NREMT Paramedic – Medical/OB-GYN — Quick Review

A 55-year-old male presents with crushing substernal chest pain radiating to the left arm, diaphoresis, and nausea. His 12-lead ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?

Right coronary artery

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Left anterior descending artery

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Left circumflex artery

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Left main coronary artery

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A patient with an inferior STEMI develops hypotension after receiving nitroglycerin. The 12-lead ECG also shows ST elevation in right-sided lead V4R. What is the most likely cause of the hypotension?

Right ventricular infarction with preload-dependent hemodynamics

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Left ventricular free wall rupture causing cardiac tamponade

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Acute mitral valve regurgitation from papillary muscle dysfunction

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Cardiogenic shock from massive left ventricular damage

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Which medication should be administered to all patients with suspected acute coronary syndrome who are not allergic and have no contraindications?

Aspirin 324 mg chewed

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Nitroglycerin 0.4 mg sublingual

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Morphine 4 mg intravenous

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Heparin 5,000 units subcutaneous

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A patient presents with severe dyspnea, bilateral crackles to the apices, frothy pink sputum, and a blood pressure of 180/110 mmHg. The SpO2 is 82% on room air. What is the most appropriate initial intervention?

Apply CPAP at 10 cm H2O and administer nitroglycerin for afterload reduction

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Administer a 500 mL normal saline bolus and place the patient supine

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Apply a nasal cannula at 6 liters per minute and obtain IV access only

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Immediately intubate the patient and initiate mechanical ventilation

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A 22-year-old female with a history of asthma presents with severe respiratory distress, use of accessory muscles, and audible wheezing. After two albuterol nebulizer treatments, the patient’s wheezing diminishes but she remains tachypneic with an SpO2 of 89%. What should the paramedic be most concerned about?

Worsening airway obstruction with inadequate air movement causing a 'silent chest'

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Resolution of the bronchospasm with improvement expected shortly

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An allergic reaction to the albuterol requiring diphenhydramine

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Development of a medication-induced cardiac arrhythmia

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Which medication is indicated as an adjunct bronchodilator for severe asthma exacerbations when combined with albuterol?

Ipratropium bromide

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Furosemide

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Methylprednisolone

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Amiodarone

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A 65-year-old male with a history of COPD presents with increased dyspnea, productive cough with purulent sputum, and a low-grade fever. His SpO2 is 86% on room air and ETCO2 is 58 mmHg. Which combination of treatments is most appropriate?

Supplemental oxygen titrated to an SpO2 of 88 to 92%, albuterol and ipratropium nebulizer, and BiPAP if tolerated

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High-flow oxygen via non-rebreather at 15 liters per minute and immediate endotracheal intubation

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Low-flow oxygen at 1 liter per minute by nasal cannula only, withholding bronchodilators

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Albuterol nebulizer only, withholding supplemental oxygen to avoid suppressing respiratory drive

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A paramedic is treating a patient with suspected pulmonary embolism who has acute dyspnea, tachycardia, pleuritic chest pain, and an SpO2 of 84%. The ETCO2 reads 22 mmHg despite the patient’s rapid respiratory rate. What does the low ETCO2 in this context indicate?

Increased dead space ventilation due to a large perfusion defect in the pulmonary vasculature

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Hyperventilation causing the patient to blow off too much carbon dioxide

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A malfunctioning capnography sensor that needs to be replaced immediately

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Adequate compensation for a primary metabolic acidosis from sepsis

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A 68-year-old female presents with sudden onset of right-sided facial droop, slurred speech, and left-sided arm weakness. Symptoms began 45 minutes ago. Her blood glucose is 110 mg/dL. The Cincinnati Stroke Scale is positive. What is the most critical time-sensitive action?

Rapidly transport to the nearest certified stroke center while providing supportive care and obtaining a 12-lead ECG

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Administer aspirin 324 mg because this is likely an ischemic event

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Remain on scene to perform a complete neurological examination and detailed history

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Administer a fluid bolus to improve cerebral perfusion pressure

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A patient is found actively seizing with tonic-clonic movements that have lasted approximately 8 minutes according to bystanders. The patient has no IV access. Which medication and route is the most appropriate first-line treatment?

Midazolam 10 mg intramuscularly

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Phenytoin 250 mg intravenously

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Diazepam 10 mg orally

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Levetiracetam 500 mg intramuscularly

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A patient presents with a severe headache described as ‘the worst headache of my life,’ nuchal rigidity, photophobia, and a brief episode of loss of consciousness. Blood pressure is 190/100 mmHg. What is the most likely diagnosis?

Subarachnoid hemorrhage

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Migraine headache with aura

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Tension-type headache with anxiety

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Acute ischemic stroke of the posterior circulation

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Which stroke assessment scale is designed to identify large vessel occlusion strokes that may benefit from endovascular thrombectomy?

RACE (Rapid Arterial oCclusion Evaluation) scale

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Cincinnati Prehospital Stroke Scale

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Glasgow Coma Scale

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NIH Stroke Scale

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A 72-year-old male presents with sudden onset of severe abdominal pain, a rigid abdomen, and hemodynamic instability with a blood pressure of 78/50 mmHg. He has a known history of abdominal aortic aneurysm. What should the paramedic prioritize?

Immediate transport to a surgical facility with large-bore IV access and cautious fluid resuscitation

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Administer pain medication and perform a detailed abdominal assessment before transport

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Place the patient in a left lateral recumbent position and administer high-flow oxygen only

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Obtain a 12-lead ECG and treat for suspected acute coronary syndrome

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A patient presenting with coffee-ground emesis and melena is most likely experiencing which type of gastrointestinal hemorrhage?

Upper gastrointestinal bleeding

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Lower gastrointestinal bleeding

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Small bowel obstruction

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Acute pancreatitis

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A 45-year-old female presents with acute right upper quadrant pain that radiates to the right shoulder, nausea, and vomiting. The pain worsened after eating a fatty meal. Which condition is the most likely cause?

Acute cholecystitis

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Acute appendicitis

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Acute pancreatitis

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Mesenteric ischemia

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A 19-year-old known diabetic presents with altered mental status, deep and rapid respirations, a fruity odor on the breath, and a blood glucose of 480 mg/dL. Which condition does this presentation indicate?

Diabetic ketoacidosis

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Hyperosmolar hyperglycemic state

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Severe hypoglycemia with rebound hyperglycemia

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Thyroid storm with secondary hyperglycemia

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What is the standard initial IV dose of dextrose 10% (D10) for treating severe hypoglycemia in an adult patient?

25 grams (250 mL of D10), titrated to clinical response

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50 grams (500 mL of D10) given as a rapid bolus

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10 grams (100 mL of D10) with no additional doses permitted

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5 grams (50 mL of D10) repeated every 30 minutes

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A paramedic is treating a patient found unresponsive with a blood glucose of 28 mg/dL. After establishing IV access and administering 25 grams of D10, the patient’s glucose rises to 180 mg/dL but the patient remains unresponsive. What should the paramedic consider?

An additional cause of altered mental status beyond hypoglycemia, such as a stroke or overdose that occurred concurrently

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The dextrose was ineffective and another 50 grams should be administered immediately

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The patient is experiencing a paradoxical reaction to dextrose that will resolve spontaneously

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The glucometer reading is falsely elevated and should be disregarded

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Which of the following is a clinical feature that distinguishes thyroid storm from other causes of tachycardia and hyperthermia?

Extreme agitation, high fever exceeding 104 degrees Fahrenheit, and a history of hyperthyroidism

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Bradycardia, hypothermia, and facial puffiness

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Gradual onset over several weeks with mild fatigue only

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Isolated tachycardia with normal temperature and no psychiatric symptoms

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A paramedic is called for a patient experiencing extreme agitation, hyperthermia of 105 degrees Fahrenheit, diaphoresis, and extraordinary muscular strength. The patient is fighting against multiple responders. Which prehospital medication is most appropriate for chemical sedation in this situation?

Ketamine administered intramuscularly

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Midazolam 5 mg intramuscularly

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Haloperidol 5 mg IV push after establishing vascular access

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Naloxone 2 mg intranasal

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When physically restraining an agitated patient for safety purposes, which position should be avoided due to the risk of positional asphyxia?

Prone (face-down) restraint with weight applied to the back

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Supine restraint with all four extremities secured to the stretcher

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Left lateral recumbent position with wrist restraints applied

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Semi-Fowler position with soft restraints on both wrists

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A paramedic responds to a call for a patient who states they are having thoughts of ending their life and have a plan to do so. The patient initially agrees to go to the hospital but changes their mind at the ambulance. What is the most appropriate action?

Explain the concern for their safety and initiate the process for involuntary psychiatric evaluation as permitted by local protocols and law

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Respect the patient's autonomy and leave the scene after documenting the refusal

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Physically force the patient onto the stretcher without consulting medical control

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Ask the patient to sign a refusal form and provide a crisis hotline number

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During a prehospital delivery, the infant’s head delivers but the anterior shoulder becomes trapped behind the pubic symphysis. What is the first maneuver the paramedic should attempt to resolve this shoulder dystocia?

McRoberts maneuver: hyperflexion of the mother's thighs against her abdomen

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Apply firm fundal pressure to push the infant through the birth canal

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Pull firmly on the infant's head to extract the shoulders by force

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Place the mother in a standing position to use gravity to assist delivery

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A 32-year-old female at 34 weeks gestation presents with severe headache, visual disturbances, right upper quadrant pain, and a blood pressure of 170/110 mmHg. She suddenly begins seizing. What is the appropriate treatment?

Administer magnesium sulfate 4 grams IV, protect the airway, position in left lateral recumbent, and transport emergently

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Administer diazepam 10 mg IV, apply supplemental oxygen, and transport in a supine position

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Administer labetalol 20 mg IV for blood pressure control only and continue on-scene assessment

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Administer phenytoin 1 gram IV as the first-line anticonvulsant for pregnancy-related seizures

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A paramedic is managing a patient with significant postpartum hemorrhage following a field delivery. The placenta has delivered and bleeding continues heavily. What is the first mechanical intervention to control uterine bleeding?

Perform uterine massage by firmly massaging the uterine fundus

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Pack the vagina with sterile gauze to tamponade the bleeding

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Apply an abdominal pressure dressing over the uterus

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Elevate the patient's legs and apply the MAST garment

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A pregnant patient in the third trimester develops hypotension when placed supine on the stretcher. What is the most likely cause and appropriate intervention?

Supine hypotensive syndrome from inferior vena cava compression; tilt the patient to the left lateral position or manually displace the uterus to the left

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Hemorrhagic shock from placental abruption; administer rapid IV fluid bolus in the supine position

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Orthostatic hypotension from dehydration; keep the patient supine and elevate the legs

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Vasovagal syncope from anxiety; maintain the supine position and provide reassurance

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A 28-year-old female presents with sudden onset of severe lower abdominal pain on the right side, vaginal spotting, and dizziness. She reports her last menstrual period was 7 weeks ago. Her blood pressure is 86/54 mmHg and heart rate is 124 bpm. What is the most likely diagnosis?

Ruptured ectopic pregnancy

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Acute appendicitis

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Ovarian cyst rupture without significant hemorrhage

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Threatened miscarriage with stable hemodynamics

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When responding to a patient who reports a sexual assault, what is the paramedic’s primary responsibility regarding evidence preservation?

Advise the patient not to change clothes, bathe, eat, or drink, and handle clothing and linens as potential evidence

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Perform a thorough pelvic examination to document injuries for the police report

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Collect DNA samples using swabs from the patient's skin and clothing

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Photograph the patient's injuries using a personal cell phone for documentation

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A 22-year-old female presents with sudden onset of severe right-sided pelvic pain, nausea, and vomiting. The pain is constant and not relieved by position changes. She denies vaginal bleeding and her pregnancy test is negative. What condition should the paramedic suspect?

Ovarian torsion

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Ruptured ectopic pregnancy

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Pelvic inflammatory disease

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Endometriosis flare

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A paramedic responds to an unresponsive patient with pinpoint pupils, a respiratory rate of 4 breaths per minute, and cyanosis. A bystander reports the patient was using drugs. After ensuring an open airway and ventilating with a BVM, what medication should be administered?

Naloxone 2 mg intranasally or 0.4 mg intravenously

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Flumazenil 0.2 mg intravenously

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Activated charcoal 50 grams orally

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Atropine 1 mg intravenously

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The mnemonic SLUDGEM (Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis, Miosis) describes the clinical findings of which type of toxidrome?

Cholinergic toxidrome (organophosphate poisoning)

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Sympathomimetic toxidrome (stimulant overdose)

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Anticholinergic toxidrome (antihistamine overdose)

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Sedative-hypnotic toxidrome (barbiturate overdose)

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A patient is found with altered mental status, a wide QRS complex on the cardiac monitor, and seizures. The patient’s family reports a history of depression and that several pill bottles are empty at the scene. Which medication class and specific antidote should the paramedic consider?

Tricyclic antidepressant overdose treated with sodium bicarbonate

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SSRI overdose treated with cyproheptadine

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Benzodiazepine overdose treated with flumazenil

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Acetaminophen overdose treated with N-acetylcysteine

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Firefighters are treating victims removed from a house fire. One patient is confused, with a cherry-red skin color and a headache. The SpO2 reads 98% on pulse oximetry. What is the most likely exposure and why is the pulse oximetry reading unreliable?

Carbon monoxide poisoning; pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin

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Cyanide poisoning; pulse oximetry malfunctions in the presence of hydrogen cyanide

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Heat exhaustion; elevated body temperature causes falsely high SpO2 readings

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Smoke inhalation injury; soot particles on the finger interfere with the sensor

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A 24-year-old male with known sickle cell disease presents with severe pain in his chest, back, and extremities. He rates the pain 10 out of 10 and is tachycardic at 118 bpm with an SpO2 of 91% on room air. What is the most appropriate prehospital management?

Administer high-flow oxygen, establish IV access, provide aggressive pain management with IV opioid analgesics, and administer an IV fluid bolus

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Withhold pain medication until blood work is obtained at the hospital

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Apply ice packs to the affected areas and administer oral ibuprofen only

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Administer aspirin 324 mg and nitroglycerin for the chest pain component

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Which condition is characterized by widespread activation of the clotting cascade, leading to simultaneous clot formation and hemorrhage throughout the body?

Disseminated intravascular coagulation (DIC)

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Hemophilia A

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Idiopathic thrombocytopenic purpura

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Von Willebrand disease

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During a blood transfusion being administered in an interfacility transport, the patient develops fever, chills, flank pain, and dark-colored urine. What type of reaction is occurring and what is the immediate treatment?

Acute hemolytic transfusion reaction; stop the transfusion immediately, maintain IV access with normal saline, and transport emergently

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Febrile non-hemolytic reaction; slow the transfusion rate and administer acetaminophen

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Mild allergic reaction; administer diphenhydramine and continue the transfusion

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Transfusion-associated circulatory overload; administer furosemide and elevate the head of the bed

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A dialysis patient presents with weakness, nausea, and an irregular heart rhythm. The ECG shows peaked T waves, widened QRS complexes, and a prolonged PR interval. Which electrolyte imbalance is most likely causing these ECG changes?

Hyperkalemia

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Hyponatremia

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Hypocalcemia

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Hypomagnesemia

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Which medication acts as a cardiac membrane stabilizer and is administered as the first-line emergent treatment for hyperkalemia with ECG changes?

Calcium chloride or calcium gluconate intravenously

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Potassium chloride intravenously

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Magnesium sulfate intravenously

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Sodium chloride 0.9% as a rapid bolus

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A construction worker was trapped under a collapsed wall for 4 hours before being freed. He has crush injuries to both legs. Shortly after extrication, he becomes hypotensive with a heart rate of 130 bpm and his urine is dark brown. What is the most dangerous complication the paramedic should anticipate?

Crush syndrome causing life-threatening hyperkalemia and acute renal failure from rhabdomyolysis

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Compartment syndrome limited to the affected extremities only

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Fat embolism syndrome causing acute respiratory failure

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Hypothermia from prolonged environmental exposure

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A 56-year-old male presents with fever of 103.2 degrees Fahrenheit, altered mental status, tachycardia at 128 bpm, blood pressure of 84/50 mmHg, and respiratory rate of 26 breaths per minute. He has a productive cough and his wife reports he has been ill for 3 days. What condition should the paramedic suspect and what is the priority treatment?

Septic shock from pneumonia; priority is IV fluid resuscitation with a 30 mL/kg crystalloid bolus and rapid transport

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Severe influenza; priority is administration of antiviral medication in the field

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Acute bronchitis; priority is nebulized bronchodilator and monitoring during transport

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Dehydration from fever; priority is oral rehydration and antipyretic medication

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Which infection control precautions are appropriate when transporting a patient with suspected meningococcal meningitis?

Droplet precautions including a surgical mask for the paramedic and a mask on the patient if tolerated

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Standard precautions only with no additional respiratory protection

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Airborne precautions with an N95 respirator and negative pressure isolation

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Contact precautions with gown and gloves only

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Which infectious disease requires airborne precautions including an N95 respirator during prehospital transport?

Pulmonary tuberculosis

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Influenza

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Streptococcal pharyngitis

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Bacterial pneumonia

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A patient develops widespread urticaria, wheezing, tongue swelling, and a blood pressure of 72/40 mmHg within minutes of a bee sting. After administering epinephrine 0.3 mg IM and starting a normal saline bolus, the patient improves but 30 minutes later the symptoms return. What has occurred?

A biphasic anaphylactic reaction

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A new allergic reaction to the epinephrine medication

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Development of cardiogenic shock unrelated to the anaphylaxis

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An adverse reaction to the normal saline infusion

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What is the correct dose, route, and concentration of epinephrine for an adult patient experiencing anaphylaxis?

Epinephrine 0.3 to 0.5 mg of the 1:1,000 (1 mg/mL) concentration administered intramuscularly in the lateral thigh

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Epinephrine 1 mg of the 1:10,000 (0.1 mg/mL) concentration administered intravenously

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Epinephrine 0.1 mg of the 1:1,000 (1 mg/mL) concentration administered subcutaneously

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Epinephrine 5 mg of the 1:100,000 concentration administered intramuscularly

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A patient with known latex allergy requires advanced airway management. Which consideration is most important when selecting airway equipment?

Ensure all equipment used is latex-free, including gloves, airway devices, and IV tubing

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Premedicate the patient with diphenhydramine before touching any equipment

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Use standard equipment and treat any allergic reaction if it develops

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Delay airway management until a latex-free kit can be obtained from the hospital

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A patient is found outdoors in winter with an altered level of consciousness and a core body temperature of 82 degrees Fahrenheit (27.8 degrees Celsius). The patient is in ventricular fibrillation. What is the appropriate management?

Deliver one defibrillation attempt, begin CPR, actively rewarm the patient, and withhold additional defibrillation attempts and medications until the core temperature exceeds 86 degrees Fahrenheit (30 degrees Celsius)

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Withhold all resuscitative efforts because the patient cannot be resuscitated at this temperature

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Deliver repeated defibrillation shocks at maximum energy with standard ACLS medications

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Perform CPR only without defibrillation because electrical therapy is ineffective in hypothermia

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Which ECG finding is characteristically associated with hypothermia?

Osborn (J) waves, a distinctive deflection at the J-point following the QRS complex

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Delta waves indicating a pre-excitation pathway

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Peaked T waves indicating hyperkalemia

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ST elevation in a regional distribution indicating myocardial infarction

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A 25-year-old male presents at an outdoor event with confusion, hot and dry skin, a core temperature of 106 degrees Fahrenheit, and tachycardia. He was performing strenuous physical activity. What is the priority treatment?

Immediate aggressive cooling with cold water immersion or ice packs to the neck, axillae, and groin, along with IV fluid resuscitation

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Administer oral fluids and move the patient to shade, monitoring for improvement

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Apply lukewarm water mist and fan the patient while withholding IV fluids

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Administer antipyretic medications such as acetaminophen to lower the temperature

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A scuba diver surfaces rapidly from a depth of 100 feet and immediately develops joint pain, paresthesias, and respiratory distress. What is the most likely condition and what is the definitive treatment?

Decompression sickness (the bends); definitive treatment is hyperbaric oxygen therapy

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Barotrauma of ascent; definitive treatment is chest tube placement

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Nitrogen narcosis; definitive treatment is high-flow oxygen and observation

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Pulmonary oxygen toxicity; definitive treatment is mechanical ventilation

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A 3-year-old child presents with a barking cough, inspiratory stridor at rest, and mild sternal retractions. The child is sitting upright and is not drooling. SpO2 is 95% on room air. What is the most likely diagnosis and appropriate prehospital treatment?

Croup (laryngotracheobronchitis); administer humidified oxygen, keep the child calm, and consider nebulized epinephrine for moderate to severe stridor

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Epiglottitis; immediately intubate the child in the field to secure the airway

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Foreign body airway obstruction; perform back blows and chest thrusts

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Bacterial tracheitis; administer IV antibiotics in the prehospital setting

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A 6-month-old infant presents with wheezing, nasal flaring, and intercostal retractions during winter. The parents report a runny nose for 2 days that has progressed to difficulty breathing. Which condition is the most common cause of this presentation in infants?

Bronchiolitis caused by respiratory syncytial virus (RSV)

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Bacterial pneumonia requiring IV antibiotics

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Asthma exacerbation requiring nebulized bronchodilators

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Foreign body aspiration requiring direct laryngoscopy

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A 4-year-old child presents with bruises in various stages of healing on the torso, buttocks, and upper arms. The child is withdrawn and avoids eye contact. The parent states the child ‘falls a lot.’ What should the paramedic suspect and what is the appropriate action?

Non-accidental trauma (child abuse); document findings objectively, provide appropriate medical care, transport to the hospital, and report concerns per mandatory reporting requirements

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A bleeding disorder; administer IV fluids and transport for lab work only

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Normal childhood bruising from active play; document and release to the parents

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Hemophilia; avoid unnecessary interventions and transport gently

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What does the term BRUE (Brief Resolved Unexplained Event) describe in pediatric medicine?

A brief episode in an infant involving color change, absent or irregular breathing, altered tone, or altered responsiveness that has resolved by the time of evaluation

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A confirmed diagnosis of infantile seizure disorder requiring anticonvulsant therapy

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An acute episode of bronchospasm in a child with established asthma

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A prolonged cardiac arrest in a pediatric patient with unsuccessful resuscitation

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An 85-year-old female presents with new-onset confusion, tachycardia, and a low-grade temperature of 99.8 degrees Fahrenheit. She is a resident of a skilled nursing facility and has a urinary catheter in place. Her family states she was acting normally yesterday. What is the most likely cause of her acute change?

Urinary tract infection causing delirium in a catheterized elderly patient

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Normal age-related cognitive decline that develops gradually over months

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Dehydration from inadequate oral intake without any infectious source

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Alzheimer disease with sudden onset of hallucinations

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Which term describes the increased risk of adverse drug interactions in elderly patients who take multiple medications prescribed by different physicians?

Polypharmacy

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Drug tolerance

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Therapeutic index

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Bioavailability

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A paramedic is called for a 78-year-old male who fell at home. The patient has a swollen, shortened, and externally rotated left leg. He takes aspirin and a prescription anticoagulant. Beyond the obvious hip fracture, what additional injury should the paramedic be especially concerned about?

Occult internal hemorrhage at the fracture site, complicated by anticoagulant therapy reducing the ability to form clots

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Urinary retention caused by pain and immobility from the hip fracture

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Hypothermia from lying on the cold floor for a prolonged period only

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Dehydration from not drinking enough fluids before the fall occurred

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A paramedic is called for an 80-year-old patient with ‘altered mental status.’ Upon arrival, a caregiver reports the patient has been increasingly confused over the past 2 days, worse in the evenings. The patient has a known history of dementia with a stable baseline. What finding would most strongly suggest an acute process (delirium) superimposed on the chronic dementia?

A fluctuating level of consciousness with periods of lucidity alternating with periods of confusion

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Difficulty remembering events from 20 years ago

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A gradual decline in the ability to perform activities of daily living over 6 months

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A stable baseline confusion that has not changed from the caregiver's report

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A 45-year-old construction worker is found sitting in the shade on a hot day. He is diaphoretic, nauseated, and has cool, clammy skin. His temperature is 38.3 C (101 F), heart rate is 112, and blood pressure is 96/64 mmHg. Which condition best describes this presentation?

Heat exhaustion

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Heatstroke

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Heat cramps

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Exertional rhabdomyolysis

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A 32-year-old marathon runner collapses at the finish line. Bystanders report he stopped sweating during the last mile. His skin is hot and dry, his temperature is 41.2 C (106.2 F), and he is confused and combative. After securing the airway, what is the most critical intervention?

Rapid whole-body cooling using the most effective method available, such as cold water immersion or ice packs to the groin, axillae, and neck

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Administer acetaminophen 1,000 mg orally to reduce the fever

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Remove the patient from the heat, provide oral fluids, and transport without active cooling

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Apply a single ice pack to the forehead and fan the patient with a towel

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Which of the following best describes the pathophysiology of frostbite?

Ice crystal formation within tissues causes direct cellular damage and microvascular thrombosis

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Excessive vasodilation leads to fluid loss and tissue necrosis

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Peripheral nerve demyelination causes permanent sensory loss

Correct Incorrect Correct answer

Anaerobic metabolism from hypothermia produces lactic acidosis in the affected extremity

Correct Incorrect Correct answer

A 68-year-old man is found unresponsive in an unheated home during winter. His core temperature is 29 C (84.2 F), heart rate is 38, and respirations are 6. He has a palpable pulse. Which rewarming strategy is most appropriate for this patient in the prehospital setting?

Passive rewarming with gentle handling, warm blankets, and warm IV fluids if available

Correct Incorrect Correct answer

Aggressive active external rewarming with hot water bottles applied directly to the extremities

Correct Incorrect Correct answer

Immediate warm water immersion to rapidly raise core temperature

Correct Incorrect Correct answer

Vigorous rubbing of the extremities to stimulate peripheral circulation

Correct Incorrect Correct answer

Paramedics respond to a lake where a 7-year-old was submerged in cold water for approximately 12 minutes. He is pulseless and apneic upon retrieval. His core temperature is 26 C (78.8 F). Which statement best guides resuscitation decisions for this patient?

Begin CPR and withhold termination of resuscitation efforts until the patient is rewarmed to at least 32 C

Correct Incorrect Correct answer

The prolonged submersion time makes survival unlikely, so resuscitation should not be initiated

Correct Incorrect Correct answer

Defibrillation should be attempted repeatedly at 2-minute intervals regardless of core temperature

Correct Incorrect Correct answer

CPR is contraindicated because chest compressions may trigger ventricular fibrillation in a hypothermic heart

Correct Incorrect Correct answer

A 25-year-old man is struck by lightning while golfing. He is found unresponsive, pulseless, and apneic. Three other golfers nearby have minor injuries but are conscious and breathing. According to mass casualty triage principles specific to lightning strikes, what is the correct approach?

Prioritize resuscitation of the pulseless patient first, as lightning arrest victims have a higher salvage rate than other cardiac arrest etiologies

Correct Incorrect Correct answer

Triage the pulseless patient as expectant and focus resources on the three conscious patients

Correct Incorrect Correct answer

Treat all four patients equally using standard START triage without modification

Correct Incorrect Correct answer

Withhold CPR because lightning injuries typically cause irreversible brain damage

Correct Incorrect Correct answer

A 30-year-old hiker at 4,200 meters elevation reports a severe headache, persistent vomiting, and ataxia that developed over the past 12 hours. His SpO2 is 82% on room air. Which condition is the most likely diagnosis?

High altitude cerebral edema (HACE)

Correct Incorrect Correct answer

Acute mountain sickness (AMS)

Correct Incorrect Correct answer

High altitude pulmonary edema (HAPE)

Correct Incorrect Correct answer

Tension pneumothorax

Correct Incorrect Correct answer

A climber at 3,800 meters develops progressive dyspnea, a dry cough that becomes productive of pink frothy sputum, and bilateral crackles on auscultation. Which condition does this presentation indicate?

High altitude pulmonary edema (HAPE)

Correct Incorrect Correct answer

High altitude cerebral edema (HACE)

Correct Incorrect Correct answer

Acute mountain sickness (AMS)

Correct Incorrect Correct answer

Community-acquired pneumonia

Correct Incorrect Correct answer

A 40-year-old man presents after being bitten on the forearm by a rattlesnake 30 minutes ago. The bite site shows two puncture wounds with progressive swelling and ecchymosis extending past the wrist. He reports tingling around his mouth. Which prehospital intervention is most appropriate?

Immobilize the extremity at or below the level of the heart, remove constricting jewelry, and transport rapidly for antivenom

Correct Incorrect Correct answer

Apply a tourniquet proximal to the bite to prevent venom spread

Correct Incorrect Correct answer

Incise the wound and apply suction to extract the venom

Correct Incorrect Correct answer

Apply ice packs directly to the bite site to slow venom absorption

Correct Incorrect Correct answer

Which spider bite is most likely to cause significant skin necrosis developing over several days after the initial bite?

Brown recluse (Loxosceles reclusa)

Correct Incorrect Correct answer

Black widow (Latrodectus mactans)

Correct Incorrect Correct answer

Hobo spider (Eratigena agrestis)

Correct Incorrect Correct answer

Wolf spider (Lycosidae family)

Correct Incorrect Correct answer

A 55-year-old woman presents with severe abdominal cramping, diffuse muscle rigidity, diaphoresis, and hypertension after being bitten by a spider in her garage. She describes the initial bite as a sharp pinprick on her hand. Which treatment is most appropriate for her symptoms?

Administer IV benzodiazepines for muscle spasm control and provide analgesics for pain management

Correct Incorrect Correct answer

Apply a pressure immobilization bandage to the affected hand and forearm

Correct Incorrect Correct answer

Administer IV diphenhydramine for the allergic reaction

Correct Incorrect Correct answer

Irrigate the wound with normal saline and apply topical antibiotics

Correct Incorrect Correct answer

A child in the southwestern United States is stung by a bark scorpion (Centruroides sculpturatus). Which symptom is most characteristic of significant scorpion envenomation in a pediatric patient?

Uncontrolled jerking eye movements (opsoclonus) and excessive salivation

Correct Incorrect Correct answer

Progressive tissue necrosis at the sting site

Correct Incorrect Correct answer

Generalized urticaria and angioedema

Correct Incorrect Correct answer

Painless numbness extending proximally from the sting site

Correct Incorrect Correct answer

A scuba diver surfaces rapidly from a 30-meter dive and develops joint pain, mottled skin, and progressive lower extremity weakness. Which prehospital treatment is most important for this patient?

Administer high-flow oxygen at 100% via non-rebreather mask and transport to a facility with a hyperbaric chamber

Correct Incorrect Correct answer

Place the patient in the Trendelenburg position and administer IV steroids

Correct Incorrect Correct answer

Administer low-flow oxygen at 2 liters per minute via nasal cannula to avoid oxygen toxicity

Correct Incorrect Correct answer

Immobilize the spine and transport to the nearest trauma center

Correct Incorrect Correct answer

A swimmer at the beach is stung on the leg by a jellyfish and develops intense pain with visible tentacle marks. What is the recommended prehospital treatment for this marine envenomation?

Rinse the affected area with vinegar to neutralize nematocysts, then immerse in hot water (43 to 45 C) for pain relief

Correct Incorrect Correct answer

Apply ice packs directly to the sting site and scrub with sand to remove tentacles

Correct Incorrect Correct answer

Rinse the area with fresh water and apply a pressure immobilization bandage

Correct Incorrect Correct answer

Apply a topical anesthetic cream and cover with a dry sterile dressing

Correct Incorrect Correct answer

A 28-year-old woman is rescued from a house fire. She was found unconscious in a smoke-filled room. Her skin is cherry red, SpO2 reads 99%, and she has altered mental status with a GCS of 9. Which factor explains the discrepancy between the SpO2 reading and her clinical condition?

Pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin, producing a falsely normal reading

Correct Incorrect Correct answer

The patient's peripheral vasoconstriction is interfering with the pulse oximeter signal

Correct Incorrect Correct answer

Smoke inhalation causes methemoglobinemia, which elevates SpO2 readings artificially

Correct Incorrect Correct answer

The high ambient temperature is causing the pulse oximeter to malfunction

Correct Incorrect Correct answer

What is the primary mechanism of heat loss in a patient who has been submerged in cold water?

Conduction

Correct Incorrect Correct answer

Radiation

Correct Incorrect Correct answer

Convection

Correct Incorrect Correct answer

Evaporation

Correct Incorrect Correct answer

A 10-year-old child develops lip swelling, diffuse urticaria, and wheezing within minutes of eating a peanut butter sandwich at school. The school nurse has the child’s prescribed epinephrine auto-injector available. Where should the EpiPen be administered?

The lateral aspect of the mid-thigh

Correct Incorrect Correct answer

The deltoid muscle of the upper arm

Correct Incorrect Correct answer

Subcutaneously into the abdominal fat

Correct Incorrect Correct answer

Intravenously through an antecubital vein

Correct Incorrect Correct answer

Which clinical finding best distinguishes angioedema from simple urticaria?

Swelling of deeper tissues including the lips, tongue, and periorbital area without pruritus

Correct Incorrect Correct answer

Raised, erythematous, pruritic wheals distributed across the trunk

Correct Incorrect Correct answer

Vesicular eruptions with serous drainage on the extremities

Correct Incorrect Correct answer

Petechial rash that does not blanch with pressure

Correct Incorrect Correct answer

A 35-year-old woman develops diffuse urticaria, facial swelling, and lightheadedness after receiving an intramuscular antibiotic injection. Her blood pressure is 78/42 mmHg and heart rate is 128. After administering intramuscular epinephrine and establishing IV access, which fluid therapy is most appropriate?

Rapid infusion of normal saline 1 to 2 liters for volume expansion

Correct Incorrect Correct answer

Dextrose 5% in water at a keep-vein-open rate

Correct Incorrect Correct answer

Lactated Ringer's solution at 125 mL per hour

Correct Incorrect Correct answer

Colloid solution such as albumin for oncotic pressure support

Correct Incorrect Correct answer

A paramedic treats a 28-year-old man for anaphylaxis following a bee sting. After two doses of intramuscular epinephrine, albuterol nebulization, and IV fluids, the patient’s symptoms resolve significantly. En route to the hospital, the patient states he feels fine and asks to be released from care. What is the most important reason to continue transport?

Biphasic anaphylactic reactions can occur up to 72 hours after the initial reaction, requiring observation

Correct Incorrect Correct answer

The epinephrine will cause rebound bronchoconstriction within 30 minutes

Correct Incorrect Correct answer

Albuterol masks the symptoms of continued allergic mediator release

Correct Incorrect Correct answer

IV fluid administration requires physician supervision for discontinuation

Correct Incorrect Correct answer

A patient experiencing anaphylaxis develops progressive inspiratory stridor despite two doses of intramuscular epinephrine. The paramedic is unable to visualize the vocal cords due to severe upper airway edema. What is the most appropriate next step in airway management?

Perform a surgical cricothyrotomy

Correct Incorrect Correct answer

Attempt blind nasotracheal intubation

Correct Incorrect Correct answer

Place a supraglottic airway device

Correct Incorrect Correct answer

Continue to administer repeated doses of epinephrine until swelling resolves

Correct Incorrect Correct answer

Which respiratory finding in anaphylaxis indicates bronchospasm of the lower airways?

Diffuse bilateral expiratory wheezing

Correct Incorrect Correct answer

High-pitched inspiratory stridor

Correct Incorrect Correct answer

Coarse bilateral crackles on inspiration

Correct Incorrect Correct answer

Diminished breath sounds in the right lung base only

Correct Incorrect Correct answer

Paramedics are transporting a 45-year-old immunocompromised patient who is receiving chemotherapy. He presents with a fever of 39.4 C (103 F), heart rate of 118, blood pressure of 88/54 mmHg, and a productive cough. His white blood cell count on the home health nurse’s recent lab slip shows 0.8 x 10^9/L. What should the paramedic recognize as the primary concern in this patient?

Neutropenic sepsis requiring aggressive fluid resuscitation and rapid transport to a facility capable of managing immunocompromised patients

Correct Incorrect Correct answer

Community-acquired pneumonia that can be managed with standard antibiotic protocols

Correct Incorrect Correct answer

Drug reaction to chemotherapy requiring discontinuation of the medication

Correct Incorrect Correct answer

Febrile seizure risk requiring prophylactic benzodiazepine administration

Correct Incorrect Correct answer

A 52-year-old kidney transplant recipient presents with fever, decreased urine output, and tenderness over the transplant site in the right iliac fossa. He reports that he stopped taking his immunosuppressive medications two weeks ago due to side effects. Which condition should the paramedic suspect?

Acute transplant rejection

Correct Incorrect Correct answer

Acute appendicitis

Correct Incorrect Correct answer

Urinary tract infection

Correct Incorrect Correct answer

Abdominal aortic aneurysm rupture

Correct Incorrect Correct answer

A patient reports a history of systemic lupus erythematosus (SLE). Which organ system is at greatest risk for a life-threatening complication requiring emergency transport?

Renal system, due to lupus nephritis leading to renal failure

Correct Incorrect Correct answer

Integumentary system, due to the characteristic butterfly rash

Correct Incorrect Correct answer

Musculoskeletal system, due to joint inflammation and arthralgia

Correct Incorrect Correct answer

Hematologic system, due to mild anemia from chronic disease

Correct Incorrect Correct answer

A 30-year-old woman with known rheumatoid arthritis presents with acute onset dyspnea and pleuritic chest pain. She takes methotrexate weekly. Her SpO2 is 91%, heart rate is 104, and she has diminished breath sounds at the right base. Which condition should the paramedic consider as a complication of her autoimmune disease and its treatment?

Pulmonary involvement from rheumatoid arthritis, such as pleural effusion or methotrexate-induced pneumonitis

Correct Incorrect Correct answer

Acute exacerbation of rheumatoid joint inflammation causing referred chest pain

Correct Incorrect Correct answer

Hyperventilation syndrome secondary to anxiety about her chronic disease

Correct Incorrect Correct answer

Gastroesophageal reflux caused by anti-inflammatory medications

Correct Incorrect Correct answer

A 60-year-old man develops diffuse urticaria, hypotension, and bronchospasm during a CT scan with iodinated contrast at an imaging center. The facility calls 911 for paramedic response. On arrival, the patient has been given IM epinephrine by the radiologist. His blood pressure remains 72/40 mmHg with persistent wheezing. What is the most appropriate next intervention?

Establish IV access and administer an epinephrine infusion while providing aggressive IV fluid boluses

Correct Incorrect Correct answer

Administer IV diphenhydramine as the primary treatment for the persistent hypotension

Correct Incorrect Correct answer

Withhold additional epinephrine because the radiologist has already given one dose

Correct Incorrect Correct answer

Administer IV corticosteroids as the definitive treatment for refractory anaphylaxis

Correct Incorrect Correct answer

Which set of clinical findings represents the hallmark multi-system presentation of anaphylaxis?

Urticaria or angioedema, bronchospasm, and hypotension

Correct Incorrect Correct answer

Fever, rash, and joint pain

Correct Incorrect Correct answer

Stridor, bradycardia, and hypertension

Correct Incorrect Correct answer

Nausea, diarrhea, and abdominal distension

Correct Incorrect Correct answer

A 34-year-old male is found standing on the edge of a bridge, stating he ‘can’t do this anymore.’ He has a suicide note in his pocket and reports giving away his personal belongings earlier today. Which factor in this presentation most significantly increases the immediate risk of a completed suicide attempt?

He has a specific plan with access to a lethal method

Correct Incorrect Correct answer

He is expressing his feelings verbally to bystanders

Correct Incorrect Correct answer

He wrote a note explaining his reasons

Correct Incorrect Correct answer

He gave away personal belongings before coming to the bridge

Correct Incorrect Correct answer

Paramedics are dispatched to a residence for a 28-year-old female experiencing a behavioral crisis. On arrival, she is pacing, screaming at unseen figures, and states that the government has implanted a tracking device in her brain. She appears agitated but has not threatened anyone. Vital signs are HR 112, BP 148/92, RR 22, SpO2 98%. What is the most appropriate initial approach?

Maintain a safe distance, speak calmly, and use verbal de-escalation techniques

Correct Incorrect Correct answer

Immediately administer midazolam intramuscularly for chemical sedation

Correct Incorrect Correct answer

Apply physical restraints to prevent her from injuring herself or others

Correct Incorrect Correct answer

Contact law enforcement and wait for them to secure the patient before approaching

Correct Incorrect Correct answer

Which of the following best describes the hallmark presentation of a patient experiencing an acute schizophrenic episode?

Auditory hallucinations, disorganized thinking, and paranoid delusions

Correct Incorrect Correct answer

Alternating episodes of euphoria and profound sadness over several weeks

Correct Incorrect Correct answer

Sudden onset of chest pain with an overwhelming sense of impending doom

Correct Incorrect Correct answer

Progressive confusion and memory loss with fluctuating consciousness

Correct Incorrect Correct answer

A 42-year-old male with a history of bipolar disorder is found by family members talking rapidly, claiming he has not slept in four days, and spending large sums of money online. He is cooperative but grandiose, stating he has discovered a cure for cancer. Vital signs are stable. Which clinical impression is most consistent with this presentation?

Acute manic episode

Correct Incorrect Correct answer

Major depressive episode with psychotic features

Correct Incorrect Correct answer

Acute paranoid schizophrenia

Correct Incorrect Correct answer

Stimulant intoxication

Correct Incorrect Correct answer

A 22-year-old female presents with sudden onset of chest tightness, tingling in her hands and around her mouth, dizziness, and a feeling that she is ‘going to die.’ Her respiratory rate is 32, SpO2 is 99%, and she is tearful and trembling. A 12-lead ECG shows sinus tachycardia at 118 with no ST changes. Which assessment finding would most strongly suggest this is NOT simply a panic attack and requires further medical evaluation?

Unilateral leg swelling noted during the physical examination

Correct Incorrect Correct answer

Bilateral hand tingling consistent with hyperventilation

Correct Incorrect Correct answer

The patient reports a history of similar episodes in the past

Correct Incorrect Correct answer

Respiratory rate normalizes with coaching and reassurance

Correct Incorrect Correct answer

Paramedics respond to a group home for a 38-year-old male with a history of schizophrenia who has become increasingly agitated and is now threatening staff with a chair. Verbal de-escalation has failed after 10 minutes of attempts. Medical direction authorizes chemical restraint. Which medication and route is most appropriate for this situation?

Midazolam 5 mg intramuscularly

Correct Incorrect Correct answer

Haloperidol 10 mg IM

Correct Incorrect Correct answer

Diazepam 10 mg orally with water

Correct Incorrect Correct answer

Ketamine 4 mg/kg IM

Correct Incorrect Correct answer

Which of the following is a primary indication for applying physical restraints to a psychiatric patient in the prehospital setting?

The patient poses an immediate danger to themselves or others despite verbal intervention

Correct Incorrect Correct answer

The patient refuses to sign a refusal of care form

Correct Incorrect Correct answer

The patient is verbally hostile but compliant with assessment

Correct Incorrect Correct answer

Family members request that the patient be restrained during transport

Correct Incorrect Correct answer

A 55-year-old male presents with flat affect, reports he has been unable to get out of bed for two weeks, has lost 15 pounds, and states ‘I just don’t see the point anymore.’ He denies a specific plan to harm himself but admits to thinking about death ‘all the time.’ His wife reports he recently gave his hunting rifles to a neighbor. What is the most important action for the paramedic?

Transport the patient for psychiatric evaluation, recognizing multiple risk factors for suicide

Correct Incorrect Correct answer

Accept the patient's denial of a plan and allow him to refuse transport

Correct Incorrect Correct answer

Contact his psychiatrist for a phone consultation before deciding on transport

Correct Incorrect Correct answer

Advise his wife to remove any remaining potential means of self-harm and follow up with his primary care physician

Correct Incorrect Correct answer

Droperidol is sometimes used in the prehospital management of acute agitation. Which adverse effect is most concerning and requires cardiac monitoring when this medication is administered?

QT prolongation with potential for torsades de pointes

Correct Incorrect Correct answer

Severe hypertension requiring emergent treatment

Correct Incorrect Correct answer

Bronchospasm and acute respiratory distress

Correct Incorrect Correct answer

Hyperglycemia with osmotic diuresis

Correct Incorrect Correct answer

A 30-year-old female is brought to the ambulance by police after she was found walking in traffic, talking incoherently. She is diaphoretic with dilated pupils, HR 138, BP 178/104, temp 39.2C, and RR 24. She alternates between combativeness and confusion. Which factor in this presentation most strongly suggests the cause is medical rather than purely psychiatric?

Hyperthermia, tachycardia, and diaphoresis indicating a sympathomimetic toxidrome

Correct Incorrect Correct answer

Incoherent speech, which is the hallmark of acute psychosis

Correct Incorrect Correct answer

The fact that police brought her rather than family or friends

Correct Incorrect Correct answer

Combativeness alternating with confusion, which is typical of bipolar disorder

Correct Incorrect Correct answer

Paramedics are called for a 19-year-old male who barricaded himself in his room and is making threats to kill his roommate. Law enforcement has secured the scene and the patient is now in custody. He is calm but states, ‘If you let me go, I will find him and kill him.’ Under what authority can this patient be transported to a psychiatric facility against his will?

Involuntary psychiatric commitment based on danger to others

Correct Incorrect Correct answer

Implied consent because the patient is clearly not thinking rationally

Correct Incorrect Correct answer

The paramedic's independent authority to determine psychiatric competency

Correct Incorrect Correct answer

The patient's family can authorize transport on his behalf as next of kin

Correct Incorrect Correct answer

A patient experiencing an acute anxiety attack presents with rapid breathing, tingling in the extremities, and carpopedal spasm. The patient’s SpO2 is 100% on room air and the 12-lead ECG is unremarkable. Which intervention should the paramedic perform first?

Coach the patient to slow their breathing rate using calm verbal instructions

Correct Incorrect Correct answer

Administer high-flow oxygen via a nonrebreather mask at 15 L/min

Correct Incorrect Correct answer

Establish IV access and administer a 500 mL normal saline bolus

Correct Incorrect Correct answer

Administer albuterol via nebulizer to relieve the respiratory distress

Correct Incorrect Correct answer

A restrained patient in the back of the ambulance suddenly becomes quiet and stops struggling. The patient was previously combative for 20 minutes and received midazolam 5 mg IM. Vital signs now show HR 56, RR 8, SpO2 88%, BP 90/60. What is the most likely cause of the patient’s deterioration?

Respiratory depression secondary to benzodiazepine administration

Correct Incorrect Correct answer

The patient is feigning unconsciousness to avoid further treatment

Correct Incorrect Correct answer

Positional asphyxia from the restraints causing gradual suffocation

Correct Incorrect Correct answer

Sudden cardiac arrest from catecholamine surge during the agitation period

Correct Incorrect Correct answer

When performing a suicide risk assessment in the prehospital setting, which mnemonic is commonly used to evaluate the patient’s level of risk?

SAD PERSONS scale, which evaluates factors such as sex, age, depression, previous attempts, and substance use

Correct Incorrect Correct answer

AVPU scale, which measures alertness, verbal response, pain response, and unresponsiveness

Correct Incorrect Correct answer

CAGE questionnaire, which screens for problematic alcohol consumption patterns

Correct Incorrect Correct answer

CIWA scale, which measures the severity of alcohol withdrawal symptoms

Correct Incorrect Correct answer

A 45-year-old female with a known history of depression calls 911 stating she took ‘a handful’ of her prescribed sertraline approximately 30 minutes ago. She is alert and oriented, HR 98, BP 132/84, RR 18, SpO2 98%. She reports mild nausea but no other symptoms. What is the most critical concern the paramedic should monitor for during transport?

Serotonin syndrome, including hyperthermia, altered mental status, and neuromuscular hyperactivity

Correct Incorrect Correct answer

Immediate cardiac arrest from sodium channel blockade

Correct Incorrect Correct answer

Acute hepatic failure requiring emergent transplant evaluation

Correct Incorrect Correct answer

Severe hypoglycemia from stimulation of pancreatic insulin secretion

Correct Incorrect Correct answer

A 26-year-old male at a concert venue is found agitated, diaphoretic, and exhibiting jaw clenching and repetitive movements. His pupils are markedly dilated, temp is 40.1C, HR 148, and BP 168/98. Friends report he took ‘something’ earlier in the evening. Which prehospital intervention takes the highest priority?

Aggressive cooling measures to address life-threatening hyperthermia

Correct Incorrect Correct answer

Administration of activated charcoal for gastrointestinal decontamination

Correct Incorrect Correct answer

Chemical sedation with haloperidol to control the agitation

Correct Incorrect Correct answer

Placement of a nasogastric tube for gastric lavage

Correct Incorrect Correct answer

When applying physical restraints to an agitated patient, which position should the paramedic avoid placing the patient in during transport?

Prone (face-down) position, due to the risk of positional asphyxia

Correct Incorrect Correct answer

Left lateral recumbent position with the head slightly elevated

Correct Incorrect Correct answer

Supine position with the head of the stretcher elevated to 30 degrees

Correct Incorrect Correct answer

Seated upright position with soft restraints on all four extremities

Correct Incorrect Correct answer

A 78-year-old female presents with general weakness and fatigue that started this morning. She denies chest pain or shortness of breath. Her vital signs are: BP 148/92 mmHg, HR 96 bpm, RR 18, SpO2 95%. Her 12-lead ECG shows ST depression in leads V4 through V6. Based on this presentation, what should the paramedic suspect?

Atypical myocardial infarction presenting without classic chest pain

Correct Incorrect Correct answer

Diabetic hypoglycemia causing generalized weakness

Correct Incorrect Correct answer

Transient ischemic attack with motor involvement

Correct Incorrect Correct answer

Dehydration from inadequate fluid intake

Correct Incorrect Correct answer

Why do elderly patients with serious infections frequently present without fever?

Age-related decline in immune response reduces the ability to mount a febrile reaction

Correct Incorrect Correct answer

Elderly patients have a higher baseline body temperature that masks fever

Correct Incorrect Correct answer

Chronic medication use eliminates all inflammatory cytokine production

Correct Incorrect Correct answer

Increased peripheral vasodilation in the elderly dissipates heat more efficiently

Correct Incorrect Correct answer

A 82-year-old male with dementia is found wandering outside his assisted living facility in 35-degree Fahrenheit weather wearing only pajamas. He is confused, shivering, and his skin is cold and pale. His core temperature reads 93.5 degrees Fahrenheit. What is the most important initial intervention?

Remove wet clothing and begin passive rewarming with warm blankets during transport

Correct Incorrect Correct answer

Administer warmed IV fluids at a rate of 500 mL per hour as the primary intervention

Correct Incorrect Correct answer

Perform vigorous active rewarming by applying hot packs directly to the skin

Correct Incorrect Correct answer

Delay transport to obtain a 12-lead ECG and blood glucose before any treatment

Correct Incorrect Correct answer

A 76-year-old male on warfarin for atrial fibrillation presents with progressively worsening headache, confusion, and left-sided weakness that developed over the past two weeks. His family reports he fell and hit his head three weeks ago but seemed fine afterward. What condition does this presentation most likely suggest?

Chronic subdural hematoma with gradual symptom progression

Correct Incorrect Correct answer

Acute epidural hematoma with rapid deterioration

Correct Incorrect Correct answer

Ischemic stroke from atrial fibrillation embolus

Correct Incorrect Correct answer

Subarachnoid hemorrhage from a ruptured aneurysm

Correct Incorrect Correct answer

A 84-year-old nursing home resident presents with altered mental status, tachypnea at 28 breaths per minute, and SpO2 of 88% on room air. She is afebrile. Lung sounds reveal coarse crackles and rhonchi in the right lower lobe. Her caregiver reports she has had difficulty swallowing recently. What is the most likely cause of this presentation?

Aspiration pneumonia secondary to dysphagia

Correct Incorrect Correct answer

Acute pulmonary embolism from deep vein thrombosis

Correct Incorrect Correct answer

Congestive heart failure exacerbation with pulmonary edema

Correct Incorrect Correct answer

Spontaneous pneumothorax in the right lung

Correct Incorrect Correct answer

Which of the following findings during a prehospital assessment is most suggestive of elder abuse?

Multiple bruises in various stages of healing on the torso and upper arms

Correct Incorrect Correct answer

A single bruise on the shin consistent with bumping into furniture

Correct Incorrect Correct answer

Dry skin and mild dehydration during summer months

Correct Incorrect Correct answer

Mild confusion in a patient with a documented history of dementia

Correct Incorrect Correct answer

A paramedic responds to a nursing home for a 90-year-old female with a reported weight loss of 15 pounds over the past month. She appears cachectic with temporal wasting, dry mucous membranes, and poor skin turgor. Her caregiver states she has been refusing meals. Which assessment finding would most strongly suggest neglect rather than voluntary food refusal?

The patient is alert and oriented and states she has not been offered meals regularly

Correct Incorrect Correct answer

The patient has advanced dementia and is unable to communicate her needs

Correct Incorrect Correct answer

The patient has a documented history of depression and appetite loss

Correct Incorrect Correct answer

The facility records show the patient was evaluated by her physician last week

Correct Incorrect Correct answer

What is the primary risk factor for pressure ulcer development in bedridden elderly patients?

Prolonged immobility causing sustained pressure over bony prominences

Correct Incorrect Correct answer

Elevated blood pressure causing capillary damage to the skin

Correct Incorrect Correct answer

Excessive exposure to sunlight causing ultraviolet skin breakdown

Correct Incorrect Correct answer

Frequent position changes causing friction on the skin surface

Correct Incorrect Correct answer

A 80-year-old male with a history of COPD presents with productive cough, tachypnea, and altered mental status. His temperature is 100.2 degrees Fahrenheit, which his caregiver dismisses as only a slight fever. His SpO2 is 86% on room air. Why should the paramedic treat this patient as having a serious infection despite the low-grade fever?

Elderly patients often mount only a minimal febrile response even with severe infections such as pneumonia

Correct Incorrect Correct answer

COPD patients cannot develop high fevers due to chronic steroid use

Correct Incorrect Correct answer

A temperature of 100.2 degrees is within the normal range for elderly patients

Correct Incorrect Correct answer

Pulse oximetry readings are unreliable in febrile patients and should be disregarded

Correct Incorrect Correct answer

A 74-year-old female presents after a ground-level fall. She reports she has been feeling dizzy for several days. Her medications include metoprolol, lisinopril, furosemide, and a daily aspirin. Her vital signs are: BP 104/62 mmHg (lying) and 78/48 mmHg (standing), HR 56 bpm. Which combination of factors most likely contributed to her fall?

Beta-blocker induced bradycardia combined with diuretic related orthostatic hypotension

Correct Incorrect Correct answer

Aspirin toxicity causing vestibular dysfunction and positional vertigo

Correct Incorrect Correct answer

Lisinopril causing hyperkalemia with resulting muscle weakness

Correct Incorrect Correct answer

Furosemide causing hypernatremia with altered sensorium

Correct Incorrect Correct answer

While assessing a bedridden 88-year-old patient, a paramedic notes a stage 3 pressure ulcer over the sacrum with exposed subcutaneous tissue. The wound has a foul odor and purulent drainage. What is the most significant prehospital concern related to this finding?

The infected pressure ulcer may indicate sepsis requiring fluid resuscitation and rapid transport

Correct Incorrect Correct answer

The wound requires immediate debridement and packing in the prehospital setting

Correct Incorrect Correct answer

The pressure ulcer should be irrigated with hydrogen peroxide before applying a dressing

Correct Incorrect Correct answer

The patient needs to be repositioned every 5 minutes during transport to prevent further breakdown

Correct Incorrect Correct answer

Which of the following best describes the condition of anemia?

A reduction in the oxygen-carrying capacity of the blood due to decreased red blood cells or hemoglobin

Correct Incorrect Correct answer

An increase in white blood cell production leading to bone marrow suppression

Correct Incorrect Correct answer

A deficiency of clotting factors resulting in uncontrolled bleeding

Correct Incorrect Correct answer

An abnormal increase in platelet count causing spontaneous clot formation

Correct Incorrect Correct answer

A 72-year-old female on warfarin presents with confusion, severe headache, and right-sided hemiparesis. Her family reports her INR was elevated at her last clinic visit. What condition should the paramedic strongly suspect?

Intracranial hemorrhage secondary to over-anticoagulation

Correct Incorrect Correct answer

Ischemic stroke from an embolus to the left middle cerebral artery

Correct Incorrect Correct answer

Hypoglycemia causing focal neurological deficits

Correct Incorrect Correct answer

Hypertensive encephalopathy

Correct Incorrect Correct answer

Which laboratory value is most commonly used to monitor the therapeutic effect of warfarin?

International Normalized Ratio (INR)

Correct Incorrect Correct answer

Partial Thromboplastin Time (PTT)

Correct Incorrect Correct answer

Platelet count

Correct Incorrect Correct answer

Fibrinogen level

Correct Incorrect Correct answer

A 58-year-old male on heparin therapy for a recent pulmonary embolism calls 911 with coffee-ground emesis and melena. His heart rate is 112 bpm and blood pressure is 96/64 mmHg. What is the priority prehospital management?

Establish IV access, administer a normal saline fluid bolus, and transport emergently

Correct Incorrect Correct answer

Administer activated charcoal to absorb the heparin

Correct Incorrect Correct answer

Apply direct pressure to the abdomen to control internal hemorrhage

Correct Incorrect Correct answer

Withhold fluids to avoid diluting clotting factors and transport

Correct Incorrect Correct answer

A 34-year-old female presents with petechiae across her extremities, gingival bleeding, and reports of easy bruising for the past two weeks. She denies trauma, takes no medications, and her vital signs are stable. Based on these findings, which hematologic disorder is most likely?

Thrombocytopenia

Correct Incorrect Correct answer

Hemophilia A

Correct Incorrect Correct answer

Disseminated intravascular coagulation

Correct Incorrect Correct answer

Sickle cell crisis

Correct Incorrect Correct answer

A 62-year-old female presents with acute onset left leg swelling, warmth, and pain. She reports recent hip replacement surgery two weeks ago and has been mostly immobile since. What condition should the paramedic suspect?

Deep vein thrombosis

Correct Incorrect Correct answer

Cellulitis from a surgical wound infection

Correct Incorrect Correct answer

Compartment syndrome of the lower leg

Correct Incorrect Correct answer

Peripheral arterial occlusion

Correct Incorrect Correct answer

Which laboratory test is used to monitor the effectiveness of unfractionated heparin therapy?

Partial Thromboplastin Time (PTT)

Correct Incorrect Correct answer

International Normalized Ratio (INR)

Correct Incorrect Correct answer

Prothrombin Time (PT)

Correct Incorrect Correct answer

Bleeding time

Correct Incorrect Correct answer

A 45-year-old male with a history of cirrhosis presents with hematemesis, altered mental status, and a blood pressure of 84/52 mmHg. His abdomen is distended with visible caput medusae. The paramedic notes prolonged bleeding from the IV insertion site. What underlying hematologic condition is contributing to this patient’s uncontrolled bleeding?

Coagulopathy from impaired hepatic synthesis of clotting factors

Correct Incorrect Correct answer

Thrombocytosis causing platelet aggregation and consumption

Correct Incorrect Correct answer

Hemophilia B from a congenital Factor IX deficiency

Correct Incorrect Correct answer

Heparin-induced thrombocytopenia

Correct Incorrect Correct answer

A patient on warfarin for atrial fibrillation reports an INR of 5.2 at their last visit. They now present with spontaneous nosebleeds that have persisted for 45 minutes and dark tarry stools. Which statement about prehospital management is most accurate?

Apply direct pressure to the nose, establish IV access, and transport for possible vitamin K and fresh frozen plasma administration

Correct Incorrect Correct answer

Administer aspirin to reduce platelet aggregation and control the bleeding

Correct Incorrect Correct answer

Pack the nose with gauze and advise the patient to follow up with their primary care physician

Correct Incorrect Correct answer

Administer tranexamic acid IV to neutralize the warfarin

Correct Incorrect Correct answer

A 28-year-old female with sickle cell disease presents with severe bilateral leg pain, fever of 39.2 C, and a heart rate of 124 bpm. She states the pain feels like her typical sickle cell crisis but worse than usual. Her SpO2 is 91% on room air. In addition to supplemental oxygen and IV fluid resuscitation, what is the most important consideration for this patient?

Aggressive pain management and monitoring for acute chest syndrome

Correct Incorrect Correct answer

Applying bilateral leg splints to reduce pain from possible fractures

Correct Incorrect Correct answer

Administering a blood thinner to prevent further sickling of red blood cells

Correct Incorrect Correct answer

Cooling the patient with ice packs to reduce the fever and prevent further hemolysis

Correct Incorrect Correct answer

Prothrombin Time (PT) measures the function of which coagulation pathway?

The extrinsic and common pathways

Correct Incorrect Correct answer

The intrinsic pathway only

Correct Incorrect Correct answer

The fibrinolytic pathway

Correct Incorrect Correct answer

The platelet adhesion pathway

Correct Incorrect Correct answer

A 22-year-old asthmatic patient has been using their albuterol inhaler every 30 minutes for the past 4 hours with no relief. On arrival, the patient can only speak in one or two word phrases, has a respiratory rate of 38, SpO2 of 84%, and you note a silent chest on auscultation. What is the most appropriate initial intervention?

Administer continuous nebulized albuterol with ipratropium and prepare for positive pressure ventilation

Correct Incorrect Correct answer

Administer a single dose of inhaled albuterol and reassess in 15 minutes

Correct Incorrect Correct answer

Place the patient on a nasal cannula at 4 L/min and establish IV access

Correct Incorrect Correct answer

Administer epinephrine 0.3 mg IM and apply CPAP at 10 cmH2O

Correct Incorrect Correct answer

A 70-year-old male with a history of CHF presents sitting upright, in acute respiratory distress with bilateral rales, pink frothy sputum, and an SpO2 of 86%. Blood pressure is 168/102 mmHg. What is the most appropriate prehospital intervention?

Apply CPAP at 5 to 10 cmH2O and administer nitroglycerin

Correct Incorrect Correct answer

Administer a 500 mL normal saline bolus and place the patient supine

Correct Incorrect Correct answer

Administer albuterol via nebulizer and obtain a 12-lead ECG

Correct Incorrect Correct answer

Intubate immediately and ventilate with a bag-valve mask

Correct Incorrect Correct answer

Which of the following is the hallmark clinical feature that distinguishes epiglottitis from croup in a pediatric patient?

Drooling with a preference for the tripod position and a toxic appearance

Correct Incorrect Correct answer

A barking, seal-like cough that worsens at night

Correct Incorrect Correct answer

Gradual onset of low-grade fever with nasal congestion

Correct Incorrect Correct answer

Bilateral expiratory wheezing on auscultation

Correct Incorrect Correct answer

A 2-year-old child presents with a barking cough, inspiratory stridor at rest, and mild intercostal retractions. The child is alert and has an SpO2 of 94% on room air. What is the most appropriate prehospital treatment?

Administer nebulized epinephrine and provide humidified oxygen

Correct Incorrect Correct answer

Perform direct laryngoscopy to visualize the airway obstruction

Correct Incorrect Correct answer

Administer albuterol via metered-dose inhaler with a spacer

Correct Incorrect Correct answer

Begin bag-valve-mask ventilation with supplemental oxygen

Correct Incorrect Correct answer

A 65-year-old male with a history of COPD and recent pneumonia presents with severe dyspnea, fever of 39.5 C, productive cough with rust-colored sputum, and crackles in the right lower lobe. SpO2 is 82% on room air. After applying a nonrebreather mask, the SpO2 only rises to 88%. What should the paramedic do next?

Apply CPAP to improve oxygenation and recruit collapsed alveoli

Correct Incorrect Correct answer

Switch to a nasal cannula at 6 L/min to avoid suppressing hypoxic drive

Correct Incorrect Correct answer

Administer albuterol to treat the underlying bronchospasm

Correct Incorrect Correct answer

Reduce the oxygen flow rate to prevent oxygen toxicity

Correct Incorrect Correct answer

A tall, thin 19-year-old male suddenly develops sharp right-sided chest pain and dyspnea while playing basketball. He has diminished breath sounds on the right side, no history of trauma, and his SpO2 is 93%. What condition should the paramedic suspect?

Spontaneous pneumothorax

Correct Incorrect Correct answer

Pulmonary embolism

Correct Incorrect Correct answer

Acute myocardial infarction

Correct Incorrect Correct answer

Costochondritis

Correct Incorrect Correct answer

A 50-year-old female with a history of breast cancer presents with progressive dyspnea over the past week. On examination, you find dullness to percussion and absent breath sounds at the left lung base. JVD is not present, and the trachea is midline. SpO2 is 89% on room air. What is the most likely cause of her respiratory distress?

Pleural effusion

Correct Incorrect Correct answer

Tension pneumothorax

Correct Incorrect Correct answer

Pulmonary embolism

Correct Incorrect Correct answer

Acute decompensated heart failure

Correct Incorrect Correct answer

A 6-month-old infant presents with wheezing, nasal flaring, intercostal retractions, and a respiratory rate of 68 breaths per minute. The parents report the child has had nasal congestion and low-grade fever for two days. SpO2 is 88%. What is the most likely diagnosis?

Bronchiolitis caused by respiratory syncytial virus (RSV)

Correct Incorrect Correct answer

Bacterial pneumonia requiring IV antibiotics

Correct Incorrect Correct answer

Foreign body airway obstruction

Correct Incorrect Correct answer

Pertussis (whooping cough)

Correct Incorrect Correct answer

A 40-year-old male found unresponsive has agonal respirations at 4 breaths per minute with a weak pulse at 40 bpm. Pupils are pinpoint. After providing bag-valve-mask ventilation, the paramedic notes the capnography waveform suddenly appears and EtCO2 reads 72 mmHg. What does this elevated EtCO2 suggest?

Severe hypoventilation with significant CO2 retention prior to ventilatory support

Correct Incorrect Correct answer

The endotracheal tube is placed in the esophagus

Correct Incorrect Correct answer

The patient is experiencing a massive pulmonary embolism

Correct Incorrect Correct answer

The patient has developed metabolic alkalosis

Correct Incorrect Correct answer

A 3-year-old child with a suspected diagnosis of epiglottitis is sitting upright in a tripod position, drooling, and has a high-pitched inspiratory stridor. The child appears anxious and has a temperature of 40.1 C. What is the most critical prehospital principle for managing this patient?

Avoid agitating the child and do not attempt to visualize the airway

Correct Incorrect Correct answer

Lay the child supine and perform direct laryngoscopy to confirm the diagnosis

Correct Incorrect Correct answer

Insert a nasopharyngeal airway to maintain airway patency

Correct Incorrect Correct answer

Administer nebulized albuterol to reduce upper airway swelling

Correct Incorrect Correct answer

Which respiratory condition is characterized by paroxysmal episodes of violent coughing followed by a high-pitched inspiratory whoop, often accompanied by post-tussive vomiting?

Pertussis (whooping cough)

Correct Incorrect Correct answer

Croup (laryngotracheobronchitis)

Correct Incorrect Correct answer

Acute bronchitis

Correct Incorrect Correct answer

Reactive airway disease

Correct Incorrect Correct answer

A 78-year-old nursing home patient presents with tachypnea, bilateral crackles, hypoxia (SpO2 84%), tachycardia, and hypotension. Chest X-ray findings from two days ago showed bilateral diffuse infiltrates. The patient has been on oxygen therapy without improvement. Based on the clinical presentation, what condition should the paramedic suspect?

Acute respiratory distress syndrome (ARDS)

Correct Incorrect Correct answer

Community-acquired pneumonia responding slowly to antibiotics

Correct Incorrect Correct answer

Acute decompensated heart failure with pulmonary edema

Correct Incorrect Correct answer

Chronic obstructive pulmonary disease exacerbation

Correct Incorrect Correct answer

A 58-year-old male with a history of chronic kidney disease presents with altered mental status, nausea, and an ammonia-like odor on his breath. His skin appears pale and slightly jaundiced. Vital signs are BP 168/102, HR 98, RR 24 (deep and labored), SpO2 94%. Which condition is most consistent with this presentation?

Uremic encephalopathy from chronic kidney disease

Correct Incorrect Correct answer

Diabetic ketoacidosis

Correct Incorrect Correct answer

Hepatic encephalopathy

Correct Incorrect Correct answer

Acute alcohol intoxication

Correct Incorrect Correct answer

A dental assistant removes a barrier-covered PSP (photostimulable phosphor) plate from a patient’s mouth. What should the assistant do before scanning the plate in the reader?

Remove the contaminated barrier carefully without touching the plate surface, then place the plate into the scanner

Correct Incorrect Correct answer

Disinfect the outside of the barrier envelope before opening it

Correct Incorrect Correct answer

Remove gloves and handle the plate with bare hands to avoid transferring contaminants from the gloves

Correct Incorrect Correct answer

Place the plate directly into the scanner with the barrier still attached

Correct Incorrect Correct answer

Why should dental handpieces not be immersed in disinfectant solutions or ultrasonic cleaners?

Immersion can damage internal components such as turbines, bearings, and fiber optics

Correct Incorrect Correct answer

Disinfectant solutions are not effective against bacterial spores found on handpieces

Correct Incorrect Correct answer

Ultrasonic cleaning removes the protective coating on the handpiece exterior

Correct Incorrect Correct answer

Immersion prevents proper air drying, which is required before sterilization

Correct Incorrect Correct answer

A 72-year-old male on peritoneal dialysis presents with abdominal pain, fever of 101.4 F, and cloudy dialysate fluid draining from his peritoneal catheter. Which condition should the paramedic suspect?

Peritonitis related to the peritoneal dialysis catheter

Correct Incorrect Correct answer

Acute appendicitis requiring emergent surgical evaluation

Correct Incorrect Correct answer

Spontaneous bacterial peritonitis from liver cirrhosis

Correct Incorrect Correct answer

Bowel obstruction with secondary infection

Correct Incorrect Correct answer

A 66-year-old female with end-stage renal disease who missed her last two dialysis sessions presents with severe dyspnea, bilateral crackles throughout both lung fields, jugular venous distension, and pink frothy sputum. SpO2 is 82% on room air. What is the most appropriate treatment approach?

Apply CPAP at 10 cmH2O and administer nitroglycerin if blood pressure permits

Correct Incorrect Correct answer

Administer a 500 mL normal saline bolus and furosemide 40 mg IV

Correct Incorrect Correct answer

Perform endotracheal intubation immediately before other interventions

Correct Incorrect Correct answer

Administer albuterol via nebulizer for bronchospasm

Correct Incorrect Correct answer

A 42-year-old male presents with sudden onset of severe left flank pain radiating to the groin. He is writhing in pain, unable to find a comfortable position. Vital signs are BP 148/88, HR 104, RR 20. He reports one episode of bloody urine earlier today. Which condition is most likely?

Renal colic from a kidney stone

Correct Incorrect Correct answer

Abdominal aortic aneurysm with impending rupture

Correct Incorrect Correct answer

Acute pyelonephritis with sepsis

Correct Incorrect Correct answer

Testicular torsion requiring emergent surgery

Correct Incorrect Correct answer

Which electrolyte imbalance is the most immediately life-threatening complication in a patient with acute renal failure?

Hyperkalemia

Correct Incorrect Correct answer

Hyponatremia

Correct Incorrect Correct answer

Hypocalcemia

Correct Incorrect Correct answer

Hypermagnesemia

Correct Incorrect Correct answer

A dental assistant experiences a needlestick injury from a syringe used on a patient. The dentist asks the patient for consent to have their blood tested. The patient refuses. What happens next according to the Bloodborne Pathogens Standard?

The employer must still provide the employee with a confidential medical evaluation and post-exposure follow-up, treating the source as unknown status

Correct Incorrect Correct answer

The employer can require the patient to submit to testing because it involves a workplace injury

Correct Incorrect Correct answer

The exposure incident is considered low risk and no further follow-up is needed

Correct Incorrect Correct answer

The dental assistant must wait 90 days and then be tested to determine if infection occurred

Correct Incorrect Correct answer

A 78-year-old male with benign prostatic hyperplasia presents with suprapubic pain, distension, and reports he has not urinated in over 18 hours despite feeling a strong urge. Which condition does this presentation suggest?

Acute urinary retention

Correct Incorrect Correct answer

Ruptured bladder requiring emergent surgery

Correct Incorrect Correct answer

Acute renal failure with anuria

Correct Incorrect Correct answer

Lower urinary tract infection with obstruction

Correct Incorrect Correct answer

When taking intraoral radiographs, what type of gloves should the dental assistant wear?

Nonsterile examination gloves

Correct Incorrect Correct answer

Sterile surgical gloves

Correct Incorrect Correct answer

Heavy-duty utility gloves

Correct Incorrect Correct answer

Polyethylene overgloves only

Correct Incorrect Correct answer

A dialysis patient presents with a palpable thrill and audible bruit over the left forearm AV fistula. The patient reports the fistula area feels warm. What does this assessment indicate?

The AV fistula is functioning normally

Correct Incorrect Correct answer

The fistula is infected and requires IV antibiotics

Correct Incorrect Correct answer

The fistula has clotted and needs surgical revision

Correct Incorrect Correct answer

The fistula is bleeding internally and causing a hematoma

Correct Incorrect Correct answer

A dental assistant is processing conventional film in a darkroom. After removing exposed film packets from barrier envelopes with contaminated gloves, what must the assistant do before handling the films for processing?

Remove contaminated gloves, wash hands, and put on new clean gloves before handling the unwrapped films

Correct Incorrect Correct answer

Continue wearing the same contaminated gloves to avoid interrupting the workflow

Correct Incorrect Correct answer

Spray the contaminated gloves with surface disinfectant before touching the unwrapped films

Correct Incorrect Correct answer

Remove all gloves and handle the films with bare, washed hands since the barrier protected them

Correct Incorrect Correct answer

What is the purpose of the exposure determination section within an Exposure Control Plan?

To identify all job classifications and tasks in which employees have occupational exposure to blood or other potentially infectious materials

Correct Incorrect Correct answer

To document the number of exposure incidents that occurred in the previous year

Correct Incorrect Correct answer

To list the types of personal protective equipment available in the office

Correct Incorrect Correct answer

To record the vaccination history of all employees

Correct Incorrect Correct answer

A 55-year-old female presents with chest pressure and dyspnea. Her 12-lead ECG shows ST depression and T-wave inversion in leads V3 through V6. Troponin level, obtained at the sending facility, is elevated. Which condition does this presentation represent?

Non-ST elevation myocardial infarction (NSTEMI)

Correct Incorrect Correct answer

ST elevation myocardial infarction (STEMI) requiring emergent catheterization

Correct Incorrect Correct answer

Unstable angina without myocardial damage

Correct Incorrect Correct answer

Stable angina from chronic coronary artery disease

Correct Incorrect Correct answer

During a busy morning, a dental assistant realizes that a digital sensor barrier was torn when retrieved from the patient’s mouth, and saliva is visible on the sensor surface. What is the correct next step?

Disinfect the sensor with an EPA-registered intermediate-level disinfectant approved for that sensor type

Correct Incorrect Correct answer

Wipe the sensor with a dry paper towel and place a new barrier for the next exposure

Correct Incorrect Correct answer

Rinse the sensor under cold running water and allow it to air dry

Correct Incorrect Correct answer

Soak the sensor in glutaraldehyde solution for high-level disinfection overnight

Correct Incorrect Correct answer

A paramedic is treating a 70-year-old male with a history of CHF who presents with severe dyspnea, bilateral rales, and peripheral edema. His blood pressure is 180/110 and SpO2 is 86%. Which intervention combination is most appropriate?

CPAP and sublingual nitroglycerin

Correct Incorrect Correct answer

Normal saline bolus and furosemide IV

Correct Incorrect Correct answer

Albuterol nebulizer and ipratropium

Correct Incorrect Correct answer

Endotracheal intubation and morphine IV

Correct Incorrect Correct answer

Where should the dental assistant press the exposure button during intraoral radiography?

At a position at least six feet from the tubehead and behind a protective barrier or wall

Correct Incorrect Correct answer

Directly beside the dental chair to monitor the patient

Correct Incorrect Correct answer

At arm's length from the tubehead while holding the PID steady

Correct Incorrect Correct answer

Inside the darkroom with the door closed

Correct Incorrect Correct answer

Which cardiac biomarker is most specific for myocardial cell injury and is used to confirm acute myocardial infarction?

Troponin I

Correct Incorrect Correct answer

Creatine kinase (CK)

Correct Incorrect Correct answer

Lactate dehydrogenase (LDH)

Correct Incorrect Correct answer

B-type natriuretic peptide (BNP)

Correct Incorrect Correct answer

A dental assistant has finished taking a full-mouth series using a digital sensor. After removing gloves, the assistant notices saliva on the sensor cable. What should the assistant do?

Put on new gloves, disinfect the sensor and cable with an intermediate-level disinfectant, then remove gloves and perform hand hygiene

Correct Incorrect Correct answer

Use bare hands to wipe the cable with an alcohol pad since gloves have already been removed

Correct Incorrect Correct answer

Submerge the sensor and cable in a cold sterilant for 20 minutes

Correct Incorrect Correct answer

Leave the cable for the end of the day and disinfect all cables at once

Correct Incorrect Correct answer

What is the primary method for preventing contamination of a digital radiographic sensor during intraoral exposure?

Covering the sensor with a disposable plastic barrier sleeve before placement

Correct Incorrect Correct answer

Immersing the sensor in a cold sterilization solution for 10 minutes between patients

Correct Incorrect Correct answer

Wiping the sensor with a dry paper towel between patients

Correct Incorrect Correct answer

Sterilizing the sensor in a chemical vapor sterilizer between patients

Correct Incorrect Correct answer

A paramedic is transporting a patient with a blood pressure of 248/142, severe headache, visual disturbances, and confusion. The patient has a history of noncompliance with antihypertensive medications. Which condition does this presentation indicate?

Hypertensive emergency with evidence of end-organ damage

Correct Incorrect Correct answer

Hypertensive urgency requiring gradual blood pressure reduction over 24 hours

Correct Incorrect Correct answer

Hemorrhagic stroke caused by a ruptured cerebral aneurysm

Correct Incorrect Correct answer

Transient ischemic attack that will resolve spontaneously

Correct Incorrect Correct answer

What is the primary difference between hypertensive emergency and hypertensive urgency?

Hypertensive emergency involves end-organ damage, while urgency does not

Correct Incorrect Correct answer

Hypertensive emergency has a systolic BP above 220, while urgency is below 220

Correct Incorrect Correct answer

Hypertensive urgency requires IV medications, while emergency requires oral medications

Correct Incorrect Correct answer

Hypertensive emergency only occurs in patients with known hypertension

Correct Incorrect Correct answer

A paramedic is treating a 58-year-old female with an acute inferior STEMI. The patient’s blood pressure is 86/54 and she appears pale and diaphoretic. A right-sided 12-lead ECG shows ST elevation in V4R. Why should nitroglycerin be avoided in this patient?

Right ventricular infarction makes the patient preload-dependent, and nitroglycerin reduces preload

Correct Incorrect Correct answer

Nitroglycerin is contraindicated in all patients with systolic BP below 100 mmHg

Correct Incorrect Correct answer

Nitroglycerin causes coronary vasospasm in inferior wall infarctions

Correct Incorrect Correct answer

Nitroglycerin increases right ventricular afterload and worsens heart failure

Correct Incorrect Correct answer

A STEMI patient at a rural facility is 90 minutes from the nearest catheterization lab. The emergency physician asks the paramedic to prepare for interfacility transport. Which time-based consideration is most important for this patient’s outcome?

First medical contact to balloon inflation should be within 120 minutes for transfer patients

Correct Incorrect Correct answer

Fibrinolytics must be administered within 30 minutes of symptom onset

Correct Incorrect Correct answer

The patient must arrive at the catheterization lab within 60 minutes of symptom onset

Correct Incorrect Correct answer

Door-to-balloon time at the receiving facility must be under 30 minutes

Correct Incorrect Correct answer

A 60-year-old male with known CHF presents with worsening dyspnea over three days. He is sitting upright, has bilateral lower extremity edema to the knees, jugular venous distension, and crackles in the lower half of both lung fields. His blood pressure is 104/68. The patient states he ran out of his diuretic medication five days ago. Which treatment approach is most appropriate?

Apply CPAP, establish IV access, and transport; avoid nitroglycerin due to borderline hypotension

Correct Incorrect Correct answer

Administer a 500 mL normal saline bolus to improve renal perfusion

Correct Incorrect Correct answer

Administer furosemide 80 mg IV push and nitroglycerin 0.4 mg sublingual

Correct Incorrect Correct answer

Place the patient supine to improve venous return and cardiac output

Correct Incorrect Correct answer

Which medication class administered in the prehospital setting is indicated to prevent further clot propagation in acute coronary syndrome?

Antiplatelet agents such as aspirin

Correct Incorrect Correct answer

Beta-blockers such as metoprolol

Correct Incorrect Correct answer

ACE inhibitors such as enalapril

Correct Incorrect Correct answer

Calcium channel blockers such as diltiazem

Correct Incorrect Correct answer

A 28-year-old female at 39 weeks gestation is having contractions every 2 minutes, each lasting 60 to 90 seconds. She reports a strong urge to push. On examination, the paramedic observes the infant’s head visible at the vaginal opening during contractions. What is the most appropriate action?

Prepare for imminent field delivery and do not attempt transport

Correct Incorrect Correct answer

Transport immediately with the patient in left lateral recumbent position

Correct Incorrect Correct answer

Instruct the patient to cross her legs to delay delivery until hospital arrival

Correct Incorrect Correct answer

Administer terbutaline to slow contractions and allow time for transport

Correct Incorrect Correct answer

A paramedic is assessing a 32-year-old female at 36 weeks gestation who reports regular contractions for the past 4 hours. She states the contractions are getting stronger and closer together, now occurring every 5 minutes and lasting 45 seconds. There is no vaginal bleeding and membranes have not ruptured. Which assessment finding would indicate the need to prepare for field delivery rather than transport?

The patient reports an uncontrollable urge to bear down and the perineum is bulging

Correct Incorrect Correct answer

Contractions are occurring every 5 minutes and lasting 45 seconds

Correct Incorrect Correct answer

The patient's water has not yet broken

Correct Incorrect Correct answer

The patient is a primigravida with no prior deliveries

Correct Incorrect Correct answer

During a normal cephalic delivery, what should the paramedic do immediately after the head delivers?

Check for a nuchal cord (umbilical cord wrapped around the neck)

Correct Incorrect Correct answer

Immediately clamp and cut the umbilical cord

Correct Incorrect Correct answer

Apply gentle traction to the head to deliver the shoulders

Correct Incorrect Correct answer

Begin drying and stimulating the infant

Correct Incorrect Correct answer

You are called for a 32-year-old female at 36 weeks gestation who presents with a foot visible at the vaginal opening. She reports intense contractions every 2 minutes. What is the most appropriate prehospital management?

Position the mother in a knee-chest position and provide rapid transport

Correct Incorrect Correct answer

Attempt to gently push the foot back into the birth canal

Correct Incorrect Correct answer

Apply gentle traction to the presenting foot to assist delivery

Correct Incorrect Correct answer

Place the mother supine and prepare for normal vaginal delivery

Correct Incorrect Correct answer

During a field delivery, you notice the umbilical cord protruding from the vagina ahead of the infant’s head. The cord has a palpable pulse. What is the priority intervention?

Insert a gloved hand to lift the presenting part off the cord and transport immediately

Correct Incorrect Correct answer

Attempt to push the cord back into the uterus past the fetal head

Correct Incorrect Correct answer

Clamp the cord in two places and cut between the clamps

Correct Incorrect Correct answer

Apply a moist dressing over the cord and place the mother supine for transport

Correct Incorrect Correct answer

After delivery, you discover a tight nuchal cord that cannot be slipped over the infant’s head. What is the most appropriate action?

Place two clamps on the cord and cut between them, then unwrap the cord

Correct Incorrect Correct answer

Continue gentle traction on the head to deliver through the loop

Correct Incorrect Correct answer

Attempt to pass the infant's body back through the cord loop

Correct Incorrect Correct answer

Wait for the cord to loosen with subsequent contractions

Correct Incorrect Correct answer

Which clinical presentation is most consistent with placenta previa?

Painless, bright red vaginal bleeding in the third trimester

Correct Incorrect Correct answer

Severe abdominal pain with dark red vaginal bleeding and a rigid uterus

Correct Incorrect Correct answer

Sudden onset of unilateral lower abdominal pain with scant vaginal spotting

Correct Incorrect Correct answer

Intermittent cramping with blood-tinged mucus discharge at 38 weeks

Correct Incorrect Correct answer

A 30-year-old female at 34 weeks gestation presents with a severe headache, blurred vision, right upper quadrant pain, and blood pressure of 178/112 mmHg. Her platelet count from a recent lab visit was 62,000/mm3. Which condition should the paramedic suspect?

HELLP syndrome

Correct Incorrect Correct answer

Gestational diabetes with hypertensive crisis

Correct Incorrect Correct answer

Acute cholecystitis

Correct Incorrect Correct answer

Chronic hypertension with superimposed migraine

Correct Incorrect Correct answer

A 25-year-old female with a positive pregnancy test presents with sudden, severe left lower quadrant pain, vaginal spotting, and signs of shock. Her last menstrual period was 7 weeks ago. What condition should the paramedic suspect?

Ruptured ectopic pregnancy

Correct Incorrect Correct answer

Threatened miscarriage

Correct Incorrect Correct answer

Placental abruption

Correct Incorrect Correct answer

Ovarian torsion unrelated to pregnancy

Correct Incorrect Correct answer

A patient at 14 weeks gestation presents with moderate vaginal bleeding and cramping. She reports passing tissue. The cervical os is open on hospital assessment. Which type of miscarriage does this presentation describe?

Inevitable miscarriage

Correct Incorrect Correct answer

Threatened miscarriage

Correct Incorrect Correct answer

Missed miscarriage

Correct Incorrect Correct answer

Complete miscarriage

Correct Incorrect Correct answer

A paramedic delivers a newborn who has a heart rate of 88, slow and irregular respiratory effort, some flexion of extremities, grimaces when stimulated, and a blue body with pink extremities. What is this infant’s Apgar score?

4

Correct Incorrect Correct answer

3

Correct Incorrect Correct answer

5

Correct Incorrect Correct answer

6

Correct Incorrect Correct answer

A newborn delivered in the field is apneic with a heart rate of 52 after 30 seconds of effective positive pressure ventilation. What is the next intervention?

Begin chest compressions coordinated with ventilations at a 3:1 ratio

Correct Incorrect Correct answer

Administer epinephrine 0.01 mg/kg via umbilical vein catheter

Correct Incorrect Correct answer

Perform endotracheal intubation before any further interventions

Correct Incorrect Correct answer

Increase the ventilation rate to 60 breaths per minute

Correct Incorrect Correct answer

You are transporting a 35-year-old at 39 weeks gestation who reports the urge to push. On exam, you see the umbilical cord presenting at the vaginal opening and delivery appears imminent. After elevating the presenting part off the cord, what is the most critical reason to avoid delaying transport for an emergency cesarean at the hospital?

Prolonged cord compression causes progressive fetal hypoxia that can result in brain injury or death

Correct Incorrect Correct answer

The mother is at high risk for uterine rupture during prolonged labor

Correct Incorrect Correct answer

Cord prolapse always requires immediate clamping and cutting of the cord

Correct Incorrect Correct answer

The fetal heart rate monitoring equipment is only available during transport

Correct Incorrect Correct answer

A 62-year-old male presents with sudden onset right-sided facial droop, right arm weakness, and slurred speech. His wife states the symptoms began approximately 45 minutes ago. Vital signs are BP 178/96, HR 88, SpO2 97%. What is the most critical piece of information for the receiving stroke center?

The exact time of symptom onset or last known well time

Correct Incorrect Correct answer

The patient's current blood glucose level

Correct Incorrect Correct answer

Whether the patient has a history of prior strokes

Correct Incorrect Correct answer

The Cincinnati Prehospital Stroke Scale results

Correct Incorrect Correct answer

The Los Angeles Motor Scale (LAMS) assesses which of the following components to identify large vessel occlusion stroke?

Facial droop, arm drift, and grip strength

Correct Incorrect Correct answer

Speech clarity, visual field deficits, and gait stability

Correct Incorrect Correct answer

Level of consciousness, pupil reactivity, and arm drift

Correct Incorrect Correct answer

Facial symmetry, leg drift, and dysarthria

Correct Incorrect Correct answer

A 55-year-old female is found unresponsive by her husband when he returned home at 1400 hours. He spoke with her on the phone at 1130 and she was normal. The patient has left hemiplegia and gaze deviation to the right. What is the last known well time?

1130 hours, when she was last known to be at her neurological baseline

Correct Incorrect Correct answer

1400 hours, when her husband found her with symptoms

Correct Incorrect Correct answer

The midpoint between 1130 and 1400, estimated at 1245 hours

Correct Incorrect Correct answer

The time cannot be determined and should be reported as unknown

Correct Incorrect Correct answer

Which type of seizure is characterized by brief episodes of staring and unresponsiveness lasting 5 to 30 seconds, most commonly seen in children?

Absence seizure

Correct Incorrect Correct answer

Complex partial seizure

Correct Incorrect Correct answer

Tonic-clonic seizure

Correct Incorrect Correct answer

Myoclonic seizure

Correct Incorrect Correct answer

A 28-year-old male with a known seizure disorder had a witnessed generalized tonic-clonic seizure that lasted approximately 90 seconds and has now stopped. He is breathing adequately but is confused, combative, and does not follow commands. What is the most likely explanation for his current presentation?

Postictal state following the generalized seizure

Correct Incorrect Correct answer

Ongoing nonconvulsive status epilepticus requiring immediate benzodiazepine

Correct Incorrect Correct answer

Traumatic brain injury sustained during the seizure

Correct Incorrect Correct answer

Hypoglycemia as the underlying cause of the seizure

Correct Incorrect Correct answer

A 2-year-old child has been seizing for the past 3 minutes according to the parents. The child has a rectal temperature of 39.8°C (103.6°F) and no seizure history. The seizure involves symmetric tonic-clonic activity of all extremities. What is the most appropriate initial management?

Protect the airway, position the child on their side, and monitor for seizure cessation

Correct Incorrect Correct answer

Administer rectal diazepam immediately to terminate the febrile seizure

Correct Incorrect Correct answer

Apply cold water immersion to rapidly reduce the core temperature

Correct Incorrect Correct answer

Establish IV access and administer a normal saline fluid bolus

Correct Incorrect Correct answer

A 32-week pregnant female presents with a blood pressure of 192/118 mmHg, severe headache, visual disturbances, and then begins seizing. What is the medication of choice to control this patient’s seizures?

Magnesium sulfate 4 g IV

Correct Incorrect Correct answer

Midazolam 5 mg IV

Correct Incorrect Correct answer

Lorazepam 4 mg IV

Correct Incorrect Correct answer

Phenytoin 15 mg/kg IV

Correct Incorrect Correct answer

A paramedic responds to a 45-year-old male found on the floor of his apartment. He is unresponsive with a GCS of 6, has pinpoint pupils bilaterally, a blood glucose of 142 mg/dL, and no signs of trauma. His roommate states the patient has been complaining of worsening headaches and a stiff neck for two days with a fever. What condition should the paramedic suspect?

Meningitis with progressing altered mental status

Correct Incorrect Correct answer

Acute ischemic stroke with basilar artery occlusion

Correct Incorrect Correct answer

Opioid overdose based on the pinpoint pupils

Correct Incorrect Correct answer

Nonconvulsive status epilepticus

Correct Incorrect Correct answer

Which clinical finding distinguishes encephalitis from meningitis in the prehospital setting?

Altered mental status, behavioral changes, or focal neurological deficits suggesting brain parenchyma involvement

Correct Incorrect Correct answer

Presence of fever and headache

Correct Incorrect Correct answer

Nuchal rigidity and photophobia

Correct Incorrect Correct answer

Elevated white blood cell count on laboratory testing

Correct Incorrect Correct answer

A paramedic is treating a 58-year-old male who was found unresponsive after a witnessed collapse. GCS is 4. The patient has a blood pressure of 210/130 mmHg, heart rate of 52, and irregular respirations at 8 per minute. The left pupil is 7 mm and nonreactive; the right is 3 mm and reactive. What is the most likely cause of these findings?

Increased intracranial pressure with uncal herniation

Correct Incorrect Correct answer

Acute ischemic stroke involving the middle cerebral artery

Correct Incorrect Correct answer

Hypertensive encephalopathy from malignant hypertension

Correct Incorrect Correct answer

Brainstem hemorrhage with locked-in syndrome

Correct Incorrect Correct answer

A patient experiencing a suspected herniation syndrome has a GCS of 5, a unilateral dilated pupil, and is being ventilated via bag-valve mask. What is the target ventilation rate for this patient?

20 breaths per minute as a brief temporizing measure for suspected active herniation

Correct Incorrect Correct answer

10 breaths per minute to match the standard adult ventilation rate

Correct Incorrect Correct answer

30 breaths per minute to maximally reduce intracranial pressure

Correct Incorrect Correct answer

6 breaths per minute to minimize the risk of cerebral vasospasm

Correct Incorrect Correct answer

A patient is experiencing status epilepticus with continuous tonic-clonic seizure activity for 8 minutes. IV access has not been established. Which medication and route is most appropriate?

Midazolam 10 mg intramuscular

Correct Incorrect Correct answer

Diazepam 10 mg intramuscular

Correct Incorrect Correct answer

Phenytoin 250 mg intramuscular

Correct Incorrect Correct answer

Lorazepam 4 mg subcutaneous

Correct Incorrect Correct answer

A 70-year-old female presents with right arm weakness and expressive aphasia. Her husband reports she was fine when he left for work at 0700 and he found her symptomatic at 1400. Current time is 1430. A stroke alert is called. Based on the timeline, is this patient potentially eligible for IV thrombolytic therapy?

No, because the last known well time of 0700 places her outside the 4.5-hour treatment window

Correct Incorrect Correct answer

Yes, because fewer than 4.5 hours have passed since symptom discovery at 1400

Correct Incorrect Correct answer

Yes, because the treating physician can use clinical judgment to extend the window to 12 hours

Correct Incorrect Correct answer

No, because thrombolytics are contraindicated in patients over 65 years of age

Correct Incorrect Correct answer

Which assessment finding is most suggestive of altered mental status caused by a metabolic etiology rather than a structural brain lesion?

Symmetric, reactive pupils with no focal neurological deficits

Correct Incorrect Correct answer

Unilateral pupil dilation with contralateral hemiparesis

Correct Incorrect Correct answer

Gaze deviation toward one side with ipsilateral arm weakness

Correct Incorrect Correct answer

Decorticate posturing on one side and decerebrate on the other

Correct Incorrect Correct answer

A 38-year-old female presents with the worst headache of her life that began suddenly 2 hours ago. She has a stiff neck, photophobia, and nausea. BP is 168/98, HR 92, GCS 14. The Cincinnati Stroke Scale is negative. What is the most likely diagnosis?

Subarachnoid hemorrhage

Correct Incorrect Correct answer

Acute ischemic stroke

Correct Incorrect Correct answer

Bacterial meningitis

Correct Incorrect Correct answer

Migraine headache with aura

Correct Incorrect Correct answer

Which set of criteria defines the Systemic Inflammatory Response Syndrome (SIRS)?

Two or more of: temperature greater than 38°C or less than 36°C, heart rate greater than 90, respiratory rate greater than 20, and white blood cell count greater than 12,000 or less than 4,000

Correct Incorrect Correct answer

Systolic blood pressure less than 90 mmHg, lactate greater than 4 mmol/L, and urine output less than 0.5 mL/kg/hr

Correct Incorrect Correct answer

Temperature greater than 40°C, heart rate greater than 120, respiratory rate greater than 30, and altered mental status

Correct Incorrect Correct answer

Any two vital sign abnormalities combined with a confirmed source of infection

Correct Incorrect Correct answer

The quick Sequential Organ Failure Assessment (qSOFA) score uses which three clinical criteria to identify patients at risk for poor outcomes from sepsis?

Respiratory rate of 22 or greater, altered mentation, and systolic blood pressure of 100 mmHg or less

Correct Incorrect Correct answer

Heart rate greater than 100, temperature greater than 38.5°C, and oxygen saturation less than 92%

Correct Incorrect Correct answer

Glasgow Coma Scale less than 13, respiratory rate greater than 30, and mean arterial pressure less than 65 mmHg

Correct Incorrect Correct answer

Systolic blood pressure less than 90 mmHg, heart rate greater than 90, and lactate greater than 2 mmol/L

Correct Incorrect Correct answer

A 74-year-old nursing home resident presents with a temperature of 39.2°C, heart rate of 118, blood pressure of 84/52, respiratory rate of 26, and altered mental status. She has a known urinary tract infection. After establishing IV access, what is the initial fluid management priority?

Administer a 30 mL/kg crystalloid fluid bolus

Correct Incorrect Correct answer

Administer a 10 mL/kg crystalloid bolus and reassess in 30 minutes

Correct Incorrect Correct answer

Start a vasopressor infusion before administering any fluids

Correct Incorrect Correct answer

Restrict IV fluids to 250 mL to prevent pulmonary edema in the elderly

Correct Incorrect Correct answer

An emergency department physician requests that the paramedic obtain a serum lactate level on a septic patient prior to arrival. Why is lactate measurement clinically significant in sepsis?

Elevated lactate indicates tissue hypoperfusion and anaerobic metabolism, serving as a marker of sepsis severity

Correct Incorrect Correct answer

Lactate levels directly measure the bacterial load in the bloodstream

Correct Incorrect Correct answer

A normal lactate level confirms that the patient does not have sepsis

Correct Incorrect Correct answer

Lactate is used to determine which specific antibiotic should be administered

Correct Incorrect Correct answer

A paramedic responds to a 52-year-old male with fever, confusion, headache, and focal seizures. His wife reports he had flu-like symptoms for 3 days before developing confusion this morning. Temperature is 40.1°C, HR 108, BP 142/88, RR 22, SpO2 96%. What is the most likely diagnosis?

Viral encephalitis

Correct Incorrect Correct answer

Bacterial meningitis without encephalitic involvement

Correct Incorrect Correct answer

Heat stroke from prolonged environmental exposure

Correct Incorrect Correct answer

Febrile seizure in an adult patient

Correct Incorrect Correct answer

Which of the following is the primary route of transmission for hepatitis B virus in the healthcare setting?

Percutaneous exposure to infected blood through needlestick injuries

Correct Incorrect Correct answer

Inhalation of airborne droplet nuclei during patient intubation

Correct Incorrect Correct answer

Ingestion of contaminated food or water in the ambulance station

Correct Incorrect Correct answer

Direct skin contact with intact skin surfaces of an infected patient

Correct Incorrect Correct answer

Which bloodborne pathogen poses the highest risk of transmission from a single needlestick exposure to an unvaccinated healthcare worker?

Hepatitis B virus

Correct Incorrect Correct answer

Human immunodeficiency virus (HIV)

Correct Incorrect Correct answer

Hepatitis C virus

Correct Incorrect Correct answer

Hepatitis A virus

Correct Incorrect Correct answer

A paramedic crew is dispatched for a patient with suspected active tuberculosis presenting with productive cough, hemoptysis, night sweats, and weight loss. What is the minimum level of personal protective equipment (PPE) required for this call?

N95 respirator, gloves, and eye protection

Correct Incorrect Correct answer

Standard surgical mask and gloves

Correct Incorrect Correct answer

Powered air-purifying respirator (PAPR) with full body suit

Correct Incorrect Correct answer

Gloves only with good hand hygiene

Correct Incorrect Correct answer

During a respiratory illness pandemic, a paramedic crew is called for a 67-year-old male with fever, cough, and rapidly progressive dyspnea. SpO2 is 84% on room air and the patient is in significant respiratory distress. The crew applies a non-rebreather mask at 15 LPM, improving SpO2 to 89%. What is the next most appropriate respiratory intervention?

Apply CPAP to improve oxygenation and reduce the work of breathing

Correct Incorrect Correct answer

Switch to a nasal cannula at 6 LPM to reduce the risk of aerosolization

Correct Incorrect Correct answer

Immediately perform endotracheal intubation to secure the airway

Correct Incorrect Correct answer

Administer a nebulized bronchodilator before escalating respiratory support

Correct Incorrect Correct answer

A paramedic sustains a needlestick injury from a needle used on a patient with known HIV infection. After thorough wound cleansing, what is the most important next step?

Report the exposure immediately and seek post-exposure prophylaxis (PEP) as soon as possible, ideally within 2 hours

Correct Incorrect Correct answer

Wait for the source patient's viral load results before deciding on treatment

Correct Incorrect Correct answer

Apply a topical antiseptic and monitor for symptoms over the next 6 months

Correct Incorrect Correct answer

Begin a 7-day course of oral antibiotics to prevent seroconversion

Correct Incorrect Correct answer

A 48-year-old male presents with altered mental status, temperature of 39.8°C, heart rate of 124, respiratory rate of 28, blood pressure of 78/42, and mottled skin on his extremities. Despite a 1-liter normal saline bolus, his blood pressure remains 82/48. What is the most appropriate next intervention?

Initiate a vasopressor infusion, such as norepinephrine, per protocol

Correct Incorrect Correct answer

Administer a second 1-liter fluid bolus and reassess before considering vasopressors

Correct Incorrect Correct answer

Administer IV dexamethasone to reduce the inflammatory response

Correct Incorrect Correct answer

Apply a pneumatic anti-shock garment to increase central blood pressure

Correct Incorrect Correct answer

During a pandemic response, which level of PPE is required when performing aerosol-generating procedures such as endotracheal intubation on a patient with a suspected novel respiratory pathogen?

N95 or higher respirator, gown, gloves, and face shield or goggles

Correct Incorrect Correct answer

Surgical mask, gloves, and hand hygiene only

Correct Incorrect Correct answer

Standard precautions with a surgical mask and gloves

Correct Incorrect Correct answer

Level A hazmat suit with self-contained breathing apparatus

Correct Incorrect Correct answer

A paramedic is called for a 12-day-old neonate with poor feeding, lethargy, and a rectal temperature of 38.4°C (101.1°F). The fontanelle is slightly bulging. Heart rate is 186, respiratory rate is 52, and the skin appears mottled. What should the paramedic suspect?

Neonatal sepsis requiring emergent transport and IV access

Correct Incorrect Correct answer

Simple febrile illness that can be managed with antipyretics and observation

Correct Incorrect Correct answer

Congenital heart disease presenting with feeding intolerance

Correct Incorrect Correct answer

Normal neonatal vital signs with parental anxiety about feeding patterns

Correct Incorrect Correct answer

What is the most common cause of cardiac arrest in the newborn immediately following delivery?

Respiratory failure leading to hypoxia and bradycardia

Correct Incorrect Correct answer

Congenital cardiac arrhythmia such as ventricular fibrillation

Correct Incorrect Correct answer

Hypovolemic shock from umbilical cord hemorrhage

Correct Incorrect Correct answer

Hypothermia from inadequate warming during resuscitation

Correct Incorrect Correct answer

A 4-month-old infant is brought to the ambulance by frantic parents. The infant has been having paroxysmal coughing fits followed by a high-pitched inspiratory sound, with occasional post-tussive emesis. The infant is afebrile and appears well between coughing episodes. What is the most likely diagnosis?

Pertussis (whooping cough)

Correct Incorrect Correct answer

Croup with characteristic stridor

Correct Incorrect Correct answer

Bronchiolitis caused by respiratory syncytial virus

Correct Incorrect Correct answer

Foreign body aspiration in the lower airway

Correct Incorrect Correct answer

A 3-year-old child presents with a rectal temperature of 40.2°C and begins having a generalized tonic-clonic seizure lasting 2 minutes. The seizure stops spontaneously. The child has no seizure history and no known neurological conditions. After the seizure, what is the most important assessment to perform?

Perform a thorough assessment to identify the source of the fever while maintaining airway patency

Correct Incorrect Correct answer

Administer a benzodiazepine immediately to prevent seizure recurrence

Correct Incorrect Correct answer

Immerse the child in cold water to rapidly reduce the core temperature

Correct Incorrect Correct answer

Obtain IV access and administer a phenytoin loading dose for seizure prophylaxis

Correct Incorrect Correct answer

A 6-week-old infant presents with irritability, poor feeding, a bulging fontanelle, and a temperature of 39.0°C. The parents report the infant has been increasingly lethargic over the past 12 hours. What is the most critical concern and appropriate prehospital action?

Suspect bacterial meningitis, maintain temperature, establish vascular access, and provide rapid transport to a pediatric facility

Correct Incorrect Correct answer

Suspect colic, provide reassurance to the parents, and transport non-emergently

Correct Incorrect Correct answer

Suspect dehydration from poor feeding, administer a 20 mL/kg fluid bolus, and transport

Correct Incorrect Correct answer

Suspect child abuse based on the irritability, and perform a detailed trauma examination

Correct Incorrect Correct answer

Which vital sign finding in a 2-month-old infant is most concerning for sepsis?

Heart rate greater than 180 beats per minute with weak peripheral pulses and prolonged capillary refill

Correct Incorrect Correct answer

Respiratory rate of 36 breaths per minute with clear breath sounds bilaterally

Correct Incorrect Correct answer

Temperature of 37.5°C (99.5°F) with normal feeding patterns

Correct Incorrect Correct answer

Blood pressure of 70/40 mmHg measured by oscillometric device

Correct Incorrect Correct answer

A 24-year-old female presents with sudden onset of severe right lower quadrant pain that began 2 hours ago. She rates the pain 9/10 and reports nausea. Her last menstrual period was 10 days ago. Vitals: BP 118/72, HR 92, RR 18. What is the most likely cause of her symptoms?

Ruptured ovarian cyst

Correct Incorrect Correct answer

Ectopic pregnancy

Correct Incorrect Correct answer

Acute appendicitis

Correct Incorrect Correct answer

Pelvic inflammatory disease

Correct Incorrect Correct answer

What is the primary role of a Sexual Assault Nurse Examiner (SANE) in the care of a sexual assault victim?

To perform a forensic medical examination and collect evidence while providing compassionate care

Correct Incorrect Correct answer

To provide crisis counseling and long-term mental health follow-up

Correct Incorrect Correct answer

To file criminal charges against the perpetrator on behalf of the victim

Correct Incorrect Correct answer

To determine whether the victim's account of the assault is credible

Correct Incorrect Correct answer

A paramedic responds to a 30-year-old female who reports soaking through a pad every 30 minutes for the past 6 hours. She is pale, diaphoretic, and lightheaded. Vitals: BP 88/56, HR 128, RR 22. What is the most appropriate prehospital management?

Establish IV access, administer a normal saline bolus, and provide rapid transport to the emergency department

Correct Incorrect Correct answer

Apply direct pressure to the perineum to control bleeding

Correct Incorrect Correct answer

Administer tranexamic acid and transport at normal priority

Correct Incorrect Correct answer

Place the patient in Trendelenburg position and withhold fluids

Correct Incorrect Correct answer

Dysmenorrhea is best defined as which of the following?

Painful menstrual cramping that may be accompanied by nausea, headache, and general malaise

Correct Incorrect Correct answer

Absence of menstrual periods for three or more consecutive months

Correct Incorrect Correct answer

Abnormally heavy or prolonged menstrual bleeding

Correct Incorrect Correct answer

Vaginal bleeding occurring between normal menstrual cycles

Correct Incorrect Correct answer

A 28-year-old female with a positive home pregnancy test presents with sudden severe left lower quadrant pain, vaginal spotting, and dizziness. Her last menstrual period was 7 weeks ago. Vitals: BP 82/50, HR 136, RR 24. She is diaphoretic with a rigid, tender abdomen. What condition should the paramedic suspect?

Ruptured ectopic (tubal) pregnancy with intraperitoneal hemorrhage

Correct Incorrect Correct answer

Threatened abortion with normal intrauterine pregnancy

Correct Incorrect Correct answer

Ruptured ovarian cyst without significant bleeding

Correct Incorrect Correct answer

Placenta previa with painless vaginal hemorrhage

Correct Incorrect Correct answer

A 22-year-old female who is 10 weeks pregnant presents with vaginal bleeding and mild cramping. On examination, her cervical os is closed. Vitals are stable: BP 122/78, HR 84, RR 16. Which type of abortion does this presentation suggest?

Threatened abortion

Correct Incorrect Correct answer

Inevitable abortion

Correct Incorrect Correct answer

Incomplete abortion

Correct Incorrect Correct answer

Missed abortion

Correct Incorrect Correct answer

Which term describes the spontaneous loss of a pregnancy before 20 weeks of gestation?

Spontaneous abortion

Correct Incorrect Correct answer

Placental abruption

Correct Incorrect Correct answer

Preterm labor

Correct Incorrect Correct answer

Placenta previa

Correct Incorrect Correct answer

A 28-year-old male is found unresponsive with pinpoint pupils, a respiratory rate of 4 breaths per minute, and a SpO2 of 72%. Bystanders report the patient was using heroin. After ensuring airway patency and providing BVM ventilations, which medication should the paramedic administer?

Naloxone (Narcan) 2 mg intranasally or 0.4 mg intravenously

Correct Incorrect Correct answer

Flumazenil 0.2 mg intravenously

Correct Incorrect Correct answer

Epinephrine 0.3 mg intramuscularly

Correct Incorrect Correct answer

Activated charcoal 50 g orally

Correct Incorrect Correct answer

Sodium thiosulfate is used as an antidote in the treatment of which type of poisoning?

Cyanide poisoning

Correct Incorrect Correct answer

Acetaminophen overdose

Correct Incorrect Correct answer

Lead poisoning

Correct Incorrect Correct answer

Iron toxicity

Correct Incorrect Correct answer

A 45-year-old male presents with visual disturbances described as a ‘snowfield’ appearance, abdominal pain, and altered mental status. His coworker reports he drank from a container of windshield washer fluid approximately 4 hours ago. Vital signs: HR 110, BP 100/60, RR 28, SpO2 97%. Which toxic alcohol is most likely responsible, and what is the initial prehospital treatment priority?

Methanol poisoning; administer sodium bicarbonate for metabolic acidosis and initiate rapid transport to a facility capable of administering fomepizole

Correct Incorrect Correct answer

Ethylene glycol poisoning; administer calcium chloride and monitor for dysrhythmias

Correct Incorrect Correct answer

Isopropyl alcohol poisoning; provide IV fluids and supportive care only

Correct Incorrect Correct answer

Ethanol intoxication; monitor airway and provide IV dextrose

Correct Incorrect Correct answer

A 3-year-old child is brought to the paramedic by a frantic parent who found the child drinking from a bottle of antifreeze approximately 30 minutes ago. The child currently appears alert and playful with no symptoms. Which statement about ethylene glycol poisoning is most accurate regarding prehospital management?

The child requires immediate transport because ethylene glycol toxicity can be delayed, and early administration of fomepizole at the hospital can prevent toxic metabolite formation

Correct Incorrect Correct answer

The child can be monitored at home since the absence of symptoms indicates a non-toxic ingestion

Correct Incorrect Correct answer

Activated charcoal should be administered immediately since the ingestion occurred within the past hour

Correct Incorrect Correct answer

Ipecac syrup should be given to induce vomiting and remove the toxin from the stomach

Correct Incorrect Correct answer

Fomepizole (Antizol) exerts its therapeutic effect in toxic alcohol poisoning by which mechanism?

Inhibiting alcohol dehydrogenase to prevent formation of toxic metabolites

Correct Incorrect Correct answer

Directly binding and neutralizing the toxic alcohol in the bloodstream

Correct Incorrect Correct answer

Enhancing renal excretion of the toxic alcohol through osmotic diuresis

Correct Incorrect Correct answer

Stimulating hepatic glucuronidation to accelerate detoxification

Correct Incorrect Correct answer

A 62-year-old diabetic patient is found unresponsive. Blood glucose reads 28 mg/dL. The paramedic is unable to establish IV access after two attempts. Which medication and route is the most appropriate alternative?

Glucagon 1 mg intramuscularly

Correct Incorrect Correct answer

Dextrose 50% 25 g intramuscularly

Correct Incorrect Correct answer

Oral glucose 15 g buccally

Correct Incorrect Correct answer

Epinephrine 1 mg subcutaneously

Correct Incorrect Correct answer

A 72-year-old female on digoxin therapy presents with nausea, visual changes described as a ‘yellow halo’ around lights, and an irregular heart rate. The cardiac monitor shows atrial tachycardia with variable block. Which treatment is specific for this presentation?

Digoxin-specific antibody fragments (Digibind/DigiFab)

Correct Incorrect Correct answer

Atropine 0.5 mg IV to increase heart rate

Correct Incorrect Correct answer

Synchronized cardioversion at 100 joules

Correct Incorrect Correct answer

Amiodarone 150 mg IV over 10 minutes

Correct Incorrect Correct answer

A 55-year-old male with a history of hypertension presents after an intentional overdose of his calcium channel blocker medication. He is hypotensive with a blood pressure of 72/40 mmHg, bradycardic at 38 beats per minute, and has warm, flushed skin. After IV fluid boluses and atropine with no improvement, which medication should the paramedic consider next?

Calcium chloride 1 g IV given slowly

Correct Incorrect Correct answer

Sodium bicarbonate 1 mEq/kg IV push

Correct Incorrect Correct answer

Naloxone 2 mg IV push

Correct Incorrect Correct answer

Magnesium sulfate 2 g IV over 10 minutes

Correct Incorrect Correct answer

A 48-year-old male presents after intentionally ingesting a large quantity of his atenolol (beta blocker) medication approximately 2 hours ago. He is obtunded with a blood pressure of 68/38 mmHg, heart rate of 32 beats per minute, and a blood glucose of 42 mg/dL. Atropine has been administered without effect. Which combination of treatments addresses the unique pathophysiology of beta blocker overdose?

Glucagon IV for its positive chronotropic and inotropic effects independent of beta receptors, along with dextrose for hypoglycemia

Correct Incorrect Correct answer

Epinephrine infusion and sodium bicarbonate to correct acidosis

Correct Incorrect Correct answer

Calcium chloride and transcutaneous pacing as the sole interventions

Correct Incorrect Correct answer

Dopamine infusion and activated charcoal for decontamination

Correct Incorrect Correct answer

Which clinical finding is most characteristic of opioid overdose and helps differentiate it from other causes of altered mental status?

Miosis (pinpoint pupils)

Correct Incorrect Correct answer

Mydriasis (dilated pupils)

Correct Incorrect Correct answer

Nystagmus (involuntary eye movements)

Correct Incorrect Correct answer

Anisocoria (unequal pupils)

Correct Incorrect Correct answer

A 22-year-old female with type 1 diabetes presents with Kussmaul respirations, a fruity odor on her breath, blood glucose of 480 mg/dL, and altered mental status. Her skin is warm and dry. What is the priority prehospital intervention?

Establish IV access and administer a normal saline fluid bolus

Correct Incorrect Correct answer

Administer 10 units of regular insulin subcutaneously

Correct Incorrect Correct answer

Administer 25 g of dextrose 50% IV

Correct Incorrect Correct answer

Assist ventilations with a bag-valve mask at 20 breaths per minute

Correct Incorrect Correct answer

What is the appropriate dose and route for glucagon administration in a hypoglycemic adult patient when IV access cannot be established?

1 mg intramuscularly

Correct Incorrect Correct answer

0.5 mg intravenously

Correct Incorrect Correct answer

2 mg subcutaneously

Correct Incorrect Correct answer

0.1 mg intranasally

Correct Incorrect Correct answer

A 68-year-old female is found unresponsive in her home during winter. Her family reports she stopped taking her thyroid medication several weeks ago. Assessment reveals hypothermia at 93.2F (34C), bradycardia at 42 bpm, hypotension at 80/50 mmHg, periorbital edema, and a non-pitting edema of the extremities. What condition does this presentation most strongly suggest?

Myxedema coma

Correct Incorrect Correct answer

Severe hypothermia as the primary diagnosis

Correct Incorrect Correct answer

Acute heart failure with cardiogenic shock

Correct Incorrect Correct answer

Adrenal crisis secondary to chronic steroid use

Correct Incorrect Correct answer

A 35-year-old male with a medical alert bracelet stating “adrenal insufficiency” presents with severe abdominal pain, vomiting, hypotension at 74/42 mmHg, and altered mental status. His skin appears hyperpigmented. Which prehospital treatment is most critical for this patient?

Aggressive IV fluid resuscitation with normal saline

Correct Incorrect Correct answer

Administer epinephrine 0.3 mg intramuscularly for suspected anaphylaxis

Correct Incorrect Correct answer

Administer ondansetron 4 mg IV for vomiting

Correct Incorrect Correct answer

Administer dextrose 50% IV for suspected hypoglycemia

Correct Incorrect Correct answer

Which endocrine emergency is characterized by excessive urine output, extreme thirst, and hypernatremia due to a deficiency of antidiuretic hormone (ADH)?

Diabetes insipidus

Correct Incorrect Correct answer

Diabetic ketoacidosis

Correct Incorrect Correct answer

Hyperosmolar hyperglycemic state

Correct Incorrect Correct answer

Syndrome of inappropriate ADH secretion (SIADH)

Correct Incorrect Correct answer

A 55-year-old male with type 2 diabetes presents with blood glucose of 820 mg/dL, extreme dehydration, altered mental status, and warm dry skin. He has no Kussmaul respirations and his breath does not have a fruity odor. What condition is this patient most likely experiencing?

Hyperosmolar hyperglycemic state (HHS)

Correct Incorrect Correct answer

Diabetic ketoacidosis (DKA)

Correct Incorrect Correct answer

Insulin shock

Correct Incorrect Correct answer

Thyrotoxic crisis

Correct Incorrect Correct answer

A paramedic is treating a 40-year-old female found unconscious by coworkers. Her blood glucose is 28 mg/dL. An IV is established and 25 g of dextrose 50% is administered. After 5 minutes, her blood glucose is 42 mg/dL but she remains obtunded. She has a medical alert bracelet indicating chronic steroid use. What should the paramedic suspect?

Concurrent adrenal crisis contributing to refractory hypoglycemia

Correct Incorrect Correct answer

Insulin overdose requiring a second dose of dextrose only

Correct Incorrect Correct answer

Hepatic failure causing impaired gluconeogenesis

Correct Incorrect Correct answer

Intracerebral hemorrhage with incidental hypoglycemia

Correct Incorrect Correct answer

What is the mechanism of action of glucagon in treating hypoglycemia?

It stimulates the liver to convert stored glycogen into glucose

Correct Incorrect Correct answer

It directly increases insulin sensitivity in peripheral tissues

Correct Incorrect Correct answer

It stimulates the pancreas to release insulin

Correct Incorrect Correct answer

It inhibits cellular glucose uptake to raise blood glucose levels

Correct Incorrect Correct answer

A 62-year-old male presents with sudden onset of severe, diffuse abdominal pain. He is lying motionless and resists any movement. On palpation, the abdomen is rigid and board-like with involuntary guarding. Vital signs are HR 118, BP 98/62, RR 26, and temperature 38.9 C. Which condition is most consistent with this presentation?

Peritonitis from a perforated viscus

Correct Incorrect Correct answer

Acute cholecystitis with gallbladder distension

Correct Incorrect Correct answer

Small bowel obstruction with cramping pain

Correct Incorrect Correct answer

Acute pancreatitis with epigastric radiation

Correct Incorrect Correct answer

A 68-year-old female presents with left lower quadrant abdominal pain, low-grade fever, and a history of constipation over the past several days. She reports the pain has gradually worsened. Vital signs are HR 96, BP 134/82, RR 18, and temperature 38.2 C. She has localized tenderness with mild guarding in the left lower quadrant. Which condition is most likely?

Acute diverticulitis

Correct Incorrect Correct answer

Ruptured ovarian cyst

Correct Incorrect Correct answer

Acute appendicitis

Correct Incorrect Correct answer

Sigmoid volvulus

Correct Incorrect Correct answer

A 52-year-old male with a known history of liver cirrhosis presents with massive hematemesis of bright red blood. He is pale, diaphoretic, and confused. Vital signs are HR 136, BP 72/40, RR 28, and SpO2 91%. Which gastrointestinal emergency is the most likely source of this hemorrhage?

Ruptured esophageal varices

Correct Incorrect Correct answer

Peptic ulcer disease with arterial bleeding

Correct Incorrect Correct answer

Mallory-Weiss tear from forceful vomiting

Correct Incorrect Correct answer

Acute gastritis from alcohol ingestion

Correct Incorrect Correct answer

A Mallory-Weiss tear is a laceration of the mucosa at the gastroesophageal junction. Which of the following is the most common precipitating factor?

Forceful or prolonged vomiting

Correct Incorrect Correct answer

Chronic use of nonsteroidal anti-inflammatory drugs

Correct Incorrect Correct answer

Ingestion of caustic substances

Correct Incorrect Correct answer

Blunt abdominal trauma

Correct Incorrect Correct answer

Ondansetron (Zofran) is commonly administered in the prehospital setting for nausea and vomiting. What is its primary mechanism of action?

Selective serotonin 5-HT3 receptor antagonist

Correct Incorrect Correct answer

Dopamine D2 receptor antagonist

Correct Incorrect Correct answer

Histamine H1 receptor antagonist

Correct Incorrect Correct answer

Muscarinic acetylcholine receptor antagonist

Correct Incorrect Correct answer

A 45-year-old female presents with severe, constant epigastric pain that radiates to her back. She is writhing and unable to find a comfortable position. She has been vomiting repeatedly. Vital signs are HR 108, BP 142/88, RR 22, and temperature 37.8 C. The abdomen is tender in the epigastric region without rigidity. What is the most appropriate prehospital management?

Establish IV access, administer ondansetron for nausea, provide analgesics for pain, and transport

Correct Incorrect Correct answer

Administer activated charcoal in case of toxic ingestion causing the abdominal pain

Correct Incorrect Correct answer

Position the patient supine with legs elevated to treat presumed hypovolemic shock

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Withhold fluids and medications until a definitive diagnosis is established in the ED

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A 70-year-old male presents with diffuse abdominal pain that he describes as “out of proportion” to what you find on physical exam. The abdomen is soft and nontender on palpation despite the patient reporting severe pain. He has a history of atrial fibrillation and is not compliant with his anticoagulation medication. Which condition should you suspect?

Acute mesenteric ischemia

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Acute appendicitis with referred pain

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Abdominal aortic aneurysm dissection

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Large bowel obstruction

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A 32-year-old construction worker is found confused and combative on a hot day. His skin is hot and dry, heart rate is 128 bpm, blood pressure is 96/60 mmHg, and core temperature is estimated at 105.2 degrees Fahrenheit. What is the priority intervention?

Aggressive whole-body cooling with cold water immersion or ice packs to the neck, axillae, and groin

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Administer oral fluids and move the patient to a shaded area

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Establish IV access and administer a 250 mL normal saline bolus over 30 minutes

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Administer acetaminophen 1,000 mg to reduce the core temperature

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A paramedic responds to a 68-year-old female found lying outdoors in near-freezing temperatures. She is responsive only to painful stimuli, her skin is cold and pale, and the cardiac monitor shows a slow, irregular rhythm at 34 bpm. What is the most appropriate initial approach to rewarming?

Handle gently, remove wet clothing, apply warm blankets, and avoid rough movement

Correct Incorrect Correct answer

Vigorously rub the extremities to restore circulation

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Immerse the patient in hot water at 104 degrees Fahrenheit

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Apply chemical heat packs directly to exposed skin on the chest and abdomen

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A 7-year-old child is pulled from a swimming pool after an estimated 4-minute submersion. Bystander CPR was started immediately. Upon arrival, the child has a pulse of 52 bpm, is not breathing, and has a SpO2 of 74%. What is the most critical initial intervention?

Provide positive pressure ventilation with high-flow oxygen via bag-valve mask

Correct Incorrect Correct answer

Perform the Heimlich maneuver to expel water from the lungs

Correct Incorrect Correct answer

Begin chest compressions since the heart rate is below 60 bpm in a child

Correct Incorrect Correct answer

Establish IV access and administer a 20 mL/kg normal saline bolus

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A drowning victim is resuscitated at the scene and regains consciousness with stable vital signs. The patient appears well but has a persistent cough. What is the most appropriate disposition for this patient?

Transport to the hospital for observation and monitoring for delayed pulmonary complications

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Release the patient at the scene if they sign a refusal form

Correct Incorrect Correct answer

Monitor on scene for 15 minutes and release if symptoms resolve

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Transport only if the SpO2 drops below 90% during scene observation

Correct Incorrect Correct answer

A group of hikers at 12,000 feet elevation calls for EMS. One hiker complains of a severe headache, nausea, and difficulty walking in a straight line. He ascended from 5,000 feet over the past 24 hours. What condition is the most likely cause of these symptoms?

High-altitude cerebral edema (HACE)

Correct Incorrect Correct answer

Acute mountain sickness (AMS) without progression

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Carbon monoxide poisoning from a camp stove

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Dehydration from insufficient fluid intake during the ascent

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A 28-year-old male is bitten on the right forearm by a rattlesnake while hiking. He presents with pain and swelling at the bite site, two visible fang marks, and mild tachycardia. The bite occurred approximately 20 minutes ago. What is the most appropriate prehospital management?

Immobilize the affected extremity at or below the level of the heart, remove jewelry, and transport promptly

Correct Incorrect Correct answer

Apply a tourniquet proximal to the bite site to prevent venom spread

Correct Incorrect Correct answer

Incise the fang marks and apply suction to extract the venom

Correct Incorrect Correct answer

Apply ice packs directly to the bite site to reduce swelling and slow venom absorption

Correct Incorrect Correct answer

Which skin finding is the hallmark presentation of an acute urticarial reaction?

Raised, erythematous, pruritic wheals (hives) on the skin

Correct Incorrect Correct answer

Purpuric, non-blanching petechiae distributed across the trunk

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Vesicular lesions following a dermatomal distribution

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Dry, scaling plaques with silvery patches on the extensor surfaces

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A paramedic treats a 35-year-old female for anaphylaxis with intramuscular epinephrine. After 15 minutes, her symptoms improve significantly: the urticaria fades, breathing normalizes, and blood pressure stabilizes. She states she feels fine and wants to remain at home. What is the most important reason to strongly encourage transport?

A biphasic reaction can cause recurrence of anaphylaxis hours after initial resolution

Correct Incorrect Correct answer

Intramuscular epinephrine always requires intravenous follow-up dosing in the hospital

Correct Incorrect Correct answer

The urticaria will inevitably progress to angioedema within 2 to 4 hours

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Epinephrine masks symptoms but does not treat the underlying allergic response

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A 10-year-old child at a school cafeteria develops facial swelling, generalized urticaria, wheezing, and difficulty swallowing after eating lunch. The child has a known peanut allergy. What is the first medication the paramedic should administer?

Epinephrine 0.15 mg intramuscularly in the lateral thigh

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Diphenhydramine 25 mg intravenously

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Albuterol 2.5 mg via nebulizer for the wheezing

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Methylprednisolone 125 mg intravenously

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A patient develops urticaria, hypotension, and bronchospasm 10 minutes after receiving an intravenous antibiotic in the emergency department. The paramedic is asked to assist with the patient’s care. Which mechanism is responsible for this reaction?

IgE-mediated type I hypersensitivity reaction causing mast cell degranulation

Correct Incorrect Correct answer

Direct toxic effect of the medication on bronchial smooth muscle

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Complement-mediated type III immune complex deposition

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Delayed T-cell mediated type IV hypersensitivity reaction

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A patient with a known allergy to iodinated contrast dye is scheduled for a CT scan with contrast. Which type of allergic reaction is most concerning in this clinical context?

Anaphylactoid reaction that mimics anaphylaxis but does not require prior sensitization

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Delayed contact dermatitis appearing 48 to 72 hours after exposure

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Serum sickness developing 7 to 14 days after the contrast injection

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Autoimmune hemolytic anemia triggered by the iodine component

Correct Incorrect Correct answer

A 4-year-old child with a history of asthma presents with severe respiratory distress. She has received three albuterol nebulizer treatments from her parents over the past 2 hours without improvement. On assessment, the child has intercostal retractions, a respiratory rate of 44, SpO2 of 88%, and diminished breath sounds bilaterally. What is the most appropriate paramedic intervention?

Administer continuous albuterol nebulization with ipratropium and prepare for assisted ventilation if the child deteriorates

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Withhold further bronchodilators since three treatments have already been given

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Administer racemic epinephrine via nebulizer for presumed croup

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Intubate immediately due to the diminished breath sounds

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A 12-year-old child with type 1 diabetes presents with altered mental status, deep rapid respirations, and a fruity odor on the breath. The blood glucose reads 480 mg/dL. What is the priority prehospital intervention?

Establish IV access and administer a 20 mL/kg normal saline bolus

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Administer insulin 0.1 units/kg subcutaneously to lower the blood glucose

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Administer dextrose 25% to prevent further metabolic derangement

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Administer sodium bicarbonate to correct the metabolic acidosis

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A paramedic assesses a 3-week-old infant who appears cyanotic. The mother reports the infant turns blue during feeding episodes. On assessment, the infant has a heart rate of 168 bpm, respiratory rate of 52, SpO2 of 72% on room air, and a loud systolic murmur is noted. Supplemental oxygen via blow-by does not improve the SpO2 above 78%. What is the most likely underlying cause?

Cyanotic congenital heart disease with a right-to-left shunt

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Bronchiolitis with associated hypoxemia

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Foreign body aspiration during feeding

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Methemoglobinemia from exposure to a topical anesthetic

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A paramedic responds to a 6-month-old infant with a reported seizure. On arrival, the infant is unresponsive. Assessment reveals bilateral retinal hemorrhages noted with an ophthalmoscope, a bulging anterior fontanelle, and bruising on the torso in various stages of healing. What clinical entity should the paramedic suspect?

Abusive head trauma (shaken baby syndrome)

Correct Incorrect Correct answer

Febrile seizure secondary to an upper respiratory infection

Correct Incorrect Correct answer

Meningitis with associated increased intracranial pressure

Correct Incorrect Correct answer

Inborn error of metabolism causing a first-time seizure

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A paramedic responds to a call for an unresponsive 3-month-old infant found in the crib by the parents. The infant is pulseless and not breathing, with no obvious signs of trauma. After initiating resuscitation, what additional actions are required at this scene?

Request law enforcement response and preserve the scene, as sudden unexpected infant death requires investigation

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Pronounce the infant deceased on scene without initiating resuscitation

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Immediately transport without scene documentation since time is critical

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Contact the medical examiner only if the parents request an autopsy

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You respond to a 28-year-old male at a convenience store. Bystanders report he was screaming, breaking items, and is now alternating between extreme agitation and unresponsiveness. He is diaphoretic with a temperature of 104.2 F, HR 168, and appears to have superhuman strength during agitation episodes. Law enforcement is on scene. What condition should you suspect?

Excited delirium syndrome

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Acute psychotic episode from schizophrenia

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Hypoglycemic seizure

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Heat exhaustion

Correct Incorrect Correct answer

Under what legal authority can a paramedic transport a patient against their will for psychiatric evaluation?

An involuntary psychiatric commitment order or emergency hold initiated by a qualified authority

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A paramedic's independent clinical judgment that the patient needs care

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A family member's verbal request for the patient to be evaluated

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Standing orders that authorize transport of all psychiatric patients

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A 35-year-old female is found by police standing on the ledge of a parking garage. She is tearful and tells you she ‘doesn’t want to live anymore.’ She has superficial lacerations on both wrists. She agrees to come down and be evaluated. During transport, what is the most important ongoing assessment priority?

Continuous monitoring for sudden behavioral changes and maintaining a safe environment in the ambulance

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Obtaining a detailed psychiatric history including all medications

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Applying bilateral wrist splints for the lacerations

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Contacting the receiving hospital to arrange for a social worker

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You are called to a group home for a 22-year-old male with a history of schizophrenia who is pacing, speaking rapidly, and states that ‘the government is watching through the television.’ Staff reports he has not taken his medications for several days. He refuses transport but is not violent. What is the most appropriate initial approach?

Speak calmly, maintain a safe distance, avoid arguing with delusions, and assess for medical causes of behavioral change

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Physically restrain the patient and transport involuntarily for safety

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Explain that the television cannot watch him and redirect his thinking

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Leave the scene since the patient is refusing care and is not an immediate danger

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A 45-year-old hiker is found unresponsive at a mountain lake in winter. He is soaking wet and pulseless. His core temperature is estimated at 82 F (28 C) based on presentation. The cardiac monitor shows ventricular fibrillation. Per cold exposure resuscitation guidelines, how should you manage defibrillation?

Deliver one defibrillation attempt, then defer additional shocks until the core temperature is above 86 F (30 C)

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Defibrillate continuously in 2-minute cycles as in normothermic cardiac arrest

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Withhold defibrillation entirely until the patient is rewarmed at the hospital

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Deliver three rapid stacked shocks before beginning CPR

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A 16-year-old male is pulled from a swimming pool after being found face down. Bystanders estimate he was submerged for approximately 3 minutes. He is unresponsive, not breathing, and has a weak pulse of 40. What is the priority intervention?

Open the airway with a jaw thrust, provide positive pressure ventilation with high-flow oxygen, and prepare for intubation

Correct Incorrect Correct answer

Begin chest compressions immediately at a rate of 100 to 120 per minute

Correct Incorrect Correct answer

Place the patient in the recovery position and suction the airway

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Deliver five abdominal thrusts to clear water from the lungs

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A patient who rapidly ascended to 12,000 feet elevation presents with severe headache, ataxia, and confusion. Which condition is most consistent with this presentation?

High altitude cerebral edema (HACE)

Correct Incorrect Correct answer

Acute mountain sickness (AMS)

Correct Incorrect Correct answer

High altitude pulmonary edema (HAPE)

Correct Incorrect Correct answer

Carbon monoxide poisoning from camp stove use

Correct Incorrect Correct answer

A 7-year-old child is bitten on the ankle by a copperhead snake while hiking. The foot is swollen and painful with two puncture marks. The child is crying but alert with stable vital signs. What is the most appropriate prehospital management?

Immobilize the affected extremity at or below the level of the heart, keep the child calm, and transport to a facility with antivenin

Correct Incorrect Correct answer

Apply a tourniquet proximal to the bite to prevent venom spread

Correct Incorrect Correct answer

Make an incision over the bite marks and apply suction to extract venom

Correct Incorrect Correct answer

Apply ice packs directly to the bite site and elevate the extremity

Correct Incorrect Correct answer

A 12-year-old child develops hives, facial swelling, and wheezing within minutes of eating a peanut butter sandwich at school. The child’s EpiPen was left at home. Vital signs show HR 130, BP 80/50, RR 28, SpO2 88%. What is the first priority medication intervention?

Administer epinephrine 0.3 mg intramuscularly from your drug kit

Correct Incorrect Correct answer

Administer diphenhydramine 25 mg IV to reverse the allergic reaction

Correct Incorrect Correct answer

Initiate a nebulized albuterol treatment for the wheezing

Correct Incorrect Correct answer

Administer methylprednisolone 125 mg IV for inflammation

Correct Incorrect Correct answer

A 55-year-old patient is receiving IV ceftriaxone in the emergency department when they suddenly develop generalized urticaria, angioedema of the lips and tongue, stridor, and hypotension. The patient has no known drug allergies. What type of hypersensitivity reaction is occurring?

Type I (immediate) IgE-mediated hypersensitivity reaction

Correct Incorrect Correct answer

Type III immune complex-mediated hypersensitivity reaction

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Type IV delayed cell-mediated hypersensitivity reaction

Correct Incorrect Correct answer

Anaphylactoid reaction not involving IgE antibodies

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A 30-year-old patient with a known allergy to iodinated contrast dye is undergoing a CT scan at an imaging center. Shortly after contrast injection, the patient develops diffuse erythema, bronchospasm, and tachycardia but maintains a blood pressure of 110/70. After administering epinephrine IM, what additional medications should the paramedic consider for this contrast reaction?

Diphenhydramine 50 mg IV and albuterol nebulization for persistent bronchospasm

Correct Incorrect Correct answer

Atropine 0.5 mg IV for the tachycardia

Correct Incorrect Correct answer

Nitroglycerin 0.4 mg sublingual for vasodilation

Correct Incorrect Correct answer

Calcium gluconate 1 g IV for cardiac stabilization

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A 24-year-old female presents with sudden onset right lower quadrant pain, vaginal bleeding, and dizziness. She reports her last menstrual period was 7 weeks ago. Vital signs show HR 118, BP 88/56, RR 22. Her abdomen is tender with guarding in the right lower quadrant. What condition should be the highest priority in your differential?

Ruptured ectopic pregnancy

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Acute appendicitis

Correct Incorrect Correct answer

Ovarian torsion

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Threatened miscarriage

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A sexual assault victim presents to your ambulance for transport to the emergency department. What is the paramedic’s primary role regarding evidence preservation for a Sexual Assault Nurse Examiner (SANE) evaluation?

Discourage the patient from bathing or changing clothes, handle clothing minimally, and document findings objectively

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Collect forensic swabs from the patient before transport to preserve time-sensitive evidence

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Photograph all injuries using your personal cell phone for documentation

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Conduct a thorough pelvic examination to identify the extent of injuries

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Which cardiac biomarker is most specific for myocardial cell injury and is commonly used in emergency departments to confirm acute myocardial infarction?

Troponin I or Troponin T

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Creatine kinase (CK-MB)

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Lactate dehydrogenase (LDH)

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Brain natriuretic peptide (BNP)

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A 72-year-old male presents with progressive dyspnea over the past week, bilateral ankle edema, and crackles in both lung bases. He is sitting upright and unable to lie flat. His medications include lisinopril, furosemide, and metoprolol. Vital signs show HR 96, BP 158/94, RR 28, SpO2 88%. What is the most likely diagnosis?

Acute decompensated congestive heart failure

Correct Incorrect Correct answer

Bilateral pneumonia

Correct Incorrect Correct answer

Acute pulmonary embolism

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Acute exacerbation of COPD

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A 58-year-old male presents with severe chest pressure radiating to his left arm. The 12-lead ECG shows ST elevation in leads II, III, and aVF. You also obtain leads V7 through V9, which show ST elevation of 1 mm or greater. What does the additional posterior lead finding indicate?

Posterior wall myocardial infarction extending from the inferior infarct

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Right ventricular infarction requiring cautious fluid administration

Correct Incorrect Correct answer

Pericarditis with diffuse ST elevation

Correct Incorrect Correct answer

Left bundle branch block obscuring the inferior STEMI

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A 68-year-old male presents with sudden onset right-sided facial droop, right arm weakness, and garbled speech. His wife states the symptoms began 45 minutes ago. He is alert and follows commands with his left side. Blood glucose is 128 mg/dL. According to current stroke guidelines, what is the critical time parameter the paramedic must communicate to the receiving facility?

The exact time of symptom onset (last known well time) for thrombolytic eligibility determination

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The patient's current blood pressure, which must be below 140/90 before thrombolytics can be given

Correct Incorrect Correct answer

The Cincinnati Stroke Scale score, which determines whether the patient receives thrombolytics

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The distance to the nearest emergency department regardless of its stroke capabilities

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In the prehospital setting, which validated stroke screening tool assesses facial droop, arm drift, and abnormal speech as its three components?

Cincinnati Prehospital Stroke Scale (CPSS)

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NIH Stroke Scale (NIHSS)

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Glasgow Coma Scale (GCS)

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FAST-ED Scale

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A 72-year-old female on warfarin presents with sudden onset severe headache, vomiting, and rapid decline in consciousness. Her GCS is 7 and her right pupil is fixed and dilated. BP is 210/118. This presentation is most consistent with which type of cerebrovascular accident?

Hemorrhagic stroke (intracerebral hemorrhage)

Correct Incorrect Correct answer

Ischemic stroke from a thrombotic occlusion

Correct Incorrect Correct answer

Transient ischemic attack (TIA)

Correct Incorrect Correct answer

Lacunar infarct from small vessel disease

Correct Incorrect Correct answer

An 80-year-old male in a nursing home presents with confusion and generalized weakness. Staff reports he has been less active for 2 days. His temperature is 97.8 F (36.6 C), HR 102, BP 100/64, and RR 22. Urinalysis at the facility was positive for leukocytes and nitrites. Despite the normal temperature, the paramedic should suspect which condition?

Urinary tract infection presenting atypically without fever (afebrile infection)

Correct Incorrect Correct answer

Normal age-related cognitive decline

Correct Incorrect Correct answer

Dehydration from inadequate fluid intake

Correct Incorrect Correct answer

Medication side effect from a new prescription

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A 75-year-old female presents with fatigue and mild shortness of breath with exertion over the past week. She denies chest pain, but her 12-lead ECG shows ST depression in leads V4 through V6 with T wave flattening. Her blood pressure is 156/88 and heart rate is 78. What diagnosis should the paramedic consider despite the absence of typical chest pain?

Acute coronary syndrome presenting as a 'silent MI' without classic chest pain

Correct Incorrect Correct answer

Normal age-related ECG changes that require no further evaluation

Correct Incorrect Correct answer

Anxiety-related ST changes in an elderly female

Correct Incorrect Correct answer

Digitalis effect from heart failure medications

Correct Incorrect Correct answer

A 70-year-old male on warfarin for atrial fibrillation fell and struck his head on the floor. He initially appeared well but 2 hours later develops progressively worsening headache, confusion, and left-sided weakness. His INR was reported as 4.2 at his last clinic visit. What is the primary concern regarding his anticoagulant status?

The elevated INR significantly increases the risk of intracranial hemorrhage and may cause rapid expansion of any bleeding

Correct Incorrect Correct answer

The warfarin has thinned his blood so much that any IV fluids will further dilute his clotting factors

Correct Incorrect Correct answer

The high INR means the patient cannot form blood clots anywhere in his body

Correct Incorrect Correct answer

Warfarin toxicity is causing the neurological symptoms independent of any head injury

Correct Incorrect Correct answer

A 55-year-old male presents with sudden onset of severe, diffuse abdominal pain. He is lying very still with his knees drawn up. His abdomen is rigid and board-like with rebound tenderness in all four quadrants. Vital signs show HR 112, BP 98/62, RR 24, and temperature 101.2 F. What clinical condition does this presentation suggest?

Acute abdomen with peritonitis from a likely perforated viscus

Correct Incorrect Correct answer

Acute gastroenteritis with dehydration

Correct Incorrect Correct answer

Lower GI bleeding from diverticulosis

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Small bowel obstruction without perforation

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A 60-year-old male with COPD presents in severe respiratory distress. You apply waveform capnography and observe a ‘shark fin’ pattern with a prolonged, upsloping expiratory phase. The ETCO2 value reads 58 mmHg. What does this waveform pattern indicate?

Bronchospasm or obstructive airway disease causing prolonged, incomplete exhalation

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Esophageal intubation with gastric CO2 detection

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Hyperventilation with excessive CO2 elimination

Correct Incorrect Correct answer

Normal capnography waveform for a COPD patient

Correct Incorrect Correct answer

A 28-year-old female at 39 weeks gestation is having contractions every 2 minutes. Upon inspection, you see the baby’s head crowning. The patient is in a calm environment with no complications evident. What is the paramedic’s primary role during an uncomplicated normal delivery?

Support and guide the delivery by controlling the speed of the head, clearing the airway, checking for nuchal cord, and supporting the infant as it delivers

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Delay delivery by having the mother cross her legs until hospital arrival

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Apply firm traction to the infant's head to expedite the delivery process

Correct Incorrect Correct answer

Clamp and cut the cord immediately before the shoulders deliver

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Firefighters rescued from a structure fire are brought to your ambulance. One presents with headache, confusion, nausea, and an SpO2 reading of 98% on a standard pulse oximeter. You suspect carbon monoxide and cyanide exposure from burning synthetic materials. Which antidote specifically addresses the cyanide component?

Hydroxocobalamin (Cyanokit) 5 g IV over 15 minutes

Correct Incorrect Correct answer

Methylene blue 1 mg/kg IV for methemoglobinemia

Correct Incorrect Correct answer

N-acetylcysteine 150 mg/kg IV for acetaminophen toxicity

Correct Incorrect Correct answer

Flumazenil 0.2 mg IV for benzodiazepine reversal

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A 10-year-old child with a known history of Type 1 diabetes presents with abdominal pain, rapid deep breathing, fruity breath odor, and altered mental status. Blood glucose reads ‘HIGH’ (above 500 mg/dL). The child’s mother reports the insulin pump malfunctioned yesterday. What is the most important prehospital intervention for this patient?

Establish IV access and administer a 20 mL/kg normal saline bolus for fluid resuscitation

Correct Incorrect Correct answer

Administer oral glucose gel to treat potential hypoglycemia

Correct Incorrect Correct answer

Administer insulin 10 units subcutaneously to lower the blood glucose

Correct Incorrect Correct answer

Apply CPAP to treat the rapid breathing pattern

Correct Incorrect Correct answer

You are dispatched for a 45-year-old male with fever, cough, and shortness of breath. Upon arrival, the patient reports recent travel and has been isolating at home for 3 days after testing positive for COVID-19. His SpO2 is 82% on room air and he appears cyanotic. What is your approach to this patient?

Don appropriate PPE including N95 respirator and eye protection, administer high-flow oxygen, establish IV access, and transport

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Refuse to enter the residence due to infectious disease risk

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Have the patient walk to the ambulance to reduce your exposure time indoors

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Administer antibiotics from your drug kit to treat the respiratory infection

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A 32-year-old female with Addison’s disease presents after a stressful event with profound weakness, nausea, and confusion. Her BP is 72/48, HR 118, and her skin appears hyperpigmented. She ran out of her hydrocortisone medication 2 days ago. What is this patient experiencing?

Adrenal crisis (acute adrenal insufficiency)

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Cushing syndrome from excessive cortisol production

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Thyroid storm from overactive thyroid function

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Diabetic ketoacidosis from insulin deficiency

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A 50-year-old male on dialysis missed his last two sessions. He presents with generalized weakness, nausea, and perioral numbness. The 12-lead ECG shows tall peaked T waves and a widened QRS complex. What is the most appropriate prehospital intervention for the suspected underlying condition?

Administer calcium chloride or calcium gluconate IV to stabilize the cardiac membrane

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Administer sodium bicarbonate 100 mEq IV push immediately

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Perform synchronized cardioversion at 100 joules

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Administer amiodarone 150 mg IV for the wide complex rhythm

Correct Incorrect Correct answer

A 52-year-old male presents with crushing chest pain. His 12-lead ECG shows ST elevation in leads II, III, aVF, and right-sided V4R. He is hypotensive with a BP of 82/50, HR 58, and JVD is present. His lungs are clear. What must the paramedic avoid administering to this patient?

Nitroglycerin, because it will worsen the hypotension in a right ventricular infarction

Correct Incorrect Correct answer

Aspirin, because it increases the risk of hemorrhagic conversion

Correct Incorrect Correct answer

Supplemental oxygen, because it causes coronary vasoconstriction

Correct Incorrect Correct answer

Normal saline, because IV fluids are contraindicated in all STEMI patients

Correct Incorrect Correct answer

A 65-year-old male presents with massive painless rectal bleeding. He has passed large amounts of bright red blood and clots. He is pale, diaphoretic, with HR 128, BP 86/52, and RR 24. His abdomen is soft and non-tender. What is the priority prehospital management?

Establish two large-bore IV lines, begin fluid resuscitation, apply the cardiac monitor, and transport emergently

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Perform a digital rectal exam to identify the source of bleeding

Correct Incorrect Correct answer

Administer activated charcoal to absorb toxins in the GI tract

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Apply a pressure dressing to the rectal area to control hemorrhage

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A 30-year-old female at 36 weeks gestation presents with a severe headache, visual disturbances (seeing spots), and edema. Her BP is 178/112, HR 88, and she has hyperactive deep tendon reflexes. During your assessment, she suddenly has a generalized tonic-clonic seizure. What medication should be administered to treat and prevent further seizures?

Magnesium sulfate 4 to 6 g IV over 15 to 20 minutes

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Diazepam 10 mg IV push

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Phenytoin 300 mg IV over 10 minutes

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Lorazepam 2 mg IV push

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A 60-year-old male presents with sudden onset of severe dyspnea, bilateral crackles to the apices, and pink frothy sputum. He is sitting bolt upright, using accessory muscles, and has an SpO2 of 78%. His BP is 188/110, HR 112. The cardiac monitor shows rapid atrial fibrillation. Which combination of interventions is most appropriate?

CPAP, nitroglycerin for afterload reduction, and IV furosemide for diuresis

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Intubation, IV normal saline bolus, and atropine for the tachycardia

Correct Incorrect Correct answer

Non-rebreather mask, morphine for preload reduction, and dopamine infusion

Correct Incorrect Correct answer

BVM ventilation, adenosine for the atrial fibrillation, and lidocaine for prophylaxis

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A 45-year-old male has a generalized tonic-clonic seizure witnessed by his coworkers. By the time you arrive, the seizure has stopped. The patient is in the postictal state, confused, and has urinary incontinence. His coworkers report the seizure lasted approximately 2 minutes. Blood glucose is 92 mg/dL. What is the priority assessment during the postictal period?

Maintain airway patency, assess breathing adequacy, monitor for recurrent seizure activity, and perform a neurological assessment

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Restrain the patient to prevent injury if another seizure occurs

Correct Incorrect Correct answer

Administer a benzodiazepine to prevent a second seizure from occurring

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Obtain a detailed psychiatric history to determine if the seizure is psychogenic

Correct Incorrect Correct answer

What is the mechanism by which epinephrine reverses the effects of anaphylaxis?

Alpha-1 stimulation causes vasoconstriction (reversing hypotension), beta-1 stimulation increases cardiac output, and beta-2 stimulation causes bronchodilation

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It directly neutralizes histamine molecules in the bloodstream through chemical binding

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It blocks mast cell degranulation and prevents further release of inflammatory mediators

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It stimulates the production of corticosteroids from the adrenal glands within minutes

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A 25-year-old male marathon runner collapses at mile 22 in 95 F heat with 80% humidity. He is confused and combative with hot, dry skin. His core temperature measured rectally is 106 F (41.1 C). HR is 140, BP 88/56. What is the priority cooling intervention?

Cold water immersion (ice water bath) or application of ice packs to the neck, axillae, and groin with aggressive external cooling

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Moving the patient to shade and providing oral fluids to rehydrate

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Applying rubbing alcohol to the skin to promote evaporative cooling

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Administering acetaminophen or ibuprofen rectally to lower the core temperature

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A 30-year-old male is found unresponsive in a garage with a running vehicle. He has cherry-red skin coloring. SpO2 reads 99% on a standard pulse oximeter. What is the appropriate oxygen therapy for this patient?

100% oxygen via non-rebreather mask or BVM, as the pulse oximeter reading is falsely normal

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Nasal cannula at 2 L/min since the SpO2 indicates adequate oxygenation

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No supplemental oxygen needed since SpO2 is above 94%

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Room air only with close monitoring of SpO2 trends

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Which neurotransmitter imbalance is classically associated with schizophrenia and is the target of most first-generation antipsychotic medications?

Excess dopamine activity in specific brain pathways

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Deficiency of serotonin in the limbic system

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Excess acetylcholine at the neuromuscular junction

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Deficiency of norepinephrine in the cerebral cortex

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A 22-year-old African American male presents with severe bilateral flank pain, fever of 102.4 F, and jaundice. He reports a history of sickle cell disease and states this feels like a ‘crisis.’ His SpO2 is 91% on room air. What is the pathophysiology causing his symptoms?

Sickle-shaped red blood cells are occluding small blood vessels, causing vaso-occlusive pain crisis with tissue ischemia

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Normal red blood cells are being destroyed by autoimmune antibodies

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A bacterial infection is directly attacking the bone marrow

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Excessive iron deposition from repeated blood transfusions is damaging organs

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A 55-year-old female with a history of Graves’ disease presents with high fever of 105 F, extreme agitation, rapid atrial fibrillation at 160 bpm, and profuse diaphoresis. Her skin is warm and flushed. The family reports she stopped taking her propylthiouracil medication last week. What endocrine emergency is this patient experiencing?

Thyroid storm (thyrotoxic crisis)

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Myxedema coma from hypothyroidism

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Pheochromocytoma crisis

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Adrenal crisis from cortisol deficiency

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A 35-year-old farmer is found in a barn with excessive salivation, lacrimation, urination, defecation, pinpoint pupils, and bradycardia. He was spraying pesticides without protective equipment. What antidote combination should be administered?

Atropine to dry secretions and block muscarinic effects, followed by pralidoxime (2-PAM) to reactivate cholinesterase

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Naloxone to reverse the pupil constriction and bradycardia

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Epinephrine for the bradycardia followed by diphenhydramine for the secretions

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Activated charcoal for GI decontamination followed by sodium bicarbonate

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A 3-year-old presents with sudden onset stridor and drooling while eating lunch at daycare. The child is sitting upright, leaning forward, and appears anxious. There is no fever. No cough or URI symptoms. The child was playing with small toy parts before the episode. What is the most likely cause and what should you avoid doing?

Foreign body airway obstruction; avoid blind finger sweeps and only perform abdominal thrusts if the airway becomes completely obstructed

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Croup; administer nebulized epinephrine and humidified oxygen

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Epiglottitis; lay the child down and perform direct laryngoscopy to visualize the obstruction

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Allergic reaction; administer epinephrine 0.15 mg IM immediately

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A 34-year-old female at 34 weeks gestation presents with sudden onset of painless, bright red vaginal bleeding that has soaked through multiple towels. She denies abdominal pain or contractions. Vital signs: HR 108, BP 104/68, RR 22. The uterus is soft and non-tender on palpation. What is the most likely diagnosis and what intervention is contraindicated?

Placenta previa; vaginal examination is contraindicated as it may worsen hemorrhage

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Placental abruption; IV fluid bolus is contraindicated until bleeding stops

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Uterine rupture; oxygen administration is contraindicated in pregnancy

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Ectopic pregnancy; left lateral positioning is contraindicated at 34 weeks

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A 40-year-old male presents with sudden onset excruciating left flank pain radiating to the groin. He is writhing in pain and unable to find a comfortable position. He is nauseated and has vomited once. Vital signs: HR 102, BP 148/92, RR 20, Temp 98.6 F. Urinalysis dipstick shows blood. What is the most likely diagnosis?

Renal calculus (kidney stone) passing through the left ureter

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Ruptured abdominal aortic aneurysm

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Left-sided pyelonephritis

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Acute appendicitis

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A 19-year-old female presents with sudden onset left lower abdominal pain that started 3 hours ago. The pain is sharp, constant, and rated 9/10. She is nauseated and has vomited once. Her last menstrual period was 2 weeks ago. Vital signs: HR 112, BP 118/72, RR 20. The abdomen is tender in the left lower quadrant with guarding. Pregnancy test is negative. What condition should be suspected?

Ovarian torsion

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Ruptured ovarian cyst without torsion

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Pelvic inflammatory disease

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Early ectopic pregnancy

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A 48-year-old female presents with palpitations and dizziness. The cardiac monitor shows a regular, narrow complex tachycardia at 188 bpm. She is alert, anxious, and has a BP of 108/72. You attempt a Valsalva maneuver, which is unsuccessful. What is the appropriate first-line pharmacological treatment?

Adenosine 6 mg rapid IV push followed by an immediate 20 mL normal saline flush

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Amiodarone 150 mg IV over 10 minutes

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Diltiazem 0.25 mg/kg IV over 2 minutes

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Synchronized cardioversion at 50 joules

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A 55-year-old male with a history of heart failure presents with acute shortness of breath at rest. He has bilateral crackles throughout all lung fields, pink frothy sputum, and extreme anxiety. SpO2 is 80% on room air. His BP is 170/100. Which breathing support intervention is most appropriate as the initial treatment?

Continuous positive airway pressure (CPAP) at 5 to 10 cm H2O with high-flow oxygen

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Nasal cannula at 4 L/min with reassessment in 10 minutes

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Nebulized albuterol 2.5 mg for the bronchospasm component

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Immediate endotracheal intubation before any other intervention

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A 28-year-old male with Type 1 diabetes is found by his roommate confused and diaphoretic. His glucometer reads 38 mg/dL. You establish IV access and administer 25 g of dextrose 50% IV. After 5 minutes, he becomes alert and oriented with a repeat glucose of 112 mg/dL. He now wants to refuse transport. What counseling should you provide before accepting his refusal?

Explain that hypoglycemia can recur, especially with long-acting insulin, and recommend eating a complex carbohydrate meal and close monitoring

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Inform him that since the glucose is now normal, there is no further risk and he can resume normal activities

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Tell him he must be transported regardless of his wishes because he was recently altered

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Advise him to take an extra dose of insulin to prevent his blood sugar from going too high

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A 70-year-old male presents with sudden onset of severe, constant abdominal pain that is ‘out of proportion’ to the physical examination findings. His abdomen is soft with minimal tenderness on palpation, yet the patient appears to be in extreme distress. He has a history of atrial fibrillation and is not on anticoagulation. What serious condition should be suspected?

Acute mesenteric ischemia from an arterial embolism

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Irritable bowel syndrome flare

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Acute gastritis from NSAID use

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Small bowel obstruction

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A 6-month-old infant presents with a fever of 104.5 F, petechial rash on the trunk and extremities, bulging fontanelle, and high-pitched crying. The infant is lethargic and difficult to arouse. What condition is most likely, and what infection control precaution is indicated for the paramedic?

Bacterial meningitis; droplet precautions with a surgical mask are indicated

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Measles; airborne precautions with an N95 respirator are indicated

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Kawasaki disease; standard precautions only are needed

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Roseola; contact precautions with gown and gloves are indicated

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A 20-year-old college student is found unconscious at a party. His respirations are 6 per minute, pupils are pinpoint, and his skin is cyanotic. A friend states he was ‘using pills.’ You administer naloxone 2 mg intranasal. After 3 minutes, the patient wakes up agitated and attempts to leave. He refuses further care. What is the critical concern about discharge after naloxone administration?

Naloxone has a shorter duration of action than most opioids, and the patient may return to respiratory depression after the naloxone wears off

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The naloxone has permanently reversed the opioid effects and there is no further risk

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The patient's agitation indicates an allergic reaction to naloxone requiring epinephrine

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The intranasal route is unreliable and the patient needs IV naloxone before being cleared

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A patient presents with white, waxy, firm skin on the fingers after prolonged cold exposure. The tissue is hard and insensate. After passive rewarming, the skin remains white and does not regain color or sensation. What degree of frostbite does this presentation represent?

Deep (third or fourth degree) frostbite with likely full-thickness tissue damage

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Frostnip, which will resolve completely with rewarming

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Superficial (first degree) frostbite with reversible damage

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Chilblains (pernio) from chronic cold exposure

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A 29-year-old female delivers a healthy newborn in the ambulance. Shortly after delivery of the placenta, she begins hemorrhaging heavily from the vagina. You estimate she has lost approximately 800 mL of blood. Her uterus feels soft and boggy on palpation. What is the most likely cause and initial treatment?

Uterine atony; perform fundal massage and administer oxytocin if available

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Cervical laceration; pack the vagina with sterile gauze

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Retained placenta; manually extract any remaining placental tissue

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Disseminated intravascular coagulation; administer fresh frozen plasma

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A patient receiving a blood transfusion develops fever, chills, flank pain, and dark-colored urine approximately 30 minutes after the transfusion started. What type of transfusion reaction is this presentation most consistent with?

Acute hemolytic transfusion reaction from ABO incompatibility

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Febrile non-hemolytic transfusion reaction

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Transfusion-related acute lung injury (TRALI)

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Allergic transfusion reaction with urticaria

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A 22-year-old tall, thin male presents with sudden onset of right-sided chest pain and shortness of breath. Breath sounds are diminished on the right. There is no history of trauma. SpO2 is 93%. Trachea is midline. What is the most likely diagnosis?

Primary spontaneous pneumothorax

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Pulmonary embolism

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Right-sided tension pneumothorax

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Acute asthma exacerbation

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A 5-year-old child has been having a continuous generalized tonic-clonic seizure for 8 minutes when you arrive. The parents report no seizure history. The child’s temperature is 98.6 F. IV access has been unsuccessful. What is the most appropriate intervention?

Administer midazolam intranasally or intramuscularly per weight-based dosing to terminate the seizure

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Wait 5 more minutes since most seizures stop on their own within 15 minutes

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Perform orotracheal intubation while the seizure is still active

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Administer rectal acetaminophen since the seizure is likely febrile in origin

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A 2-year-old presents with a 3-day history of cough, runny nose, and low-grade fever. Today the child developed respiratory distress with wheezing and crackles on auscultation. SpO2 is 90%. The child has nasal flaring and subcostal retractions. This is the child’s first wheezing episode. What is the most likely diagnosis?

Bronchiolitis, most commonly caused by respiratory syncytial virus (RSV)

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Acute asthma exacerbation

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Bacterial pneumonia

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Foreign body aspiration

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Which toxidrome is characterized by hyperthermia, agitation, tachycardia, dilated pupils, dry skin, decreased bowel sounds, and urinary retention?

Anticholinergic toxidrome

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Sympathomimetic toxidrome

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Cholinergic toxidrome

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Opioid toxidrome

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What is the hallmark ECG finding of Brugada syndrome, a genetic condition that can cause sudden cardiac death in young, apparently healthy individuals?

Coved ST elevation with T wave inversion in leads V1 through V3 (Type 1 Brugada pattern)

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Shortened QT interval less than 300 ms in all leads

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Delta waves with a shortened PR interval (Wolff-Parkinson-White pattern)

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Deeply inverted T waves in leads V4 through V6 (apical hypertrophic cardiomyopathy)

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A patient treated for anaphylaxis with epinephrine has symptom resolution. Thirty minutes later during transport, symptoms return with worsening wheezing and urticaria. What is this phenomenon called, and how should it be managed?

Biphasic anaphylaxis; administer a repeat dose of epinephrine and continue aggressive management

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Epinephrine rebound; discontinue all epinephrine and switch to antihistamines only

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Treatment failure; the original reaction was not truly anaphylaxis and needs a different diagnosis

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Serum sickness; this delayed reaction does not require additional epinephrine

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A patient presents with projectile vomiting of undigested food, abdominal distension, and colicky abdominal pain that comes in waves. The patient reports not having a bowel movement for 3 days. High-pitched, hyperactive bowel sounds are heard on auscultation. What gastrointestinal condition is most consistent with these findings?

Small bowel obstruction

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Acute pancreatitis

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Ruptured appendix with peritonitis

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Gastroesophageal reflux disease

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During a field delivery, the infant’s head delivers but the shoulders do not follow with normal downward traction. The infant’s head retracts slightly against the perineum (‘turtle sign’). What obstetric emergency is occurring, and what maneuver should you attempt?

Shoulder dystocia; apply the McRoberts maneuver by hyperflexing the mother's thighs against her abdomen while applying suprapubic pressure

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Breech presentation; push the head back in and prepare for cesarean delivery

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Nuchal cord; clamp and cut the cord before attempting to deliver the shoulders

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Prolapsed umbilical cord; place the mother in knee-chest position and elevate the presenting part

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A 78-year-old male presents with dizziness and near-syncope when he stands up from his chair. Supine BP is 142/88 and standing BP drops to 98/60 within 1 minute. His heart rate increases only slightly from 72 to 78 upon standing. He takes doxazosin for an enlarged prostate and atenolol for hypertension. What is the cause of his symptoms?

Orthostatic hypotension exacerbated by medications that impair the compensatory response to position changes

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Vertebrobasilar insufficiency from cervical spine arthritis

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Benign paroxysmal positional vertigo (BPPV)

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Transient ischemic attack from carotid artery stenosis

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A patient with a known history of depression is found with empty bottles of aspirin nearby. Which classic acid-base disturbance pattern is associated with salicylate (aspirin) toxicity?

A mixed respiratory alkalosis and metabolic acidosis

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Pure respiratory acidosis from central respiratory depression

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Pure metabolic alkalosis from excessive bicarbonate generation

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Respiratory acidosis with compensatory metabolic alkalosis

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A paramedic responds to a patient who is unconscious and suspected of being hypoglycemic, but IV access cannot be obtained. What alternative route and medication can be used to treat severe hypoglycemia when IV access is unavailable?

Glucagon 1 mg administered intramuscularly

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Oral glucose gel placed under the tongue of the unconscious patient

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Dextrose 50% administered intranasally

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Insulin glargine administered intramuscularly to stimulate glucose release

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A 65-year-old male with a known history of atrial fibrillation presents with sudden onset of cold, pulseless, and pale right lower extremity. The leg is painful and has decreased sensation. The left leg is warm with palpable pulses. What is the most likely cause?

Acute arterial embolism to the right lower extremity from atrial thrombus

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Deep vein thrombosis in the right leg

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Peripheral neuropathy from uncontrolled diabetes

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Compartment syndrome from a recent injury

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A 25-year-old male with asthma is in severe respiratory distress. He has received three nebulized albuterol treatments without improvement. He is now unable to speak in full sentences, has intercostal retractions, and his SpO2 is 86% despite high-flow oxygen. ETCO2 is 52 mmHg and rising. What does the rising ETCO2 indicate, and what intervention is needed?

The rising ETCO2 indicates impending respiratory failure from exhaustion and severe bronchospasm; prepare for intubation and consider IV magnesium sulfate

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The rising ETCO2 is a sign that the albuterol is working and bronchospasm is improving

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The ETCO2 sensor is malfunctioning from humidity in the nebulizer circuit

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The rising ETCO2 indicates a pneumothorax requiring needle decompression

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A 50-year-old diabetic male presents with left-sided facial droop and left arm weakness. Blood glucose is 45 mg/dL. After administering dextrose 50%, the blood glucose rises to 128 mg/dL. The facial droop and arm weakness completely resolve. What does this response indicate?

The neurological deficits were caused by hypoglycemia mimicking stroke, not an actual cerebrovascular event

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The dextrose cured the ischemic stroke by providing energy to the brain

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The patient had a transient ischemic attack that coincidentally resolved during glucose administration

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The glucose correction caused a hemorrhagic stroke to stop bleeding

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A 32-year-old female at 38 weeks gestation presents with sudden, severe abdominal pain and a rigid, board-like abdomen. She has dark red vaginal bleeding. Fetal heart tones are absent. Her BP is 86/52 and HR is 132. The uterus is tender and hypertonic. What obstetric emergency is this?

Placental abruption (abruptio placentae) with probable fetal demise

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Placenta previa with painless hemorrhage

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Normal labor with bloody show

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Uterine rupture from prior cesarean scar dehiscence

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A 6-month-old infant has a temperature of 103 F and has had three episodes of generalized seizure activity within 24 hours, each lasting less than 5 minutes with spontaneous resolution. The infant appears well between episodes. What type of seizure is most likely occurring?

Complex febrile seizure, because multiple episodes occurred within 24 hours

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Status epilepticus requiring emergency benzodiazepine therapy

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Infantile spasms (West syndrome) requiring ACTH treatment

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Simple febrile seizure with a benign prognosis

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A scuba diver surfaces too quickly from a depth of 100 feet and develops joint pain, skin mottling, and neurological symptoms including confusion and lower extremity weakness. What condition is occurring, and what prehospital intervention is critical?

Decompression sickness (the bends); administer 100% oxygen and transport to a facility with a hyperbaric chamber

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Nitrogen narcosis; remove the dive equipment and allow time for symptoms to resolve

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Barotrauma from rapid ascent; perform needle decompression of both lungs

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Hypothermia from cold water exposure; initiate active rewarming

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A patient with a known mechanical heart valve presents with new-onset dyspnea, muffled heart sounds, and a new cardiac murmur. He reports he stopped taking his warfarin 2 weeks ago due to cost. What complication should the paramedic suspect?

Prosthetic valve thrombosis or dysfunction due to discontinuation of anticoagulation

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Aortic dissection from the mechanical valve eroding through the aorta

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Infective endocarditis from a recent dental procedure

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Pericardial effusion from an autoimmune reaction to the valve material

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A 55-year-old male presents with fever of 103.8 F, altered mental status, tachycardia at 118, hypotension at 86/52, and warm, flushed skin. His wife states he has been ill for 2 days with urinary symptoms. Lactate would likely be elevated. What clinical syndrome does this presentation represent?

Sepsis with suspected septic shock from a urinary source

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Cardiogenic shock from acute heart failure

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Anaphylactic shock from an unknown allergen exposure

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Neurogenic shock from a spinal cord injury

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A 45-year-old male is found unresponsive with pinpoint pupils, respiratory rate of 4, and a bag of white powder nearby. You administer naloxone 2 mg intranasal. After 4 minutes, there is no clinical improvement. The patient remains apneic and bradycardic. What should you consider about this presentation?

The patient may have ingested a high-potency synthetic opioid (such as a fentanyl analog) that requires higher or repeated doses of naloxone

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The naloxone is expired and should be discarded

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The patient does not have opioid toxicity since naloxone did not work

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Intranasal naloxone is always ineffective and only IV naloxone works

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A patient with chronic kidney disease presents with progressive fatigue, nausea, and confusion. Lab results from a recent clinic visit showed a BUN of 92 mg/dL and creatinine of 8.4 mg/dL. What metabolic condition is causing these symptoms?

Uremia from accumulation of metabolic waste products due to renal failure

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Hepatic encephalopathy from liver failure

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Hyperthyroidism from excessive thyroid hormone production

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Adrenal insufficiency from cortisol deficiency

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An 82-year-old female with hypothyroidism is found lethargic with profound hypothermia (core temperature 91 F / 32.8 C), bradycardia at 44, hypotension at 78/48, and periorbital edema. Her family reports she has not been taking her levothyroxine for months. What endocrine emergency is this patient experiencing?

Myxedema coma from severe, untreated hypothyroidism

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Thyroid storm from excess thyroid hormone

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Diabetic ketoacidosis from insulin deficiency

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Adrenal crisis from glucocorticoid withdrawal

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A 30-year-old female presents with heavy vaginal bleeding, cramping abdominal pain, and passage of tissue. She reports she is 10 weeks pregnant based on her last menstrual period. She has soaked through four pads in the last 2 hours. Vital signs: HR 106, BP 104/66, RR 18. What obstetric complication is occurring?

Spontaneous abortion (miscarriage) with significant hemorrhage

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Normal implantation bleeding in early pregnancy

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Placenta previa at 10 weeks gestation

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Molar pregnancy (hydatidiform mole)

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What respiratory condition presents with sudden onset of dyspnea, pleuritic chest pain, and a friction rub heard on auscultation over the affected area?

Pulmonary infarction from pulmonary embolism causing pleuritis

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Pneumothorax

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Asthma exacerbation

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Pneumonia with consolidation

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What is the recommended intramuscular injection site for epinephrine administration in anaphylaxis, and why is this site preferred?

The anterolateral thigh (vastus lateralis), because it has rich blood supply and allows rapid absorption

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The deltoid muscle, because it is the easiest to access

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The gluteal region (dorsogluteal), because it has the largest muscle mass

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The subcutaneous tissue of the upper arm, because it prevents systemic absorption

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A 9-month-old infant presents with a barking cough that sounds like a seal, inspiratory stridor, and mild intercostal retractions. The child is alert, drinking from a bottle, and has no drooling or high fever. Temperature is 100.4 F. SpO2 is 96%. What is the most likely diagnosis?

Croup (laryngotracheobronchitis)

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Epiglottitis requiring immediate intubation

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Pertussis (whooping cough)

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Bronchiolitis from respiratory syncytial virus

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A 68-year-old male presents with sudden onset severe tearing abdominal pain, back pain, and a pulsatile abdominal mass. He is pale, diaphoretic, with BP 72/48 and HR 136. He has a history of hypertension and smoking. What life-threatening condition is most likely?

Ruptured abdominal aortic aneurysm (AAA)

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Acute mesenteric ischemia

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Perforated duodenal ulcer

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Acute pancreatitis

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A lightning strike victim is found lying in a field after a thunderstorm. He is apneic and pulseless. Two other victims nearby are conscious and ambulatory with minor injuries. Per standard triage protocols, dead patients are tagged and bypassed. However, lightning strike victims require a different approach. What is the unique triage principle for lightning injuries?

Reverse triage: prioritize the apparently dead victims first, as they may be in reversible cardiac arrest and respond to early resuscitation

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Follow standard START triage and tag the pulseless patient as black (deceased)

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Treat the ambulatory patients first since they can provide information about what happened

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Do not approach any victim until the storm has completely passed to avoid secondary strikes

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A 22-year-old college athlete collapses during basketball practice. He is unresponsive and pulseless. The AED advises a shock. After one defibrillation and CPR, he achieves ROSC. He has no known cardiac history. His father died suddenly at age 35 during exercise. What underlying condition is most likely?

Hypertrophic cardiomyopathy (HCM), the leading cause of sudden cardiac death in young athletes

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Acute myocardial infarction from coronary artery disease

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Commotio cordis from a blow to the chest

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Wolff-Parkinson-White syndrome

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A 3-year-old child is brought to you after the mother found the child playing with an open bottle of iron supplement tablets. The child has vomited a gray-brown substance. She is lethargic with abdominal pain. What specific toxicity concern makes iron ingestion particularly dangerous in children?

Iron is directly corrosive to the GI mucosa and can cause hemorrhagic necrosis, hepatic failure, and cardiovascular collapse in the toxic phase

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Iron binds to hemoglobin and prevents oxygen transport, similar to carbon monoxide

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Iron causes rapid hypoglycemia by depleting liver glycogen stores

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Iron is immediately excreted by the kidneys, causing acute renal failure within minutes

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What is the pathophysiologic mechanism by which tension pneumothorax causes cardiovascular collapse?

Progressive air accumulation in the pleural space increases intrathoracic pressure, compressing the heart and great vessels, reducing venous return and cardiac output

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Air entering the pleural space creates a direct air embolism in the coronary arteries

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The collapsed lung releases inflammatory mediators that cause systemic vasodilation

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Tension pneumothorax directly ruptures the pericardium, causing cardiac tamponade

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Which cardiac medication used in the prehospital setting works by blocking the sodium-potassium ATPase pump, increasing intracellular calcium, and thereby increasing myocardial contractility?

Digoxin (cardiac glycoside)

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Metoprolol (beta-blocker)

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Diltiazem (calcium channel blocker)

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Nitroglycerin (nitrate vasodilator)

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A 45-year-old male presents with altered mental status, rapid deep breathing (Kussmaul respirations), fruity breath odor, and dry mucous membranes. Blood glucose is 520 mg/dL. His wife reports he has been urinating excessively and drinking large amounts of water for 3 days. What electrolyte abnormality is most dangerous in this condition and can cause cardiac arrest?

Hyperkalemia, which can occur despite total body potassium depletion due to acidosis-driven extracellular shift

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Hypernatremia from excessive water loss

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Hypocalcemia from calcium binding to ketone bodies

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Hypermagnesemia from renal magnesium retention

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During a field delivery, the umbilical cord prolapses through the cervix before the baby’s head. The cord is pulsating and visible at the vaginal opening. What is the critical immediate intervention?

Insert a gloved hand into the vagina and elevate the presenting part off the compressed cord while placing the mother in the knee-chest position, and transport emergently for cesarean delivery

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Clamp and cut the prolapsed cord immediately to prevent the baby from pulling it taut

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Push the cord back through the cervix and into the uterus

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Begin fundal pressure to expedite vaginal delivery before the cord stops pulsating

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A 35-year-old female with a history of multiple sclerosis presents with right eye pain that worsens with eye movement and progressive blurring of vision in the right eye over several days. She reports colors appear washed out in the affected eye. Her left eye has normal vision. Vital signs are normal. What neurological complication is she likely experiencing?

Optic neuritis, a common manifestation of multiple sclerosis causing demyelination of the optic nerve

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Retinal detachment presenting with painless vision loss

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Acute angle-closure glaucoma requiring emergent treatment

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Central retinal artery occlusion from an embolus

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A patient with a known bee sting allergy is stung on the hand. He has localized swelling and redness at the sting site but no generalized urticaria, no respiratory symptoms, and stable vital signs. He is anxious. Does this patient require epinephrine?

No, a localized reaction without systemic symptoms does not meet the criteria for anaphylaxis and does not require epinephrine

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Yes, any patient with a known allergy who is stung should receive epinephrine regardless of symptoms

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Yes, the localized swelling will inevitably progress to anaphylaxis within minutes

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No, but the patient should receive diphenhydramine 50 mg IV push immediately

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A 58-year-old male presents with acute chest pain and is found to have an irregular rhythm. The 12-lead ECG shows ST elevation in leads II, III, and aVF with new-onset atrial fibrillation at 130 bpm. He is diaphoretic but has a BP of 112/74. Should you administer nitroglycerin for this patient?

Not before obtaining right-sided leads (V4R) to rule out right ventricular infarction, as nitroglycerin is contraindicated in RV infarction

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Yes, administer nitroglycerin immediately since the blood pressure is above 90 systolic

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No, nitroglycerin is contraindicated in all patients with atrial fibrillation

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Yes, but only if the patient has taken nitroglycerin before without adverse effects

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What physiologic change in the cardiovascular system of elderly patients makes them more susceptible to heart failure and less tolerant of rapid IV fluid administration?

Decreased ventricular compliance (stiffened myocardium) with impaired diastolic filling, making the heart less able to accommodate volume increases

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Increased cardiac output that overwhelms the coronary circulation

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Decreased blood viscosity that allows fluid to leak out of vessels

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Enhanced baroreceptor sensitivity that causes excessive vasoconstriction

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Which toxidrome is characterized by tachycardia, hypertension, hyperthermia, dilated pupils, diaphoresis, and agitation?

Sympathomimetic toxidrome

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Anticholinergic toxidrome

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Sedative-hypnotic toxidrome

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Serotonin syndrome

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An EMS provider sustains a needlestick injury from a used needle during patient care. What is the immediate first step in managing this occupational exposure?

Wash the wound immediately with soap and water, then report the exposure to the supervisor for post-exposure prophylaxis evaluation

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Apply a tourniquet above the needlestick site to prevent bloodborne pathogen spread

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Squeeze the wound to force blood out and then apply hydrogen peroxide

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Continue patient care and address the needlestick after the call is complete

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A patient with Addison’s disease presents after several days of illness with weakness, dizziness, abdominal pain, and hypotension (BP 72/48) unresponsive to IV fluid boluses. What endocrine emergency should the paramedic suspect?

Adrenal crisis (acute adrenal insufficiency) requiring urgent steroid replacement and aggressive fluid resuscitation

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Myxedema coma from severe hypothyroidism

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Thyroid storm from uncontrolled hyperthyroidism

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Cushing syndrome from cortisol excess

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A 45-year-old female presents with palpitations, fever of 104 F, agitation, and tremors. She has a goiter and exophthalmos. Heart rate is 160 bpm (atrial fibrillation), BP 180/90. She reports stopping her thyroid medication two weeks ago. What endocrine emergency is most likely?

Thyroid storm (thyrotoxic crisis) precipitated by medication noncompliance

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Pheochromocytoma causing catecholamine surge

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Myxedema coma from severe hypothyroidism

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Sympathomimetic toxicity from stimulant use

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An 82-year-old patient presents with confusion that the family reports developed over 24 hours. The patient was oriented and conversational yesterday. The patient takes warfarin, metoprolol, and lisinopril. Vital signs show temperature 100.8 F, HR 92, BP 108/64, and SpO2 93%. What is the most important consideration for this patient?

Acute delirium in an elderly patient requires a thorough assessment for underlying causes such as infection, medication changes, or metabolic disturbances

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The patient has dementia and the confusion is expected for their age

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The confusion is likely a normal side effect of metoprolol and does not require emergent evaluation

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Elderly patients with confusion should be left at home if vital signs are stable

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A 65-year-old male presents with sudden onset of severe, diffuse abdominal pain. His abdomen is rigid and board-like on palpation. Vital signs show HR 120, BP 90/60, RR 26, and temperature 101 F. He has a history of peptic ulcer disease. What condition is most likely?

Perforated peptic ulcer with peritonitis, requiring rapid transport to a surgical facility

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Acute appendicitis with localized right lower quadrant pain

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Gastroesophageal reflux disease exacerbation

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Irritable bowel syndrome flare causing diffuse discomfort

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What is the most common cause of upper gastrointestinal bleeding?

Peptic ulcer disease (gastric or duodenal ulcers)

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Esophageal varices from portal hypertension

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Mallory-Weiss tear from forceful vomiting

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Gastric carcinoma

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A 50-year-old male with a history of heavy alcohol use presents with massive hematemesis (vomiting bright red blood). He appears pale, diaphoretic, with HR 130, BP 78/50, and has a distended abdomen with caput medusae visible. What is the most likely source of bleeding?

Esophageal varices secondary to portal hypertension from liver cirrhosis

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Peptic ulcer disease from NSAID overuse

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Gastric carcinoma causing slow, chronic blood loss

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Aortoenteric fistula from an abdominal aortic aneurysm

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A 70-year-old female presents with left lower quadrant abdominal pain, low-grade fever, and reports of change in bowel habits over several days. Vital signs are HR 98, BP 138/82, temperature 100.6 F. What condition should the paramedic suspect?

Acute diverticulitis, an infection or inflammation of diverticula in the sigmoid colon

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Acute appendicitis, which typically presents with right lower quadrant pain

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Ovarian torsion causing acute pelvic pain

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Mesenteric ischemia from arterial insufficiency

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What does the presence of melena (black, tarry stools) indicate in a patient presenting with abdominal complaints?

Bleeding from the upper gastrointestinal tract, where blood has been partially digested during transit through the bowel

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Active bleeding from the lower gastrointestinal tract (colon or rectum)

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A normal variant caused by iron supplement use only

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A sign of hepatic encephalopathy from liver failure

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A 28-year-old female presents with sudden onset of severe right lower quadrant pain, nausea, and vomiting. She reports her last menstrual period was 3 weeks ago and uses oral contraceptives. She denies vaginal bleeding. Vital signs are HR 110, BP 118/74. What gynecological emergency should the paramedic consider?

Ovarian torsion causing ischemia from twisting of the ovary on its vascular pedicle

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Ruptured ectopic pregnancy with internal hemorrhage

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Endometriosis flare from menstrual cycle changes

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Pelvic inflammatory disease from ascending infection

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A 22-year-old female presents with lower abdominal pain, fever of 102.5 F, and purulent vaginal discharge. She reports multiple sexual partners and inconsistent barrier contraception use. On palpation, she has bilateral lower quadrant tenderness with cervical motion tenderness. What is the most likely diagnosis?

Pelvic inflammatory disease (PID) from ascending sexually transmitted infection

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Ruptured ovarian cyst with peritoneal irritation

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Urinary tract infection with lower abdominal pain

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Acute appendicitis with atypical presentation

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A 34-year-old female with a positive home pregnancy test presents with unilateral lower abdominal pain, vaginal spotting, and dizziness upon standing. She is approximately 7 weeks pregnant by her last menstrual period. Vital signs show HR 118, BP 92/58, and orthostatic changes. What is the most critical prehospital concern?

Ruptured ectopic pregnancy with intra-abdominal hemorrhage requiring IV fluid resuscitation and rapid surgical transport

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Threatened miscarriage requiring bed rest and reassurance

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Urinary tract infection causing referred abdominal pain

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Round ligament pain from early pregnancy stretching

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What is the most common location for an ectopic pregnancy to implant?

The fallopian tube (tubal pregnancy)

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The cervix (cervical pregnancy)

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The ovary (ovarian pregnancy)

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The abdominal cavity (abdominal pregnancy)

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A 40-year-old female presents with heavy vaginal bleeding, soaking through multiple pads per hour for the past 3 hours. She denies pregnancy and has a history of uterine fibroids. She is dizzy, pale, with HR 124 and BP 88/56. What is the prehospital priority?

Treat for hemorrhagic shock with IV fluid resuscitation, apply external pads for absorption, and transport emergently

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Pack the vagina with gauze to control the hemorrhage

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Administer tranexamic acid orally and observe for improvement

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Position the patient in Trendelenburg and withhold IV fluids to avoid diluting clotting factors

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What is the significance of Kehr’s sign in a patient with suspected ruptured ectopic pregnancy?

Referred shoulder pain caused by diaphragmatic irritation from intra-abdominal blood pooling

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Vaginal bleeding that increases with ambulation

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Rebound tenderness localized to McBurney's point

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Involuntary guarding of the right upper quadrant

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A 25-year-old female with sickle cell disease presents with severe bilateral leg pain, chest pain, and shortness of breath. Her SpO2 is 88% and she is in obvious distress. What prehospital interventions are most important?

High-flow oxygen to maximize hemoglobin saturation, IV fluid bolus for hydration, pain management, and rapid transport

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Apply ice packs to the painful extremities and withhold IV fluids to prevent fluid overload

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Administer aspirin for the chest pain and apply CPAP for the respiratory distress

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Place a tourniquet on the affected limbs to reduce blood flow and manage the pain

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What is disseminated intravascular coagulation (DIC) and what clinical signs should a paramedic recognize?

A condition where widespread activation of the clotting cascade consumes clotting factors, leading to simultaneous bleeding and thrombosis throughout the body

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A localized blood clot in a deep vein that requires anticoagulation therapy

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A genetic bleeding disorder similar to hemophilia that presents in childhood

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An allergic reaction to blood products that causes diffuse urticaria

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A patient on warfarin therapy presents with a nosebleed that has persisted for 45 minutes despite direct pressure. The patient also has extensive bruising on both arms. What additional concern should the paramedic have?

Supratherapeutic anticoagulation creating a high risk for spontaneous internal hemorrhage, including intracranial bleeding

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The nosebleed is a normal side effect of warfarin and requires no additional workup

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The bruising indicates physical abuse and should be reported to law enforcement

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The patient is likely allergic to warfarin and needs immediate discontinuation

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A paramedic responds to a college dormitory for a 19-year-old with sudden high fever, severe headache, neck stiffness, and a non-blanching petechial rash on the trunk and extremities. What infectious disease emergency should be suspected?

Meningococcal meningitis, a rapidly progressive bacterial infection requiring immediate transport and droplet precautions

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Viral influenza with a typical seasonal presentation

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Lyme disease from a recent tick bite

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Mononucleosis causing fever and fatigue

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A 42-year-old male presents writhing in pain with severe, colicky left flank pain radiating to the groin. He is nauseous and unable to find a comfortable position. Vital signs are HR 108, BP 148/92. Urinalysis shows hematuria. What is the most likely diagnosis?

Renal colic from a ureteral calculus (kidney stone) causing acute obstruction

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Abdominal aortic aneurysm rupture requiring immediate surgical intervention

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Acute pyelonephritis from ascending urinary tract infection

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Testicular torsion causing referred flank pain

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A patient with end-stage renal disease on hemodialysis three times weekly presents with generalized weakness, nausea, and an irregular pulse. The ECG shows tall, peaked T waves. What electrolyte abnormality is most likely?

Hyperkalemia, which is common in dialysis patients who miss treatments or have dietary indiscretion

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Hyponatremia from excessive water intake

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Hypocalcemia from vitamin D deficiency

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Hypomagnesemia from malabsorption

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NREMT Paramedic – Medical/OB-GYN — Quick Review

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