ALS Theoretical Test 1 PDF

Adult Advanced Life Support: Theoretical Test 1 For questions 1-15 the candidate must achieve 100% For questions 15-35 the candidate must achieve 80% (16/20) Please select the best answer then write it on the answer sheet provided not the test paper. 1. The following rhythm is: a) Atrial fibrill...

Adult Advanced Life Support: Theoretical Test 1 For questions 1-15 the candidate must achieve 100% For questions 15-35 the candidate must achieve 80% (16/20) Please select the best answer then write it on the answer sheet provided not the test paper. 1. The following rhythm is: a) Atrial fibrillation b) Complete heart block c) Sinus bradycardia d) Ventricular fibrillation 2. The most appropriate immediate treatment for the above rhythm is to: a) Administer Adrenaline 1mg b) Defibrillation c) Perform synchronised cardioversion d) Administer Lignocaine 3. When preparing to defibrillate, what does the acronym COACHED stand for? a) Cease compressions, Oxygen Away, All others away, Charging, Hands off, Examine the patient, Defibrillate b) Clear the bed, Oxygen Away, Appropriate staff, Charging, Hands Off, Evaluate the rhythm, Defibrillate or Dump c) Continue compressions, Oxygen on, All others carry on, Charging, Hands off, Evaluate the Rhythm, Dump charge d) Continue compressions, Oxygen Away, All others away, Charging, Hands off, Evaluate the rhythm, Defibrillate or Dump 4. Following defibrillation, your immediate priority with an unresponsive patient is to: a) Resume chest compressions b) Defibrillate a second time c) Proceed with drug administration d) Check the rhythm 5. The following rhythm is: a) Asystole b) Ventricular standstill c) Sinus rhythm d) Complete heart block ****6. Which of these statements best describes when to administer Adrenaline: a) Adrenaline is given in cases of Ventricular Fibrillation/Pulseless VT after the second DC shock has been delivered. b) The initial dose of Adrenaline 1mg IV is repeated during every 2nd cycle of CPR if an organised rhythm has not been established. c) For non-shockable rhythms (asystole and pulseless electrical activity (PEA)) Adrenaline is given during the initial cycle of CPR and then repeated every 2nd cycle until return of spontaneous circulation. d) All of the above are true. 7. The following rhythm is: a) Ventricular tachycardia b) Atrial fibrillation c) Sinus tachycardia d) Supra ventricular tachycardia 8. Choose the answer that correctly describes a situation in which could use a first line IV arrhythmic in a cardiac arrest and the recommended medication a) Amiodarone is given In a Torsades de Point arrest after to second shock b) Lignocaine is used in a VF/pulseless VT arrest after the second shock c) Amiodarone is given in a VF/pulseless VT arrest after 3 shock after adrenalin d) Both b and c are correct 9. correct dose of IV amiodarone in a pulseless VT arrest is: a) 300 mg in 50-100 mL glucose 5% IV over 30 minutes b) 300 mg in 20 mL normal saline over 1-2 minutes c) 300 mg in 20 mL glucose 5% IV over 1-2 minutes d) 5 mg/kg up to 300 mg in 50-100 mL normal saline over 30 minutes 10. If a patient has a known hypersensitivity to amiodarone, what alternative drug/dosage should be used? a) Lignocaine 300mg and a further 150mg may be given if required. b) Atropine 600mcg can be repeated up to a maximum of 3mg c) A bolus of Lignocaine 1mg/kg and further 0.5mg/kg may be given if required d) An Adrenaline 1mg bolus is followed by an infusion. 11. Why is adrenaline given in a cardiac arrest situation? a) To cause vasoconstriction in order to raise diastolic BP and increase b) To increase heart rate and contractility and coronary perfusion. c) It may facilitate defibrillation by improving myocardial perfusion during CPR d) Both a and c. 12. During a cardiac arrest, if you do not have IV access, the correct dose and route of administration for Adrenaline is: a) 10mg of adrenaline (1:1000 dilution) - Intramuscular injection (IMI) b) 3mg of adrenaline (1:1000 dilution) - Nebulised c) 1mg of adrenaline (1:10000 dilution) - Intraosseous (10) d) 1mg of adrenaline (1:10000 dilution) - Endotracheal Tube (ETT) 13. Which answer best describes the Australian and New Zealand Committee on Resuscitation (ANZCOR) recommendations regarding the use of Atropine. Atropine is used in the management of bradyarrhythmia when: a) The heart rate is < 60 bpm b) The Systolic BP is < 90 mmHg c) The heart rate Amiodarone b) Tachycardia and delirium or confusion-> Atropine c) Tachyarrythmias, severe hypertension and tissue necrosis if extravasation occurs -> Adrenaline d) Hypotension, bradycardia, heart block, asystole, confusion, seizures and coma ->Lignocaine e) Hyperkalaemia with peaked T waves, bradycardia, hypotension and thrombophlebitis -> Potassium 16. As per the chain of survival, which of the following is most likely to improve the chance of survival during a cardiac arrest? a) Early intubation b) Early referral to a consultant c) Early CPR - good quality chest compressions d) Early drug administration 18. Your patient is unresponsive and not breathing normally and the monitor shows this rhythm... what is it? a) In this situation it is Normal Sinus Rhythm b) In this situation it is Pulseless Electrical Activity (PEA) c) This is 1" degree heart block d) This is ventricular tachycardia 19. The above situation is potentially reversible by: a) Defibrillation b) Lignocaine bolus c) Adenosine bolus d) Identifying and treating the cause 20. You respond to a monitor alarm and find your patient to be in conscious ventricular tachycardia. On assessment, they are awake and speaking. What is your next immediate action? a) Administer Adrenaline b) Call for help and remain with the patient, apply oxygen, check blood pressure and perform a 12 lead ECG if they are haemodynamically stable c) Administer Amiodarone d) Call for help and set up for cardioversion 21. The intra-osseous route: a) Should be used only in paediatric cardiac arrest. b) Provides access to give drugs but not fluids. c) Is the preferred alternative when IV access is unavailable in both adults and children d) Cannot be used to draw bloods for laboratory evaluation. 22. The following rhythm is: a) Atrial fibrillation b) 2nd degree Heart Block (Type II) c) Junctional rhythm d) 3rd degree Heart Block (Complete) 23. The most appropriate immediate treatment for the above rhythm is to a)Defibrillate b) Check the patient to see if they are responsive and breathing normally, or have any degree of compromise c) Apply oxygen d) Administer a bolus dose of Adrenaline 24. Select the recommended bolus dose of IV Potassium given during a cardiac arrest when the patient is hypokalaemic: a) 5 mmol b) 1 gram c) 20 mmol d) 10 mmol 25. Rhythm below is: a)Torsade de pointes b)Ventricular tachycardia c)Supraventricular tachycardia (SVT) d)Fine ventricular tachycardia 26) Which situation is the administration of Magnesium recommended? a)Torsarde de pointes b)Cardiac arrest associated with digoxin toxicity and documented hypokalaemia c)documented hypomagnesaemia with VF/Pulseless VT d)all of the above 27. The following rhythm is: a) Sinus bradycardia b) Asystole c) Atrial fibrillation d) Complete heart block 28. During cardiac arrest resuscitation, which of the statements below is correct? a) No fluids should be given to a hypotensive patient b) There is no evidence to support routine administration of IVI fluids c) All patients in asystole should receive a 500ml bouls of 0.9% saline d) All of the above are correct 29. During a cardiac arrest the airway operator informs you that they are having difficulty achieving chest rise and fall with a Bag Valve Mask (BVM). Which of the following would you recommend: a)Check for good seal and consider an oropharyngeal or nasopharyngeal airway b)Immediately proceed to intubation c)Move to continuous chest compression d)Attempt mouth to mouth ventilation, ensuring you have a good seal 30. The ANZCOR guidelines emphasis the use of waveform capnography to: a)Confirm and continually monitor the correct position of an endotracheal tube b)Provide an early indication of a return to spontaneous circulation c)Monitor the adequacy of CPR d)All of the above 31. A precordial thump: a)To be effective, should deliver at least 200J of mechanical energy b)Is a sharp blow to the mid to lower sternum delivered within 15secs of monitored witnessed pulseless VT arrest. It should not delay defibrillation c)Should not be used because of the increased risk of chest trauma d)is recommended for VF if delivered within 15secs 32. A Jaw thrust and chin lift should be tried before a head tilt in an unconscious patient when: a)There is only one person carrying out resuscitation b)The patient is not breathing c)A neck injury is suspected d)The patient is in complete heart block 33. Oropharyngeal (Guedel) airways: a)Are recommended for airway management in conscious patients b)Are measured from the corner of the mouth to the bottom of the ear or the angle of the jaw to ensure the correct size c)using a poorly sized Guedel airway can result in an obstructed airway d)Both b and c are correct 34. Which of the following is true regarding Sodium Bicarbonate use in a cardiac arrest: a)It is not given routinely in a cardiac arrest b)It may be considered in shockable and non-shockable rhythms associated with hyperkalaemia or tricyclic overdose c)The dose is 1mmol/kg d)All of the above are true 35. In the post-resuscitation phase of care, the ANZCOR guidelines recommend a)Titrating oxygen therapy to maintain the SaO2 over 98% b)Continuing respiratory support and maintaining cerebral perfusion (MAP>70) c)Determining and treating the cause of the arrest d)Both b and c  1. In regards to the following rhythm strip: A. The ventricular rate is in the range of 200-250 beats per minute. B. P waves are clearly visible C. the QRS rhythms is regular D. The rhythm is an example of ventricular Tachycardia - P wave is not clear because it hidden due to the preceding T wave, then what rhythm? Sinus Tachycardia or supraventricular tachycardia 2. Prior to ceasing efforts in a cardiac arrest the team leader would: A. Phone the poisons information centre B. Check with the relatives. C. Check with the team members for agreement D. Apply one last precordial thump 3. All communication during an arrest needs to be A. Kept to a minimum so the CPR is not interrupted B. Clear with eye contact using team members names where possible C. Open-loop communication D. Closed-loop communication 4. After the return of spontaneous circulation (ROSC): A. Titrate oxygen delivery to maintain SaO2 between 94-98% B. Intervention in the post resuscitation period is unlikely to impact patient outcomes C. Maintenance of airway, breathing and circulation should continue D. Arterial blood gases should be performed to guide further treatment 5. Waveform Capnography A. Values less than 10mmHg, after 20minutes of CPR, are associated with positive patient outcomes B. Can be used to assess the quality of chest compressions during CPR C. Can guide ventilation during cardiac arrest and in the post resuscitative phase D. Cab be used to alert to the presence of ROSC 6. Oropharyngeal airways A. Should be forcibly inserted B. Should not be forcibly inserted C. Do not induce vomiting D. Need to be sized prior to insertion Oropharyngeal airways:(Guedel) Contraindicated in a conscious patient as it may stimulate the patient’s gag reflex Holds the tongue away from the posterior portion of the pharynx Correct size is measured from the corner of the mouth to the bottom of the ear or from the corner of the mouth to the angle of the jaw Correct size is important. Too small will push on the base of the tongue causing it to obstruct the airway and too big will push on the glottis causing it to obstruct the airway Insertion is achieved with the concave side up until it is past the tongue, then rotate the device 180 degrees and then gently insert the remaining length of the oropharyngeal airway 7. When ventilating a patient with an advanced airway in place: A. Ventilate at rate of 12-15 breaths per minute B. Ventilate the lungs at rate of 6-10 breaths per minute C. Pause CPR to allow for each breath to be given over one second D. Simultaneous ventilation and compression may adversely effect coronary perfusion - a rate of 8 – 10 breaths per minute with no pause for chest compressions. 8. Following intubation during cardiac arrest: A. deliver ventilations at 21% O2 to avoid hyperoxia B. Auscultation should be used as the only reliable method of confirming endotracheal tube placement C. Deliver 6-10 breaths per minute, without pause for chest compression D. ventilate at a rate of 6-10 breaths per minute, with breaths delivered during a pause in chest compression 9. Non shockable rhythm & Shockable rhythm 10. When monitoring cardiac rhythms: A. A normal ventricular rate is 60-100 beats per minute B. Asystole presents as a completely straight line C. Ventricular tachycardia will always require immediate cardioversion D. All patients in atrial fibrillation require cardioversion 11. With reference to the following rhythm: A. This rhythm is compatible with spontaneous circulation B. Synchronised cardioversion is appropriate treatment for this rhythm C. This rhythm is Ventricular Fibrillation D. The most appropriate immediate treatment is adrenaline (epinephrine) 1mg 1:10000 IV 12. In Ventricular Fibrillation: A. The ECG will show irregular deflections of random frequency and amplitude B. There is never a palpable central pulse C. Defibrillation should be delayed until after 2minute of CPR D. A three shock strategy could be used if the patient has a monitored and witnessed cardiac arrest and can be defibrillated 13. In regards to the following rhythm strip: A. The ventricular rate is between 150-175 beats/minute B. The QRS rhythm is regular C. The P waves are hidden within the QRS complex D. The QRS complex duration is prolonged 14. The following reversible causes need to be considered during a cardiac arrest: A. Cardiac tamponade B. Pulmonary tamponade C. Cardiac thrombosis D. Pulmonary tamponde 4 T’s Tension pneumothorax Tamponade (cardiac) Toxins/poisons/drugs Thromboembolism (PulmonaryEmbolism or coronary thrombus->myocardial infarction) 4 H’s Hypoxaemia Hypovolaemia (shock) Hypo/Hyperthermia Hyper/hypokalaemia, hypocalcaemia, acidaemia & metabolic disorders 15. Reversible causes of cardiopulmonary arrests are: A. Hypoxia, Hypervolaemia, Hyperkalaemia, Hyper/Hypothermia, Cardiac Tamponade, Tension Pneumothorax. Thrombus, Thoxins/poisons B. Hyperoxia, Cardiac Tamponade, Tension Pneumothorax. Thromboembolism, Hypovolaemia, Hypoglycaemia, Hyper/Hypokalaemia, Toxic Shock C. Hypoxia, Toxins, Tamponade, Hypovolaemia, Hyper/Hypokalaemia/Metabolic disorders, Tension pneumothorax. Thrombosis, Hypo/Hyperthermia D. Hypoxia, Hypovloaemia, Cardiac toxicity, Tamponade, Hypo/Hyperkalaemia, Thrombus, Hyperthermia, Pneumothorax 16. Defibrillation A. Causes repolarisation of cardiac cells. B. Causes depolarisation of cardiac cells C. Should not be delayed until 2 minutes of CPR has been completed D. Can be effective in Asystole if performed within 2 minutes of a witnessed arrest - application of sufficient electrical energy to the heart to simultaneously depolarise enough myocardial cells to produce repolarisation, thereby allowing the sinus node to resume its function as the heart’s pacemaker - recommend biphasic energy levels of 200 joules and monophasic energy levels of 360 joules for defibrillation of VF and pulseless VT in adults - In these circumstances, towards the end of the 2 minute CPR cycle the person performing defibrillation should clearly communicate they are charging the defibrillator: eg. “Charging 200j, continue CPR”. Once it has charged state “Stop CPR to assess the rhythm” and if a shock is appropriate state “Stand Clear” and then follow the above procedure from that point. If the defibrillation is inappropriate when the rhythm is assessed, safely disarm the defibrillator. 17. In an adult cardiac arrest: A. Pulseless Ventricular Tachycardia can be defined as asynchronous chaotic activity that produces no cardiac output. B. Good CPR may increase the likelihood of successful defibrillation C. Pulseless Electrical Activity may have a weak central pulse D. Three-stacked shocks may be given if initiated within 20 seconds of witnessed and monitored Ventricular Fibrillation 18. When using a defibrillator in manual mode, the defibrillator should be charged: A. Once the person performing chest compressions is safely away, to ensure their safety and danger to all is minimised B. While CPR is continued, oxygen is away and all others are away C. At the end of the 2 min loop of CPR. to ensure that CPR is not interrupted prematurely, as this has been shown to have better outcomes D. During CPR as the end of the 2 min loop of CPR approaches, to minimise interruptions to CPR and increase the likelihood of shock success 19. After defibrillation of a shockable rhythm and 2 mins of CPR, you prepare for rhythm assessment. You observe the following rhythm, then you: A. Debribrillate and administer adrenaline (epinephrine) 1mg 1:10,000 IV B. Disarm the defibrillator and check for an output C. Recommence CPR and adrenaline (epinephrine) 1mg 1:10,000 IV (if the patient is unresponsive and pulseless D. Identify the rhythm as Ventricular Fibrillation 20. In an asystole arrest, after commencing CPR and administering adrenaline (epinephrine) 1mg 1:10,000 IV A. Administer atropine 1mg repeated to a maximum of 3mg B. Intubation is the highest priority C. Administer atropine 1mg once only D. Consider and treat the reversible causes 21. If the initial defibrillation shock fails to revert pulseless ventricular tachycardia, identify the first drug that should be given to improve myocardial and cerebral perfusion: A. Lignocaine B. Amiodarone C. Magnesium D. Adrenaline (epinephrine) 22. Adrenaline (epinephrine): A. Increases peripheral blood flow due to vasodilation B. Increases cerebral and coronary perfusion pressure C. Has both alpha and beta effects D. Can be administered via an LMA if unable to achieve IV or IO access 23. Regarding the use of amiodarone: A. It reduces the duration of the action potential and refractory period B. It slows atrioventricular conduction C. It has a positive inotropic action and causes peripheral vasoconstriction D. Adverse effects include AV block and hypotension 24. The use of atropine in a cardiopulmonary emergency is limited to: A. Following amiodarone is in a VF/VT arrest B. One dose only, 20 minutes after the patient arrested C. Symptomatic bradycardia D. Intravenous administration only 25. Sodium Bicarbonate: A. Dosage is 1mmol/kg given IV or IO over 2-3 minutes B. Should be considered immediately during a cardiac arrest C. Is given during a cardiac arrest when the patient has a documented alkalosis D. May inactivate adrenaline (epinephrine) if given in the same line