
Originally posted by DJTHEMAC
Howdy all! I am a newly registered EMT-B. I applied to work for a private ambulance transport company and was given a 30 question "entrance exam," which i failed. I guess you need 24/30 to pass. What irritates the heck out of me is that I passed my EMT class with 95%, and nailed the NREMT test the first time, yet I failed some dinky test. Anyhow, if anybody could help me rethink some of my answers, I can retest at a later date.

Q1. Your Patient has just had a seizure and has an altered LOC. His girlfriend is there and tells you that he has a history of seizures, and has been prescribed tegritol. The MOST appropriate question to ask is:
1. Is the patient an alcohol abuser? (my choice)
2. Describe the onset of the seizure
3. When was the last time he saw his physician
4. How long has this patient had a history of seizures?


I'd bet 2 was the correct answer. Go by the book on entrance exams. OPQRST man. If not 2, then I'd pick 4.

Q2. What is the correct treatment for a child who has had a seizure?

1. Cool down with wash cloths
2. Rapid transport, calm the mother down enroute.

While you may instinctively think "febrile seizure", don't forget that state protocols do not prescribe "wash cloths" as treatment. I'd go with 2.

Q3. Your patient has chest pain and is breathing at 24times a minute adequately. The MOST correct treatment is
1. BVM/O2 assist vent (my choice, due to the 24 times a minute, but the question said some that the breaths were ADEQUATE meaning maybe a non rebreather is a better option)
2. Non-rebreather focused history/physical

Definitely 2. If his breathing is adequate, there is no need to bag him. Get him on an NRB @ 15 LPM.

Q4. You have an elderly patient who recent had a hip replacement. This patient wakes up in the middle of the night with dried blood around her mouth and chest pain. She most like has
1. COPD
2. Pulmonary Edema (my choice)
3. Spontaneous pnuemothorax
4. one other injury

Not sure. Pulmonary edema can result in coughing up of blood (thus the blood around her mouth, and the trouble breathing could be resulting in the chest pain. COPD can also result in bloody sputum, but is not usually a dead ringer for chest pain. A spontaneous pneumothorax would most likely not present as "blood around the mouth and chest pain" on a test. There are quite a few more obvious indicators (lung sounds absent on one side, for instance). I'd rule out number 3. I'd have to know number 4, but right now I'm tempted to agree with you that our of those 3, number 2 is the best choice. .

Q5. What injury is most to present pain in the the Right Upper Quadrant
1. appendicitis
2. pancreatitis (my choice, but I had no idea)
3. Cholecysticitis
4. another injury with an "itis" in it.

Appendicitis is usually central/lower right, so we can rule that one out. Pancreatitis is usually in the upper quadrants, so 2 is a possibility. Chyolesystitis involves the gall bladder, which is in the upper right quadrant. 3 is the best answer.

Q6. What disease might a patient with a "barrel chest" have?

Barrel chest = COPD. You'll also usually see the patient presenting with tripoding.



Hope this helps!

DJTHEMAC
09-05-2007, 20:28
Thanks For the advice!! I agree with your answers, and after talking to my dad, he suggested that the hip fracture question could cause a "pulmonary embolism." That might have been the fourth injury answer I couldn't remember.

As far as the washcloths question, you are right, I did think febrile seizure (upon further consideration, the question may have included a reference to a fever of some sort), and my thought process was "hey its not as scary as it looks, get to the hospital calm the mother down," but in hindsight I wonder if i should have done some sort of cooling method. In my EMT class book, the treatment suggested was

"If the condition is a result of heat exposure, and if local protocols permit, cover the child with a towel soaked in tepid water. This will cool the child quickly."

I wonder if this question was designed around a febrile seizure scenario, and if it was i should have picked the answer that included active cooling.

gruntmedik
09-05-2007, 23:07
Question #4, my first thought was PE as well.

The biggest mistake I see people make when taking these tests, is they read into the question. Don't speculate on what they may be asking, just take the question at face value. Sometimes there may be more than one correct answer--if so, choose the most appropriate answer.

Good luck. :thumbsup:

DJTHEMAC
09-06-2007, 14:02
Thanks for the advice! I passed the test today with an 88% up from 60%

:supergrin: :supergrin: :supergrin:

4095fanatic
09-06-2007, 16:01
Glad we could help! Now get ready to post "Guys, it's been two weeks and I'm burned out..." :).

Gotta love the private sector.

DJTHEMAC
09-06-2007, 16:22
Originally posted by 4095fanatic
Glad we could help! Now get ready to post "Guys, it's been two weeks and I'm burned out..." :).

Gotta love the private sector.


Lmao. I'll be weary of that!

lakota222
09-09-2007, 07:41
private ambulance services are not worth a red pi$$ and if I had to pass an entrance exam to be employed by one, I would keep looking for another employer.

obxprnstar
09-10-2007, 22:33
You passed your NR exam on your first try?

We have one of those around here.

DJTHEMAC
09-11-2007, 00:21
Originally posted by obxprnstar
You passed your NR exam on your first try?

We have one of those around here.

I was surprised as hell! I did really well in my emt classes, but the NR test was extremely difficult for me. It cut off after 70 questions, and I thought I had failed it for sure, but i got my card in the mail a few days later. :supergrin:

kashton
09-13-2007, 00:11
I just finished my Paramedic class and am doing my clinicals at the moment but here is my short take on that exam:

1. (#2) Describe the onset of the seizure (The last time he saw his physician is irrelevant at the moment, so is how long his seizure history has been. Alcohol is something I would ask but the most important question is knowing what type of seizure he had.

2. (#2) no need for wash cloths unless his temp his fairly high and transport time is longer.

3. (#2) no need for BVM at 24 bpm

4. I would say she has a possible pulmonary embolism from a blood clot from recent surgery so I donít know which one to pick from those 4.

5. I think #2, the liver is in the upper right q too and so is the gallbladder (Cholecysticitis).

6. I think they are looking for COPD. I believe it is the way that they breathe that over time, gives them that barrel chest look...

FiremanMike
09-16-2007, 07:50
1. B - history of seizures leads you to believe real seizures unless proven otherwise. alcohol can be a secondary diagnosis that should be looked into but not focused on.

2. B - active cooling is never preferred, and the question didn't specify febrile seizure. That being said, one thing to remember with febrile seizures is not necessarily the actual core temperature, but the rate of rise, as well as the rate of decline, of said temperature. Active cooling can cause another seizure.

3. B - NRB for sure. I don't like to focus on breathing rate (for the most part) when I decide to BVM something, but rather use that number in conjunction with the rest of my assessment in determining that.

4. Probably B, however not enough information to be quite honest, was there pain in the leg, swelling to one leg or both, recent isn't a very good description, was it 3 months ago and the patient is already rehabing, or was it two days ago and the patient is still bed-bound. Bad question IMHO.

5. C, but bad info. Gall bladder pain is RUQ, and usually correlates coming right after a meal.

6. COPD

Truckee
09-22-2007, 14:39
Originally posted by lakota222
private ambulance services are not worth a red pi$$ and if I had to pass an entrance exam to be employed by one, I would keep looking for another employer.

Man lakota, that's a broad stroke (no pun). Did some 'private boy' steal your girlfriend or something? {don't be offended please, that was ONLY a joke}.

Although I have seen examples backing your opinion, I too have seen contraindications (again, no pun) of it. For two examples, Google "Carilion EMS" and then on to "Acadian Ambulance Service" and read what pops up. Some of the most educated and knowledgable EMS personnel that I know of work with those companies.

lakota222
09-22-2007, 19:57
I meant no offense to people working for private service. (unfortunately I work for one.) What I was speaking of is their management and ownership, and the half-assed way they do things, and the way they use up good people. The way they jeopadise crew and patient sfety in the never ending quest for the almighty dollar.

There may be well run private services out there, but I have yet to find one. I have worked for many services in the past 15 years and none of them have had any respect for me or my time. At all of them I have been treated as an inanimate piece of company property.

Of course the way these companies treat their employees probably has something to do with the fact that there are 6 or more paramedic training programs in the area pumping out 120+ medics per year.

I have actually overheard managers saying that if the crews dont like the way things are run then tough XYZ Paramedic school will be graduating a new crop in a few weeks.

Things may be better in other parts of the country, but in Ohio going to paramedic school is largely an exercise in futility.

Truckee
09-22-2007, 20:37
Originally posted by lakota222
I meant no offense to people working for private service. (unfortunately I work for one.) What I was speaking of is their management and ownership, and the half-assed way they do things, and the way they use up good people. The way they jeopadise crew and patient sfety in the never ending quest for the almighty dollar.

There may be well run private services out there, but I have yet to find one. I have worked for many services in the past 15 years and none of them have had any respect for me or my time. At all of them I have been treated as an inanimate piece of company property.

Of course the way these companies treat their employees probably has something to do with the fact that there are 6 or more paramedic training programs in the area pumping out 120+ medics per year.

I have actually overheard managers saying that if the crews dont like the way things are run then tough XYZ Paramedic school will be graduating a new crop in a few weeks.

Things may be better in other parts of the country, but in Ohio going to paramedic school is largely an exercise in futility.

With this clarification, I can agree with you.

I too despise the way companies treat their employees. Unfortunately, the two that I reference likely represent your description. I'm afraid it's the "corporate attitude" we live under.

I once overheard the director of one of those companies say, "if we can keep an employee two years, I'm happy with it." {Note, around those parts, the medic program is a two-year degree... but students are practicing as EMT-Bs out of the gate and as medics within eight months. That's no way to view one's personnel and business model. In that sort of business, experience and wellbeing count for much more than with many other 'business' ventures.

I'd take paramedics over nurses any day (no offense to nurses). Even though both are two-year degrees, one is considered 'just a certification,' while the other is seen as a licensed profession. That's a skewed viewpoint IMO.

To reiterate though, most of the individuals I know of in private EMS are top notch. I know some boobs too, but they're in every walk of life.

Please keep safe lakota,
Truck

FirNaTine
09-24-2007, 11:17
Originally posted by Truckee
I'd take paramedics over nurses any day (no offense to nurses). Even though both are two-year degrees, one is considered 'just a certification,' while the other is seen as a licensed profession. That's a skewed viewpoint IMO.


In MD at least, all ALS providers are indeed licensed.

I have had had more than a few nurses be surprised when I informed them of such. After talking at length with them, man still seem to have the old views of EMS just providing transport, and little formal training. After discussing with them the amount of training I went through and the skills I am licensed to perform, many were completely unaware (and a tad jealous) of us. They had no idea for example that I am allowed to perform a surgical cricothyrotomy, needle chest decompression, etc.

Having worked in a hospital in various positions, I view them as distinctly separate skill sets. Paramedic programs are almost entirely based around preparing you to operate in a field EMS setting where as nursing programs cover the whole continuum of health care.

As far as private EMS is concerned. I was there for two years as an EMT-B, before getting hired in a career FD. Suffice it to say I am glad I got out of there without any issues.

Truckee
09-25-2007, 08:59
Originally posted by FirNaTine
In MD at least, all ALS providers are indeed licensed.

I have had had more than a few nurses be surprised when I informed them of such. After talking at length with them, man still seem to have the old views of EMS just providing transport, and little formal training. After discussing with them the amount of training I went through and the skills I am licensed to perform, many were completely unaware (and a tad jealous) of us. They had no idea for example that I am allowed to perform a surgical cricothyrotomy, needle chest decompression, etc.

Having worked in a hospital in various positions, I view them as distinctly separate skill sets. Paramedic programs are almost entirely based around preparing you to operate in a field EMS setting where as nursing programs cover the whole continuum of health care.

As far as private EMS is concerned. I was there for two years as an EMT-B, before getting hired in a career FD. Suffice it to say I am glad I got out of there without any issues.

FirNaTine,
Hummm, interesting, I did not know that Maryland got that done. I used to work there in the '80s. When I left in the early '90s, I knew of the push toward licensure.

I was going to PM you and inquire. However, I thought others might be interested in several issues concerning licensure of Medics and decided to go open forum.

Tell ya what, instead of hyjacking DJTHEMAC's thread, I'm going to a new post that I'd like you to respond to if you find the time.

Thanks,
Truck