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Toronto Written Examination Questions
and Answers Already Passed
During a breech delivery, how long do you wait after the delivery of the baby's head before attempting the mauriceau smellie veit maneuver? ✔✔2-3 minutes
What is the croup dosage for a 6kg 11 month old infant? ✔✔2.5 mg of epinephrine nebulized
Cardiac Ischemia patient no hx of nitro, SBP 110, NSTEMI - whats the nitro dosage? ✔✔NA - no hx
Cardiac ischemia pt, you're PCP IV, SBP 120, STEMI + 12 lead - whats the nitro dose? ✔✔0.3/0.4 mg X 3 doses (every 5 minutes)
Cardiac ischemia pt, pt has taken nitro before, SBP 165, NSTEMI - whats the nitro dose? ✔✔0.3/0.4 mg X 6 doses (every 5 minutes)
Pt with CHF, HR is 160, SBP is 155, Hx of nitro use - whats the nitro dose? ✔✔NA - no nitro d/t HR parameter
Pt with CHF, HR is 135, SBP is 143, you're PCP IV - whats the nitro dose? ✔✔0.6/0.8 mg X 6 doses (every 5 minutes)
Pt with CHF, HR is 125, SBP is 123, you're PCP IV - whats the nitro dose? ✔✔0.3/0.4 mg X 6 doses (every 5 minutes)
Hypoglycemic pt, 5 y/o, what is the dose of D10? ✔✔4g in 40 mL X 2 doses (every 10 minutes)
Hypoglycemic pt., 12 y/o, 50kg, what is the dose of D10? ✔✔10g in 100 mL X 2 doses (every 10 minutes)
Which of the following is NOT allowed to sign a DNR?
a. RT
b. RN
c. RPN
d. MD ✔✔a. RT
Whats the GCS of a pt who opens eyes to pain, responds with incomprehensible sounds/ speech, and has decorticate posturing ✔✔2 + 2 + 3 = 7
Whats the GCS of a pt who opens eyes to verbal, responds to questions inappropriatly, and moves with painful stimulus? ✔✔3 + 3 + 5 = 11
You have 1800 psi in your D tank, and you need to transport a patient on a nasal cannula at 4 L/min to Cambridge, how much time do you have before you have to change your tank? ✔✔ 64 minutes
You have 1500 psi left in your M tank, and youre transporting a patient on an NRB at 10L/min, how much time until the tank runs out? ✔✔202.8 minutes
What is the population of Toronto? ✔✔2,731,
What is the population of the GTA? ✔✔6,196,
What is the North boundary of Toronto? ✔✔Steeles Avenue
What is the South boundary of Toronto? ✔✔Lake Ontario
What is the West boundary of Toronto? ✔✔Etobicoke Creek and highway 427
What is the East boundary of Toronto? ✔✔Rouge river and rouge park
What is the suction value for infants? ✔✔60-100 mmHg
What analgesic drug should be given for renal colic pain? ✔✔ketorolac
What are 3 identifiers of appendicitis pain? ✔✔RLQ, umbilical, McBurney's point (1/3 the distance from the ASIS to umbilicus)
What is Beck's triad? what are the 3 factors? ✔✔Cardiac tamponade - JVD, muffled heart sounds, hypotension
What is Cushings triad? what are the 3 factors? ✔✔Increased ICP - increased PP, decreased pulse rate, decreased respirations
What leads when elevated, indicate an occlusion of the circumflex artery? ✔✔I, avL, V5, V
What leads when elevated, indicate an occlusion of the left anterior descending coronary artery, aka the widow maker? ✔✔Anterior leads, V3 and V
- possible lateral (I, avL, V5, V6) or septal (V1, V2) involvement
What leads when elevated, indicate an occlusion to the posterior descending artery (branched from the RCA)? ✔✔Posterior STEMI, ie. elevation in the II, III, and AvF leads.
What leads might show elevation when the right coronary artery becomes occluded? ✔✔Inferior STEMI (II, III, avF) and a posterior STEMI (V3 and V4 ST depression (> 2mm) and a large R wave in V2-3)
What are signs of DKA? ✔✔polyuria, tachypnea, dehydration, confusion, abdominal pain, nausea and vomiting, fruity breath, excessive thirst, frequent urination
What are signs of Respiratory acidosis? What will the ETCO2 come back as? ✔✔Failure of ventilation (hypoventilation > hypoxia, rapid shallow respirations), body is inadequately blowing
off CO2 created by body's metabolic processes. ETCO2 will be high. S&S are tremor, decreased BP, headache, dysrhythmias (d/t increased potassium), drowsiness, dizziness
What are causes of respiratory acidosis? ✔✔respiratory depression (anesthesia, overdose, increased ICP), FBAO, decreased alveolar capillary diffusion (pneumonia, COPD, ARDS, PE)
What are S&S of respiratory alkalosis? what will the ETCO2 measurment be? ✔✔Seizures, deep rapid breathing, hyperventilation, tachycardia, decreased/normal BP, hypokalemia, numbness/ tingling extremities, lethargy/ confusion, light headedness, nausea/ vomiting
What are the causes of respiratory alkalosis? ✔✔hyperventilation (anxiety, PE, fear), mechanical ventilation
What are the S&S of metabolic acidosis? ✔✔headache, decreased BP, hyperkalemia, muscle twitching, warm/ flushed skin, N/V/D, changes in LOC, Kussmaul breathing (deep rapid breathing)
What are causes of metabolic acidosis? ✔✔DKA, severe diarrhea, renal failure, shock
What are the causes of distributive shock? (by subtype) ✔✔Septic shock: infection in the body > vaso/veno dilation > drop in blood pressure > blood pooling, increased cap permeability > 3rd spacing > reduced preload, depressed myocardial contracility
Anaphylactic shock: allergic reaction > pulmonary vasoconstriction, veno arteriolar dilatation, and increased capillary permeability
Neurogenic shock: injury to spinal cord > loss of sympathetic tone > vasodilation and lack of compensatory tachycardia and peripheral vasoconstriction
What are the S&S of distributive shock? ✔✔S&S: high cardiac output, hypotension, increased pulse pressure, low diastolic pressure, warm capillaries (good cap refill)
What is distributive shock? ✔✔vasodilatory shock, causing inadequate tissue perfusion. Systemic vasodilation leads to decreased blood flow to brain/ heart/ kidneys causing damage to vital organs.
What is obstructive shock? ✔✔Conditions that obstruct the blood flow, decrease the perfusion and cause shock
What causes obstructive shock? ✔✔intrinsic or extrinsic ( obstruction of circulation, inability to produce adequate cardiac output despite normal intravascular volume and myocardial function
What are the S&S of obstructive shock? ✔✔- tension pneumo > absent breath sounds
- cardiac tamponade > distant heart sounds
- PE > chest pain, dyspnea, hemoptysis, swollen calf
- fluid overload
- JVD
What is cardiogenic shock? ✔✔Your heart suddenly cant pump enough blood to meet your body's needs. Pump failure, arrhythmias, decompensated stenosis, heart valve failure.
What causes cardiogenic shock? ✔✔weakening of the heart
-MI
-arrhythmias
-impaired valves
What is the order of the brainstem from superior to inferior? ✔✔midbrain, pons, medulla
What are the cranial nerves from I - XII? ✔✔I: olfactory, II: optic, III: oculomotor, IV: trochlear, V: trigeminal, VI: abducens, VII: facial, VIII: vestibularcochlear, IX: glossopharynx, X: vagus, XI: accessory, XII: hypoglossal
What does the olfactory nerve control? ✔✔smell
What does the optic nerve control? ✔✔vision
What does the occulomotor nerve do? ✔✔movement of eyeball
What does the trigeminal nerve control? ✔✔sensation of touch, taste, mastication, movement of lower jaw
What does the facial nerve control? ✔✔taste, salivation, tear secretion
What does the glossopharyngeal nerve do? ✔✔taste, salivation, swallowing
What does the vagus nerve do? ✔✔Gastric and pancreatic secretion, GI movement, cardiac reflex, visceral reflex, respiratory reflex
What does hypoglossal nerve do? ✔✔tongue movement
How many lobes and fissures does the right lung have? ✔✔3 lobes 2 fissures
If you suspect child abuse, what is the appropriate procedure? ✔✔1. ensure patient is not left alone
- request police assistance at scene when believe patient is at risk of imminent harm
- obtain clear hx: check validity of story provided, interaction between parents/caretakers and children, parents response to childs injury/ distress, appropriateness of childs behaviour relevant to situation
- make no comments about suspicions to parents/ bystandards
- always transport child
If elder abuse is suspected, it must be reported to whom? ✔✔police notified, and receiving hospital
In what 6 conditions require consistent high concentration oxygen? ✔✔1. confirmed/suspected carbon monoxide/ cyanide toxicity or noxious gas exposure
- upper airway burns
- scuba diving related disorders
- ongoing cardiopulmonary arrest
- compete FBAO
- sickle cell anemia with suspected vaso-occlusive crisis
If the pulse oximetry is not functioning, or no interpretable wave form, give high concentration oxygen to patients with critical findings such as: ✔✔age-specific hypotension, respiratory distress, cyanosis/ ashen colour/ pallor, altered LOC, abnormal pregnancy/ labour
When should the report be given for CTAS 1 and 2 patient? ✔✔report should be given on route to hospital
What are the physiological criteria for FTT? ✔✔1. patient does not follow commands
- systolic blood pressure < 90 mmHg
- respiratory rate <10 or >/= 30 breaths/ min OR need for ventilatory support
AND < 30 minutes to LTH
What are the anatomical criteria for FTT? ✔✔1. penetrating injuries to head, neck, torso and extremities proximal to elbow or knee
- chest wall instability or deformity
- two or more proximal long-bone fractures
- crushed, degloved, mangled, or pulseless extremity
- amputation proximal to wrist or ankle
- pelvic fractures
- open or depressed skull fracture
- paralysis
AND < 30 min TT to LTH
If you are unable to secure the patients airway or suvival to LTH is unlikely, where should you transport the pt? ✔✔closest emergency department
If your pt has a penetrating trauma to the torso or head/neck AND VSA but not TOR AND land transport is < 30 minutes - where do you transport them? ✔✔LTH
- VSA AND TOR approved by BHP
- VSA and subject of a withold resuscitation order given be BHP
What is the effect on a RBC if emersed in a hypertonic solution? ✔✔Water moves from blood to solution > RBC will shrivvel
What is the effect on a RBC if emersed in an isotonic solution? ✔✔No net movement of water, cell remains normal in size
What is the effect on a RBC if emersed in an hypotonic solution? ✔✔Water moves from solution to cell (lysed, and overflowing)?
What are signs of heat stroke vs heat exhaustion? ✔✔heat exhaustion: faint/ dizzy, excessive sweating, cool/pale/clammy, N/V, rapid/ weak pulse, muscle cramps
heat stroke: throbbing headache, no sweating, body temperature above 103 degrees, N/V, rapid/ strong pulse, decreased LOC
What are examples of a hypertonic solution? ✔✔>/= 3% saline, dextrose, ringers lactate
What are examples of a hypotonic solution? ✔✔Saline solution (<= 0.4%NaCl)
What are examples of isotonic solutions? ✔✔0.9% saline
What is the order of treatment for a wound to an extremity? ✔✔1. apply direct digital pressure at site of bleeding
- apply a tourniquet, if tourniquet fails to stop bleeding completely or cannot be used for any reason then apply 2nd tourniquet
- pack the wound with hemostatic dressing if appropriate and available or std gauze, maintain pressure and secure with pressure dressing.
What is the order of treatment for a wound to a junctional location? (head, shoulders, armpit, neck, pelvis, groin) ✔✔1. apply well-aimed, direct digital pressure at the site of bleeding
- pack the wound with hemostatic dressing if appropriate and available or standard gauze, maintain pressure an secure with a pressure dressing
What is the order of treatment for a wound to the hollow spaces of the skull/ chest/ abdomen? ✔✔1. apply manual digital pressure with a flat palm and a hemostatic dressing where available and applicable OR a std gauze if not.
