EPRC Clinical Course 8hr

A patient suffering blast effect presents with dyspnea, some hearing loss, and tinnitus following an explosion. Which of the following is NOT a likely diagnosis?


Intestinal rupture

 


Following a nuclear detonation, some of the casualties with survivable injuries are possibly contaminated with radiological material. Which of the below courses of action is most appropriate for the situation?


Treat all life-threatening injuries first.

 


An explosion casualty suffering from crush injuries of the lower extremities has been admitted to your hospital with severe hyperkalemia. What emergency treatment is NOT recommended?


Limit fluids.

 


A patient is suffering from painful, highly corrosive burns similar to acid, and wheals have begun to appear on the skin. Which vesicant (blister agent) is suspected?


Phosgene oxime

 


You are certain that your patient, who is now convulsing from nerve agent exposure, has already received three MARK 1/ATNAA kits and their diazepam. What else should be done?


All of the Above

 

 

Provide ventilator assistance, oxygen, and IV fluids
Administer more atropine to reduce secretions and relax the airway
Give more diazepam to prevent seizures


Wearing can put the responder at considerable risk both physically and psychologically. Which of the following is NOT considered a risk factor?


Hyperactivity

 


What type of laboratory test(s) would NOT be conducted if you suspect a patient has contracted plague?


Gas Chromatography-Mass Spectrometry

 


Which of these are fast-acting compounds that attack oxygen-dependent tissues known to be particularly sensitive to these compounds?


Cyanide Compounds

 


In industry, cyanide compounds are widely used during:


All of the Above

Plastic production
Gold and silver extraction
Hide tanning

 


Which post disaster phase is generally characterized by optimism due to an infusion of resources?


Honeymoon phase

 


Select the three components, in correct order of administration, utilized in the treatment for cyanide exposure.


Amyl nitrite, sodium nitrite, sodium thiosulfate

 


Which of the following statements does NOT describe spores produced by Bacillus anthracis, causative agent of anthrax?


Sensitive to UV light.

 


One of the contributing factors to stress reactions is the physical factor. Which of the following is associated with this factor?


preexisting medical conditions

 


________ damage brings death very quickly so that the consequences of exposure to other systems do not have time to express themselves.


Neurovascular

 


When conducting a medical assessment, what status is checked first?


Respiratory Status

 


A group of victims has been admitted to your triage unit. All victims have recently been in an area where canisters exploded spraying them with an amber colored liquid that smells like flowers and burns intensely. You suspect Lewisite.
Which of the following is not a consideration during treatment of the victims?


Unroofing of blisters.

 


Disaster victims presenting for medical care should be assessed for common short-term stress reactions which fall into what categories EXCEPT?


Intellectual

 


All of the following are procedures for activating the Incident Command System (HICS) EXCEPT:


Refer to your Job Action Sheet (JAS) for response duties

 


What treatment should be given to a patient exposed to T-2 mycotoxins via ingestion?


Therapy for poison ingestion including the administration of super-activated charcoal.

 


Which of the following bacterial diseases is contagious person to person?


Pneumonic plague

 


How is the victim of nerve agent exposure presenting with convulsions classified?


Immediate

 


Experts anticipate that a ________ incident is the least likely to occur but would have a great impact upon the environment and people.


Nuclear

 


What is the most available explosive agent?


Nitroglycerin

 


An all-hazards approach affects preparedness by allowing communities to:


Increase the speed, effectiveness, and efficiency of incident management.

 


A patient presents to the hospital. He has been feeling ill since his return from safari in Africa a few days ago. He exhibits symptoms of fever, mild hypotension, flushing, conjunctival injection, and now a bad rash has appeared that is bleeding in spots. What type of viral infection do you suspect?


Viral Hemorrhagic Fever

 


__________ occurs outside of the incident area when people come in contact with a contaminated person or object.


Secondary Contamination

 


What type of care is a stress management component that fosters a mourning process and helps treat psychological stress reactions?


Pastoral care

 


One of the five intervention principles in the management of the stress response is promoting the sense of safety. How can this be accomplished?


Leadership provide an accurate, organized voice to help circumvent threat

 


Used in life-threatening situations, the goal is to remove contaminant as quickly as possible.


Immediate decontamination

 


What type of biological toxin is predominantly derived from the bean of the castor plant?


Ricin

 


What form of ionizing radiation can penetrate deeply into body tissue?


Photon

 


What is the comprehensive preparedness required to manage the casualties resulting from the host of possible hazards?


All-hazard preparedness

 


A metallic taste in the mouth, epigastric distress, and possible nausea and vomiting are ingestion symptoms for which chemical agent?


Cyanide

 


The primary toxicity of pulmonary agents is to the ________ and follows __________ of smoke, particles, vapors, or gases.


airways, inhalation

 


Penetrating trauma caused by shrapnel is usually attributed to which of the following?


Secondary blast effect

 


Which nerve agent is the most persistent, is very oily, and will stay active in an area for several days?


VX

 


What blood test is available that will give an accurate estimate of radiation dose?


Lymphocytes count

 


Secretary of Defense has the responsibility to provide defense support to civil authorities when the actions:


are legal

 


Which of the following is considered a pulmonary (choking) agent?


Chlorine

 


For which virus is the mosquito not known as a possible vector?


Smallpox

 


What Mission Oriented Protective Posture (MOPP) level provides the greatest level of protection?


IV

 


What directive establishes policies to strengthen the preparedness of the US to prevent and respond to threatened or actual domestic terrorist attack, major disasters and other emergencies by requiring a national domestic all-hazards preparedness goal?


Presidential Policy Directive-8

 


Decontamination will be conducted in the __________ hazard zone.


Warm

 


What types of CBRNE agents are man-made and act rapidly, burn and blister skin, mucous membranes, airways and gastrointestinal systems?


Vesicants

 

 

Personal Protective Equipment (PPE) is generally divided into two categories. They are:


Respiratory Protection & Chemical Protective Garments

 


A secondary explosive device has been spotted. Which of the following options describes how to proceed?


Withdraw at least 50 yards from the scene and tell the Incident Commander (IC) immediately.

 


How is the victim of a pulmonary agent exposure presenting with respiratory distress less than 4 hours after exposure classified?


Expectant

 


Over 20 people who worked together developed cough, excess fluid in their lungs, and difficulty breathing. Chest x-rays show bilateral infiltrates with bronchial aspirates rich in protein. Several died. What was the likely agent?


Ricin

 


Which of the following cell types are most sensitive to radiation damage?


Cells that are actively dividing

 


A patient was admitted to the hospital suffering from the following symptoms for the past week: fever, chills and weakness, very swollen tender lymph nodes of bubo, and skin ulcerations. He states the ulcerations are exactly where very small insects bit him. Which type of plague is responsible for the patient's symptoms?


Bubonic

 


A patient presents to the emergency room all exhibiting the following symptoms: nausea, vomiting, problems with eye movement, dry mouth, sore throat, difficulty swallowing, no gag reflex, and extreme weakness. Patient is alert and oriented during the exam. What toxin do you suspect and how do you treat it?


Botulinum toxin, supportive care and antitoxin.

 


The amount of radiation that an individual absorbs depends on ____?


All of the Above

Time exposed to a radioactive source
Distance a person is from a radioactive source
Type and amount of shielding between a person and a radioactive source

 


What command system is a widely used and accepted tool for command, control and coordination of a response to a disaster?


Incident Command System

 

 

Definitive diagnosis of Viral Hemorrhagic Fever rests on _______________.


Specific virologic diagnosis

 


What is the role of the liaison officer within the Hospital Incident Command System (HICS)?


Function as the incident contact person for representatives from other agencies

 


What is the purpose of a secondary device?


Injure or kill first responders

 


Wearing PPE can put the responder at considerable risk both physically and psychologically. Which of the following is NOT considered a risk factor?


Hyperactivity

 


Which of the following decontamination method is NOT recommended for removing vesicants from
casualties?


Wash patient with their clothing still on.

 


Type of decontamination that is carried out by a unit to reduce contamination equal to natural background or to the lowest level possible.


Thorough

 


Which of the following is NOT relevant to a laboratory diagnosis of smallpox (variola)?


A positive Tzank smear

 


Which of the bacterial diseases produces a non-specific illness that may produce a prolonged disability but is rarely fatal?


Q Fever

 


What phase is characterized by improvement of symptoms but becomes shorter with increasing doses.


Latent

 


ICS has been used to manage incidents such as fires, earthquakes, hurricanes, and acts of terrorism. Which of the following situations represents another viable application for the use of ICS?


The planning and operation of the Central City annual Labor Day celebration, including a parade and fair.

 


Victims caught in a fire have inhaled toxic smoke from furnishings and plastics that have released cyanide in the burning process. What precaution/side effects should you be aware of when administering cyanide antidotes?


Sodium nitrite can increase methemoglobin levels, which will decrease blood oxygenation

 


Experts anticipate that biological incidents are ________________.
the most likely to occur, and will have the greatest impact on the greatest number of people.


How does cyanide cause cell death in the body?


Interferes with anaerobic metabolism of the cell

 


All-hazards are often categorized as:


Man-made: technological

 


Radiation burns, which cause delayed, irreversible changes of the skin, can be caused by high doses of what form of ionizing radiation?


Beta

 


A bomb blast victim presents with nausea and abdominal pain. A Computed Tomography (CT) scan shows no hemorrhage. What treatment should be recommended?


Admit patient for observation for 12 to 24 hours in case a hematoma develops.

 


You are certain that your patient, who is now convulsing from nerve agent exposure, has already received three MARK 1/ATNAA kits and their diazepam. What else should be done?


All of the Above

 


Vesicant (blister) agents include all of the following, EXCEPT:


Sarin (GB)

 


Which phase of CBRN response synchronizes planning and execution efforts with the efforts of the supported civil authorities?


Phase III - Operate

 


What form of ionizing radiation is the least penetrating?


Alpha

 


The Disaster Mental Health Response Team can be called upon to assist victims and disaster responders. Which of the following is NOT a service that they may provide:


Provide professional psychological treatment

 


The majority of the injuries to gas-containing organs is usually attributed to which of the following?


Primary blast effect

 


What type of explosive is widely used by the military, and is one of the least sensitive explosives.


TNT

 


An all-hazards approach affects preparedness by allowing communities to:


increase the speed, effectiveness, and efficiency of incident management.

 

 

What bacterial infection requires confirmation through serological testing since it is difficult to culture the organism (causative agent)?

Q Fever

 


Which of the following statements does NOT describe Brucellosis?


The brucellae are highly infectious via the aerosol route and brucellosis is associated with a high mortality rate.

 


An explosion victim was admitted to your facility approximately 4 hours ago with chest pain, normal oxygenation and radial pulse. His condition continues to worsen with symptoms that include labored, rapid breathing, low blood pressure, and semi-consciousness. What emergency treatment would be appropriate?


Intubate and provide assisted ventilation with PEEP

 


Treatment of patients suffering from pulmonary agent exposure should focus on?


Recognizing which compartment(s) are damaged and minimizing that damage.

 


What technique may be used to test for T-2 Mycotoxins in environmental and clinical samples?
Gas Chromatography-Mass Spectrometry


MOPP Level __ has flexibility built into the system to allow relief during hot weather.
IV

 


Which of these are fast-acting compounds that attack oxygen-dependent tissues known to be
particularly sensitive to these compounds?


Cyanide Compounds

 


A patient is suffering from painful, highly corrosive bums similar to acid, and wheals have
begun to appear on the skin. Which vesicant (blister agent) is suspected?


Phosgene oxime

 


This form of detection provides warning in sufficient time to implement protective and/or
treatment measures before exposure to agent.


Detection to protect or treat

 


Which of the following bacterial agents is contagious person to person?


Pneumonic plague

 


Disaster victims presenting for medical care should be assessed for common short-term
stress reactions which fall into all categories EXCEPT?


Intellectual

 


One of the five intervention principles in the management of the stress response is promoting
the sense of safety. How can this be accomplished?


Leadership provides an accurate, organized voice to help circumvent the threat

 


___ may be thought of as a form of identification.


Detection to protect or treat

 


What color triage tag would be used for a patient that requires immediate treatment?


Red

 


What type of CBRNE agent acts by inhibiting a crucial enzyme called acetylcholinesterase
(AChE)?


Nerve

 


How is the victim of a pulmonary agent exposure presenting with respiratory distress less
than 4 hours after exposure classified?


Expectant

 


When washing with water, what procedures should be used when decontaminating a patient
that has been exposed to a CBRNE agent?


Use high-flow, low-pressure water for 2-3 min. Gently scrub with soap and water using a
soft b1istle brush.

 


Which post disaster phase is generally characterized by optimism due to an infusion of
resources?


Honeymoon phase

 


A male, non-smoking chemical worker is accidentally exposed to phosgene. The chest
radiograph taken 2 hours post-exposure is normal. Should you discharge him?


No, because pulmonary edema normally takes longer to develop, he should be closely
watched

 


Secretary of Defense has the responsibility to provide defense support to civil authorities
when the actions:


Are legal

 


Following a nuclear detonation, some of the casualties with survivable inju1ies are possibly
contaminated with radiological material. Which of the below courses of action is most
appropriate for the situation?


Treat all life-threatening injuries first

 


In a stress management briefing, a clinician attendee says this is the first disaster to which
she has been called. She states her biggest frustration is that no one has really defined her role.
What category of stressor is this responder experiencing?


Occupational factors

 


When should the self-protection measures of time, distance, and shielding be implemented?


Immediately upon arrival at the incident scene

 


How is the victim of a vesicant agent presenting with pulmonary distress more than 4 hours
after exposure classified?


Immediate

 


The Disaster Mental Health Response Team can be called upon to assist victims and
disaster responders. ·which of the following is NOT a service that they may provide:


Provide professional psychological treatment

 


Which nerve agent is the most persistent, is very oily, and will stay active in an area for
several days?


vx

 


A patient who works at an insecticide manufacturing plant is admitted to the emergency
room. He states he was splashed with a large quantity of liquid and is now exhibiting symptoms
of vomiting, diarrhea, difficulty breathing, body twitching and is generally very weak. What is
the preferred treatment to block the effects of accessive ACh?


Administer additional 2-PAM

 


Which of the following is NOT critical in the treatment of a nerve agent casualty?


Administering pyridostigmine bromide (PB)

 


What directive establishes a single comprehensive national incident management system
that allows all levels of government to work efficiently and effectively together?


Homeland Security Presidential Directive-5

 


Wearing PPE can put the responder at considerable risk both physically and
psychologically. Which of the following is NOT considered a risk factor?


Hyperactivity

 


What level of civilian chemical equipment would healthcare providers don when providing
initial medical treatment after an incident but not involved with decontamination?
Level C


What is the value of ve1ification or confirmation of biological agents?


Determination of genetic differences in pathogens may allow determination of source
laboratories

 


The maj01ity of injuries to gas-containing organs are usually attributed to which of the
following?


Primary blast effect

 


For which vims is the mosquito not known as a possible vector?


Smallpox

 


An explosion victim was admitted to your facility approximately 4 hours ago with chest
pain, nonnal oxygenation and radial pulse. His condition continues to worsen with symptoms
that include labored, rapid breathing, low blood pressure, and semi-consciousness. What
emergency treatment would be appropriate?


Intubate and sedate

 


Which of the following decontamination method is NOT recommended for removing
vesicants from casualties?


Wash patient with their clothing still on

 


Radiodermatitis, which causes delayed, in-eversible changes of the skin, can be caused by
high doses of what form of ionizing radiation?


Beta

 


A patient presents to the hospital. He has been feeling ill since his return from safari in
Africa a few days ago. He exhibits symptoms of fever, mild hypotension, flushing, conjunctival
injection, and now a bad rash has appeared that is bleeding in spots. What type of viral infection do you suspect?


Viral Hemorrhagic Fever

 


Experts anticipate that biological incidents are ________
most likely to occur, and will have the greatest impact on the greatest number of people
What type of decontamination neutralizes the contaminant?


Chemical decontamination

 


Processed foods and temperature-abused foods are most commonly associated with
____ poisoning.


Staphylococcal Enterotoxin B (SEB)

 

 

A metallic taste in the mouth, epigastric distress, and possible nausea and vomiting are
ingestion symptoms for which chemical agent?


Cyanide

 


What is the correct order for the phases of Acute Radiation Syndrome (ARS)?


Prodromal, latent, and manifest

 


What type of ionizing radiation is the least penetrating?


Alpha

 


Which of the following CBRNE Consequence Task Pillars coordinates activities that
include exercise; warning and reporting; and command and control.


Coordinate operations

 


START stands for ____ ?


Simple Triage and Rapid Treatment

 


What type of explosive is widely used by the military, and is one of the least sensitive
explosives.


C-4

 


The following equipment is used for collection and/or detection of biological agents,
EXCEPT:


Surface Acoustic Wave (SAW) detectors

 


Definitive diagnosis of Viral Hemorrhagic Fever rests on -------


Specific virologic diagnosis

 


Pulmonary (choking) agents primarily enter the victim by what means?


Inhalation

 


__________ occurs outside of the incident area when people come in contact with a
contaminated person or object.


Secondary contamination

 


A patient suffering blast effect presents with dyspnea, some hearing loss, and tinnitus
following an explosion. Which of the following is NOT a likely diagnosis?


Intestinal rupture

 


Victims caught in a fire have inhaled toxic smoke from furnishings and plastics that have
released cyanide in the burning process. What precaution/side effects should you be aware of
when administering cyanide antidotes?


Sodium nitrite can increase methemoglobin levels, which will decrease blood oxygenation

 


What types of objects might a terrorist use to disguise a secondary explosive device?


All of the above

Knapsack, backpack, or parcel
Trash can or dumpster
Automobile or truck

 


Attendants at the hockey game are complaining of a strange smell and headaches. Some
have begun to vomit. Only those in the arena seem to be affected. Which CBRNE agent would
most likely produce this outcome?


Chemical

 


An avid outdoorsman who was hunting rabbits about a week ago presents with the
following symptoms: fever, headache, sore throat, diarrhea, conjunctivitis, and inflammation of
lymph nodes. What is responsible for the patient's symptoms?


Tularemia

 


What bacterial infection requires confirmation through serological testing, because it is
difficult to culture the organism (causative agent)?


Q Fever

 


Your patient is recovering from injuries sustained in a terrorist incident and is exhibiting
stress symptoms. Which of the following is a common behavior reaction associated with severe
short-term stress reactions?


Substance abuse

 


Burned skin, shrapnel wounds, blunt trauma injuries, and ruptured organs may be
symptoms of what type of CBRNE exposure?


Explosives

 


Who is responsible for directing the command and control of all operations.


Incident Commander

 


What CBRNE agent inhibits the enzyme AChE allowing Ach to accumulate affecting the
way cells transmit signals to the body?


Nerve agents

 


Your unit has responded within minutes to a suspected CBRNE incident. Select the
important steps that you should take.


Practice protective measures of time, distance, and shielding

 

 

A patient was admitted to the hospital suffering from the following symptoms for the past
week: fever, chills and weakness, very swollen tender lymph nodes of bubo, and skin
ulcerations. He states the ulcerations are exactly where very small insects bit him. Which type
of plague is responsible for the patient's symptoms?


Bubonic

 


The decontamination site should NOT be located:


Near waterways and drainage systems

 


What command system is a widely used and accepted tool for command, control, and
coordination of a response to a disaster?


Incident Command System

 


Advantages of adopting a comprehensive all-hazards approach includes the following
EXCPECT:


Attent10n is directed towards a single hazard

 


Which of the following is NOT a physical requirement of those expected to wear PPE?


Ability to handle emergency condition;

 


Which of the following cell types are least sensitive to ionizing radiation damage?


Cells that divide slowly (correct)

 


A group of people is presenting with a delayed onset of blisters and a dry productive cough that later turns productive. What is the likely culprit?


Mustard

 


__________ occurs when people come in direct contact with a harmful agent at or near an incident.


Contamination

 


Patient presents with 5-day-old blisters/rash mostly on the arm, face, and hands. No scabs are present. Patient reports fever started several days before blisters appeared. Based on the information would you suspect chickenpox or smallpox?


Smallpox, because the rash is centrifugal on the patient

 


How do nerve agents produce effects in the body?

 

They inhibit the enzyme Acetylcholinesterase (AChE) allowing Acetylcholine (ACh) to accumulate

 


A nerve gas attack has occurred in one of the city's underground subway stations. This is the second attack this month. After arriving on the scene, a veteran responder, considered a "tough guy" by his team, freezes up and is unable to continue. After talking to him, you determine he responded to the previous attack. What personal situation stressor is this veteran exhibiting?


Prior disaster experience

 


A patient is exhibiting the following symptoms: fever, cough, dyspnea, prominent gastrointestinal symptoms, and absence of buboes. Which form of plague is responsible?


Pneumonic

 


Which of the following bacterial diseases typically produce ulcers on the skin?


Tularemia

 


Patients with concurrent surgical injuries and radiation exposure should either be operated on expeditiously or _____________________________.


delayed until past the time of bone marrow suppression and delayed wound healing

 


How is the victim of vesicant (blister agent) exposure with skin burn over less than 5 percent of Body Surface Area (BSA) and minor eye irritation classified?


Minimal

 


A patient was admitted to the hospital suffering from the following symptoms for the last 5 days: fever, malaise, fatigue, and nonproductive cough. Chest x-rays reveal a widened mediastinum and the patient's white blood cell count is elevated. Which type of anthrax is responsible for the patient's symptoms?


Inhalational

 


Which of the following is NOT a challenge in gaining access and acceptance?


similar cultural values

 


Smallpox can spread from one person to another by the following routes:


All of the Above

 


Which phase of CBRN response focuses on the prioritization of forces to deploy for mission task?


Phase II – Response

This article will provide you with the complete questions and answers to EPRC Clinical Course 8hr


During which post disaster phase do survivors realize that they will need to solve their problems of rebuilding their homes, businesses, and lives and have gradually assumed the responsibility to do so?

Reconstruction/Recovery Phase

 

Cyanide is historically found in the following EXCEPT:

Teflon