KO: Emergency Preparedness and Response Course - CBRN for Medical Personnel and First Responders (4 hrs).

1) 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 excessive ACh?
Administer additional 2-PAM Cl (correct)
Administer two-three Mark I kits
2 mg atropine IV
Administer diazepam

2) Vesicant (blister) agents include all of the following, EXCEPT:
Nitrogen Mustard (HN)
Sarin (GB) (correct)
Lewisite (L)
Phosgene oxime (CX)

3) 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?
Cyanide
Phosgene oxime
Mustard (correct)
Sarin

4) Which of the following decontamination method is NOT recommended for removing vesicants from casualties?
Wash patient with their clothing still on. (correct)
Remove patients clothing, ensure agent does not contact skin during removal.
Use a stick to remove large globs of agent off the skin.
Use the M291 decontamination kit to absorb the agent.

5) 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. (correct)
Decontaminate victims by washing, flush eyes for at least 5 minutes.
Aggressive fluid management.
If available, administer antidote BAL.

6) Cyanide is historically found in the following EXCEPT:
Teflon (correct)
Burning plastics
Seeds of plants
Gold and silver mining operations

7) Which of these are fast-acting compounds that attack oxygen-dependent tissues known to be particularly sensitive to these compounds?
Cyanide Compounds (correct)
Vesicants
Nerve
Pulmonary

8) How does cyanide cause cell death in the body? [Remediation Accessed :N]
Interferes with anaerobic metabolism of the cell (correct)
Inhibits the enzyme AChE
Inhibits ability of blood to coagulate
Inhibits ability of nerves to transmit messages

9) A metallic taste in the mouth, epigastric distress, and possible nausea and vomiting are ingestion symptoms for which chemical agent?
Cyanide (correct)
Nerve
Pulmonary
Vesicants

10) You approach the scene of a terrorist incident that occurred 2 minutes prior in an enclosed room. It is reported that the smell of bitter almonds is in the air. The door is open; many victims are lying on the floor. What do you do first?
Don your mask before going into the room (correct)
Don your mask and protective clothing and organize a decontamination station setup
Administer amyl nitrite or sodium nitrite
Administer sodium thiosulfate

11) Select the three components, in correct order of administration, utilized in the treatment for cyanide exposure.
Amyl nitrite, sodium nitrite, sodium thiosulfate (correct)
Sodium nitrite, sodium thiosulfate, amyl nitrite
Amyl nitrite, sodium thiosulfate, sodium nitrite
Sodium thiosulfate, sodium nitrite, amyl nitrite

12) Which of the following is considered a pulmonary (choking) agent?
Cyanide
Soman
Chlorine (correct)
All of the above

13) Pulmonary (choking) agents primarily enter the victim by what means?
Inhalation (correct)
Absorption through the skin
Ingestion
Injection

14) Treatment of patients suffering from pulmonary agent exposure should focus on?
Recognizing which compartment(s) are damaged and minimizing that damage. (correct)
Identifying the agent that caused the injury.
Administering antidotes
Administering antibiotics

15) 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. (correct)
Brucellosis typically presents as a non-specific flu-like illness.
If a diagnosis of brucellosis is suspected in a patient, clinical laboratory specimens (particularly blood cultures) must be processed in a BSL3 laboratory for safety reasons.
Treatment of brucellosis requires a combination therapy with doxycycline and rifampin.

16) Which of the bacterial diseases produces a non-specific illness that may produce a prolonged disability but is rarely fatal?
Q Fever (correct)
Anthrax
Plague
Tularemia

17) Which of the following bacterial diseases typically produce ulcers on the skin?
Tularemia (correct)
Brucellosis
Q fever
Ebola virus

18) 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 (correct)
Septicemic
Pneumonic
Secondary pneumonic

19) Smallpox can spread from one person to another by the following routes:
Aerosols generated by a patient sneezing or coughing
Droplets during face-to-face contact with a patient
Direct contact with the patient's scabs
All of the Above (correct)

20) For which virus is the mosquito not known as a possible vector?
Smallpox (correct)
Yellow Fever
Western Equine Encephalitis
Dengue fever

21) 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 (correct)
Smallpox
Venezuelan Equine Encephalitis
Equine Encephalitis's Virus

22) 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 (correct)
Chickenpox, because the rash is centrifugal on the patient
Smallpox, because there are several blisters on the torso as well
Chickenpox, because the fever presented prior to the rash

23) Processed foods and temperature-abused foods are most commonly associated with ________ poisoning.
Staphylococcal Enterotoxin B (SEB) (correct)
Ricin
T-2 Mycotoxins
Botulinum Neurotoxin

24) What type of biological toxin is predominantly derived from the bean of the castor plant?
Ricin (correct)
Staphylococcal Enterotoxin B
Botulinum Neurotoxin
T-2 Mycotoxins

25) 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. (correct)
Ricin, supportive care and vigorous gastric lavage.
Staphylococcal Enterotoxin B, supportive care and observe for pulmonary edema.
T-2 mycotoxins, supportive care and poison therapy.

26) The amount of radiation that an individual absorbs depends on ____?
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
All of the Above (correct)

27) What form of ionizing radiation is the least penetrating?
Alpha (correct)
Beta
Gamma
Neutrons
28) Which type of nerve agent is the MOST persistent?
VX (correct)
Tabun
Sarin
Soman

29) How is the victim of nerve agent exposure presenting with convulsions classified?
Immediate (correct)
Minimal
Delayed
Expectant

30) Radiation burns, which causes delayed, irreversible changes of the skin, can be caused by high doses of what form of ionizing radiation?
Beta (correct)
Alpha
Photon
Neutrons

31) Which of the following cell types are most sensitive to radiation damage?
Cells that are actively dividing (correct)
Cells that replicate slowly
Cells that do not have a nucleus
Cells that do not divide

32) What blood test is available that will give an accurate estimate of radiation dose?
Lymphocytes count (correct)
Red Blood Cell count
Platelet count
Monocyte count

33) What method is used to estimate a radiation dose by measuring the biological response to an absorbed dose of ionizing radiation?
Biodosimetry (correct)
Biometrics
Radiation Absorbed Dose
Seivert

34) What phase is characterized by improvement of symptoms but becomes shorter with increasing doses.
Latent (correct)
Prodromal
Manifest
Recovery

35) ________ damage brings death very quickly so that the consequences of exposure to other systems do not have time to express themselves.
Neurovascular (correct)
Cardiovascular
Musculoskeletal
Intestinal

36) 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 (correct)
after approximately 4 days, with any required reconstructive surgery scheduled later
delayed until after the prodromal phase to allow the patient to stabilize
after a 1-week course of ticarcillin, combined with an aminoglycoside like tobramycin

37) 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?
Immediately evaluate for radiation exposure.
Debride wounds and administer antibiotics.
Provide comfort and place in expectant category.
Treat all life-threatening injuries first. (correct)

38) Personal Protective Equipment (PPE) is generally divided into two categories. They are:
Respiratory Protection & Chemical Protective Garments (correct)
Body Substance Isolation (BSI)
Mission Oriented Protective Posture (MOPP)
Level D with no mask

39) 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 (correct)
Immediately enter zone and remove casualties
Be aware of wind direction and remain downwind if possible
Do not enter zone until agent is identified

40) What Mission Oriented Protective Posture (MOPP) level provides the greatest level of protection?
I
II
III
IV (correct)

41) Wearing PPE can put the responder at considerable risk both physically and psychologically. Which of the following is NOT considered a risk factor?
Hyperactivity (correct)
Claustrophobia
Heat Stress and increased fatigue
Tactile and dexterity difficulties

42) __________ occurs when people comes in direct contact with a harmful agent at or near an incident.
Contamination (correct)
Exposure
Secondary Contamination
Decontamination

43) __________ occurs outside of the incident area when people come in contact with a contaminated person or object.
Secondary Contamination (correct)
Contamination
Exposure
Decontamination

44) Type of decontamination that is carried out by a unit to reduce contamination equal to natural background or to the lowest level possible.
Thorough (correct)
Operational
Clearance
Immediate

45) Decontamination will be conducted in the __________ hazard zone.
Warm (correct)
Hot
Cold
Incident

46) Used in life-threatening situations, the goal is to remove contaminant as quickly as possible.
Immediate decontamination (correct)
Chemical decontamination
Direct contamination
Physical decontamination

47) The decontamination site should NOT be located:
Near waterways and drainage systems (correct)
Upwind of the hot zone
On a hard, non-porous surface
Uphill from the hot zone

48) What is the best method of decontamination?
Removing clothing and washing with warm soapy water (correct)
Removing clothing only
Washing with 5% hypochlorite solution
Using sand to absorb the chemical

49) How is the victim of a pulmonary agent exposure presenting with respiratory distress less than 4 hours after exposure classified?
Expectant (correct)
Immediate
Minimal
Delayed

50) How do nerve agents produce effects in the body?
They inhibit the enzyme Acetylcholinesterase (AChE) allowing Acetylcholine (ACh) to accumulate (correct)
They inhibit cell aerobic metabolism causing death
They effect receptor cells in the brain causing seizures
They react to water in the body to form an acid