NREMT Paramedic – Full Practice Exam

A paramedic is treating a 55-year-old male with a STEMI identified on 12-lead ECG. The patient is conscious, complaining of chest pain rated 8/10, has a blood pressure of 90/60, a heart rate of 110, and an SpO2 of 94% on room air. Which sequence of interventions is most appropriate?

Aspirin administration, cautious IV fluid bolus, fentanyl for pain, and emergent transport to a PCI-capable facility

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Nitroglycerin sublingual, morphine IV, aspirin, and transport to the nearest emergency department

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Obtain serial 12-lead ECGs every 5 minutes, administer high-flow oxygen, then consider transport

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Administer a 2-liter normal saline bolus, nitroglycerin drip, and transport to the nearest hospital

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A 50-year-old male presents with sudden onset severe abdominal pain, tachycardia at 130 bpm, and hypotension at 78/50 mmHg. His abdomen is rigid and distended. He has a history of atrial fibrillation and recently stopped taking his anticoagulant medication. What is the most likely diagnosis?

Acute mesenteric ischemia from arterial embolism

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Ruptured abdominal aortic aneurysm

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Perforated peptic ulcer with peritonitis

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Acute pancreatitis with hemorrhagic complications

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You are treating a patient with a severe allergic reaction who was initially tachycardic and hypotensive. After treatment with epinephrine, fluids, and diphenhydramine, the patient’s blood pressure has stabilized, breathing is comfortable, and hives are resolving. Twenty minutes into transport, the patient develops a recurrence of facial swelling, wheezing, and a blood pressure drop to 82/54 mmHg. What is this phenomenon called and how should you respond?

A biphasic anaphylactic reaction; administer another dose of epinephrine and resume aggressive fluid resuscitation

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A rebound reaction to diphenhydramine; discontinue diphenhydramine and observe

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A new allergic reaction to the IV fluids; change to a different crystalloid solution

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An expected progression of the original reaction; continue current treatment without modification

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A patient being treated for anaphylaxis with epinephrine 0.3 mg IM begins to improve initially, but five minutes later develops a wide-complex tachycardia at 180 bpm and becomes diaphoretic with chest pain. His blood pressure is now 100/70 mmHg and he is alert. What is the most likely cause of this new rhythm?

Epinephrine-induced tachydysrhythmia

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Worsening anaphylactic shock causing a compensatory tachycardia

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New onset ventricular tachycardia unrelated to the current treatment

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Pulseless electrical activity from cardiovascular collapse

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A 67-year-old male presents with left-sided weakness, facial droop, and slurred speech. His blood glucose reading is 42 mg/dL. After administering dextrose 10% IV, his blood glucose rises to 128 mg/dL, but his neurological symptoms persist unchanged. What should you consider?

The patient may have a concurrent stroke that was masked by the hypoglycemia

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The dextrose was administered too slowly to be effective

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The blood glucose meter is malfunctioning and should be recalibrated

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The patient is experiencing a transient ischemic attack that will resolve spontaneously

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A 70-year-old male presents with altered mental status, fever of 39.2 C (102.6 F), tachycardia at 124 bpm, blood pressure of 86/52 mmHg, and warm, flushed skin. His wife reports he has had a urinary tract infection being treated with oral antibiotics for three days. Which type of shock is this patient most likely experiencing?

Distributive shock from sepsis

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Hypovolemic shock from dehydration

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Cardiogenic shock from a silent myocardial infarction

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Obstructive shock from a pulmonary embolism

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A 72-year-old female with a history of COPD and congestive heart failure presents with severe respiratory distress. She has bilateral crackles to the mid-lung fields, jugular vein distention, and peripheral edema. Her SpO2 is 82%, blood pressure is 190/110 mmHg, and she has a productive cough with pink frothy sputum. Her ETCO2 waveform shows a shark fin pattern. Which treatment approach best addresses this patient’s comorbidities?

Apply CPAP at 5 to 10 cmH2O and administer sublingual nitroglycerin

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Administer a nebulized bronchodilator and begin IV furosemide

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Intubate immediately and administer IV morphine for preload reduction

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Apply high-flow oxygen via nonrebreather mask and establish IV access only

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A 66-year-old male with a history of aortic valve replacement presents to you with severe dyspnea, a new systolic murmur, bilateral pulmonary edema, and altered mental status. His blood pressure is 82/58 mmHg, heart rate is 118 bpm, and SpO2 is 79% on room air. He reports his symptoms started suddenly about 30 minutes ago. What is the most appropriate management approach?

Provide positive pressure ventilation with CPAP, establish IV access, and transport emergently to a cardiac surgery center

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Administer nitroglycerin sublingually and furosemide IV to reduce preload

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Intubate immediately and begin a norepinephrine infusion for the hypotension

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Apply high-flow oxygen by nonrebreather and administer aspirin for suspected ACS

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A patient in anaphylaxis received epinephrine 0.3 mg IM and diphenhydramine 50 mg IV. Despite treatment, urticaria and bronchospasm persist. The paramedic considers an alternative treatment approach. What is most appropriate?

Repeat epinephrine 0.3 mg IM every 5 to 15 minutes as needed, add albuterol nebulizer for persistent bronchospasm, and continue IV fluid resuscitation

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Administer epinephrine 1 mg IV push as used in cardiac arrest protocols

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Switch to oral diphenhydramine since the IV dose was ineffective

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Discontinue all medications and perform endotracheal intubation

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You are treating a patient with a suspected allergic reaction who is developing worsening stridor and hypotension. Your standing orders authorize epinephrine 0.3 mg IM for anaphylaxis. After administering the first dose, the patient continues to deteriorate with severe airway compromise. Your protocols do not specifically address repeat dosing or IV epinephrine. What is the most appropriate next step?

Contact online medical control for authorization to administer a repeat dose or IV epinephrine

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Administer a second IM dose without medical control contact since the first was ineffective

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Withhold further epinephrine and focus solely on airway management

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Administer diphenhydramine IV as the definitive treatment for refractory anaphylaxis

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A 38-year-old female presents with acute onset dyspnea, pleuritic chest pain on the right side, tachycardia at 118 bpm, and an SpO2 of 88%. She recently had knee surgery and has been on bed rest for two weeks. Her lung sounds are clear bilaterally and her trachea is midline. Which condition should you suspect?

Pulmonary embolism

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Right-sided tension pneumothorax

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Acute exacerbation of asthma

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Community-acquired pneumonia

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You are treating a 70-year-old patient with chest pain who initially presented with stable vital signs. After administering aspirin and nitroglycerin, the patient becomes a worsening patient with increasing diaphoresis, a heart rate rising from 88 to 130 bpm, and blood pressure dropping from 140/90 to 84/56 mmHg. Which action is most appropriate?

Discontinue nitroglycerin, establish IV access, administer a fluid bolus, and prepare for possible cardiogenic shock management

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Administer a second dose of nitroglycerin to relieve the chest pain

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Administer morphine 4 mg IV for pain control and reassess

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Apply a 12-lead ECG and wait for medical direction before making any changes

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An 80-year-old female presents after a ground-level fall. She reports tripping over a rug. She has right hip pain and an externally rotated, shortened right leg. She is on aspirin, metoprolol, lisinopril, and amlodipine. Her vital signs show HR 64, BP 110/72. Given her medication profile, why should the paramedic be cautious about interpreting these vital signs as ‘normal’?

Beta-blockers (metoprolol) blunt the heart rate response to pain and hemorrhage, masking the tachycardia that normally indicates compensatory shock

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Aspirin is causing internal bleeding that prevents accurate blood pressure measurement

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ACE inhibitors (lisinopril) artificially elevate the heart rate, making tachycardia appear normal

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Calcium channel blockers (amlodipine) cause pulse oximetry readings to be falsely elevated

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A 42-year-old male presents with acute onset chest pain that worsens with deep inspiration and improves when he leans forward. He reports a recent viral illness. His 12-lead ECG shows diffuse ST elevation in multiple leads with PR segment depression. His troponin was negative two hours ago at urgent care. What is the most likely diagnosis?

Acute pericarditis

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Acute ST-elevation myocardial infarction

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Aortic dissection

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Costochondritis

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A paramedic administers 0.5 mg of epinephrine 1:1,000 intramuscularly for anaphylaxis but accidentally documents the dose as 1 mg of epinephrine 1:10,000 intravenously. Upon realizing the error after submitting the ePCR, what is the most appropriate action?

Submit an addendum to the ePCR correcting the medication, dose, and route with an explanation of the error

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Delete the original entry and rewrite the correct information in a new report

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Contact the receiving hospital verbally and consider the documentation complete

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Leave the documentation as written because altering a medical record is illegal

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An 82-year-old female with a history of Alzheimer’s disease is brought from her assisted living facility for ‘acting different.’ Her baseline mental status per staff is oriented to person only and able to follow simple commands. Today she is combative, unable to follow commands, and has a temperature of 99.8 F. Her medications include donepezil and sertraline. Which assessment finding is most significant?

The acute change from her known baseline mental status, suggesting an underlying medical cause

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The low-grade fever, which is normal for elderly patients in care facilities

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The combative behavior, which is typical of advanced Alzheimer's disease

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The medication list, which suggests a serotonin syndrome presentation

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A paramedic is completing an electronic patient care report (ePCR) after transporting a patient with chest pain. Which element is most critical to include for continuity of care and legal documentation?

Time-stamped vital signs, interventions performed, and the patient's response to each treatment

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The names of all bystanders present at the scene

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A detailed description of the neighborhood where the call originated

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The paramedic's personal opinion about the patient's long-term prognosis

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A paramedic is delivering a verbal report to the emergency department nurse during patient handoff. Which of the following represents the most effective verbal report?

A concise summary including age, chief complaint, pertinent findings, interventions performed, and current status

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A complete reading of every data field from the electronic patient care report

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A brief statement of the patient's name and the reason for transport only

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A detailed narrative of the entire call from dispatch to arrival in chronological order

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An 82-year-old female is found on the floor of her bedroom after falling during the night. She complains of severe pain in her right hip, and the right leg appears shortened and externally rotated. She takes warfarin for atrial fibrillation and lisinopril for hypertension. Her blood pressure is 104/62 mmHg and heart rate is 92 bpm. Beyond pain management and splinting, what additional concern should guide your assessment of this patient?

The fall may have been caused by an underlying medical event such as a syncopal episode or dysrhythmia

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The patient should be assessed primarily for a spinal injury before addressing the hip

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Warfarin use means the hip fracture cannot be surgically repaired

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The patient should be placed in a traction splint to stabilize the hip fracture

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You are called to assess a 6-month-old infant who the parents say ‘isn’t breathing right.’ Using the Pediatric Assessment Triangle (PAT), you observe the infant has a weak cry, is pale with mottled skin, and has nasal flaring with intercostal retractions. What does this PAT assessment indicate?

Cardiopulmonary failure requiring immediate intervention

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Mild respiratory distress requiring monitoring only

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An isolated behavioral or CNS problem

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A normal infant who is simply upset from being examined

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A paramedic administers morphine to a patient but accidentally documents the dose as 4 mg when the actual dose was 2 mg. After noticing the error, how should the paramedic correct the patient care report?

Draw a single line through the error, write the correct information, initial the correction, and note the date and time of the correction

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Use correction fluid to cover the error and write the correct dose over it

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Create an entirely new patient care report without the error and discard the original

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Leave the error and add a separate note at the end of the report with the correction

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What minimum data set elements are typically required by state EMS regulatory agencies for a complete patient care report?

Patient demographics, chief complaint, assessment findings, vital signs, interventions performed, patient response, and disposition

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Only the patient's name, chief complaint, and transport destination

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Only vital signs and medications administered

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Only the dispatch information and time stamps

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You are managing a patient in cardiogenic shock with a dopamine infusion running at 10 mcg/kg/min. On reassessment, the patient’s blood pressure has improved from 72/48 to 96/64 mmHg, but the cardiac monitor now shows frequent premature ventricular complexes and short runs of ventricular tachycardia. What should you do?

Reduce the dopamine infusion rate and consider switching to norepinephrine

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Increase the dopamine rate to further improve blood pressure

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Administer amiodarone 150 mg IV while maintaining the current dopamine rate

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Discontinue dopamine immediately and observe the rhythm

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During an interfacility transport, your patient with a known diagnosis of sepsis on a norepinephrine drip at 10 mcg/min begins to develop worsening hypotension (BP dropping from 90/60 to 72/44 mmHg), new onset atrial fibrillation with rapid ventricular response at 158 bpm, and decreasing urine output. Lactate was 6.2 mmol/L at the sending facility. What should you do?

Increase the norepinephrine infusion rate and administer an additional fluid bolus while closely monitoring the rhythm

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Perform synchronized cardioversion for the rapid atrial fibrillation

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Discontinue norepinephrine and switch to a dobutamine infusion

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Administer amiodarone 150 mg IV to control the heart rate

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A paramedic responds to a 45-year-old patient who refuses transport against medical advice. The patient was found unresponsive by coworkers but is now alert with stable vitals and a blood glucose of 58 mg/dL after receiving oral glucose. Which documentation element is most important for this refusal?

Documented evidence that the patient was informed of the risks of refusing transport, including potential recurrence of hypoglycemia

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A statement that the patient appeared competent to make decisions without further detail

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The signature of the patient's coworker as a witness that the patient seemed fine

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A note that the paramedic recommended the patient eat lunch within the next hour

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A paramedic responds to a two-vehicle collision with four patients. Patient A has a penetrating chest wound with labored breathing and tachycardia. Patient B is ambulatory with a laceration to the forearm. Patient C is unresponsive, apneic, and pulseless. Patient D has bilateral femur fractures with controlled bleeding and is alert and oriented. In an MCI with limited resources, which patient should receive immediate treatment first?

Patient A, who has a life-threatening but treatable chest injury

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Patient C, because cardiac arrest patients always receive CPR first

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Patient D, because bilateral femur fractures indicate high-energy mechanism

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Patient B, because ambulatory patients are triaged and treated first

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A paramedic arrives to find a 55-year-old male who is diaphoretic, clutching his chest, and reporting crushing substernal pain radiating to the left arm. His blood pressure is 88/56 mmHg, heart rate is 110 bpm, respirations are 24, and SpO2 is 94%. A 12-lead ECG shows ST elevation in leads II, III, and aVF. Which intervention should the paramedic perform first?

Establish IV access and administer a fluid bolus for the hypotension

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Administer sublingual nitroglycerin to relieve the chest pain

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Administer morphine 4 mg IV for pain management

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Apply CPAP at 10 cmH2O for the increased respiratory rate

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Which of the following vital sign findings would be considered normal for a healthy 2-year-old child?

Heart rate 110, respiratory rate 26, systolic BP 90 mmHg

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Heart rate 70, respiratory rate 16, systolic BP 120 mmHg

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Heart rate 150, respiratory rate 40, systolic BP 70 mmHg

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Heart rate 60, respiratory rate 12, systolic BP 100 mmHg

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You initiated a dopamine infusion at 5 mcg/kg/min for a patient in cardiogenic shock. The patient’s blood pressure has improved from 78/50 to 96/64 over 15 minutes. However, the patient now reports new onset of chest pain, and the cardiac monitor shows frequent premature ventricular contractions (PVCs). What modification to the treatment plan is most appropriate?

Reduce the dopamine infusion rate and monitor, as the catecholamine effect may be causing myocardial irritability

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Increase the dopamine to 15 mcg/kg/min since the blood pressure has not fully normalized

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Administer amiodarone 150 mg IV to suppress the PVCs while maintaining the current dopamine rate

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Discontinue dopamine immediately and administer a fluid bolus as an alternative

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A 52-year-old male presents with sudden onset severe chest pain that he describes as tearing, radiating to his back between the shoulder blades. His blood pressure is 200/110 mmHg in the right arm and 158/88 mmHg in the left arm. He has a history of poorly controlled hypertension. His 12-lead ECG shows sinus tachycardia without ST changes. Which condition should you most strongly suspect?

Acute aortic dissection

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Acute ST-elevation myocardial infarction

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Massive pulmonary embolism

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Esophageal rupture

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A paramedic is treating a trauma patient with a suspected tension pneumothorax. The patient has absent breath sounds on the left, tracheal deviation to the right, JVD, and progressive hypotension. The paramedic must decide between performing needle decompression on scene versus loading and transporting immediately to a hospital 8 minutes away. Which decision framework best applies?

Perform needle decompression on scene because tension pneumothorax is a rapidly fatal condition that requires immediate intervention, and the 8-minute transport time without decompression carries unacceptable mortality risk

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Always transport first because definitive care can only be provided at the hospital and field procedures waste time

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Perform decompression only if the patient loses pulses during transport, as prophylactic decompression is contraindicated

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Request medical control authorization before performing any invasive procedure, even if it delays treatment by several minutes

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In the context of trauma care, the concept of the ‘golden hour’ refers to which principle?

Critically injured patients have improved outcomes when they receive definitive surgical care within the first hour after injury

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Paramedics should spend no more than one hour on scene for any trauma patient

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All trauma patients must arrive at a trauma center within 60 minutes of the 911 call

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The first hour of a paramedic's shift has the highest call volume for trauma

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You are treating a 60-year-old male for an anterior STEMI. He is on aspirin, heparin drip, and oxygen. His pain has resolved with nitroglycerin. The PCI-capable hospital is 40 minutes away. Suddenly the patient develops ventricular fibrillation. You defibrillate successfully and achieve ROSC. The patient is now awake and following commands. What is your transport decision?

Continue transport to the PCI-capable hospital for emergent catheterization since the underlying STEMI caused the VF

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Divert to the closest hospital since the patient experienced cardiac arrest

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Return to the scene and wait for air medical transport

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Stop transport and observe the patient on scene for 30 minutes before continuing

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In the prehospital patient care report, what is the purpose of documenting pertinent negative findings?

To demonstrate that relevant conditions were assessed and ruled out during the clinical evaluation

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To increase the overall length and thoroughness of the written narrative

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To record only the symptoms the patient explicitly denies having

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To list every possible condition that could be associated with the chief complaint

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A 62-year-old male presents with sudden onset of left-sided weakness, slurred speech, and confusion. His blood glucose is 42 mg/dL. After administering dextrose, his neurological symptoms completely resolve. What does this clinical scenario most likely represent?

Hypoglycemia mimicking stroke symptoms

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An ischemic stroke that was reversed by dextrose administration

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A transient ischemic attack that coincidentally resolved at the same time

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A hemorrhagic stroke with temporary symptom improvement

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A paramedic is assessing a 70-year-old patient with altered mental status and a blood glucose of 38 mg/dL. The patient has no IV access, IO access is not immediately available, and the patient is unable to swallow safely. What is the most appropriate intervention?

Administer glucagon 1 mg intramuscularly

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Administer oral glucose gel sublingually

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Administer dextrose 50% via IO access only

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Withhold treatment and transport immediately to the hospital

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You administered epinephrine via auto-injector to a patient experiencing anaphylaxis with urticaria, wheezing, and hypotension. After five minutes, the wheezing has resolved and urticaria is fading, but her blood pressure remains at 78/50 mmHg despite a 500 mL normal saline bolus. Her heart rate is 108 bpm. What is your next step?

Administer a second dose of epinephrine and continue IV fluid resuscitation

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Administer diphenhydramine 50 mg IV and wait for the initial epinephrine to take full effect

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Begin a norepinephrine infusion as a first-line vasopressor for refractory anaphylaxis

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Withhold additional epinephrine to avoid tachycardia and focus on fluid resuscitation alone

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A paramedic is called for a 3-month-old infant found unresponsive in the crib by the parents. The infant is pulseless and apneic, and the body is cool with dependent lividity. Rigor mortis is not yet present. What is the most appropriate course of action?

Begin resuscitation, contact medical control, and transport unless signs of obvious death are confirmed

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Pronounce the infant deceased and contact law enforcement

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Begin CPR for 20 minutes and then pronounce death if there is no response

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Withhold resuscitation due to the cool body temperature and lividity

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While documenting a patient care report for a patient who refused transport, what elements are legally essential to include to protect the paramedic and the agency from liability?

Documentation that the patient was alert and oriented, understood the risks of refusal, was informed of potential consequences including death, and signed a refusal form with a witness

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Only the patient's signature on the refusal form is needed, with no additional documentation required

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A statement that the patient seemed fine and did not need treatment based on your clinical judgment

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The patient's insurance information and primary care physician contact details

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A paramedic responds to a 45-year-old male with severe abdominal pain. The patient is alert and oriented, has a history of chronic pain, and requests that the paramedic not administer morphine because it causes him severe nausea. Protocol lists morphine as the first-line analgesic. Fentanyl is also carried on the unit. What is the best clinical decision?

Contact medical control to request authorization for fentanyl as an alternative analgesic based on the patient's stated history

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Administer morphine as directed by protocol since the patient's preference does not override standing orders

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Withhold all analgesics and advise the patient that pain management will occur at the hospital

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Administer fentanyl without contacting medical control since the patient has a documented adverse reaction

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You administered morphine 4 mg IV to a 68-year-old female with an isolated hip fracture. Her pain improved from 9/10 to 6/10, but on reassessment her respiratory rate has decreased from 18 to 8 breaths per minute and her SpO2 has dropped from 97% to 89%. Her blood pressure remains stable at 128/78 mmHg. What is your next action?

Administer naloxone to reverse the respiratory depression and provide supplemental oxygen

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Administer an additional 2 mg morphine to achieve better pain control

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Apply a nonrebreather mask at 15 LPM and continue monitoring without additional intervention

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Reposition the patient and wait for the morphine to metabolize

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A paramedic is managing a critical trauma patient with suspected tension pneumothorax and a severely angulated open fracture of the tibia. The patient is hypotensive with absent breath sounds on the left side and tracheal deviation to the right. Which intervention takes priority?

Needle decompression of the left chest

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Realignment and splinting of the open tibial fracture

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Establishing two large-bore IV lines for fluid resuscitation

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Applying a sterile dressing to the open fracture wound

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You respond to a multi-vehicle collision where a 58-year-old male presents with a flail chest on the left side, a distended abdomen with guarding, and an open fracture of the right femur. His blood pressure is 78/50 mmHg, heart rate is 128 bpm, respiratory rate is 32 and labored, and SpO2 is 84% on room air. He is alert but confused. Which intervention should you perform first?

Assist ventilations with a bag-valve mask and supplemental oxygen

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Apply a tourniquet to the right lower extremity

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Establish two large-bore IV lines and begin fluid resuscitation

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Perform needle decompression on the left chest

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You arrive on scene to find a 45-year-old male who was involved in a motorcycle collision. He is alert but confused, has a respiratory rate of 28, a weak radial pulse of 120, and an obvious open femur fracture with moderate bleeding. He also complains of difficulty breathing with diminished breath sounds on the left side. Which intervention should be performed first?

Needle decompression of the left chest

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Apply a tourniquet to the left thigh

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Establish IV access and administer a fluid bolus

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Splint the open femur fracture

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A paramedic needs to determine the correct medication dose for a 4-year-old child of unknown weight who is seizing. No caregiver is present to provide a weight. What is the most reliable method for estimating this child’s weight in the prehospital setting?

Use a length-based resuscitation tape (Broselow tape)

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Estimate based on the child's apparent age using the formula (age + 4) x 2

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Ask the responding firefighters to estimate the child's weight visually

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Use a standard adult dose reduced by 50% for all pediatric patients

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A paramedic discovers an error in a completed patient care report after it has been submitted. The report incorrectly states a medication dose that was administered. What is the correct way to address this documentation error?

Write an addendum or late entry that corrects the information with the current date and time

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Delete the original report and create a new one with the corrected information

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Use correction fluid or digital deletion to remove the incorrect entry

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Leave the original report unchanged since it has already been submitted

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You are treating a 55-year-old male with an acute asthma exacerbation. After two nebulized albuterol treatments, his wheezing has diminished but his respiratory rate has increased from 26 to 34, he appears more fatigued, and his ETCO2 has risen from 32 to 48 mmHg. What does this change in ETCO2 indicate?

The patient is tiring and developing ventilatory failure despite apparent improvement in bronchospasm

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The albuterol treatments are working and the patient's condition is improving

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The ETCO2 reading is falsely elevated due to the nebulizer interfering with the sensor

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The patient is hyperventilating and needs coaching to slow his breathing

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You applied a CPAP device at 5 cmH2O to a 74-year-old female with acute pulmonary edema. After 10 minutes, her SpO2 has improved from 82% to 88%, but she remains in severe respiratory distress with persistent crackles and an unchanged respiratory rate of 36. What is the most appropriate modification to your treatment plan?

Increase the CPAP pressure to 10 cmH2O and reassess in 5 minutes

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Remove the CPAP and switch to a nonrebreather mask since CPAP is not working

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Maintain the current CPAP settings since SpO2 is improving

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Remove the CPAP and immediately proceed to endotracheal intubation

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You respond to a two-vehicle collision with four patients. Patient A has a GCS of 3 with agonal respirations. Patient B has an amputated hand with controlled bleeding. Patient C is ambulatory with a wrist deformity. Patient D has a flail chest with an SpO2 of 88%. Using standard field triage principles, which patient should receive your immediate treatment first?

Patient D with flail chest and hypoxia

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Patient A with GCS of 3 and agonal respirations

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Patient B with the amputated hand

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Patient C with the wrist deformity

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A 58-year-old male presents with chest discomfort, diaphoresis, and nausea. His blood pressure is 88/60 mmHg, heart rate is 110 bpm, respiratory rate is 22 breaths per minute, and SpO2 is 94% on room air. Which assessment finding should most concern the paramedic when forming an initial clinical impression?

The combination of hypotension and tachycardia suggesting hemodynamic compromise

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The nausea, which indicates a likely gastrointestinal etiology

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The SpO2 of 94%, which requires immediate high-flow oxygen therapy

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The respiratory rate of 22, which suggests primary respiratory failure

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You are the sole paramedic treating a 40-year-old male involved in a motorcycle collision. He has a GCS of 9, a large scalp laceration with active bleeding, diminished breath sounds on the left with tracheal deviation to the right, and an obviously deformed left femur. His HR is 130 and BP is 82/50. What is your immediate priority intervention?

Perform needle decompression of the left chest for suspected tension pneumothorax

Correct Incorrect Correct answer

Apply direct pressure to the scalp laceration to control hemorrhage

Correct Incorrect Correct answer

Splint the left femur fracture to reduce pain and blood loss

Correct Incorrect Correct answer

Perform endotracheal intubation for airway protection given the low GCS

Correct Incorrect Correct answer

A 62-year-old male involved in a high-speed MVC presents with chest pain, hypotension (BP 80/60 mmHg), and muffled heart sounds. His 12-lead ECG shows low-voltage QRS complexes and sinus tachycardia at 120 bpm. During transport, he becomes more hypotensive despite a 500 mL normal saline bolus and his jugular veins are distended. What complication should you suspect is developing?

Cardiac tamponade

Correct Incorrect Correct answer

Tension pneumothorax

Correct Incorrect Correct answer

Aortic rupture

Correct Incorrect Correct answer

Myocardial contusion progressing to cardiogenic shock

Correct Incorrect Correct answer

When calculating the Glasgow Coma Scale for a preverbal infant, which modification is applied to the verbal component?

Smiling, cooing, and crying are used instead of oriented speech responses

Correct Incorrect Correct answer

The verbal component is omitted and only motor and eye opening are scored

Correct Incorrect Correct answer

The verbal score is automatically assigned a value of 3

Correct Incorrect Correct answer

The verbal component uses the same descriptors as for adults

Correct Incorrect Correct answer

A 25-year-old female presents with a severe headache that has been progressively worsening over 3 days. She has papilledema on fundoscopic exam, nausea, and reports her vision goes gray when she stands up. She is obese and takes oral contraceptives. CT scan at a recent ER visit was normal. What condition should be considered?

Idiopathic intracranial hypertension (pseudotumor cerebri)

Correct Incorrect Correct answer

Acute bacterial meningitis

Correct Incorrect Correct answer

Subarachnoid hemorrhage from aneurysm rupture

Correct Incorrect Correct answer

Migraine with visual aura

Correct Incorrect Correct answer

A 60-year-old male presents with acute dyspnea and wheezing that began 20 minutes ago. He has no history of asthma or COPD. He does have a history of heart failure. Examination reveals bilateral inspiratory and expiratory wheezing, jugular vein distention, and bilateral ankle edema. His SpO2 is 88% and BP is 168/102 mmHg. What is the most likely cause of his wheezing?

Cardiac asthma from acute decompensated heart failure

Correct Incorrect Correct answer

New onset bronchial asthma triggered by an environmental allergen

Correct Incorrect Correct answer

Acute exacerbation of undiagnosed COPD

Correct Incorrect Correct answer

Anaphylaxis from an unknown exposure

Correct Incorrect Correct answer

You are the only paramedic on scene at a rural farmstead where a 28-year-old male was found in a grain bin with suspected crush injury to both lower extremities after being trapped for approximately 90 minutes. He is conscious with a BP of 110/78 mmHg and HR of 96 bpm prior to extrication. Which action is most critical to perform before extrication begins?

Establish IV access and administer a normal saline bolus and sodium bicarbonate prior to release of the compressive force

Correct Incorrect Correct answer

Apply tourniquets to both lower extremities before the compressive force is released

Correct Incorrect Correct answer

Wait for extrication to be complete before initiating any IV fluid therapy

Correct Incorrect Correct answer

Administer fentanyl for pain management and begin extrication immediately

Correct Incorrect Correct answer

A paramedic is treating a 72-year-old female in respiratory distress with bilateral crackles, JVD, and SpO2 of 84%. Standing orders call for CPAP at 10 cmH2O. After five minutes on CPAP, the patient becomes increasingly agitated, her SpO2 drops to 78%, and she is now producing frothy pink sputum. What treatment decision is most appropriate?

Continue CPAP, establish IV access, and administer nitroglycerin to reduce preload while preparing for endotracheal intubation if the patient continues to deteriorate

Correct Incorrect Correct answer

Immediately remove CPAP and perform endotracheal intubation

Correct Incorrect Correct answer

Discontinue CPAP, switch to a non-rebreather mask at 15 LPM, and transport emergently

Correct Incorrect Correct answer

Increase CPAP pressure to 15 cmH2O and administer a fluid bolus to support blood pressure

Correct Incorrect Correct answer

You are managing a septic patient with a norepinephrine infusion at 10 mcg/min. The patient’s MAP has improved from 52 to 68 mmHg. However, the patient now develops ST elevation on the cardiac monitor. What is the most likely mechanism causing this new finding?

Vasopressor-induced coronary vasoconstriction or increased myocardial oxygen demand exceeding supply

Correct Incorrect Correct answer

The norepinephrine is directly toxic to cardiac muscle cells

Correct Incorrect Correct answer

The patient was misdiagnosed and actually has an acute MI rather than sepsis

Correct Incorrect Correct answer

The blood pressure improvement caused the ST changes through mechanical stretching

Correct Incorrect Correct answer

A 4-year-old child is found unresponsive in a swimming pool. Bystanders pulled the child from the water approximately 2 minutes ago. The child is not breathing and has no pulse. How does the initial resuscitation priority differ from adult cardiac arrest?

The priority emphasizes early ventilations because drowning cardiac arrest is caused by hypoxia, making oxygenation and ventilation critical from the outset

Correct Incorrect Correct answer

There is no difference; the standard CAB sequence applies to all cardiac arrests including drowning

Correct Incorrect Correct answer

Drowning arrests require immediate defibrillation before any other intervention

Correct Incorrect Correct answer

Chest compressions should be withheld until the lungs are cleared of water using abdominal thrusts

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A 70-year-old female with a history of atrial fibrillation presents with acute onset left-sided weakness and slurred speech. Her blood glucose is 110 mg/dL, blood pressure is 182/96, and symptoms began 45 minutes ago. Which action takes the highest priority?

Rapid transport to the nearest certified stroke center

Correct Incorrect Correct answer

Administer aspirin 324 mg for suspected cerebrovascular event

Correct Incorrect Correct answer

Establish IV access and administer a 500 mL normal saline bolus

Correct Incorrect Correct answer

Attempt to lower blood pressure with labetalol IV before transport

Correct Incorrect Correct answer

A 58-year-old male presents with sudden onset chest pain radiating to the left arm, diaphoresis, and nausea. His 12-lead ECG shows ST elevation in leads II, III, and aVF. Which of the following best describes the process the paramedic should use to confirm the clinical impression?

Correlate the ECG findings with the patient's symptoms, history, and physical exam to confirm an inferior STEMI

Correct Incorrect Correct answer

Obtain serial troponin levels in the field before forming a clinical impression

Correct Incorrect Correct answer

Wait for reciprocal changes in lateral leads before considering STEMI activation

Correct Incorrect Correct answer

Base the diagnosis solely on the patient's complaint of chest pain without ECG correlation

Correct Incorrect Correct answer

You are treating a patient who speaks only Mandarin Chinese. The patient appears to be in pain and is pointing to their abdomen. No translator is available on scene. Which communication strategy is most appropriate to gather essential medical history?

Use a phone-based medical interpreter service, supplemented by gestures, pointing, and visual pain scales

Correct Incorrect Correct answer

Ask a bystander who claims to speak 'a little Chinese' to translate complex medical questions

Correct Incorrect Correct answer

Proceed directly to the hospital without attempting any communication with the patient

Correct Incorrect Correct answer

Speak English louder and more slowly until the patient understands

Correct Incorrect Correct answer

During a secondary survey, which mnemonic is used to gather a focused history from the patient regarding their chief complaint?

OPQRST

Correct Incorrect Correct answer

AVPU

Correct Incorrect Correct answer

DCAP-BTLS

Correct Incorrect Correct answer

AEIOU-TIPS

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In the current ACLS guidelines for cardiac arrest management, which sequence correctly describes the approach to a patient found in cardiac arrest?

CAB: Compressions, Airway, Breathing

Correct Incorrect Correct answer

ABC: Airway, Breathing, Compressions

Correct Incorrect Correct answer

BAC: Breathing, Airway, Compressions

Correct Incorrect Correct answer

CBA: Compressions, Breathing, Airway

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A paramedic is assessing an 80-year-old male with altered mental status. His daughter states he has a history of dementia and “gets confused sometimes.” The patient is febrile at 101.4 F, has a heart rate of 104 bpm, and is more confused than his baseline according to the daughter. The daughter asks whether transport is necessary since “he always gets like this.” How should the paramedic approach this situation?

Transport is indicated because acute worsening from baseline, fever, and tachycardia suggest delirium superimposed on dementia from an underlying infection

Correct Incorrect Correct answer

Defer to the daughter's assessment since she knows the patient's baseline better than the paramedic

Correct Incorrect Correct answer

Decline transport since the patient has a known history of confusion episodes

Correct Incorrect Correct answer

Administer acetaminophen for the fever and reassess in 30 minutes before deciding on transport

Correct Incorrect Correct answer

A 48-year-old male presents with dyspnea at rest. Assessment reveals JVD, bilateral crackles in the lower lung fields, peripheral edema, and an SpO2 of 89%. His blood pressure is 168/102 and heart rate is 112. The patient states he ran out of his ‘water pill’ a week ago. A pertinent negative in this assessment would be which of the following?

Absence of chest pain, which helps narrow the differential away from acute coronary syndrome

Correct Incorrect Correct answer

Bilateral crackles indicating fluid overload in the lungs

Correct Incorrect Correct answer

Jugular venous distention indicating elevated right-sided heart pressures

Correct Incorrect Correct answer

SpO2 of 89% demonstrating impaired gas exchange

Correct Incorrect Correct answer

A paramedic arrives to find a conscious patient who is hearing-impaired and uses American Sign Language. The paramedic does not know sign language and there is no interpreter available. What is the best approach to communicate with this patient?

Use written communication, gestures, and simple visual aids while facing the patient directly

Correct Incorrect Correct answer

Speak louder and more slowly to ensure the patient can hear

Correct Incorrect Correct answer

Direct all questions to a family member instead of the patient

Correct Incorrect Correct answer

Skip the history and rely solely on physical examination findings

Correct Incorrect Correct answer

You are assessing a 2-year-old child who is febrile at 103.8 F. The child’s normal heart rate for age is 80 to 130 bpm. The current heart rate is 168 bpm and the child is irritable but consolable. The parents report the fever started 4 hours ago. Which interpretation of the vital signs is most accurate?

The tachycardia is expected as a physiologic response to fever and does not independently indicate shock

Correct Incorrect Correct answer

The heart rate confirms compensated shock requiring immediate fluid resuscitation

Correct Incorrect Correct answer

The heart rate is normal for a 2-year-old and requires no further evaluation

Correct Incorrect Correct answer

The tachycardia indicates a primary cardiac arrhythmia requiring cardioversion

Correct Incorrect Correct answer

During a critical care interfacility transport, your intubated patient on a ventilator suddenly develops hypotension (BP 72/40 mmHg), tachycardia (HR 134 bpm), and a rising peak inspiratory pressure. You notice the ETCO2 waveform has lost its plateau and SpO2 is dropping rapidly. Breath sounds are absent on the right side. What is your immediate action?

Perform needle decompression of the right chest

Correct Incorrect Correct answer

Increase the ventilator rate and FiO2 to 100%

Correct Incorrect Correct answer

Disconnect the ventilator and begin manual bag-valve ventilation

Correct Incorrect Correct answer

Administer a 500 mL normal saline bolus for the hypotension

Correct Incorrect Correct answer

A 45-year-old male presents with sudden severe dyspnea while lifting heavy furniture. He has decreased breath sounds on the left side, tachycardia at 126 bpm, and SpO2 of 86%. His blood pressure is 132/88 mmHg, his trachea is midline, and he has no jugular vein distention. He is tall and thin with no history of lung disease. What is the most likely diagnosis?

Spontaneous pneumothorax

Correct Incorrect Correct answer

Left-sided tension pneumothorax

Correct Incorrect Correct answer

Acute pulmonary embolism

Correct Incorrect Correct answer

Spontaneous hemothorax

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A paramedic is caring for a 70-year-old female with sudden onset right-sided weakness and slurred speech. Her blood glucose is 68 mg/dL. After administering dextrose, her symptoms completely resolve. What does this finding suggest about the differential?

Hypoglycemia was the cause of the stroke-like symptoms, and the resolution after glucose administration confirms it as a stroke mimic

Correct Incorrect Correct answer

The patient had a true stroke that was reversed by the dextrose administration

Correct Incorrect Correct answer

The patient should still receive fibrinolytic therapy despite symptom resolution

Correct Incorrect Correct answer

Symptom resolution after dextrose indicates a transient ischemic attack rather than hypoglycemia

Correct Incorrect Correct answer

A 35-year-old female presents with acute onset of severe chest pain that is sharp, pleuritic, and worsens with deep inspiration. She is tachycardic at 120 bpm, tachypneic at 28 breaths per minute, and has an SpO2 of 88% on room air. She recently returned from a long international flight. Which condition should be highest on the paramedic’s differential?

Pulmonary embolism

Correct Incorrect Correct answer

Spontaneous pneumothorax

Correct Incorrect Correct answer

Acute pericarditis

Correct Incorrect Correct answer

Unstable angina

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A 66-year-old female with a history of COPD and heart failure presents with progressive dyspnea over three days. She reports increased leg swelling and sleeping on three pillows. Which historical finding is most useful in differentiating cardiac-related dyspnea from a COPD exacerbation?

Orthopnea and paroxysmal nocturnal dyspnea, which suggest fluid overload from heart failure rather than bronchospasm

Correct Incorrect Correct answer

Presence of wheezing on auscultation, which is exclusive to COPD exacerbation

Correct Incorrect Correct answer

Elevated respiratory rate, which only occurs during COPD exacerbations

Correct Incorrect Correct answer

Use of accessory muscles, which is specific to cardiac causes of dyspnea

Correct Incorrect Correct answer

You are working with a partner on a cardiac arrest call. CPR is in progress, the patient is on the monitor in ventricular fibrillation, and you have just delivered the first shock. How should you most effectively assign tasks between yourself and your partner?

One provider resumes compressions immediately while the other prepares epinephrine and establishes vascular access

Correct Incorrect Correct answer

Both providers pause to check the rhythm again before resuming any treatment

Correct Incorrect Correct answer

One provider attempts intubation while the other pauses compressions to apply defibrillation pads

Correct Incorrect Correct answer

Both providers focus on establishing IV access before resuming compressions

Correct Incorrect Correct answer

Which component of the patient handoff report is most critical for ensuring continuity of care at the receiving facility?

Changes in patient condition and interventions performed during transport

Correct Incorrect Correct answer

The patient's insurance information and emergency contacts

Correct Incorrect Correct answer

The exact time of each radio communication with dispatch

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The specific route taken to the receiving facility

Correct Incorrect Correct answer

A 52-year-old female presents with severe epigastric pain radiating to her back, nausea, and vomiting. She is in significant distress, with HR 124, BP 92/58, RR 28, SpO2 94%, and temp 38.8C. She has a history of gallstones and heavy alcohol use. Blood glucose is 268 mg/dL. The paramedic’s comprehensive assessment should integrate these findings to form which clinical impression?

Acute pancreatitis with systemic inflammatory response, requiring aggressive fluid resuscitation and pain management

Correct Incorrect Correct answer

Diabetic ketoacidosis precipitated by infection, requiring insulin administration

Correct Incorrect Correct answer

Acute cholecystitis requiring surgical evaluation but no prehospital intervention beyond transport

Correct Incorrect Correct answer

Perforated peptic ulcer requiring a nasogastric tube for decompression

Correct Incorrect Correct answer

You initiated transcutaneous pacing on a patient with symptomatic bradycardia at 34 bpm and a blood pressure of 68/44 mmHg. The pacer is set at a rate of 70 bpm and output of 80 mA. The monitor shows pacer spikes with consistent electrical capture, but the patient’s blood pressure remains 70/46 mmHg and he is still altered. What should you do next?

Verify mechanical capture by palpating a pulse that corresponds to the paced rate and consider a fluid bolus

Correct Incorrect Correct answer

Increase the pacing rate to 100 bpm to improve cardiac output

Correct Incorrect Correct answer

Discontinue pacing since it is not improving the blood pressure

Correct Incorrect Correct answer

Administer atropine 0.5 mg IV as an adjunct to the pacing

Correct Incorrect Correct answer

You are managing a 48-year-old female with septic shock who sustained a femur fracture during a fall at home. Her temperature is 39.8 C (103.6 F), heart rate is 140 bpm, blood pressure is 74/42 mmHg, and lactate is elevated on your point-of-care device. She received 2 liters of normal saline with minimal improvement. Her femur is angulated and significantly swollen. How should you prioritize treatment during transport?

Initiate a vasopressor infusion to support blood pressure while splinting the femur for pain control and hemorrhage management

Correct Incorrect Correct answer

Administer another 2-liter normal saline bolus before considering vasopressors

Correct Incorrect Correct answer

Focus exclusively on femur reduction and splinting since the fracture is the likely source of hemorrhage

Correct Incorrect Correct answer

Withhold vasopressors until arrival at the hospital and continue fluid boluses only

Correct Incorrect Correct answer

A paramedic is on scene with a patient experiencing a suspected allergic reaction with urticaria and mild lip swelling but no respiratory distress, wheezing, or hypotension. Standing orders authorize epinephrine 0.3 mg IM for anaphylaxis. What is the most appropriate action?

Withhold epinephrine, administer diphenhydramine per protocol, monitor closely for progression to anaphylaxis, and contact medical control if the condition worsens

Correct Incorrect Correct answer

Administer epinephrine 0.3 mg IM immediately since lip swelling indicates anaphylaxis

Correct Incorrect Correct answer

Administer epinephrine 0.15 mg IM as a reduced dose for a mild allergic reaction

Correct Incorrect Correct answer

Withhold all medications and transport immediately to the nearest emergency department

Correct Incorrect Correct answer

A paramedic responds to a 78-year-old male found on the floor by his home health aide. The patient has a bruise on his right hip, is unable to bear weight, and the right leg appears shortened and externally rotated. What is the most important additional assessment beyond the obvious injury?

Determine the cause of the fall, including syncope, stroke, cardiac event, or medication effects

Correct Incorrect Correct answer

Obtain bilateral pedal pulses to rule out peripheral vascular disease

Correct Incorrect Correct answer

Perform a detailed musculoskeletal exam of all four extremities

Correct Incorrect Correct answer

Assess the home environment for fall hazards to prevent future falls

Correct Incorrect Correct answer

A paramedic administers fentanyl 1 mcg/kg IV to a patient with an isolated femur fracture. On reassessment 5 minutes later, the patient’s pain is unchanged but respiratory rate has decreased from 18 to 10 breaths per minute. What is the most appropriate action?

Withhold additional fentanyl, provide supplemental oxygen, and closely monitor respirations

Correct Incorrect Correct answer

Administer a second dose of fentanyl since the pain has not improved

Correct Incorrect Correct answer

Administer naloxone 0.4 mg IV to reverse the respiratory depression

Correct Incorrect Correct answer

Reposition the patient and reassess pain in 10 minutes without further intervention

Correct Incorrect Correct answer

You are treating a patient with a supraventricular tachycardia at 186 bpm who is complaining of chest pain and lightheadedness. Blood pressure is 92/60 mmHg. You administer adenosine 6 mg rapid IV push followed by a flush. The rhythm briefly converts to sinus rhythm but returns to SVT within 30 seconds. What should you do?

Administer adenosine 12 mg rapid IV push with a saline flush

Correct Incorrect Correct answer

Perform immediate synchronized cardioversion at 50 to 100 joules

Correct Incorrect Correct answer

Administer a second dose of adenosine 6 mg since the first dose showed transient response

Correct Incorrect Correct answer

Start a diltiazem infusion to maintain sinus rhythm

Correct Incorrect Correct answer

You are dispatched to a complex scenario involving a two-vehicle collision with four patients. Patient 1 has an open femur fracture with controlled bleeding, Patient 2 is unconscious with snoring respirations, Patient 3 is ambulatory with a wrist deformity, and Patient 4 is pulseless and apneic. With two paramedic units on scene, which patient should receive your immediate attention?

Patient 2, the unconscious patient with snoring respirations

Correct Incorrect Correct answer

Patient 4, the pulseless and apneic patient

Correct Incorrect Correct answer

Patient 1, the patient with the open femur fracture

Correct Incorrect Correct answer

Patient 3, the ambulatory patient with wrist deformity

Correct Incorrect Correct answer

A paramedic is treating a 30-year-old female involved in a high-speed motor vehicle collision. She is conscious, tachycardic at 130 bpm, hypotensive at 78/50 mmHg, with diminished breath sounds on the left side and jugular vein distension. Which intervention takes priority?

Perform needle decompression of the left chest

Correct Incorrect Correct answer

Initiate rapid fluid resuscitation through two large-bore IVs

Correct Incorrect Correct answer

Apply a pelvic binder to stabilize a potential pelvic fracture

Correct Incorrect Correct answer

Administer 1 mg of epinephrine IV push for the hypotension

Correct Incorrect Correct answer

A paramedic responds to a 68-year-old male with a chief complaint of generalized weakness. The patient has a history of atrial fibrillation, hypertension, and type 2 diabetes. His medications include warfarin, metoprolol, lisinopril, and metformin. He reports dark, tarry stools for two days but did not think it was important. How should this history finding integrate into the overall patient assessment?

Dark tarry stools in a patient on warfarin indicate possible GI hemorrhage as the cause of weakness, requiring serial vital signs and close monitoring for shock

Correct Incorrect Correct answer

Dark stools are a common side effect of metformin and are not clinically significant

Correct Incorrect Correct answer

The warfarin dose should be held and the patient monitored at home with follow-up

Correct Incorrect Correct answer

The finding is unrelated to the chief complaint and should be documented for the receiving physician

Correct Incorrect Correct answer

When calculating medication doses for pediatric patients, which method provides the most accurate weight-based dosing in the prehospital setting?

Using a length-based resuscitation tape (Broselow tape) when an actual weight is unavailable

Correct Incorrect Correct answer

Estimating the child's weight by asking the parent's weight and dividing by four

Correct Incorrect Correct answer

Using the child's age in years multiplied by 5 to estimate weight in kilograms

Correct Incorrect Correct answer

Administering a standard adult dose divided in half for any pediatric patient

Correct Incorrect Correct answer

A paramedic is treating a 45-year-old female in anaphylaxis. After administering 0.3 mg epinephrine IM, albuterol via nebulizer, and establishing IV access with a normal saline bolus, the patient’s blood pressure improves from 72/40 to 96/64 mmHg. However, five minutes later, blood pressure drops to 78/48 mmHg and wheezing worsens. What does this clinical pattern most likely indicate?

A biphasic anaphylactic reaction requiring a repeat dose of epinephrine

Correct Incorrect Correct answer

An adverse reaction to the albuterol nebulizer treatment

Correct Incorrect Correct answer

Volume overload from the normal saline bolus

Correct Incorrect Correct answer

Medication error in the initial epinephrine dose

Correct Incorrect Correct answer

A 40-year-old female presents after a motorcycle accident with bilateral femur fractures, a pelvic fracture, and abdominal rigidity. She is tachycardic at 138 bpm with a blood pressure of 70/palpation. She has received bilateral femur traction splints and a pelvic binder. After two large-bore IVs and a rapid 1-liter bolus, her BP remains 72/palpation. What best explains the persistent hemodynamic instability?

Ongoing intra-abdominal hemorrhage requiring surgical intervention

Correct Incorrect Correct answer

Inadequate traction on the femur splints causing continued thigh bleeding

Correct Incorrect Correct answer

Neurogenic shock from a concurrent spinal cord injury

Correct Incorrect Correct answer

Tension pneumothorax from rib fractures sustained in the crash

Correct Incorrect Correct answer

You intubated a trauma patient and confirmed tube placement with bilateral breath sounds, positive ETCO2 waveform, and chest rise. During transport over rough terrain, you notice the ETCO2 waveform has suddenly lost its characteristic shape and now shows a flat line at zero, while SpO2 begins to drop. Breath sounds are now heard only over the epigastric area. What has occurred?

The endotracheal tube has become dislodged into the esophagus

Correct Incorrect Correct answer

The ETCO2 sensor has malfunctioned due to vibration during transport

Correct Incorrect Correct answer

The patient has developed a tension pneumothorax from positive pressure ventilation

Correct Incorrect Correct answer

The patient has gone into cardiac arrest

Correct Incorrect Correct answer

An intoxicated 25-year-old male involved in a motor vehicle collision has an obvious femur deformity and is screaming in pain. He repeatedly states, ‘Don’t touch me, I’m fine, leave me alone.’ He is unable to describe the mechanism of injury or state what day it is. How should the paramedic proceed?

Treat and transport under implied consent, as the patient's intoxication and altered mental status impair his decision-making capacity

Correct Incorrect Correct answer

Honor the patient's verbal refusal and have him sign a refusal of care form

Correct Incorrect Correct answer

Splint the injured extremity but do not transport unless the patient gives verbal consent

Correct Incorrect Correct answer

Wait on scene until the patient sobers up enough to provide informed consent or refusal

Correct Incorrect Correct answer

You are transporting a 55-year-old male who presented with an acute STEMI. You administered aspirin and nitroglycerin per protocol and are en route to a PCI-capable facility 40 minutes away. Fifteen minutes into transport, the patient develops a sudden onset third-degree heart block at 32 bpm with a blood pressure of 68/40 mmHg. He is drowsy but responsive. What is your immediate intervention?

Initiate transcutaneous pacing and titrate to achieve hemodynamic improvement

Correct Incorrect Correct answer

Administer atropine 1 mg IV push and repeat every 3 to 5 minutes as needed

Correct Incorrect Correct answer

Administer a 1-liter normal saline bolus and reassess the rhythm

Correct Incorrect Correct answer

Begin a dopamine infusion at 5 mcg/kg/min to support blood pressure

Correct Incorrect Correct answer

A 45-year-old male presents with acute abdominal pain, vomiting, and tachycardia. He has a history of alcohol use disorder. His abdomen is tender in the epigastric region with voluntary guarding. Vitals: BP 96/62, HR 122, RR 24, SpO2 96%. Which additional finding would most strongly suggest a perforated viscus rather than acute pancreatitis?

Diffuse involuntary rigidity with rebound tenderness across all quadrants

Correct Incorrect Correct answer

Pain radiating to the back with a history of heavy alcohol use

Correct Incorrect Correct answer

Tachycardia with mild hypotension

Correct Incorrect Correct answer

Jaundice with elevated bilirubin on point-of-care testing

Correct Incorrect Correct answer

Which documentation practice is most important for establishing an accurate timeline of a cardiac arrest resuscitation?

Recording specific times for each intervention, rhythm change, and medication administration

Correct Incorrect Correct answer

Writing a detailed narrative summary after the call is completed from memory

Correct Incorrect Correct answer

Documenting only the total duration of the resuscitation

Correct Incorrect Correct answer

Recording the time of arrival and time of transport only

Correct Incorrect Correct answer

A paramedic is assessing a patient with shortness of breath. The pulse oximeter reads 99% on room air, but the patient appears cyanotic with labored breathing and altered mental status. Capnography shows an ETCO2 of 18 mmHg. Which interpretation best accounts for the conflicting data?

The high SpO2 reading may be falsely elevated due to carbon monoxide exposure or methemoglobinemia, and the clinical presentation should take priority over the device reading

Correct Incorrect Correct answer

The pulse oximeter is accurate, so the patient's cyanosis and altered mental status must be psychological in origin

Correct Incorrect Correct answer

The capnography reading is unreliable when SpO2 is normal, so it should be disregarded

Correct Incorrect Correct answer

Cyanosis with normal SpO2 always indicates a peripheral vascular problem unrelated to oxygenation

Correct Incorrect Correct answer

Paramedics respond to a group home for a 35-year-old patient with Down syndrome who is experiencing severe abdominal pain. The patient has difficulty describing symptoms and becomes upset when approached. A caregiver is present. What is the most appropriate communication strategy?

Use simple, concrete language with the patient while gathering supplemental history from the caregiver

Correct Incorrect Correct answer

Direct all questions exclusively to the caregiver since the patient cannot provide reliable information

Correct Incorrect Correct answer

Sedate the patient with midazolam to facilitate a thorough physical examination

Correct Incorrect Correct answer

Use medical terminology to ensure clinical accuracy during the patient interview

Correct Incorrect Correct answer

A patient presents with tearing chest pain that radiates to the back, a blood pressure of 200/110 mmHg in the right arm, and a blood pressure of 160/90 mmHg in the left arm. Which condition does this presentation most strongly suggest?

Aortic dissection

Correct Incorrect Correct answer

Acute myocardial infarction

Correct Incorrect Correct answer

Pulmonary embolism

Correct Incorrect Correct answer

Tension pneumothorax

Correct Incorrect Correct answer

Which documentation format uses the headings Subjective, Objective, Assessment, and Plan?

SOAP format

Correct Incorrect Correct answer

CHART format

Correct Incorrect Correct answer

SAMPLE format

Correct Incorrect Correct answer

OPQRST format

Correct Incorrect Correct answer

A paramedic is assessing a deaf patient who uses American Sign Language (ASL). The patient appears to be in moderate distress from abdominal pain. No ASL interpreter is available. Which communication strategy is most effective?

Write questions and instructions on paper or use a smartphone text application, maintaining eye contact when possible

Correct Incorrect Correct answer

Speak loudly and slowly while facing the patient so they can read lips

Correct Incorrect Correct answer

Direct all questions to the family member who called 911

Correct Incorrect Correct answer

Proceed with treatment without attempting to obtain consent since the patient cannot communicate verbally

Correct Incorrect Correct answer

An 8-month-old infant presents with a brief episode of becoming limp, turning blue, and becoming unresponsive. The episode lasted approximately 30 seconds, and the infant now appears well with normal vital signs. The parents are very anxious. This presentation is most consistent with which condition?

Brief resolved unexplained event (BRUE)

Correct Incorrect Correct answer

Febrile seizure

Correct Incorrect Correct answer

Breath-holding spell

Correct Incorrect Correct answer

Infantile spasm

Correct Incorrect Correct answer

You are treating two patients simultaneously at a remote hiking trail. Patient 1 is a 45-year-old male in cardiac arrest with bystander CPR in progress. Patient 2 is a 30-year-old female with an estimated 1,000 mL blood loss from a deep laceration to the thigh with controlled bleeding after tourniquet application. No additional resources will arrive for 30 minutes. How should you prioritize your care?

Continue resuscitation efforts on Patient 1 while monitoring Patient 2's tourniquet and vital signs between interventions

Correct Incorrect Correct answer

Cease resuscitation on Patient 1 and focus entirely on Patient 2's hemorrhage management

Correct Incorrect Correct answer

Delegate all care for Patient 2 to bystanders and focus exclusively on Patient 1

Correct Incorrect Correct answer

Begin transport of Patient 2 immediately and perform CPR on Patient 1 during transport

Correct Incorrect Correct answer

Which of the following best describes why geriatric patients may present with atypical signs of acute myocardial infarction?

Age-related changes in pain perception and autonomic nervous system response can mask typical symptoms

Correct Incorrect Correct answer

Geriatric patients cannot develop ST-elevation myocardial infarctions

Correct Incorrect Correct answer

Heart attacks in elderly patients are always painless by definition

Correct Incorrect Correct answer

Elderly patients have higher pain thresholds that eliminate all cardiac symptoms

Correct Incorrect Correct answer

A paramedic arrives at a scene where a 16-year-old was involved in a motor vehicle collision. The patient has an isolated arm deformity and is alert and oriented. The patient’s mother arrives and is visibly upset, repeatedly asking questions about the severity of the injuries and demanding immediate transport. How should the paramedic best manage communication with both patient and parent?

Calmly address the mother's concerns with reassurance, explain the assessment and treatment plan, and continue providing care to the patient

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Ask the mother to wait in her car until the patient has been fully assessed and treated

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Focus exclusively on the patient and ignore the mother's questions to avoid distractions

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Allow the mother to direct the assessment sequence and treatment priorities

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A paramedic is transporting a patient receiving a nitroglycerin infusion for acute pulmonary edema. The patient’s blood pressure drops from 140/90 mmHg to 82/54 mmHg over 5 minutes. The patient reports feeling dizzy and lightheaded. What is the most appropriate immediate action?

Stop the nitroglycerin infusion and place the patient in a supine position with legs elevated

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Reduce the nitroglycerin infusion rate by half and continue monitoring

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Increase the IV fluid rate while maintaining the current nitroglycerin dose

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Administer an additional dose of nitroglycerin to further reduce preload

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A paramedic administers midazolam 2.5 mg IV for seizure management. After 5 minutes, the patient’s seizure activity has not stopped. Based on the need to modify treatment, what should the paramedic do next?

Administer a repeat dose of midazolam and reassess; if seizures persist, consider alternative anticonvulsant therapy

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Wait an additional 15 minutes for the first dose to take full effect

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Administer naloxone to reverse the midazolam and try a different approach

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Immediately perform endotracheal intubation to protect the airway

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A paramedic is treating a patient involved in a motor vehicle collision who has a Glasgow Coma Scale score of 7, a deformed left femur, and bright red blood spurting from a laceration on the right forearm. What should the paramedic address first?

Control the arterial hemorrhage from the forearm laceration

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Splint the deformed left femur to prevent further injury

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Perform a detailed secondary survey of the entire body

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Obtain a complete set of vital signs before beginning treatment

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You are transporting a patient with a suspected hip fracture. You administered fentanyl 50 mcg IV for pain. The patient’s pain improved from 9/10 to 6/10. Vital signs are stable with RR 16, SpO2 98%, and the patient is alert. Your protocol allows a repeat dose. Should you administer additional analgesia?

Yes, administer a repeat dose per protocol since the patient remains in significant pain and is tolerating the medication well

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No, the pain decreased by 3 points which is an adequate response

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No, additional opioids should never be given in the prehospital setting

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Yes, but switch to a non-opioid analgesic only since the opioid is clearly not working

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You are the first paramedic unit on scene at a building collapse with multiple casualties. You identify three patients: Patient A is unconscious with no respirations after repositioning the airway; Patient B has an open femur fracture with controlled bleeding, is alert, and is screaming in pain; Patient C has rapid, shallow breathing at 34 per minute with cyanosis and a weak radial pulse. Using START triage, which patient should receive treatment first?

Patient C, who has respiratory compromise with signs of shock and is categorized as Immediate

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Patient A, because an unconscious patient without respirations is the highest priority

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Patient B, because the open fracture requires immediate surgical intervention

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All three patients should receive simultaneous treatment before any transport decisions

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A 65-year-old female is found responsive only to pain with sonorous respirations and vomiting. She has a strong radial pulse at 88 bpm and BP of 142/86. Blood glucose is 34 mg/dL. After opening the airway with a head-tilt chin-lift and suctioning vomitus, what is the next priority intervention?

Administer dextrose 50% (D50) 25 g IV to correct the hypoglycemia

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Perform endotracheal intubation to secure the airway before any other treatment

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Administer naloxone 2 mg intranasal to reverse potential opioid overdose

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Place the patient on a non-rebreather mask and transport emergently

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A paramedic is transporting a critically ill child to the emergency department. The mother is in the ambulance and is visibly distraught. She repeatedly asks what is wrong with her child. While the paramedic’s partner manages the patient, which response to the mother is most appropriate?

"Your child is very sick. We are giving her medications and oxygen to help her right now, and the hospital team is preparing for our arrival."

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"I cannot discuss your child's condition with you during transport for legal reasons."

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"We think your child might have meningitis, but we will not know until we get to the hospital."

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"Please sit back and stay quiet so we can focus on treating your child."

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A paramedic is managing a patient with altered mental status, a blood glucose of 28 mg/dL, and an active seizure. Which intervention should be performed first?

Administer IV dextrose to correct the hypoglycemia causing the seizure

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Administer IV midazolam to stop the seizure activity

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Perform endotracheal intubation to protect the airway during the seizure

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Obtain a 12-lead ECG to rule out a cardiac cause of the altered mental status

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A patient reports sudden onset of severe headache and has a blood pressure of 220/130 mmHg, unequal pupils, and right-sided weakness. The paramedic notes these as pertinent positives. Which pertinent negative finding would be most important to document?

No history of recent head trauma

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No history of seasonal allergies

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No current complaint of knee pain

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No previous history of appendectomy

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A paramedic uses the Pediatric Assessment Triangle (PAT) to evaluate a 3-year-old child. The child appears limp with a blank stare, has audible stridor, and the skin is pale with delayed capillary refill. Which assessment finding from the PAT is most concerning for imminent respiratory failure?

Abnormal appearance combined with abnormal work of breathing suggests respiratory failure

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Audible stridor alone is diagnostic of a complete airway obstruction

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Delayed capillary refill indicates cardiogenic shock rather than a respiratory problem

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A blank stare is a normal finding in a frightened toddler

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A paramedic responds to an 82-year-old female who presents with confusion, tachycardia, and a low-grade fever. She takes 12 daily medications including warfarin, metoprolol, lisinopril, metformin, amlodipine, omeprazole, sertraline, gabapentin, furosemide, potassium chloride, atorvastatin, and aspirin. Which aspect of this presentation most complicates the paramedic’s clinical assessment?

Polypharmacy, which can mask symptoms, cause drug interactions, and mimic acute illness

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The patient's age alone, which makes all findings unreliable

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The low-grade fever, which rules out a serious infection in elderly patients

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The tachycardia, which is always caused by dehydration in geriatric patients

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A 88-year-old male presents with vague abdominal discomfort and confusion. His caregiver reports he has been “off” for the past day. Vital signs are BP 92/58, HR 104, RR 22, SpO2 94%, and temperature 36.2 C. Blood glucose is 142 mg/dL. The patient has a history of heart failure and chronic kidney disease. Which clinical concern should be prioritized in this patient?

Sepsis with an atypical presentation, given the hemodynamic instability and low-grade hypothermia

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Hyperglycemic emergency, given the elevated blood glucose level

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Acute heart failure exacerbation, based on the patient's cardiac history alone

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Dehydration as the sole cause, requiring only fluid bolus without further evaluation

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A paramedic has administered albuterol via nebulizer to a patient with acute bronchospasm. On reassessment, the wheezing has worsened and the patient’s SpO2 has dropped from 92% to 87%. What is the most appropriate next step?

Administer a second albuterol treatment and consider adding ipratropium while preparing for CPAP or advanced airway management

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Discontinue bronchodilator therapy since the first treatment was ineffective

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Wait 20 minutes for the full effect of the first albuterol dose before reassessing

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Switch to a nasal cannula at 2 liters per minute for supplemental oxygen only

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How frequently should a paramedic reassess vital signs on a critical or unstable patient during transport?

Every 5 minutes

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Every 15 minutes

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Every 10 minutes

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Only upon arrival at the hospital

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A 78-year-old female presents after tripping over a rug and falling onto her outstretched hand. She has deformity and tenderness at the distal right forearm consistent with a Colles fracture. She reports she had a similar fracture two years ago from a minor fall. Her medications include calcium supplements and alendronate. What underlying condition most likely contributed to both fractures from relatively minor mechanisms?

Osteoporosis causing decreased bone density and increased fracture susceptibility

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Osteoarthritis weakening the joint cartilage and predisposing to fractures

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Warfarin-induced bone demineralization from long-term anticoagulant use

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Age-related muscle atrophy causing falls without bone pathology

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A paramedic must inform a family that their 16-year-old son, who was involved in a motor vehicle collision, has injuries consistent with a poor prognosis and is being transported to a trauma center. The family is asking if their son will survive. Which response demonstrates the best communication practice for breaking bad news?

"Your son has very serious injuries. We are doing everything we can, and we are taking him to the trauma center where the surgical team is standing by."

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"He will be fine once we get him to the hospital. Try not to worry."

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"His injuries are not survivable. You should prepare yourselves for the worst."

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"I am not a doctor, so I really cannot tell you anything about his condition."

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A paramedic needs to administer diphenhydramine to a 22 kg child experiencing an allergic reaction. The standard pediatric dose is 1 mg/kg, and the available concentration is 50 mg/mL. What volume should be drawn up for administration?

0.44 mL

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0.22 mL

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1.1 mL

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2.2 mL

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A paramedic is managing a patient involved in a high-speed motorcycle collision. The patient has bilateral femur fractures, a distended abdomen, and a blood pressure of 70/40 mmHg. IV access has been established and 500 mL of normal saline has been administered with minimal improvement. The hospital is 20 minutes away. What is the most appropriate approach?

Initiate rapid transport, apply pelvic binder, continue permissive hypotension with a target systolic of 80 to 90 mmHg, and request air medical transport if available

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Remain on scene to administer an additional 2 liters of normal saline before transport

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Apply traction splints to both femurs before initiating transport to reduce blood loss

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Delay transport to establish a second IV line and administer vasopressors

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A 58-year-old female with a history of atrial fibrillation presents with sudden onset right-sided weakness and expressive aphasia. Her blood glucose is 112 mg/dL. Symptoms began approximately 45 minutes ago according to her husband. Her blood pressure is 178/96 mmHg and her heart rate is irregularly irregular at 88 bpm. What is the most likely mechanism of this patient’s presentation?

Cardioembolic stroke from a clot originating in the fibrillating atria

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Hemorrhagic stroke from hypertension-induced vessel rupture

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Transient ischemic attack that will resolve within 60 minutes

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Todd's paralysis following an unwitnessed seizure

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You are called to evaluate an 88-year-old hospice patient with end-stage COPD. The patient’s daughter, who is the healthcare power of attorney, shows you a valid Do Not Resuscitate (DNR) order. The patient is currently conscious, in moderate respiratory distress, and asks you for help breathing. What is the most appropriate course of action?

Provide comfort measures including oxygen therapy and positioning while honoring the DNR for cardiac arrest interventions

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Withhold all treatment since the patient has a DNR and is on hospice

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Disregard the DNR because the patient is requesting help, which overrides the document

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Contact medical control to have the DNR overridden for this call

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A paramedic has intubated a cardiac arrest patient and initial ETCO2 reads 12 mmHg. After adjusting CPR technique and ensuring proper compression depth and rate, the ETCO2 rises to 28 mmHg. What does this change indicate?

Improved CPR quality resulting in better cardiac output and pulmonary perfusion

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The endotracheal tube has migrated into the right mainstem bronchus

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The patient has developed acute bronchospasm during resuscitation

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The capnography equipment has malfunctioned and needs recalibration

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A 55-year-old male presents with epigastric pain that radiates to the back, nausea, and vomiting. He appears jaundiced and reports dark urine. He has a history of heavy alcohol use and gallstones. Vital signs: HR 104, BP 108/68, RR 22, Temp 101.4 F. He is lying on his side with knees drawn up. What condition does this integrated assessment suggest?

Acute pancreatitis

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Gastric ulcer perforation

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Acute cholecystitis

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Abdominal aortic aneurysm rupture

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A 35-year-old male on a long flight presents with sudden pleuritic chest pain, tachycardia, and dyspnea. His SpO2 is 91% with diminished breath sounds on the right side. Which clinical features help differentiate PE vs pneumothorax in this patient?

Hyperresonance to percussion with absent breath sounds suggests pneumothorax, while clear lung sounds with signs of right heart strain suggest PE

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Both conditions always present with identical findings and cannot be differentiated in the field

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PE typically presents with unilateral wheezing while pneumothorax causes bilateral crackles

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Subcutaneous emphysema is more commonly associated with PE than pneumothorax

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You respond to a 70-year-old male with altered mental status. His wife reports he had a hip replacement 5 days ago and has been bedridden. He is diaphoretic with JVD, HR 128, BP 88/62, RR 30, SpO2 85% on room air. The 12-lead ECG shows sinus tachycardia with right axis deviation and S1Q3T3 pattern. Bilateral lung sounds are clear. Which condition requires the most urgent consideration in your differential?

Massive pulmonary embolism

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Acute inferior myocardial infarction

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Tension pneumothorax

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Acute decompensated heart failure

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A paramedic arrives on scene to find a 58-year-old male with crushing substernal chest pain, diaphoresis, and a 12-lead ECG showing ST elevation in leads II, III, and aVF. The patient states he took sildenafil two hours ago. Local protocol calls for nitroglycerin administration for STEMI patients. What is the most appropriate clinical decision?

Withhold nitroglycerin due to the recent sildenafil use and expedite transport to a PCI-capable facility

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Administer nitroglycerin as directed by the STEMI protocol since the ECG findings take priority

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Administer a reduced dose of nitroglycerin and monitor blood pressure closely

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Contact medical control to request an alternative vasodilator medication

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A paramedic crew responds to a residence where CPR is in progress on a 58-year-old man. After 40 minutes of advanced resuscitation with persistent asystole and no reversible causes identified, the medical director authorizes termination of efforts. The patient’s wife and adult son are present. Which approach to delivering this notification is most appropriate?

Make eye contact, use the patient's name, state clearly that he has died, allow silence for the family to process, and express condolences

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Use indirect language such as "he has passed away" or "we lost him" to soften the impact of the news

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Explain the detailed medical reasons for the death before expressing condolences

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Ask the family to step into another room so the body can be prepared before the notification

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A paramedic is treating a patient with SVT who converted to normal sinus rhythm after the first dose of adenosine. Five minutes later, the monitor shows the SVT has returned. What is the appropriate decision regarding whether to de-escalate or repeat treatment?

Administer a second dose of adenosine at a higher dose (12 mg) since the SVT has recurred; it is not appropriate to de-escalate at this time

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De-escalate to vagal maneuvers only since adenosine already worked once

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Begin synchronized cardioversion immediately for refractory SVT

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Administer verapamil IV since adenosine has failed to provide lasting conversion

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A 62-year-old male presents with acute onset chest pain radiating to his left arm, diaphoresis, and nausea. During the primary survey, the paramedic notes he is alert but anxious, with clear lung sounds bilaterally, a radial pulse of 88 and regular, and SpO2 of 96%. What is the most appropriate next step?

Obtain a 12-lead ECG while gathering a focused history including OPQRST and SAMPLE

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Administer aspirin and nitroglycerin before performing any further assessment

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Begin a detailed head-to-toe secondary survey to identify additional injuries

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Start a large-bore IV and administer a 1-liter normal saline bolus

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A paramedic is managing a patient with a known history of COPD who presents with severe respiratory distress, tripod positioning, and an SpO2 of 78%. ETCO2 is 65 mmHg. The patient is becoming increasingly lethargic. The scene is 35 minutes from the nearest hospital. What is the most appropriate management strategy?

Initiate BiPAP, administer bronchodilators, and prepare for endotracheal intubation if the patient's level of consciousness continues to decline

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Place the patient on a nasal cannula at 2 liters per minute to avoid suppressing their hypoxic drive

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Immediately intubate the patient due to the prolonged transport time

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Apply CPAP at 5 cm H2O and withhold additional treatments during transport

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A paramedic is assessing a 74-year-old female who called for ‘feeling weak.’ Initial vital signs are BP 148/88, HR 78, RR 18, SpO2 95%, and blood glucose 142 mg/dL. SAMPLE history reveals hypertension, type 2 diabetes, and a recent medication change. During the focused assessment, the paramedic notices right-sided facial droop and slurred speech that the patient attributes to ‘being tired.’ Which assessment integration step is most critical at this point?

Perform a stroke screening tool and establish the time the patient was last known well

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Accept the patient's explanation and perform a routine medical assessment

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Recheck the blood glucose because hypoglycemia can mimic stroke symptoms

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Obtain orthostatic vital signs to evaluate for dehydration as a cause of weakness

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Which communication framework is recommended for providing a structured verbal handoff report when transferring patient care to hospital staff?

SBAR (Situation, Background, Assessment, Recommendation)

Correct Incorrect Correct answer

OPQRST (Onset, Provocation, Quality, Radiation, Severity, Time)

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DCAP-BTLS (Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations, Swelling)

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AEIOU-TIPS (Alcohol, Epilepsy, Insulin, Overdose, Uremia, Trauma, Infection, Psychiatric, Stroke)

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When assessing an elderly patient who has fallen, which factor is most important to evaluate as a modifiable risk factor for preventing future falls?

Medication review for polypharmacy and drugs that cause orthostatic hypotension or sedation

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The patient's age, since fall risk increases linearly with each decade of life

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The patient's bone density, which can be assessed in the prehospital setting

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The type of flooring in the patient's home to determine slip resistance

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A 72-year-old male presents with hypotension (BP 78/50), tachycardia (HR 128), altered mental status, and a temperature of 103.2F. He has a history of a urinary tract infection. Which assessment approach best differentiates sepsis vs shock from other etiologies?

Warm, flushed skin with a known infection source and fever suggests sepsis vs shock from hemorrhage, which typically presents with cool, clammy skin

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A rapid heart rate alone confirms cardiogenic shock as the primary diagnosis

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Altered mental status in an elderly patient is always caused by stroke until proven otherwise

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Hypotension with tachycardia is specific to hypovolemic shock from internal bleeding

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A paramedic is called to a scene where a patient is agitated, pacing, and making verbal threats. The patient has not made any physical moves toward the crew. What is the most appropriate initial approach?

Maintain a safe distance, use a calm and non-threatening tone, and attempt verbal de-escalation

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Immediately request law enforcement and withhold all patient contact until they arrive

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Approach the patient directly and firmly instruct them to sit down and be still

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Administer chemical restraint immediately to prevent the situation from escalating

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A 24-year-old female presents with chest tightness, tingling in her fingers and around her mouth, tachycardia at 112 bpm, and rapid shallow breathing at 28 breaths per minute. She states she feels like she is going to die. Her SpO2 is 99%, blood pressure is 138/84 mmHg, and 12-lead ECG shows sinus tachycardia without ST changes. Which finding would most strongly suggest this is a cardiac event rather than anxiety?

New onset diaphoresis with nausea and a sense of pressure radiating to the jaw

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A self-reported history of similar episodes in the past

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An elevated respiratory rate above 24 breaths per minute

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Tingling and numbness in the bilateral extremities

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During transport, a paramedic performs serial vital sign assessments on a patient with suspected internal bleeding from blunt abdominal trauma. The initial set shows HR 92, BP 118/76, RR 20. Fifteen minutes later, the repeat shows HR 118, BP 98/62, RR 26. What do these trending vitals indicate?

Progressive hemorrhagic shock requiring escalation of treatment and expedited transport

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Normal physiologic response to the stress of being in the ambulance

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Vasovagal response from the pain of the abdominal injury

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Anxiety-induced tachycardia that will resolve with verbal reassurance

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During an interfacility transfer, a paramedic is transporting a patient on a mechanical ventilator and vasopressor infusion. The ventilator alarm sounds indicating high peak airway pressures. The patient’s SpO2 begins to drop rapidly. What should the paramedic do first?

Disconnect the patient from the ventilator and ventilate with a bag-valve mask while troubleshooting the cause

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Silence the ventilator alarm and increase the pressure limit setting

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Increase the FiO2 to 100% on the ventilator and continue monitoring

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Suction the endotracheal tube blindly without disconnecting the ventilator

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You arrive at a motor vehicle collision where your patient, a 25-year-old female, has a blood pressure of 90/60, HR 120, and a rigid abdomen. Your local protocol states that all trauma patients with systolic BP below 90 should receive a 1-liter normal saline bolus. However, you suspect this patient has an active intra-abdominal hemorrhage. Current evidence supports permissive hypotension in uncontrolled hemorrhage. How should you reconcile this conflict?

Contact medical control to discuss deviation from protocol based on clinical judgment and current evidence

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Follow the protocol exactly as written regardless of your clinical assessment

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Ignore the protocol entirely and treat based solely on your personal experience

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Withhold all fluids and document that the protocol does not apply to this situation

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A 4-year-old child is brought to the paramedic crew by a parent for a broken arm. On assessment, the paramedic notices multiple bruises in various stages of healing on the child’s back and buttocks, along with what appear to be circular burn marks. The injury history provided is inconsistent with the physical findings. What is the paramedic’s most appropriate action?

Provide medical care, document findings objectively, and report suspected abuse to the appropriate authorities

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Confront the parent about the inconsistent injury history before transporting

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Provide medical care and advise the parent to follow up with their pediatrician

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Delay transport until law enforcement arrives to investigate the scene

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A 34-year-old female presents in her third trimester of pregnancy with a severe headache, visual disturbances, right upper quadrant abdominal pain, and a blood pressure of 182/118 mmHg. She has 3+ pitting edema in both lower extremities and her urine output has been minimal. What condition should you suspect?

Severe preeclampsia progressing toward eclampsia

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Gestational diabetes with hypertensive crisis

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Placental abruption with referred pain

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Hepatic rupture from HELLP syndrome

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You respond to a residential structure fire where a 35-year-old male presents with stridor, facial burns, singed nasal hairs, and carbonaceous sputum. His SpO2 reads 98% on pulse oximetry. Vitals are: BP 146/88 mmHg, HR 110 bpm, RR 24. While preparing for transport, his voice becomes increasingly hoarse and he reports it is getting harder to swallow. What is your priority intervention?

Perform endotracheal intubation before the airway swells further

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Apply high-flow oxygen via nonrebreather mask and monitor during transport

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Administer nebulized epinephrine to reduce upper airway swelling

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Apply CPAP at 10 cmH2O to stent the airway open during transport

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You are called to a long-term care facility for a 90-year-old female with dementia who has been in decline for weeks. She now has agonal respirations and is unresponsive. The facility nurse presents you with a POLST (Physician Orders for Life-Sustaining Treatment) form indicating ‘Comfort Measures Only.’ The patient’s daughter arrives and demands that you ‘do everything’ to save her mother. How should you proceed?

Follow the valid POLST order for comfort measures only, explain the legal authority of the document to the daughter, and provide supportive care

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Follow the daughter's wishes and initiate full resuscitation since family wishes override all advance directives

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Do nothing until you can contact the patient's physician to clarify the orders

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Begin resuscitation while waiting for your supervisor to arrive and make the decision

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You are treating a 55-year-old male with acute pulmonary edema with CPAP at 10 cm H2O. Initially, his SpO2 improved from 82% to 90% and respiratory rate decreased from 32 to 24. However, 10 minutes later, SpO2 drops to 84%, respiratory rate increases to 36, and the patient becomes more obtunded. What is the most appropriate modification to your treatment plan?

Remove CPAP, prepare for endotracheal intubation, and provide positive pressure ventilation with BVM

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Increase the CPAP pressure to 15 cm H2O and continue monitoring

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Discontinue CPAP and apply a nasal cannula at 6 L/min

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Continue current CPAP settings since the initial improvement suggests the treatment is working

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Which communication technique involves restating the patient’s words back to them to confirm understanding and demonstrate active listening?

Reflective listening

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Confrontational questioning

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Closed-ended interviewing

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Authoritative directing

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What is the normal resting heart rate range for a 2-year-old child?

80 to 130 beats per minute

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60 to 100 beats per minute

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120 to 160 beats per minute

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40 to 80 beats per minute

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A paramedic is performing a comprehensive assessment on a 35-year-old female who was involved in a moderate-speed motor vehicle collision. She is alert, oriented, and ambulatory at the scene. She denies pain but has a steering wheel bruise on her anterior chest. Initial vital signs are normal. Twenty minutes into transport, the paramedic notes the patient has become anxious, her skin is cool and clammy, HR has risen from 82 to 116, and breath sounds are now diminished on the left. What does integrating these serial assessment findings suggest?

Delayed tension pneumothorax or hemothorax requiring immediate intervention

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Anxiety disorder triggered by the stress of the motor vehicle collision

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Musculoskeletal chest wall pain from the steering wheel impact

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Vasovagal presyncope that will resolve by laying the patient flat

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Which screening tool is recommended for paramedics to identify potential elder abuse during patient assessment?

Observing for unexplained injuries, poor hygiene, malnutrition, and inconsistent histories between patient and caregiver

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Administering the Mini-Mental State Examination to assess cognitive function

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Performing a complete blood count to screen for nutritional deficiencies

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Using the CAGE questionnaire to assess substance use patterns

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A paramedic is called to testify in a malpractice case regarding a call from two years ago. The patient care report contains a gap in documentation between the time of medication administration and the next set of vital signs. How does this gap most likely affect the legal proceedings?

The documentation gap creates the presumption that the omitted care was not performed, weakening the defense

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The gap is irrelevant because the paramedic can rely on memory to fill in the details

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The gap strengthens the defense by showing the paramedic was focused on patient care rather than paperwork

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The gap has no legal significance because it occurred more than one year ago

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A paramedic arrives at a single-vehicle crash to find a 45-year-old male who is unresponsive, has sonorous respirations, and is bleeding profusely from a large scalp laceration. Vital signs are HR 128, RR 8 and irregular, BP 88/60, and SpO2 82%. Which intervention sequence is most appropriate?

Open the airway with a jaw thrust, provide ventilations with high-flow oxygen, then control the scalp hemorrhage

Correct Incorrect Correct answer

Apply direct pressure to the scalp laceration first, then manage the airway

Correct Incorrect Correct answer

Establish IV access and begin a fluid bolus, then address the airway

Correct Incorrect Correct answer

Immediately intubate the patient, then address the hemorrhage and hypotension

Correct Incorrect Correct answer

A paramedic arrives to find an elderly woman in respiratory distress. She is anxious and crying, saying she cannot breathe. While preparing to administer CPAP, which statement best demonstrates empathy?

"I can see how frightened you are. We are going to help you breathe more easily right now."

Correct Incorrect Correct answer

"Try to calm down. You are making your breathing worse by getting upset."

Correct Incorrect Correct answer

"This happens to a lot of people your age. It is nothing to worry about."

Correct Incorrect Correct answer

"I need you to stop talking so I can listen to your lungs."

Correct Incorrect Correct answer

A paramedic arrives at a residence to find a valid Do Not Resuscitate (DNR) order for a 92-year-old patient in cardiac arrest. The patient’s family is present and pleading with the paramedic to ‘do everything.’ What is the most appropriate action?

Honor the DNR order and provide comfort measures while empathetically communicating with the family

Correct Incorrect Correct answer

Begin full resuscitative efforts because the family's verbal request overrides the written DNR

Correct Incorrect Correct answer

Contact online medical control to have the DNR order revoked by the physician

Correct Incorrect Correct answer

Initiate CPR until law enforcement arrives to make the final decision

Correct Incorrect Correct answer

An 82-year-old nursing home resident presents with confusion and agitation that the staff reports developed over the past 6 hours. The patient has a baseline diagnosis of mild dementia but is normally oriented and conversational. Which condition should the paramedic suspect?

Acute delirium from an underlying medical cause

Correct Incorrect Correct answer

Normal progression of the patient's known dementia

Correct Incorrect Correct answer

A primary psychiatric emergency requiring sedation

Correct Incorrect Correct answer

Sundowning behavior typical of Alzheimer disease

Correct Incorrect Correct answer

A paramedic is transporting a patient with an acute asthma exacerbation who received an initial albuterol nebulizer treatment. During ongoing assessment, the patient’s wheezing has resolved but SpO2 has dropped from 95% to 89%. What should the paramedic do?

Increase supplemental oxygen delivery and reassess; silent chest after wheezing may indicate worsening bronchospasm despite apparent improvement

Correct Incorrect Correct answer

Discontinue all treatments since the wheezing has resolved, indicating clinical improvement

Correct Incorrect Correct answer

Administer epinephrine 1:1000 IM for suspected anaphylaxis

Correct Incorrect Correct answer

Perform endotracheal intubation immediately due to the drop in oxygen saturation

Correct Incorrect Correct answer

A 72-year-old male presents with acute onset chest pain, diaphoresis, and nausea. His 12-lead ECG shows ST elevation in V1 through V4. He also has active hematemesis (vomiting blood). His BP is 100/68, HR 96, RR 20. How does the active hemorrhage affect your STEMI treatment plan?

Administer aspirin with caution and transport emergently for PCI, but avoid fibrinolytic therapy due to active bleeding

Correct Incorrect Correct answer

Withhold all cardiac medications including aspirin and focus solely on the GI bleed

Correct Incorrect Correct answer

Administer fibrinolytic therapy since the STEMI takes priority over the GI bleeding

Correct Incorrect Correct answer

Delay transport to control the bleeding before addressing the cardiac emergency

Correct Incorrect Correct answer

What is the primary purpose of a POLST (Physician Orders for Life-Sustaining Treatment) form in the prehospital setting?

To provide specific, actionable medical orders regarding resuscitation and life-sustaining interventions

Correct Incorrect Correct answer

To document the patient's general preferences for future medical decision-making

Correct Incorrect Correct answer

To designate a healthcare proxy who can make decisions on the patient's behalf

Correct Incorrect Correct answer

To provide a summary of the patient's current medications and medical history

Correct Incorrect Correct answer

A 78-year-old nursing home resident presents with acute confusion, agitation, and an inability to recognize familiar staff members. The patient’s baseline mental status, per facility records, is alert and oriented to person, place, and time. Vital signs are BP 148/88, HR 96, RR 20, SpO2 96%, and temperature 37.1 C. The patient’s family states she was “fine this morning.” Which clinical finding most strongly suggests delirium rather than dementia?

Acute onset with a clearly documented change from her normal baseline

Correct Incorrect Correct answer

Inability to recognize familiar people in the environment

Correct Incorrect Correct answer

Elevated blood pressure and heart rate on initial assessment

Correct Incorrect Correct answer

Agitation and restlessness during the encounter

Correct Incorrect Correct answer

You are treating a 42-year-old asthmatic female in severe respiratory distress. After two nebulized albuterol treatments, she initially improved but now has become suddenly silent with no wheezing, decreased level of consciousness, and SpO2 of 78%. ETCO2 reads 62 mmHg. What does this change in presentation most likely indicate?

Impending respiratory failure with severe bronchospasm and air trapping

Correct Incorrect Correct answer

Resolution of bronchospasm with clinical improvement

Correct Incorrect Correct answer

Development of a spontaneous pneumothorax

Correct Incorrect Correct answer

Allergic reaction to the albuterol medication

Correct Incorrect Correct answer

A newborn is delivered in the field at 38 weeks gestation. At 1 minute of life, the infant has a heart rate of 80, slow and irregular respirations, some flexion of extremities, a grimace in response to stimulation, and acrocyanosis. What is this newborn’s 1-minute APGAR score?

5

Correct Incorrect Correct answer

3

Correct Incorrect Correct answer

7

Correct Incorrect Correct answer

4

Correct Incorrect Correct answer

A paramedic is calling a hospital notification for an incoming acute stroke patient. Which information is most critical to communicate during this radio report?

The time the patient was last known to be at neurological baseline and current stroke scale findings

Correct Incorrect Correct answer

The patient's insurance information and primary care physician name

Correct Incorrect Correct answer

A detailed list of all medications the patient takes at home

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The specific route the ambulance is taking to the hospital

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A 66-year-old male presents with severe tearing chest pain radiating to the back, a blood pressure of 200/110, and a widened mediastinum noted on the monitor. When considering ACS vs aortic dissection, which finding is most specific for dissection?

Tearing pain radiating to the back with a significant blood pressure differential between arms suggests aortic dissection over ACS

Correct Incorrect Correct answer

ST elevation on the 12-lead ECG, which is diagnostic for aortic dissection

Correct Incorrect Correct answer

Diaphoresis and nausea, which are exclusive to acute coronary syndrome

Correct Incorrect Correct answer

Hypertension, which eliminates the possibility of aortic dissection

Correct Incorrect Correct answer

Which type of medical direction involves physicians developing protocols and standing orders that paramedics follow without real-time physician contact?

Offline (indirect) medical control

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Online (direct) medical control

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Prospective quality assurance review

Correct Incorrect Correct answer

Retrospective chart review oversight

Correct Incorrect Correct answer

A paramedic is assessing a 40-year-old male with chest pain. Which symptom pattern is most consistent with pericarditis rather than acute myocardial infarction?

Sharp, pleuritic chest pain that worsens when lying supine and improves when leaning forward

Correct Incorrect Correct answer

Crushing substernal pressure radiating to the left arm with diaphoresis

Correct Incorrect Correct answer

Sudden onset tearing pain radiating to the back between the shoulder blades

Correct Incorrect Correct answer

Diffuse abdominal pain with nausea, vomiting, and referred shoulder pain

Correct Incorrect Correct answer

A 45-year-old male presents after a ground-level fall. He denies significant mechanism but has diffuse bruising, a swollen knee, and mild confusion. He is not intoxicated. His medications include enoxaparin (Lovenox) injections and warfarin. He reports a history of deep vein thrombosis and pulmonary embolism. Why are these medication and history details critically important for this seemingly minor mechanism?

Anticoagulated patients are at significantly higher risk for internal hemorrhage from even minor trauma, and confusion may indicate intracranial bleeding

Correct Incorrect Correct answer

The medications indicate the patient has a bleeding disorder that prevents clot formation entirely

Correct Incorrect Correct answer

The history of DVT/PE means this fall was likely caused by a new pulmonary embolism

Correct Incorrect Correct answer

The anticoagulants will prevent the patient from developing compartment syndrome in the swollen knee

Correct Incorrect Correct answer

A competent adult patient with chest pain and ECG findings consistent with an acute STEMI refuses transport to the hospital. The paramedic has explained the risks including death. What is the most appropriate course of action?

Ensure the patient understands the life-threatening nature of the condition, document the informed refusal thoroughly, and have the patient sign a refusal form

Correct Incorrect Correct answer

Transport the patient against their will because the condition is immediately life-threatening

Correct Incorrect Correct answer

Contact law enforcement to place the patient under an involuntary psychiatric hold

Correct Incorrect Correct answer

Leave the scene immediately to avoid liability for staying with a refusing patient

Correct Incorrect Correct answer

A patient with a suspected inferior STEMI has been treated with aspirin, nitroglycerin, and IV fluids. During transport, the patient’s blood pressure drops from 110/70 to 78/48 and the heart rate slows to 42. What decision to escalate care is most appropriate?

Discontinue nitroglycerin, administer a fluid bolus, and prepare atropine for symptomatic bradycardia

Correct Incorrect Correct answer

Administer another dose of nitroglycerin to reduce cardiac workload

Correct Incorrect Correct answer

Begin transcutaneous pacing immediately without further assessment

Correct Incorrect Correct answer

Administer epinephrine 1 mg IV push for the hypotension

Correct Incorrect Correct answer

An 85-year-old female fell at home and has been on the floor for approximately 18 hours before being found by her neighbor. She is alert but unable to move her right hip. She is hypothermic at 95 F, dehydrated with poor skin turgor, and has dark concentrated urine. In addition to treating the hip injury, what systemic complication from prolonged immobilization must be considered?

Rhabdomyolysis from prolonged pressure on skeletal muscle, which can cause acute renal failure

Correct Incorrect Correct answer

Acute appendicitis triggered by the fall and prolonged immobility

Correct Incorrect Correct answer

Pulmonary embolism from deep vein thrombosis that formed during the 18 hours

Correct Incorrect Correct answer

Myocardial infarction caused by the emotional stress of being on the floor

Correct Incorrect Correct answer

You are treating a 55-year-old male with chest pain suspicious for STEMI. The nearest PCI-capable hospital is 50 minutes away, within the 120-minute guideline. During transport, the patient develops sustained monomorphic ventricular tachycardia with a pulse. He is alert but complains of lightheadedness. BP is 96/64. What is your treatment decision?

Administer amiodarone 150 mg IV over 10 minutes while continuing transport to the PCI center, and prepare for synchronized cardioversion if the patient becomes unstable

Correct Incorrect Correct answer

Immediately perform synchronized cardioversion since any VT is a life-threatening emergency

Correct Incorrect Correct answer

Divert to the closest hospital to address the dysrhythmia before continuing to the PCI center

Correct Incorrect Correct answer

Administer lidocaine 300 mg IV push as the first-line antiarrhythmic

Correct Incorrect Correct answer

Which formula is used to estimate the minimum normal systolic blood pressure for a child between 1 and 10 years of age?

70 + (2 x age in years)

Correct Incorrect Correct answer

80 + (2 x age in years)

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90 + (age in years)

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60 + (3 x age in years)

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Which cognitive bias occurs when a paramedic forms an initial impression of a patient’s condition and then fails to adjust that impression despite new contradictory information?

Anchoring bias

Correct Incorrect Correct answer

Confirmation bias

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Availability heuristic

Correct Incorrect Correct answer

Dunning-Kruger effect

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A paramedic diagnoses a patient with an allergic reaction after noting hives and facial swelling. When the patient develops stridor and hypotension, the paramedic continues treating for a simple allergic reaction rather than escalating to anaphylaxis management. Which error in clinical reasoning does this represent?

Premature closure, where the paramedic stopped considering alternative or worsening diagnoses after reaching an initial conclusion

Correct Incorrect Correct answer

Gambler's fallacy, where the paramedic assumed the condition would not worsen based on probability

Correct Incorrect Correct answer

Sunk cost fallacy, where the paramedic continued the current treatment because of time already invested

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Recency bias, where the paramedic was influenced by a recently treated allergic reaction case

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A paramedic responds to a 72-year-old female with altered mental status. Family reports she was fine two hours ago. Vitals: BP 188/102, HR 88, RR 16, SpO2 97%, BGL 142 mg/dL. She has right-sided facial droop and left gaze deviation. Which approach best describes forming a differential for this patient?

Consider stroke as the primary working diagnosis while also evaluating for hypoglycemia, postictal state, and intracranial mass as alternate causes of focal neurological deficits

Correct Incorrect Correct answer

Immediately confirm stroke based on facial droop alone without considering other possible causes

Correct Incorrect Correct answer

Assume the altered mental status is due to hypertensive crisis since the blood pressure is elevated

Correct Incorrect Correct answer

Attribute the presentation to a transient ischemic attack because the patient was normal two hours ago

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A paramedic assesses a 48-year-old male complaining of chest tightness and mild dyspnea. Vitals are within normal limits and the ECG shows no acute changes. The patient states he had a large meal and thinks it is just heartburn. He wants to refuse transport. The paramedic recalls that a similar patient last week turned out to have a STEMI. How should this prior experience influence the current clinical decision?

Use the prior experience as a reminder to maintain a broad differential and thoroughly assess for cardiac causes, without assuming this patient has the same condition

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Insist on transport because the previous patient's outcome proves this patient is also having a STEMI

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Disregard the prior experience entirely because each patient is unique and past cases have no educational value

Correct Incorrect Correct answer

Document that the patient is having a STEMI based on the similarity to the previous case

Correct Incorrect Correct answer

When communicating with a patient who is hearing impaired, which technique is most likely to improve the effectiveness of the interaction?

Face the patient directly, speak clearly at a normal pace, and minimize background noise

Correct Incorrect Correct answer

Shout loudly to ensure the patient can hear the questions

Correct Incorrect Correct answer

Write all questions and answers on paper without attempting verbal communication

Correct Incorrect Correct answer

Stand behind the patient and speak directly into their better ear

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In the SAMPLE history mnemonic used during patient assessment, what does the ‘P’ stand for?

Past medical history

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Present illness severity

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Primary complaint description

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Pertinent physical findings

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A 70-year-old female is found unresponsive with left-sided hemiparesis and a blood glucose of 38 mg/dL. After considering the symptom pattern, what should the paramedic do first?

Administer dextrose IV to correct the hypoglycemia, then reassess for persistent neurological deficits

Correct Incorrect Correct answer

Initiate a stroke alert and transport immediately since hemiparesis indicates stroke

Correct Incorrect Correct answer

Administer oral glucose and monitor for improvement in neurological status

Correct Incorrect Correct answer

Obtain a 12-lead ECG to evaluate for cardiac arrhythmia causing the altered mental status

Correct Incorrect Correct answer

A paramedic arrives on scene to find a 45-year-old male who fell 15 feet from a roof. He is conscious but confused, with a blood pressure of 88/52 mmHg, heart rate of 128 bpm, and obvious deformity of the left femur. What should be the first action?

Assess and manage the airway while maintaining cervical spine stabilization

Correct Incorrect Correct answer

Apply a traction splint to the left femur fracture

Correct Incorrect Correct answer

Establish two large-bore IV lines and begin fluid resuscitation

Correct Incorrect Correct answer

Perform a rapid trauma assessment and expose the patient fully

Correct Incorrect Correct answer

A 76-year-old female with terminal pancreatic cancer is receiving palliative care at home. Her family called 911 because she is unresponsive with agonal respirations. The family produces a valid advance directive stating the patient does not want intubation or mechanical ventilation but does want “all other treatments.” The patient has no pulse. What is the most appropriate action?

Begin CPR and defibrillation because the advance directive does not specifically refuse resuscitation

Correct Incorrect Correct answer

Withhold resuscitation because agonal respirations indicate an irreversible condition

Correct Incorrect Correct answer

Contact medical control before initiating any interventions to clarify the directive

Correct Incorrect Correct answer

Provide bag-valve-mask ventilation only, since the directive refuses intubation but permits other treatments

Correct Incorrect Correct answer

A paramedic is treating a 52-year-old male with chest pain. Initially, his 12-lead ECG shows normal sinus rhythm without ST changes, and his pain is rated 6/10. After 10 minutes, his pain increases to 9/10, he becomes diaphoretic, and a repeat ECG now shows 3 mm ST elevation in V1 through V4. What is the most appropriate response to this evolving presentation?

Activate STEMI alert, administer aspirin and nitroglycerin per protocol, and initiate rapid transport to a PCI-capable facility

Correct Incorrect Correct answer

Continue monitoring because the initial ECG was normal and a single repeat may be artifact

Correct Incorrect Correct answer

Administer morphine for pain control and obtain a third ECG before making any transport decisions

Correct Incorrect Correct answer

Transport to the nearest emergency department regardless of PCI capability since the initial ECG was normal

Correct Incorrect Correct answer

Which document allows a competent adult to designate another person to make healthcare decisions on their behalf if they become unable to do so?

Durable power of attorney for healthcare

Correct Incorrect Correct answer

POLST form

Correct Incorrect Correct answer

Do Not Resuscitate order

Correct Incorrect Correct answer

Living will

Correct Incorrect Correct answer

A 72-year-old female with end-stage COPD is enrolled in a hospice program. Her family calls 911 requesting help because she is increasingly short of breath. Upon arrival, the patient is alert, speaking in short phrases, and states she does not want to go to the hospital. She has a valid POLST indicating comfort measures only. Which action best aligns with the palliative care approach?

Administer oxygen, position the patient upright, and coordinate with the hospice team for ongoing management

Correct Incorrect Correct answer

Initiate CPAP at 10 cmH2O to treat the acute COPD exacerbation

Correct Incorrect Correct answer

Explain that she must be transported to the hospital for further evaluation

Correct Incorrect Correct answer

Withhold oxygen since the patient is enrolled in hospice and has comfort measures orders

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Which statement best describes the legal significance of the patient care report in EMS?

It serves as the primary legal document of the encounter and may be used in court proceedings years after the call

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It is only used for billing purposes and has no legal standing

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It can be modified at any time after the call without restriction

Correct Incorrect Correct answer

It is only relevant during the initial quality assurance review period

Correct Incorrect Correct answer

A paramedic is called for an 88-year-old female who has become increasingly unable to care for herself over the past two weeks. She can no longer prepare meals, has stopped bathing, and has not been taking her medications. Her daughter reports she was independent one month ago. What does this pattern of progressive functional decline most likely represent?

An acute or subacute medical condition causing functional deterioration that requires emergency evaluation

Correct Incorrect Correct answer

Normal aging that the family should manage with home care services

Correct Incorrect Correct answer

Depression that should be referred to outpatient psychiatric care

Correct Incorrect Correct answer

Caregiver burden causing the daughter to exaggerate the patient's decline

Correct Incorrect Correct answer

You are treating a 60-year-old female with acute pulmonary edema. She is sitting upright, has bilateral crackles to the apices, RR 32, SpO2 84% on room air, HR 112, and BP 186/110. She is alert and following commands. What is the most important initial intervention?

Apply CPAP at 5 to 10 cmH2O with supplemental oxygen

Correct Incorrect Correct answer

Establish IV access and administer furosemide 40 mg IV

Correct Incorrect Correct answer

Administer nitroglycerin 0.4 mg sublingually

Correct Incorrect Correct answer

Begin positive pressure ventilation with a bag-valve mask

Correct Incorrect Correct answer

A paramedic responds to a call where a patient refuses transport despite showing signs of a possible stroke (facial droop, arm weakness, slurred speech). What elements must be documented in the patient care report regarding the refusal?

The patient's presentation, risks of refusal explained, the patient's demonstrated understanding of those risks, and the patient's or legal representative's signature

Correct Incorrect Correct answer

Only the patient's signature on the refusal form is required

Correct Incorrect Correct answer

Document that the patient was advised to see their doctor at their convenience

Correct Incorrect Correct answer

Note that the patient refused and document no further details about the encounter

Correct Incorrect Correct answer

A paramedic is treating a hypotensive patient with suspected sepsis. After administering a 500 mL normal saline bolus, the patient’s blood pressure improves from 82/54 to 94/62 mmHg. The paramedic initiates a second 500 mL bolus. On reassessment after the second bolus, blood pressure is 90/60 mmHg and the patient has developed crackles in bilateral lung bases. What should the paramedic do?

Slow the IV fluid rate and reassess for signs of fluid overload

Correct Incorrect Correct answer

Administer a third 500 mL bolus to achieve a systolic pressure above 100 mmHg

Correct Incorrect Correct answer

Stop all IV fluids and administer furosemide 40 mg IV

Correct Incorrect Correct answer

Switch from normal saline to lactated Ringer's solution

Correct Incorrect Correct answer

A paramedic is reassessing an intubated patient during transport. The ETCO2 waveform suddenly drops from 38 mmHg to 4 mmHg with a loss of the normal rectangular waveform. What is the most likely cause?

Endotracheal tube displacement from the trachea

Correct Incorrect Correct answer

Bronchospasm causing airway obstruction

Correct Incorrect Correct answer

Right mainstem intubation

Correct Incorrect Correct answer

Equipment malfunction of the capnography sensor

Correct Incorrect Correct answer

Paramedics arrive at a hospice facility for a 91-year-old patient in respiratory distress. The patient has a valid DNR order and a POLST form indicating comfort measures only. The patient is conscious, tachypneic at 32 breaths per minute, and has an SpO2 of 82%. The hospice nurse asks you to help manage the patient’s distress. Which intervention is most appropriate?

Administer supplemental oxygen and position the patient for comfort

Correct Incorrect Correct answer

Initiate bag-valve-mask ventilation to improve the oxygen saturation

Correct Incorrect Correct answer

Withhold all interventions because the patient has a DNR order

Correct Incorrect Correct answer

Contact medical control to override the DNR due to the low oxygen saturation

Correct Incorrect Correct answer

An 82-year-old male presents with generalized weakness and malaise over the past two days. He denies chest pain. His skin is pale and diaphoretic. Vital signs are BP 100/70, HR 110 and irregular, RR 22, SpO2 93% on room air, and temperature 36.8 C. A 12-lead ECG shows ST elevation in leads II, III, and aVF. Which factor best explains why this patient’s presentation differs from a typical acute myocardial infarction?

Elderly patients frequently present with silent MI, lacking classic chest pain

Correct Incorrect Correct answer

The irregular heart rate indicates atrial fibrillation rather than MI

Correct Incorrect Correct answer

Hypotension in elderly patients is most commonly caused by dehydration

Correct Incorrect Correct answer

ST elevation in inferior leads suggests a chronic rather than acute process

Correct Incorrect Correct answer

When differentiating between a cardiac and respiratory cause of dyspnea in the prehospital setting, which assessment tool provides the most useful information?

Lung auscultation combined with 12-lead ECG, as they help distinguish pulmonary edema or bronchospasm from acute coronary syndrome or dysrhythmia

Correct Incorrect Correct answer

Pulse oximetry alone, as it definitively distinguishes cardiac from pulmonary causes

Correct Incorrect Correct answer

Blood pressure measurement, which reliably separates cardiac from respiratory dyspnea in all cases

Correct Incorrect Correct answer

Capillary refill time, which is the primary tool for differentiating cardiac and respiratory emergencies

Correct Incorrect Correct answer

A 44-year-old male presents with acute onset substernal chest pain that worsens with deep inspiration and improves when leaning forward. His 12-lead ECG shows diffuse ST elevation without reciprocal changes. Which diagnosis is most consistent with these findings?

Acute pericarditis, based on pleuritic chest pain, positional relief, and diffuse ST elevation without reciprocal depression

Correct Incorrect Correct answer

Acute STEMI, because any ST elevation on ECG requires immediate cardiac catheterization activation

Correct Incorrect Correct answer

Costochondritis, because pleuritic chest pain is always musculoskeletal in origin

Correct Incorrect Correct answer

Tension pneumothorax, because chest pain with inspiration indicates trapped air in the pleural space

Correct Incorrect Correct answer

A paramedic responds to a competent adult patient who is experiencing an acute asthma exacerbation with severe dyspnea and wheezing. The patient refuses all treatment and transport despite being informed of the risks. The patient’s SpO2 is 88% and declining. What is the most ethically appropriate course of action?

Ensure the patient understands the severity of the situation, document the informed refusal thoroughly, and arrange for follow-up contact while respecting patient autonomy

Correct Incorrect Correct answer

Administer nebulized albuterol against the patient's wishes because the declining SpO2 constitutes implied consent

Correct Incorrect Correct answer

Contact law enforcement to place the patient under a psychiatric hold for refusing life-saving treatment

Correct Incorrect Correct answer

Leave the scene immediately since the patient has refused care and no further obligation exists

Correct Incorrect Correct answer

During a focused assessment of a 40-year-old asthmatic female in respiratory distress, the paramedic notes wheezing on auscultation, accessory muscle use, and an SpO2 of 88%. After two albuterol nebulizer treatments, the wheezing has disappeared, but the patient appears more lethargic and the SpO2 has dropped to 82%. How should the paramedic interpret this change?

The disappearance of wheezing with worsening clinical status indicates critical air trapping and impending respiratory failure

Correct Incorrect Correct answer

The albuterol treatments have resolved the bronchospasm and the patient is improving

Correct Incorrect Correct answer

The nebulizer treatments caused a paradoxical bronchospasm that will self-resolve

Correct Incorrect Correct answer

The pulse oximeter is malfunctioning and should be replaced with a different sensor

Correct Incorrect Correct answer

A 4-month-old infant with a known history of a congenital heart defect presents with cyanosis that does not improve with supplemental oxygen administration. The infant is tachypneic at 68 breaths per minute with subcostal retractions and a heart rate of 180. Which assessment finding is most significant in guiding the paramedic’s treatment plan?

The lack of improvement with supplemental oxygen suggests a right-to-left cardiac shunt

Correct Incorrect Correct answer

The tachypnea indicates a primary respiratory problem requiring CPAP

Correct Incorrect Correct answer

The tachycardia is likely supraventricular tachycardia requiring adenosine

Correct Incorrect Correct answer

The cyanosis will resolve once the infant is warmed and calmed

Correct Incorrect Correct answer

A 58-year-old male with a history of COPD and heart failure presents with progressive dyspnea, bilateral crackles, and peripheral edema. His SpO2 is 88% on room air. Which assessment finding best helps the paramedic distinguish cardiac vs pulmonary etiology of this patient’s respiratory distress?

Elevated jugular venous distension with an S3 heart sound suggests cardiac failure as the primary cause

Correct Incorrect Correct answer

Bilateral wheezing on auscultation confirms COPD exacerbation as the primary etiology

Correct Incorrect Correct answer

Peripheral edema alone is diagnostic of right-sided heart failure in this setting

Correct Incorrect Correct answer

A respiratory rate greater than 24 indicates the primary cause is pulmonary in nature

Correct Incorrect Correct answer

A 60-year-old male presents with acute onset of excruciating pain in his right great toe. The toe is red, hot, swollen, and exquisitely tender to even light touch. He reports eating a large steak dinner last night and consuming several alcoholic beverages. Vital signs are unremarkable except for a temperature of 100.2 F. What is the most likely diagnosis?

Acute gout (gouty arthritis) from uric acid crystal deposition

Correct Incorrect Correct answer

Cellulitis of the great toe requiring IV antibiotics

Correct Incorrect Correct answer

Fracture of the proximal phalanx from an unrecognized injury

Correct Incorrect Correct answer

Deep vein thrombosis of the lower extremity

Correct Incorrect Correct answer

During medication reconciliation for a geriatric patient, what is the most important action for the paramedic to take?

Gather all medication bottles, including over-the-counter drugs and supplements, and bring them to the receiving facility

Correct Incorrect Correct answer

Ask the patient to verbally list all medications and doses from memory

Correct Incorrect Correct answer

Document only the prescription medications listed in the patient's medical record

Correct Incorrect Correct answer

Contact the patient's pharmacy to obtain a current medication list

Correct Incorrect Correct answer

Which of the following is an example of a closed-ended question during a patient interview?

"Does the pain get worse when you take a deep breath?"

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"Can you describe the pain you are feeling?"

Correct Incorrect Correct answer

"What makes the pain better or worse?"

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"Tell me about when this started."

Correct Incorrect Correct answer

You respond to a call for a 30-year-old female having a severe allergic reaction. She has widespread urticaria, facial and tongue swelling, inspiratory stridor, and wheezing. Vital signs are HR 130, BP 80/palpation, RR 28, and SpO2 90%. What is the single most critical intervention for this patient?

Administer epinephrine 0.3 mg intramuscularly in the lateral thigh

Correct Incorrect Correct answer

Establish IV access and administer diphenhydramine 50 mg IV

Correct Incorrect Correct answer

Administer albuterol via nebulizer to treat the bronchospasm

Correct Incorrect Correct answer

Apply high-flow oxygen via nonrebreather mask and reassess

Correct Incorrect Correct answer

A paramedic is called for an 82-year-old male found unresponsive. His wife shows the paramedic a valid Do Not Resuscitate order and an advance directive specifying comfort care only. The patient has a weak pulse at 40 bpm and agonal respirations. The patient’s adult son arrives and demands full resuscitative measures. What is the most appropriate action?

Honor the valid DNR order and provide comfort care as specified, while compassionately explaining the legal standing of the advance directive to the son

Correct Incorrect Correct answer

Begin full resuscitation because the family member's verbal request overrides a written advance directive

Correct Incorrect Correct answer

Withhold all care including comfort measures because the DNR prohibits any medical intervention

Correct Incorrect Correct answer

Contact medical control and delay all care until a physician makes the final decision about the DNR

Correct Incorrect Correct answer

A paramedic is transporting a patient who sustained a head injury. Initial GCS was 13 (E3 V5 M5). At the 5-minute reassessment, GCS is 10 (E2 V4 M4). At the 10-minute reassessment, GCS is 7 (E1 V2 M4). What is the most important clinical implication of this GCS trend?

The patient has rapid neurological deterioration suggesting an expanding intracranial lesion, requiring emergent transport to a trauma center with neurosurgical capability and preparation for advanced airway management

Correct Incorrect Correct answer

The patient's condition is stable and the GCS changes are within normal variation

Correct Incorrect Correct answer

The decline indicates a need for bilateral IV access before transport

Correct Incorrect Correct answer

The patient requires immediate hyperventilation to reduce intracranial pressure

Correct Incorrect Correct answer

During a mass casualty incident, you are the only paramedic with limited supplies. You must determine resource allocation among three red-tagged patients: Patient A has a tension pneumothorax, Patient B has uncontrolled hemorrhage from a thigh wound, and Patient C has an altered mental status with a GCS of 8 and snoring respirations. Which patient should receive treatment first?

Patient A, the patient with a tension pneumothorax

Correct Incorrect Correct answer

Patient B, the patient with uncontrolled hemorrhage

Correct Incorrect Correct answer

Patient C, the patient with altered mental status

Correct Incorrect Correct answer

Treat all three patients simultaneously by delegating tasks

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When differentiating critical from non-critical patients during initial triage, which finding most reliably identifies a patient requiring immediate life-saving intervention?

Absent radial pulse with altered mental status

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Blood pressure of 148/92 with a headache

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Isolated closed forearm fracture with controlled pain

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Heart rate of 88 with a complaint of nausea

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A paramedic administered morphine 4 mg IV to a patient with severe abdominal pain 10 minutes ago. On reassessment, the patient reports pain decreased from 9/10 to 7/10. Vital signs remain stable with blood pressure 128/82 mmHg, heart rate 88 bpm, respiratory rate 16, and SpO2 98%. What is the most appropriate reassessment decision?

Administer an additional dose of morphine per protocol since pain remains significant and vitals are stable

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Withhold further analgesia because the pain improved by 2 points

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Switch to ketorolac IV because morphine was ineffective

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Contact medical control because the initial dose was inadequate

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A paramedic is treating a patient with a stab wound to the left chest at the 4th intercostal space. The patient is conscious with HR 130, BP 78/50, RR 30, and SpO2 88%. Breath sounds are absent on the left, and the trachea is deviated to the right. Jugular venous distension is noted. The patient’s condition is rapidly deteriorating. Should the paramedic stay on scene to treat or initiate immediate transport?

Perform needle decompression of the left chest immediately, then initiate rapid transport

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Initiate immediate transport without any on-scene interventions

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Stay on scene to establish bilateral IVs and administer a fluid bolus before transport

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Apply an occlusive dressing to the stab wound and transport without decompression

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A paramedic crew is performing a critical care transport of an intubated patient on a ventilator and vasopressor infusion. During transport, the patient’s blood pressure drops from 110/70 to 68/40 mmHg, the SpO2 falls to 82%, and you notice the ventilator is alarming for high airway pressures. What should you assess first?

Verify endotracheal tube placement and check for a tension pneumothorax

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Increase the vasopressor infusion rate immediately

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Administer a 500 mL normal saline bolus

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Disconnect the ventilator and switch to bag-valve ventilation at a rate of 20 breaths per minute

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A paramedic intubates a patient in cardiac arrest. Initial ETCO2 reads 12 mmHg. After 2 minutes of high-quality CPR and epinephrine administration, ETCO2 gradually rises to 28 mmHg. The patient remains pulseless. What does this ETCO2 trend most likely indicate?

Improved cardiac output and tissue perfusion from effective CPR

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The endotracheal tube has migrated into the right mainstem bronchus

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The patient is developing metabolic acidosis from prolonged arrest

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Return of spontaneous circulation has occurred

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A paramedic is trending vital signs on a trauma patient during a 20-minute transport. Initial vitals were HR 96, BP 118/78, RR 18, SpO2 97%. At the 10-minute reassessment, vitals are HR 112, BP 104/72, RR 22, SpO2 96%. Which vital sign trend is most concerning for developing hemorrhagic shock?

The progressive rise in heart rate from 96 to 112 bpm combined with the declining blood pressure from 118/78 to 104/72 mmHg

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The 1% decrease in SpO2 from 97% to 96%

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The increase in respiratory rate from 18 to 22 breaths per minute alone

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The stable diastolic pressure component of the blood pressure

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A paramedic is managing an intubated patient in cardiac arrest. After achieving ROSC, the patient loses pulses again. The monitor shows PEA, ETCO2 drops from 38 to 8 mmHg, and the IV line infiltrates. This represents a cascade failure of multiple systems. What is the priority intervention?

Resume CPR, establish IO access, and administer epinephrine while troubleshooting reversible causes

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Attempt to restart the IV line in the same extremity before resuming any medications

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Immediately extubate and attempt to reinsert the endotracheal tube

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Administer a precordial thump and recheck the rhythm in 2 minutes

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Which of the following best describes informed consent in the prehospital setting?

The patient is told the nature of the condition, proposed treatment, risks, benefits, and alternatives before agreeing to care

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The patient signs a written consent form before any treatment is initiated

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The patient verbally agrees to transport without needing an explanation of the treatment plan

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A family member provides consent on behalf of an alert and oriented adult patient

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A paramedic responds to a call for a 70-year-old patient from a cultural background where family members typically make medical decisions for elderly relatives. The patient’s adult son insists on answering all questions and making treatment decisions. The patient appears alert and oriented. What is the most appropriate approach?

Respectfully address the patient directly while including the family, and confirm the patient's own wishes regarding care

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Defer entirely to the son since the family's cultural practices should be followed without question

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Ask the son to leave the room so the patient can speak freely without family influence

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Refuse to provide care until the patient verbalizes consent independently

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A 62-year-old male presents with acute onset chest pain radiating to the back, diaphoresis, and a blood pressure of 210/120 mmHg in the right arm and 170/100 mmHg in the left arm. Which condition should the paramedic rule out before administering nitroglycerin?

Aortic dissection, based on the blood pressure differential between arms and tearing back pain

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Acute myocardial infarction, based on the diaphoresis and chest pain presentation

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Pulmonary embolism, based on the sudden onset of symptoms and hypoxia

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Tension pneumothorax, based on the unequal blood pressures and respiratory distress

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A 55-year-old male presents with sudden onset of severe chest pain, diaphoresis, and dyspnea. His 12-lead ECG shows ST elevation in leads V1 through V4. Vital signs are HR 100, BP 92/64, RR 24, and SpO2 94%. The patient is 45 minutes from the nearest cardiac catheterization facility. What is the first priority in managing this patient?

Administer aspirin 324 mg and prepare for rapid transport to the catheterization facility

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Administer nitroglycerin 0.4 mg sublingually to manage the chest pain

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Establish two large-bore IVs and administer a 500 mL normal saline bolus

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Administer morphine 4 mg IV for pain management before transport

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A 62-year-old male presents with fever of 102.8F, altered mental status, heart rate of 118, respiratory rate of 24, and blood pressure of 86/52. His skin is warm and flushed. He has a history of a recent urinary tract infection. Which combination of findings is most consistent with sepsis?

Suspected infection combined with two or more SIRS criteria (fever, tachycardia, tachypnea) plus end-organ dysfunction indicated by hypotension and altered mental status

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Warm, flushed skin alone, which is diagnostic for sepsis without the need for additional criteria

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Tachycardia in the setting of fever, which always indicates sepsis regardless of blood pressure

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Altered mental status with a history of UTI, which confirms urosepsis without meeting systemic criteria

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A newborn is delivered in the field at 39 weeks gestation. At 1 minute of age, the infant has a heart rate of 110 bpm, a weak cry, some flexion of extremities, grimaces in response to stimulation, and the body is pink with blue extremities. What is this newborn’s APGAR score?

6

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5

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7

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8

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A paramedic is assessing a 35-year-old female with abdominal pain. She presents with right lower quadrant tenderness, low-grade fever, and nausea. The paramedic immediately suspects appendicitis based on the classic presentation. However, the patient also reports a missed menstrual period and vaginal spotting. What clinical reasoning error should the paramedic guard against?

Anchoring bias, by failing to consider ectopic pregnancy as an alternative diagnosis that shares overlapping symptoms with appendicitis

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Base rate neglect, because appendicitis is rare in females of childbearing age

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Framing effect, because the dispatch information biased the paramedic toward an abdominal complaint

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Normalcy bias, because the paramedic assumed the patient's condition would not deteriorate

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A 50-year-old female presents with severe epigastric pain radiating to the back, nausea, and vomiting. She has a history of gallstones. Vitals: BP 108/72, HR 104, RR 22, SpO2 97%. Her abdomen is tender in the epigastric region without rigidity. Which differential diagnosis is most appropriate for the paramedic to consider alongside acute pancreatitis?

Acute cholecystitis, posterior myocardial infarction, and peptic ulcer disease, as all can present with epigastric pain

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Only acute appendicitis, since it is the most common abdominal emergency in adults

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Pulmonary embolism exclusively, because it always presents with epigastric pain and vomiting

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Renal colic alone, since kidney stones and gallstones have identical presentations

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A 45-year-old male is found face-down in a swimming pool. Bystanders pulled him out approximately 2 minutes ago. He is unresponsive and apneic. His pulse is present but weak at 50 bpm. No cervical spine injury is suspected based on the circumstances. What is the treatment priority sequence for this drowning victim?

Open the airway, provide immediate rescue breaths with high-flow oxygen, and ventilate aggressively since the primary pathology is hypoxia

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Begin chest compressions immediately since the heart rate is below 60

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Attempt the Heimlich maneuver to remove water from the lungs

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Apply the AED first to check for a shockable rhythm

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An 85-year-old male presents with a fall. He lives alone and has fallen 4 times in the past month. He is on 12 medications including two antihypertensives, a sedative, and a muscle relaxant. His home has throw rugs, poor lighting, and clutter. This presentation is best described as what type of geriatric problem?

A multifactorial fall risk involving polypharmacy, environmental hazards, and likely age-related physiologic changes

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A single acute medical event causing repeated syncopal episodes

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An isolated orthopedic problem requiring only fracture evaluation

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Elder neglect requiring mandatory reporting to adult protective services

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A 78-year-old female in a skilled nursing facility presents with acute onset confusion and urinary incontinence. Staff reports she was alert and oriented this morning. Vitals: BP 134/82, HR 92, RR 18, SpO2 96%, temp 99.8F, BGL 118 mg/dL. Which approach best reflects appropriate differential diagnosis in this geriatric patient?

Consider urinary tract infection, medication adverse effects, stroke, and delirium from metabolic causes, as all are common causes of acute confusion in elderly patients

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Assume dementia because confusion in elderly patients is always chronic and progressive

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Diagnose a stroke based solely on the acute onset of confusion without focal neurological findings

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Attribute the presentation to normal aging and withhold further assessment or intervention

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You respond to a 50-year-old male complaining of chest pain. He is a physician and insists on self-diagnosing, telling you it is ‘just indigestion.’ However, your 12-lead ECG shows 2 mm ST elevation in leads V1 through V4 with reciprocal depression in II, III, and aVF. He refuses to believe the ECG findings and wants to stay home. How should you proceed?

Clearly explain the ECG findings and their life-threatening implications, strongly recommend transport, and if he continues to refuse, ensure informed refusal with documented risks including death

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Accept his self-diagnosis since he is a physician and has medical knowledge to make his own decisions

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Override his refusal and transport him against his will since the ECG is diagnostic

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Leave without further discussion since he has the right to refuse care

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An 85-year-old female resident of an assisted living facility presents with altered mental status and tachycardia. Staff report she has had decreased oral intake for three days and a productive cough. Vital signs are BP 86/52, HR 118, RR 26, SpO2 90% on room air, and temperature 36.4 C. Which finding should raise the paramedic’s suspicion for sepsis despite the absence of fever?

Hypotension with tachycardia in the setting of an apparent infection source

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The low oxygen saturation, which independently confirms a sepsis diagnosis

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Altered mental status, which in elderly patients always indicates a systemic infection

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Decreased oral intake, which is the most reliable marker for sepsis in the elderly

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A paramedic is treating a multi-trauma patient whose initial GCS was 12. During transport, the patient’s GCS drops to 8 and respiratory effort becomes irregular. This dynamic assessment finding warrants which immediate intervention?

Secure the airway with endotracheal intubation or supraglottic device, as the declining GCS indicates loss of airway protective reflexes

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Continue monitoring and reassess in 10 minutes to see if the GCS stabilizes

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Apply a non-rebreather mask and increase the oxygen flow rate

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Administer naloxone IV in case the mental status change is opioid-related

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A paramedic is assessing a 6-month-old infant who is lethargic and has a bulging anterior fontanelle. The parents report the child has had a fever for two days. Which condition should the paramedic suspect?

Meningitis with increased intracranial pressure

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Severe dehydration from fluid losses

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Normal variant of fontanelle fullness during crying

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Congenital hydrocephalus presenting acutely

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A 50-year-old female presents with chest pain and dyspnea. Her ECG shows sinus tachycardia with right axis deviation. She recently had knee surgery. The paramedic notes this is an atypical presentation compared to standard ACS. What diagnosis should be considered?

Pulmonary embolism, given the recent surgery, sinus tachycardia with right axis deviation, and atypical presentation for ACS

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Acute STEMI, because any chest pain with ECG changes requires cath lab activation

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Anxiety disorder, because sinus tachycardia with chest pain is benign in post-surgical patients

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Pericarditis, because right axis deviation is the hallmark ECG finding

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You respond to a 40-year-old male who ingested an unknown quantity of his prescribed metoprolol tablets approximately 1 hour ago in a suicide attempt. He is bradycardic at 38, hypotensive at 68/40, and lethargic. He is responsive to verbal stimuli. Atropine 1 mg IV had no effect. What pharmacologic intervention addresses the receptor-level problem in beta-blocker overdose?

Glucagon 3 to 5 mg IV, which activates cardiac adenylyl cyclase independent of beta-receptor blockade

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Epinephrine 1 mg IV push as in cardiac arrest dosing

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Calcium chloride 1 g IV to stabilize the cardiac membrane

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Naloxone 2 mg IV to reverse potential co-ingestion of opioids

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A paramedic is called to evaluate a patient who speaks only Mandarin. The patient appears to be in moderate distress and is clutching his chest. No bystanders can translate. What is the most appropriate communication strategy?

Use a telephone language interpretation service to facilitate the patient history and consent

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Rely solely on hand gestures and physical examination findings without attempting verbal communication

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Ask the patient's 8-year-old child who speaks some English to interpret medical questions

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Skip the history entirely and transport based on visual assessment alone

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A 50-year-old female presents with sudden onset of severe headache, nausea, and neck stiffness. She describes it as the ‘worst headache of my life.’ Vital signs are HR 92, BP 188/104, RR 18, SpO2 97%. She has no focal neurologic deficits. Her history and physical exam findings are most consistent with which condition?

Subarachnoid hemorrhage

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Migraine headache with aura

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Hypertensive urgency

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Bacterial meningitis

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A 34-year-old male with a laceration to his forearm is alert, oriented, and not intoxicated. He states clearly that he does not want any treatment or transport and understands that the wound may require sutures. He has been informed of the risks of refusing care, including infection and excessive blood loss. What should the paramedic do?

Respect the patient's right to refuse care, have him sign a refusal form, and document the interaction thoroughly

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Contact law enforcement to place the patient in protective custody for his own safety

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Transport the patient against his wishes under implied consent since the wound requires hospital care

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Contact medical control to override the patient's refusal and authorize forced transport

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A paramedic is treating a critically ill patient when a fire department captain on scene insists the patient be transported to a specific hospital that is farther away and does not have the specialty services the patient needs. Medical control has recommended the closer trauma center. What is the most appropriate action?

Follow medical control's recommendation and transport to the closer trauma center, as patient care decisions fall under medical direction authority

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Defer to the fire captain's request because the incident commander has ultimate authority over all scene decisions

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Transport to whichever facility the patient's family requests regardless of medical considerations

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Refuse to transport until the fire captain and medical control reach an agreement

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A paramedic arrives to find a 55-year-old male with sudden onset weakness, slurred speech, and facial droop. His blood glucose is 110 mg/dL. Which red flags in this presentation should prompt immediate transport to a stroke center?

Acute onset facial droop, slurred speech, and unilateral weakness with a normal blood glucose are red flags for acute stroke requiring emergent transport

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These symptoms require observation for 30 minutes before initiating transport

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Normal blood glucose rules out an emergent condition, so routine transport is appropriate

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Slurred speech alone is sufficient to diagnose Bell's palsy rather than stroke

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You arrive to evaluate a 16-year-old female whose parents called 911 for her abdominal pain. The parents are present and want to stay during your assessment. The patient appears uncomfortable when you ask about her menstrual history with her parents in the room. What is the most appropriate approach?

Respectfully ask the parents to step out briefly so you can complete a private portion of the assessment, explaining that this is routine for all patients

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Skip the menstrual history questions since they make the patient uncomfortable

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Ask the menstrual history questions in front of the parents since they need to know

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Whisper the questions to the patient so the parents cannot hear

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A 40-year-old male presents with sudden onset of tearing chest pain radiating to the back. He has a history of uncontrolled hypertension. BP in the right arm is 192/110 and in the left arm is 148/88. Heart rate is 102. The 12-lead ECG shows sinus tachycardia without ST changes. What should be highest on your differential?

Acute aortic dissection

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Acute myocardial infarction

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Spontaneous pneumothorax

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Acute pericarditis

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A paramedic arrives at a two-vehicle collision with four patients. Patient A has a GCS of 6 with agonal respirations. Patient B has an open femur fracture with controlled bleeding. Patient C is ambulatory with wrist pain. Patient D has paradoxical chest wall movement and SpO2 of 84%. Using START triage, which patient should the paramedic treat first after triage is complete?

Patient D, because the flail chest with significant hypoxia represents an immediate (red) category patient with a treatable life threat

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Patient A, because the lowest GCS always receives treatment first regardless of survivability

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Patient B, because open fractures require immediate surgical intervention in the field

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Patient C, because ambulatory patients should be assessed first to clear them from the scene

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In the CHART documentation format, what does the letter “R” represent?

Rx (treatment provided)

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Reassessment findings

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Response time from dispatch

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Referral to a specialist

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How frequently should a paramedic obtain serial vitals on a critically ill patient during transport?

Every 5 minutes for critical patients, with continuous cardiac monitoring

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Every 15 minutes, consistent with stable patient protocols

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Only at the beginning and end of transport

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Every 30 minutes unless the patient reports new symptoms

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A paramedic is treating a 70-year-old woman experiencing severe dyspnea from acute pulmonary edema. She is extremely anxious, hyperventilating, and repeatedly asking if she is going to die. Which response is most appropriate while initiating CPAP therapy?

"I understand you are scared. You are getting the treatment you need right now, and I will stay with you the entire time."

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"I cannot promise anything, but statistically most patients survive this condition."

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"Please try to relax. Your anxiety is making your breathing worse."

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"Do not worry about that right now. I need you to focus on keeping this mask on your face."

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A paramedic assesses a 55-year-old male with chest pain. He has equal bilateral breath sounds, a soft abdomen, and no JVD. His 12-lead ECG shows normal sinus rhythm without ST changes. Vitals: BP 148/88, HR 78, RR 18, SpO2 98%. Which physical exam finding would most help differentiate a musculoskeletal cause from a cardiac origin of chest pain?

Reproducible pain with palpation of the chest wall, suggesting a musculoskeletal etiology

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A normal respiratory rate, which reliably excludes cardiac causes of chest pain

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Absence of diaphoresis, which definitively rules out acute coronary syndrome

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Normal oxygen saturation, which confirms the chest pain is non-cardiac in origin

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In EMS documentation, what does the acronym CHART stand for as a documentation framework?

Chief complaint, History, Assessment, treatment (Rx), Transport

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Cardiac, History, Airway, Respiration, Transport

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Complaint, Hemodynamics, Allergies, Response, Time

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Clinical, Hospital, Assessment, Referral, Transfer

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A paramedic is treating a patient who expresses reluctance to go to the hospital despite having signs of a STEMI on the 12-lead ECG. Which approach best reflects motivational interviewing techniques?

"I understand you have concerns about going to the hospital. Can you tell me what worries you most, so we can talk through it together?"

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"You are having a heart attack and you will die if you do not go to the hospital immediately."

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"I have been doing this for 15 years and every patient I have seen like this needed the hospital."

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"If you refuse transport, you will need to sign a refusal form and accept all responsibility."

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A paramedic crew arrives at a structure fire with reports of multiple victims. Their unit carries enough equipment for two critical patients. They locate five victims: two are unconscious with burns and smoke inhalation, two are ambulatory with minor burns, and one has a pulseless apneic presentation. Additional units are 20 minutes away. How should the crew prioritize their limited resources?

Focus resources on the two unconscious patients with burns and smoke inhalation who have the greatest potential for survival with intervention, triage the pulseless patient as expectant, and direct ambulatory patients to a safe area

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Divide all equipment equally among the five patients to ensure fair resource distribution

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Focus all resources on the pulseless patient because cardiac arrest always takes priority over other conditions

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Treat the ambulatory patients first because they can provide information about other victims inside the structure

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A paramedic responds to a 91-year-old female in a skilled nursing facility. The patient has a valid Do Not Resuscitate (DNR) order and is currently in respiratory distress with SpO2 of 82% on room air. She is conscious and requesting help. What is the most appropriate action?

Provide supplemental oxygen and supportive care; a DNR does not prohibit treatment of reversible conditions in a conscious patient

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Withhold all interventions because the DNR order prohibits medical treatment

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Contact medical control before providing any care to determine the scope of the DNR

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Intubate the patient because respiratory distress is not covered by a standard DNR

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A 28-year-old female presents with palpitations, chest tightness, tingling in both hands, and a respiratory rate of 32. She reports severe stress at work. Her vitals show HR 118, BP 138/86, SpO2 99%. When differentiating anxiety vs cardiac etiology, which finding most supports a non-cardiac cause?

Bilateral hand tingling with hyperventilation and normal SpO2, consistent with respiratory alkalosis from anxiety

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Heart rate of 118, which indicates a cardiac arrhythmia requiring immediate intervention

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Chest tightness, which is specific for myocardial ischemia in young adults

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Elevated blood pressure, which confirms a hypertensive emergency as the cause

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A paramedic is transporting a 58-year-old male with chest pain who received 324 mg aspirin and sublingual nitroglycerin 3 minutes ago. The patient initially rated his pain 8/10. On reassessment, his pain is now 4/10, blood pressure is 94/62 mmHg (previously 136/88 mmHg), and heart rate is 78 bpm. What is the most appropriate next action?

Continue monitoring and reassess in 5 minutes before considering additional nitroglycerin, given the significant blood pressure decrease

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Immediately administer a second dose of nitroglycerin since the pain has not completely resolved

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Discontinue the 12-lead ECG monitoring since the treatment is working

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Administer morphine 4 mg IV for persistent pain

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A 28-year-old female presents with acute dyspnea and pleuritic chest pain. She started oral contraceptives two months ago and recently took a long flight. Vitals: BP 110/70, HR 112, RR 28, SpO2 91%. Lung sounds are clear bilaterally. Which finding in this clinical context most strongly supports pulmonary embolism over other causes of dyspnea?

Hypoxia with clear lung sounds in a patient with risk factors for venous thromboembolism (oral contraceptives and prolonged immobility)

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Tachycardia alone, which is specific to pulmonary embolism and does not occur with other respiratory conditions

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Pleuritic chest pain, which exclusively indicates pulmonary embolism in young females

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A respiratory rate of 28, which rules out all causes of dyspnea except pulmonary embolism

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You are treating a 68-year-old male who initially presented with chest pain and stable vitals. En route, he becomes diaphoretic, his blood pressure drops from 136/84 to 82/50, and his heart rate increases from 80 to 130. The monitor shows a new wide-complex tachycardia. What is the most appropriate priority shift in your treatment?

Prepare for immediate synchronized cardioversion due to hemodynamic instability

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Administer amiodarone 150 mg IV push and reassess in 10 minutes

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Increase the IV fluid rate and obtain a repeat 12-lead ECG before any intervention

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Administer adenosine 6 mg rapid IV push to determine the underlying rhythm

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Paramedics arrive at a scene where an unresponsive 58-year-old male is found on the bathroom floor by his wife. She reports he complained of a sudden severe headache before collapsing approximately 10 minutes ago. During the rapid assessment, the paramedic finds unequal pupils, decorticate posturing on the left side, and a blood pressure of 218/124. Which field diagnosis is most consistent with these findings?

Hemorrhagic stroke with increased intracranial pressure

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Hypoglycemic episode requiring dextrose administration

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Cardiac syncope from a dysrhythmia

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Opioid overdose with respiratory depression

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A 4-year-old child presents with sudden onset stridor, drooling, and high fever. The child is sitting upright in a tripod position and appears toxic. Which age-based differential consideration is most important for this presentation?

Epiglottitis should be strongly suspected in a febrile child with acute stridor, drooling, and tripod positioning, as this presentation is more characteristic in pediatric patients

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Croup is the most likely diagnosis because it is the only cause of stridor in children under age 5

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Foreign body aspiration is the primary concern because children this age cannot develop epiglottitis

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Asthma exacerbation is most likely since wheezing and stridor are clinically identical in pediatric patients

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During the primary survey of an unconscious patient, which assessment component takes priority immediately after addressing airway patency?

Assessing breathing effectiveness, including rate, depth, and chest rise

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Obtaining a complete set of vital signs including blood pressure

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Performing a Glasgow Coma Scale assessment to quantify neurological status

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Gathering the SAMPLE history from bystanders at the scene

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A paramedic is managing a multi-system trauma patient. The patient’s initial assessment showed a tension pneumothorax, which was treated with needle decompression. Five minutes after decompression, breath sounds remain diminished on the affected side, tracheal deviation persists, and SpO2 has not improved. What is the most appropriate next step?

Perform a second needle decompression at an alternate site, as the initial attempt likely failed

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Continue monitoring because needle decompression takes up to 15 minutes to show improvement

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Perform endotracheal intubation to improve oxygenation

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Apply a chest seal over the needle decompression site

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A paramedic is assessing a 76-year-old male with chest pain. The patient rates his pain as 3/10. His wife states he has been clutching his chest and moaning for the past hour and “never complains about anything.” Vital signs show ST elevation in leads II, III, and aVF. How should the paramedic interpret the patient’s pain report?

Geriatric patients often underreport pain; the clinical findings and wife's observations suggest a more significant presentation than the reported pain level

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The pain score of 3/10 is accurate and indicates a minor cardiac event

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The wife's observations are unreliable and should not influence clinical decision-making

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The ST elevation is likely a chronic finding in an elderly patient and is not related to the chest pain

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A 30-year-old female presents with acute shortness of breath and chest tightness. She is anxious and reports tingling in her fingers and around her mouth. RR is 32, HR 102, BP 128/78, SpO2 99% on room air. ETCO2 reads 22 mmHg. Lung sounds are clear bilaterally. What is the most likely cause of her symptoms?

Hyperventilation syndrome with respiratory alkalosis causing perioral and peripheral paresthesias

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Acute asthma exacerbation with bronchospasm

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Pulmonary embolism with acute hypoxia

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Acute myocardial infarction with atypical presentation

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You arrive at a scene with two patients from a domestic dispute. Patient A is a 35-year-old male with a knife wound to the left chest who is conscious but tachycardic and hypotensive. Patient B is a 30-year-old female who is unconscious, not breathing, and has no pulse, with multiple stab wounds to the abdomen. You are the only ALS provider with one EMT partner. How should you prioritize your care?

Focus resources on Patient A (the salvageable patient with signs of life), as Patient B's injuries may be incompatible with survival given the limited resources available

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Begin CPR on Patient B since she is in the most critical condition

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Treat both patients equally by alternating between them every 2 minutes

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Wait for additional resources before treating either patient

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A 79-year-old male with a history of Alzheimer’s disease is found by his caregiver to be more confused than usual and unable to perform activities he could do yesterday. The caregiver states, “He is always a little forgetful, but today he doesn’t know where he is.” Which assessment approach is most appropriate for this patient?

Compare the current mental status to the patient's documented baseline to identify acute changes

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Attribute the confusion to the known Alzheimer's diagnosis and focus on other complaints

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Administer dextrose immediately because confusion in elderly patients is usually hypoglycemia

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Apply physical restraints to prevent injury during transport

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A paramedic is writing a patient care report for a patient who was verbally abusive during transport. Which approach to documenting the patient’s behavior is most appropriate?

Document the patient's exact statements in quotation marks and describe specific observable behaviors objectively

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Write that the patient was 'difficult and uncooperative' without specific details

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Omit the patient's behavior from the report to avoid potential conflict

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Document personal opinions about the patient's character and motivations

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You respond to a patient who fell from a ladder and also appears to be having an acute asthma exacerbation. He has significant wheezing with accessory muscle use, an SpO2 of 84%, a deformed right forearm, and tenderness over the right lateral chest wall with crepitus. Which treatment priority principle best applies to this patient?

Medical priorities (hypoxia and bronchospasm) take precedence because airway and breathing threats supersede the traumatic injuries present

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Trauma priorities always take precedence over medical conditions when a mechanism of injury is present

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The forearm fracture should be splinted first to prevent fat embolism syndrome

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The chest wall injury and the asthma exacerbation are equally weighted, so treat whichever you encounter first during the secondary survey

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A patient with suspected sepsis received a 500 mL normal saline bolus. Serial vitals show the heart rate has decreased from 128 to 116, but blood pressure remains at 82/54 mmHg. The paramedic notes a change in condition with no improvement in perfusion. What is the most appropriate next step?

Administer an additional fluid bolus and prepare to initiate a vasopressor if hypotension persists after adequate volume resuscitation

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Discontinue IV fluids because the heart rate is improving, indicating adequate resuscitation

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Administer a vasopressor immediately without additional fluid resuscitation

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Slow the IV to a keep-vein-open rate and monitor for spontaneous improvement

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You respond to a 35-year-old female who is 32 weeks pregnant and in cardiac arrest. Bystanders are performing CPR. The cardiac monitor shows pulseless electrical activity. In addition to standard ACLS interventions, what modification to resuscitation is critical for a pregnant patient in cardiac arrest?

Perform continuous left lateral uterine displacement to relieve aortocaval compression, and consider perimortem cesarean delivery if ROSC is not achieved within 4 to 5 minutes

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Tilt the entire backboard to a 45-degree left lateral position during compressions

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Reduce the compression depth to avoid injury to the fetus

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Withhold epinephrine and vasopressors due to the risk of uterine vasoconstriction

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You are treating a 55-year-old male with an anterior STEMI. During transport to the cath lab, he suddenly becomes unresponsive, and the monitor shows polymorphic ventricular tachycardia (torsades de pointes). He has no pulse. In addition to CPR and defibrillation, what specific medication should be prioritized for this rhythm?

Magnesium sulfate 1 to 2 g IV push

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Amiodarone 300 mg IV push as the first-line antiarrhythmic

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Procainamide 20 mg/min IV infusion

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Lidocaine 1 mg/kg IV push

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A 38-year-old male presents after a syncopal episode. He reports sudden onset severe abdominal pain prior to passing out. Vitals: BP 82/54, HR 132, RR 26, SpO2 95%. His abdomen is distended and tender. He has no trauma history. Which differential distinction is most critical for this patient?

Identifying whether the hemodynamic instability is caused by a vascular catastrophe or intra-abdominal hemorrhage requiring emergent surgical intervention

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Determining whether the pain is somatic or visceral in origin

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Distinguishing food poisoning from a gastric ulcer

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Ruling out dehydration as the cause of hypotension

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A paramedic evaluates a patient with multiple complaints: headache, nausea, blurred vision, and bilateral leg weakness. Vitals: BP 242/138, HR 68, RR 16, SpO2 98%, BGL 104 mg/dL. The paramedic must synthesize these findings into a clinical impression. Which interpretation best integrates all available information?

Hypertensive emergency with signs of end-organ dysfunction (neurological symptoms including headache, visual changes, and weakness)

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Migraine headache with associated nausea and visual aura, since the blood pressure is likely a pain response

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Bilateral stroke affecting both hemispheres simultaneously, which is the most common cause of bilateral weakness

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Diabetic emergency, because nausea and weakness are hallmark signs of hyperglycemia

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A paramedic is assessing a 5-year-old child who fell from a swing set. The child opens her eyes to voice, produces incomprehensible sounds, and withdraws from painful stimuli. Using the pediatric Glasgow Coma Scale, what is this child’s score?

9 (Eyes 3, Verbal 2, Motor 4)

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7 (Eyes 2, Verbal 2, Motor 3)

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11 (Eyes 3, Verbal 3, Motor 5)

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6 (Eyes 2, Verbal 1, Motor 3)

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A paramedic arrives at a scene where a 45-year-old female is experiencing a severe allergic reaction with urticaria, wheezing, and hypotension. The local protocol authorizes a single dose of epinephrine 0.3 mg IM for anaphylaxis, with additional doses requiring medical control authorization. After the first dose, the patient shows no improvement after 5 minutes. What is the most appropriate next action?

Contact online medical control for authorization to administer a repeat dose of epinephrine

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Administer diphenhydramine IV and wait for the epinephrine to take effect

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Withhold additional epinephrine because the maximum dose has been given

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Switch to an alternative medication such as albuterol for bronchospasm only

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A 60-year-old male presents with sudden onset of vertigo, nausea, vomiting, nystagmus, and difficulty walking. He describes the room as ‘spinning.’ He has no hearing loss or tinnitus. His speech is slurred and he has difficulty with finger-to-nose testing. What finding distinguishes this from benign peripheral vertigo and raises concern for a central (posterior circulation stroke) cause?

The presence of cerebellar signs (ataxia, dysarthria, dysmetria) indicates central vertigo requiring emergent evaluation for posterior circulation stroke

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The severity of the nausea and vomiting indicates a more serious cause

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The nystagmus pattern alone determines whether vertigo is central or peripheral

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The sudden onset confirms this is benign positional vertigo

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At a mass casualty incident, a paramedic using START triage encounters a patient who is not breathing. After opening the airway, the patient begins breathing spontaneously at a rate of 24 breaths per minute. What triage category should this patient receive?

Immediate (red)

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Delayed (yellow)

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Minor (green)

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Expectant (black)

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In mass casualty incident triage, which principle guides the allocation of limited resources among multiple patients?

Provide the greatest good for the greatest number of patients

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Treat the most critically injured patient first regardless of survival probability

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Treat patients in the order they are discovered during the scene survey

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Prioritize patients based on age, with the youngest receiving care first

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A paramedic is called to assist a visually impaired patient who has fallen and sustained a possible wrist fracture. Which approach best supports effective communication during the encounter?

Verbally narrate each step of the assessment and treatment before touching the patient

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Ask a family member to explain each procedure to the patient

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Position the patient so they can see the equipment being used

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Treat the patient in the same manner as any sighted patient without modifications

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You respond to a call for a 70-year-old male with chest pain. When you arrive, the patient’s wife is frantic and talks over the patient, answering every question you ask before the patient can respond. The patient appears to want to speak but keeps being interrupted. What is the best communication strategy?

Respectfully acknowledge the wife's concern, then redirect by speaking directly to the patient and explaining you need to hear from him personally

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Let the wife continue answering since she likely knows his medical history better than he does

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Ask the wife to leave the room so you can conduct the assessment without interference

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Ignore both of them and focus only on obtaining vital signs and performing the 12-lead ECG

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You are treating a 62-year-old female in acute respiratory distress with an SpO2 of 82%, audible wheezing, and a blood pressure of 92/58. Your partner is preparing the stretcher. Which combination of simultaneous interventions is most appropriate to assign?

High-flow oxygen via non-rebreather mask with nebulized bronchodilator, while establishing IV access for fluid resuscitation

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Immediate endotracheal intubation while your partner establishes bilateral large-bore IVs

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CPAP at 10 cmH2O with inline nebulizer while deferring IV access until en route

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Nebulized albuterol via simple mask at 6 LPM while administering a 500 mL bolus

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A paramedic arrives at a scene where a 22-year-old man is pacing, yelling, and throwing objects. He is holding a broken bottle. Bystanders state he was involved in a physical altercation. Law enforcement has not yet arrived. What is the most appropriate initial action?

Maintain a safe distance, identify an exit route, and use verbal de-escalation techniques from a position of safety

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Approach the patient calmly and attempt to take the bottle from his hand

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Restrain the patient immediately using soft restraints to prevent further injury

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Administer intramuscular ketamine to sedate the patient before he injures someone

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A paramedic is managing a patient in cardiac arrest following a heroin overdose. ROSC is achieved after naloxone administration and CPR. The patient is now breathing spontaneously at 14 breaths/min with a SpO2 of 96%. The patient suddenly becomes combative and attempts to remove the IV. He states he wants to leave and refuses further care. What is the most appropriate clinical judgment?

Strongly encourage the patient to continue care, explaining that naloxone wears off and respiratory arrest may recur, and thoroughly document the interaction if he ultimately refuses

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Restrain the patient and continue transport since he was just in cardiac arrest and cannot make rational decisions

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Immediately discontinue care and allow the patient to leave since he is now alert and verbal

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Administer midazolam for sedation to ensure the patient remains cooperative during transport

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A paramedic is trending vital signs on a patient being transported for abdominal pain. The initial blood pressure was 130/80 mmHg with a heart rate of 88 bpm. Fifteen minutes later, the blood pressure is 104/68 mmHg with a heart rate of 112 bpm. What does this trend most likely indicate?

Developing hypovolemic shock, likely from internal hemorrhage

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Anxiety related to transport, causing normal physiological changes

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Medication side effects from prehospital analgesic administration

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Normal variation in vital signs during ambulance transport

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An 82-year-old female with a history of heart failure, COPD, and renal insufficiency presents with acute dyspnea, bilateral rales, and peripheral edema. Her SpO2 is 86%, blood pressure is 168/98, and heart rate is 104. She is also confused, which her family states is new. Which factor most significantly influences treatment prioritization in this geriatric patient?

The potential for rapid decompensation due to limited physiologic reserve, requiring earlier and more aggressive respiratory intervention

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Her elevated blood pressure, which must be corrected with IV antihypertensives before treating respiratory distress

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Her renal insufficiency, which prevents the use of any IV fluids or diuretics

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Her confusion, which requires a stroke alert activation before any other treatment

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A newborn is assessed at 1 minute after birth. Which scoring system is used to evaluate the newborn’s condition and determine the need for further resuscitative interventions?

Apgar score

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Glasgow Coma Scale

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Revised Trauma Score

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Cincinnati Stroke Scale

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A paramedic is called to a nursing facility for an 85-year-old patient with acute confusion. The nursing staff reports the patient was oriented and conversational yesterday but is now agitated, pulling at her IV, and unable to recognize her daughter. Her baseline mental status per the facility records is alert and oriented to person, place, and time. What is the most likely clinical distinction?

Acute delirium, based on the sudden onset and fluctuating course from a known baseline

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Progression of Alzheimer's dementia with a sudden cognitive decline

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A psychiatric emergency requiring chemical sedation

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Normal age-related cognitive decline that does not require medical evaluation

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A paramedic is called to a residence for a 78-year-old female who is confused and has a blood glucose of 42 mg/dL. The patient’s daughter, who holds healthcare power of attorney, insists that no IV access be established and no dextrose be given because her mother ‘would not want that.’ The patient is unable to communicate her wishes. What is the most appropriate action?

Administer dextrose to correct the life-threatening hypoglycemia under implied consent, as the power of attorney cannot refuse emergency treatment for a reversible condition

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Honor the daughter's wishes as the legal healthcare proxy and withhold dextrose

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Administer oral glucose instead of IV dextrose to respect the proxy's refusal of IV access

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Contact online medical control and wait for a physician order before taking any action

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Which of the following is considered a common mimic of acute coronary syndrome that should be included in the paramedic’s differential diagnosis for chest pain?

Acute pericarditis

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Acute appendicitis

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Urinary tract infection

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Peripheral neuropathy

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A paramedic responds to a 79-year-old male who fell and struck his head on a coffee table. He has a 3 cm laceration on his forehead but is alert and oriented with stable vital signs. He takes warfarin for atrial fibrillation. Why does this patient require transport and evaluation despite appearing stable?

Anticoagulation with warfarin significantly increases the risk of delayed intracranial hemorrhage even from minor head trauma

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All patients over 75 with lacerations require emergency department evaluation

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The laceration requires suturing that cannot be performed in the field

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Atrial fibrillation requires cardiac monitoring that is only available in the hospital

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A 58-year-old male with chest pain has a 12-lead ECG showing ST elevation in leads II, III, and aVF. His blood pressure is 88/54, heart rate is 42, and he is diaphoretic. He has bilateral clear lung sounds. Given these findings, which risk stratification concern should guide your treatment approach?

Inferior STEMI with right ventricular involvement causing cardiogenic hypotension, requiring volume resuscitation rather than vasodilators

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Anterior STEMI with left ventricular failure requiring nitroglycerin and furosemide

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Unstable angina with vasovagal response requiring atropine only

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Pericarditis with cardiac tamponade requiring immediate pericardiocentesis

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A newborn delivered in the field has a heart rate of 60 beats per minute despite 30 seconds of effective positive pressure ventilation. What is the next appropriate intervention?

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

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Administer epinephrine 0.01 mg/kg IV immediately

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Continue positive pressure ventilation alone for another 30 seconds

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Begin chest compressions at a 15:2 ratio with ventilations

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A 45-year-old female presents with substernal chest pressure, nausea, and jaw pain. She has a history of anxiety disorder and states she feels like she is having a panic attack. What presenting signs should guide the paramedic’s initial clinical impression?

Substernal chest pressure with jaw radiation and nausea, which are concerning for acute coronary syndrome regardless of anxiety history

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Hyperventilation and tingling in the extremities, which confirm a panic attack diagnosis

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History of anxiety disorder, which makes cardiac etiology unlikely in this age group

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Absence of diaphoresis, which effectively excludes myocardial ischemia

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A 62-year-old male presents with chest pain. He states the pain is worse with deep breathing and improved by sitting up and leaning forward. He denies radiation to the arm or jaw. Vital signs are stable. The 12-lead ECG shows diffuse ST elevation in multiple leads with PR depression. The patient also reports a recent upper respiratory infection. What is the significance of the pertinent negative findings in this case?

The absence of arm or jaw radiation and the positional relief make acute MI less likely, supporting pericarditis as the diagnosis

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The absence of radiation confirms this is musculoskeletal chest pain

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Pertinent negatives have no diagnostic value and should not influence clinical decision-making

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The absence of dyspnea rules out both cardiac and pulmonary causes of chest pain

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The Pediatric Assessment Triangle (PAT) evaluates which three components during the initial ‘across the room’ assessment of a pediatric patient?

Appearance, work of breathing, and circulation to skin

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Airway patency, breathing rate, and capillary refill time

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Heart rate, respiratory rate, and blood pressure

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Level of consciousness, pupil reactivity, and skin temperature

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You administer fentanyl 100 mcg IV to a 80 kg trauma patient for severe pain. Three minutes later, the patient’s respiratory rate drops from 18 to 6 breaths per minute, SpO2 drops to 86%, and the patient becomes difficult to arouse. What is the appropriate intervention?

Assist ventilations with BVM, administer naloxone 0.04 mg IV titrated in small increments to restore respiratory drive

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Administer naloxone 2 mg IV push immediately to fully reverse all opioid effects

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Stimulate the patient by sternal rub and reposition the head; do not give naloxone since the fentanyl was medically administered

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Intubate the patient immediately without attempting naloxone

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A 42-year-old obese female presents with right upper quadrant pain that radiates to the right shoulder. The pain began after eating a fatty meal. She is nauseated and has vomited twice. Vital signs: HR 98, BP 138/84, RR 20, Temp 100.8 F. Murphy’s sign is positive on exam. Integrating all assessment findings, what is the most likely diagnosis?

Acute cholecystitis (gallbladder inflammation)

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Acute appendicitis

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Right-sided renal colic

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Peptic ulcer perforation

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Paramedics are called to a home where a Somali family has called 911 for their grandmother who is experiencing chest pain. The family members speak limited English and the patient speaks none. Which approach is most appropriate for obtaining an accurate patient history?

Use a professional medical interpreter service via phone while performing the assessment

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Have the youngest grandchild who speaks English interpret for the patient

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Use hand gestures and simple single-word commands to communicate directly

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Skip the history and rely entirely on the physical exam and vital signs

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You applied a tourniquet to a patient’s left upper arm for a traumatic amputation at the forearm. The bleeding is controlled and the patient is stable. During a 45-minute transport, the patient develops severe pain in the arm proximal to the tourniquet and requests that you loosen it. What is the appropriate response?

Keep the tourniquet in place, explain why it must remain tight, and manage the pain with analgesic medication per protocol

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Loosen the tourniquet slightly to relieve the pain since the bleeding has stopped

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Remove the tourniquet and convert to a pressure dressing since 45 minutes has elapsed

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Apply a second tourniquet below the first and remove the proximal one

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A 78-year-old male presents with acute confusion, fluctuating attention, and visual hallucinations that started yesterday. His wife reports he was cognitively normal last week. He was recently started on a new medication for a urinary tract infection. Which feature best distinguishes this presentation as delirium rather than dementia?

The rapid onset over hours to days with fluctuating attention and visual hallucinations

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The presence of visual hallucinations, which only occur in dementia

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The patient's age of 78, since delirium only affects those over 80

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The wife's report that he was previously normal, which excludes any cognitive disorder

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A 2-year-old child is found listless, with a weak cry, pallor, and delayed capillary refill of 5 seconds. The heart rate is 180 bpm and the respiratory rate is 40 breaths per minute. Using the Pediatric Assessment Triangle, which assessment category best describes this child?

Cardiopulmonary failure requiring immediate intervention

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Stable with mild respiratory distress only

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Isolated respiratory distress without circulatory compromise

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Primary behavioral or neurological emergency

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A 70-year-old female presents with acute shortness of breath. She has a history of COPD and heart failure. She has bilateral wheezing and bilateral crackles to the mid-lung fields. SpO2 is 84%, ETCO2 is 55 mmHg. BP is 168/96, HR 108. She has mild peripheral edema. Both her COPD and heart failure appear to be contributing. How should you prioritize your treatment approach?

Apply CPAP to address both conditions simultaneously, with a bronchodilator in-line if possible, and reassess for dominant pathology

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Treat only the COPD with albuterol and withhold CPAP since it could worsen air trapping

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Administer IV furosemide first and withhold bronchodilators since the wheezing is cardiac

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Intubate immediately since neither CPAP nor medications will help with dual pathology

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A paramedic is treating a 60-year-old male in cardiac arrest. The patient has a shockable rhythm, and two defibrillation attempts have been unsuccessful. The paramedic considers administering amiodarone but realizes the drug box contains only lidocaine. The nearest hospital is 25 minutes away, and an ALS intercept unit is 15 minutes out. What is the best risk-benefit decision?

Administer lidocaine as an alternative antiarrhythmic, continue high-quality CPR, and request the ALS intercept for amiodarone while transporting toward the hospital

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Withhold all antiarrhythmic medications and continue defibrillation only until amiodarone is available from the intercept unit

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Cease resuscitation efforts because the lack of amiodarone makes survival unlikely

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Delay transport and wait on scene for the intercept unit to arrive with amiodarone before giving any medications

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A 35-year-old male presents with pleuritic chest pain that worsens with inspiration, a dry cough, and low-grade fever. He recently returned from a 14-hour international flight. He is tachycardic at 110, BP 126/78, RR 26, SpO2 92% on room air. The 12-lead ECG shows sinus tachycardia with S1Q3T3 pattern. What diagnosis should the paramedic prioritize?

Pulmonary embolism

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Community-acquired pneumonia

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Acute pericarditis

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Spontaneous pneumothorax

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How frequently should a paramedic reassess a patient classified as unstable during transport?

Every 5 minutes

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Every 10 minutes

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Every 15 minutes

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Every 2 minutes

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You respond to a 38-year-old female with severe abdominal pain. She is writhing in pain, rating it 10/10. Your protocol allows fentanyl 1 mcg/kg IV for pain management. Her estimated weight is 70 kg. You administer 70 mcg fentanyl IV. Five minutes later, her pain is 8/10 and she is requesting additional medication. Your protocol allows a repeat dose of 0.5 mcg/kg. What factor is most important in your decision to administer a second dose?

Reassessment of vital signs, respiratory status, and level of consciousness to ensure the patient is tolerating the medication safely

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The patient's subjective pain rating, which should be zero before considering additional doses

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The total dose ceiling listed in the protocol, regardless of the patient's response

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Whether the patient has a documented allergy to morphine, which cross-reacts with fentanyl

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A 28-year-old female presents with bilateral lower extremity weakness that has been progressive over the past 3 days. She reports a viral illness 2 weeks ago. Deep tendon reflexes are absent in both legs. Sensation is intact. She denies back pain or trauma. Vital signs are normal. What condition should be highest on your differential?

Guillain-Barre syndrome (ascending paralysis)

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Transverse myelitis from spinal cord compression

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Multiple sclerosis with an acute exacerbation

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Bilateral deep vein thrombosis

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A paramedic is called for an 88-year-old patient who fell at home. The patient takes warfarin and metoprolol. The patient is alert but confused, with a blood pressure of 100/60 mmHg and a heart rate of 68 bpm. There is a large hematoma on the right temporal area. Why is this presentation particularly concerning?

Metoprolol masks the tachycardic response to hemorrhage, and warfarin increases the risk of intracranial bleeding

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The blood pressure is too high for a patient on warfarin therapy

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The heart rate is normal, which rules out any significant blood loss

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Confusion is expected in all elderly patients after a fall

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A paramedic is treating a patient with chest pain and considers administering aspirin per standing orders. The patient reports a history of aspirin allergy that causes hives but no respiratory distress or anaphylaxis. What is the most appropriate approach to this clinical decision?

Withhold aspirin and contact medical control to discuss the allergy history and determine if an alternative antiplatelet is available

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Administer aspirin since hives alone are not a true allergy and the cardiac benefit outweighs the risk

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Administer half the standard aspirin dose to reduce the likelihood of an allergic reaction

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Administer diphenhydramine prophylactically and then give the full aspirin dose

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During transport, a paramedic encounters a clinical situation not addressed by local protocols. The patient is stable but requires a medication that is carried on the unit yet not covered under standing orders. What is the most appropriate course of action?

Contact online medical control to obtain a direct physician order for the medication

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Administer the medication based on clinical judgment since it is available on the unit

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Withhold the medication entirely and document the situation for quality review after the call

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Ask the patient to sign a consent form and then administer the medication

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What is the primary distinction between decision-making capacity and legal competency?

Capacity is a clinical determination made by healthcare providers, while competency is a legal determination made by a court

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Capacity applies only to patients under 18, while competency applies to adults

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Capacity is permanent once established, while competency can change over time

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Capacity requires a psychiatric evaluation, while competency is determined by any physician

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You are treating a 55-year-old male with chest pain and ST elevation in leads II, III, and aVF on the 12-lead ECG. During transport, the patient suddenly develops nausea, diaphoresis, and a heart rate of 38 with a blood pressure of 72/48. The monitor shows a third-degree AV block. You have already established IV access and administered aspirin. What is your next priority intervention?

Initiate transcutaneous pacing

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Administer atropine 1 mg IV push

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Perform synchronized cardioversion at 50 joules

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Administer a 250 mL normal saline bolus and reassess

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You have been managing a diabetic patient with a blood glucose of 28 mg/dL. You administered dextrose 10% IV, and on reassessment the blood glucose is now 86 mg/dL. The patient is awake, alert, and oriented with stable vital signs. He states he accidentally took a double dose of his long-acting insulin this morning. Why is continued monitoring especially important for this patient?

Long-acting insulin will continue to lower blood glucose after the dextrose is metabolized, creating a risk of recurrent hypoglycemia

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The dextrose infusion may cause dangerous hyperglycemia requiring insulin administration

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The patient is at risk for diabetic ketoacidosis from the glucose correction

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Long-acting insulin will interact with the dextrose to cause an unpredictable metabolic response

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When providing a verbal radio report to the receiving emergency department, what is the recommended order of information in a structured handoff communication?

Unit identification, patient age and sex, chief complaint, pertinent history, assessment findings, interventions performed, current condition, and ETA

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Patient name, insurance information, home address, physician preference, and allergies

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Dispatch information, scene description, weather conditions, and number of bystanders

Correct Incorrect Correct answer

Medication list first, then vitals, then chief complaint, then history

Correct Incorrect Correct answer

A paramedic treats a patient with an acute asthma exacerbation using continuous albuterol nebulization. On reassessment, the patient’s wheezing has resolved, but the patient appears more lethargic and has diminished breath sounds bilaterally. What does this reassessment finding suggest?

Worsening airway obstruction with insufficient air movement to generate wheezing

Correct Incorrect Correct answer

Successful resolution of bronchospasm with the patient becoming relaxed

Correct Incorrect Correct answer

An allergic reaction to the albuterol medication

Correct Incorrect Correct answer

Development of a spontaneous pneumothorax

Correct Incorrect Correct answer

A paramedic is calculating a medication dose for a 5-year-old child weighing 20 kg who requires epinephrine for anaphylaxis. The correct pediatric dose of epinephrine 1:1000 (1 mg/mL) for IM administration is 0.01 mg/kg. What volume should be administered?

0.2 mL

Correct Incorrect Correct answer

0.02 mL

Correct Incorrect Correct answer

0.5 mL

Correct Incorrect Correct answer

2.0 mL

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A paramedic is called to a delivery where a newborn has just been born. The infant is limp, not crying, and has a heart rate of 80 bpm. Using newborn assessment principles, what is the most appropriate initial intervention?

Dry and stimulate the infant, clear the airway, and provide positive pressure ventilation with room air or supplemental oxygen

Correct Incorrect Correct answer

Begin chest compressions immediately at a 3:1 compression-to-ventilation ratio

Correct Incorrect Correct answer

Administer epinephrine 0.01 mg/kg via the umbilical vein

Correct Incorrect Correct answer

Intubate the newborn immediately and ventilate at a rate of 40 to 60 breaths per minute

Correct Incorrect Correct answer

A 2-week-old neonate presents with projectile vomiting after feeding, a palpable olive-shaped mass in the right upper quadrant, and signs of dehydration. Which congenital condition is most likely?

Pyloric stenosis

Correct Incorrect Correct answer

Intussusception

Correct Incorrect Correct answer

Meconium ileus

Correct Incorrect Correct answer

Hirschsprung disease

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You respond to simultaneous emergencies at a large event: a 55-year-old male in cardiac arrest in the parking lot and a 30-year-old female experiencing a severe asthma attack inside the venue. You are the only ALS unit on scene with two BLS crews available. What is the most appropriate course of action?

Direct BLS to begin CPR and apply the AED on the cardiac arrest patient while you treat the severe asthma attack with ALS interventions

Correct Incorrect Correct answer

Treat the cardiac arrest patient first because it is the most immediately life-threatening condition

Correct Incorrect Correct answer

Split your ALS equipment between both patients and treat them at the same time

Correct Incorrect Correct answer

Wait for a second ALS unit before initiating treatment on either patient

Correct Incorrect Correct answer

A patient receiving a dopamine infusion at 5 mcg/kg/min for cardiogenic shock shows improving blood pressure but develops a new onset of premature ventricular contractions. What is the most appropriate action to adjust dose or modify the infusion?

Reduce the dopamine infusion rate and reassess, as PVCs may be a dose-related adverse effect of dopamine

Correct Incorrect Correct answer

Increase the dopamine infusion rate to further improve blood pressure

Correct Incorrect Correct answer

Immediately discontinue the dopamine and administer amiodarone for the PVCs

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Maintain the current rate since PVCs are expected and benign during vasopressor therapy

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During interfacility transport, a paramedic is caring for a patient on a norepinephrine drip. The patient’s blood pressure was 98/64 mmHg at departure. On reassessment 15 minutes into transport, blood pressure is 84/52 mmHg despite the infusion running at the prescribed rate. What should the paramedic do first?

Verify IV line patency and check for infiltration or disconnection

Correct Incorrect Correct answer

Immediately increase the norepinephrine infusion rate

Correct Incorrect Correct answer

Administer a 1 L normal saline bolus wide open

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Contact medical control to request addition of a second vasopressor

Correct Incorrect Correct answer

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

The extrinsic and common pathways

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The intrinsic pathway only

Correct Incorrect Correct answer

The fibrinolytic pathway

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The platelet adhesion pathway

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

Auditory hallucinations, disorganized thinking, and paranoid delusions

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Alternating episodes of euphoria and profound sadness over several weeks

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

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Progressive confusion and memory loss with fluctuating consciousness

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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

Correct Incorrect Correct answer

Left ventricular free wall rupture causing cardiac tamponade

Correct Incorrect Correct answer

Acute mitral valve regurgitation from papillary muscle dysfunction

Correct Incorrect Correct answer

Cardiogenic shock from massive left ventricular damage

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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

Correct Incorrect Correct answer

A new allergic reaction to the epinephrine medication

Correct Incorrect Correct answer

Development of cardiogenic shock unrelated to the anaphylaxis

Correct Incorrect Correct answer

An adverse reaction to the normal saline infusion

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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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)

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Deliver repeated defibrillation shocks at maximum energy with standard ACLS medications

Correct Incorrect Correct answer

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

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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

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Painless numbness extending proximally from the sting site

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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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Administer antipyretic medications such as acetaminophen to lower the temperature

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

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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

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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

Correct Incorrect Correct answer

Excessive vasodilation leads to fluid loss and tissue necrosis

Correct Incorrect Correct answer

Peripheral nerve demyelination causes permanent sensory loss

Correct Incorrect Correct answer

Anaerobic metabolism from hypothermia produces lactic acidosis in the affected extremity

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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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Administer dextrose 25% to prevent further metabolic derangement

Correct Incorrect Correct answer

Administer sodium bicarbonate to correct the metabolic acidosis

Correct Incorrect Correct answer

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

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

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

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Treat all four patients equally using standard START triage without modification

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Withhold CPR because lightning injuries typically cause irreversible brain damage

Correct Incorrect Correct answer

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 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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Right ventricular infarction requiring cautious fluid administration

Correct Incorrect Correct answer

Pericarditis with diffuse ST elevation

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Left bundle branch block obscuring the inferior STEMI

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

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Place the patient in Trendelenburg position and withhold fluids

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Acute appendicitis with referred pain

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Abdominal aortic aneurysm dissection

Correct Incorrect Correct answer

Large bowel obstruction

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

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Ethylene glycol poisoning; administer calcium chloride and monitor for dysrhythmias

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Isopropyl alcohol poisoning; provide IV fluids and supportive care only

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Ethanol intoxication; monitor airway and provide IV dextrose

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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 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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

The glucometer reading is falsely elevated and should be disregarded

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Left anterior descending artery

Correct Incorrect Correct answer

Left circumflex artery

Correct Incorrect Correct answer

Left main coronary artery

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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

Correct Incorrect Correct answer

Administer aspirin 324 mg because this is likely an ischemic event

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Administer a fluid bolus to improve cerebral perfusion pressure

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

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

It stimulates the liver to convert stored glycogen into glucose

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It directly increases insulin sensitivity in peripheral tissues

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It stimulates the pancreas to release insulin

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It inhibits cellular glucose uptake to raise blood glucose levels

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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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Acute bronchitis; priority is nebulized bronchodilator and monitoring during transport

Correct Incorrect Correct answer

Dehydration from fever; priority is oral rehydration and antipyretic medication

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

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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

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Lactate is used to determine which specific antibiotic should be administered

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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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Immediately intubate the patient and initiate mechanical ventilation

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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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Hyperventilation causing the patient to blow off too much carbon dioxide

Correct Incorrect Correct answer

A malfunctioning capnography sensor that needs to be replaced immediately

Correct Incorrect Correct answer

Adequate compensation for a primary metabolic acidosis from sepsis

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Standard precautions only with no additional respiratory protection

Correct Incorrect Correct answer

Airborne precautions with an N95 respirator and negative pressure isolation

Correct Incorrect Correct answer

Contact precautions with gown and gloves only

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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

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

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 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

Correct Incorrect Correct answer

Delayed contact dermatitis appearing 48 to 72 hours after exposure

Correct Incorrect Correct answer

Serum sickness developing 7 to 14 days after the contrast injection

Correct Incorrect Correct answer

Autoimmune hemolytic anemia triggered by the iodine component

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

Correct Incorrect Correct answer

Type IV delayed cell-mediated hypersensitivity reaction

Correct Incorrect Correct answer

Anaphylactoid reaction not involving IgE antibodies

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Frostnip, which will resolve completely with rewarming

Correct Incorrect Correct answer

Superficial (first degree) frostbite with reversible damage

Correct Incorrect Correct answer

Chilblains (pernio) from chronic cold exposure

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

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

Correct Incorrect Correct answer

Administer acetaminophen 1,000 mg orally to reduce the fever

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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

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

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

Correct Incorrect Correct answer

Vesicular lesions following a dermatomal distribution

Correct Incorrect Correct answer

Dry, scaling plaques with silvery patches on the extensor surfaces

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Vertebrobasilar insufficiency from cervical spine arthritis

Correct Incorrect Correct answer

Benign paroxysmal positional vertigo (BPPV)

Correct Incorrect Correct answer

Transient ischemic attack from carotid artery stenosis

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

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

Correct Incorrect Correct answer

Pneumothorax

Correct Incorrect Correct answer

Asthma exacerbation

Correct Incorrect Correct answer

Pneumonia with consolidation

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

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

What is the most common cause of upper gastrointestinal bleeding?

Peptic ulcer disease (gastric or duodenal ulcers)

Correct Incorrect Correct answer

Esophageal varices from portal hypertension

Correct Incorrect Correct answer

Mallory-Weiss tear from forceful vomiting

Correct Incorrect Correct answer

Gastric carcinoma

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

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Push the cord back through the cervix and into the uterus

Correct Incorrect Correct answer

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

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

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 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

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)

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Withhold defibrillation entirely until the patient is rewarmed at the hospital

Correct Incorrect Correct answer

Deliver three rapid stacked shocks before beginning CPR

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 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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Foreign body airway obstruction; perform back blows and chest thrusts

Correct Incorrect Correct answer

Bacterial tracheitis; administer IV antibiotics in the prehospital setting

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Hypernatremia from excessive water loss

Correct Incorrect Correct answer

Hypocalcemia from calcium binding to ketone bodies

Correct Incorrect Correct answer

Hypermagnesemia from renal magnesium retention

Correct Incorrect Correct answer

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

The fallopian tube (tubal pregnancy)

Correct Incorrect Correct answer

The cervix (cervical pregnancy)

Correct Incorrect Correct answer

The ovary (ovarian pregnancy)

Correct Incorrect Correct answer

The abdominal cavity (abdominal pregnancy)

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 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

Correct Incorrect Correct answer

Pheochromocytoma causing catecholamine surge

Correct Incorrect Correct answer

Myxedema coma from severe hypothyroidism

Correct Incorrect Correct answer

Sympathomimetic toxicity from stimulant use

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 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)

Correct Incorrect Correct answer

Metoprolol (beta-blocker)

Correct Incorrect Correct answer

Diltiazem (calcium channel blocker)

Correct Incorrect Correct answer

Nitroglycerin (nitrate vasodilator)

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Pulmonary embolism

Correct Incorrect Correct answer

Right-sided tension pneumothorax

Correct Incorrect Correct answer

Acute asthma exacerbation

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Difficulty remembering events from 20 years ago

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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 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 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

Correct Incorrect Correct answer

Acute appendicitis

Correct Incorrect Correct answer

Ovarian cyst rupture without significant hemorrhage

Correct Incorrect Correct answer

Threatened miscarriage with stable hemodynamics

Correct Incorrect Correct answer

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 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

Correct Incorrect Correct answer

Ruptured ovarian cyst with peritoneal irritation

Correct Incorrect Correct answer

Urinary tract infection with lower abdominal pain

Correct Incorrect Correct answer

Acute appendicitis with atypical presentation

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 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

Correct Incorrect Correct answer

Flumazenil 0.2 mg intravenously

Correct Incorrect Correct answer

Activated charcoal 50 grams orally

Correct Incorrect Correct answer

Atropine 1 mg intravenously

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 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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Nebulized albuterol 2.5 mg for the bronchospasm component

Correct Incorrect Correct answer

Immediate endotracheal intubation before any other intervention

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Barotrauma from rapid ascent; perform needle decompression of both lungs

Correct Incorrect Correct answer

Hypothermia from cold water exposure; initiate active rewarming

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

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

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

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

Correct Incorrect Correct answer

The deltoid muscle, because it is the easiest to access

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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

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 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

Correct Incorrect Correct answer

Normal implantation bleeding in early pregnancy

Correct Incorrect Correct answer

Placenta previa at 10 weeks gestation

Correct Incorrect Correct answer

Molar pregnancy (hydatidiform mole)

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 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)

Correct Incorrect Correct answer

Bacterial pneumonia requiring IV antibiotics

Correct Incorrect Correct answer

Asthma exacerbation requiring nebulized bronchodilators

Correct Incorrect Correct answer

Foreign body aspiration requiring direct laryngoscopy

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 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

Correct Incorrect Correct answer

Acute myocardial infarction from coronary artery disease

Correct Incorrect Correct answer

Commotio cordis from a blow to the chest

Correct Incorrect Correct answer

Wolff-Parkinson-White syndrome

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Administer pain medication and perform a detailed abdominal assessment before transport

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Iron causes rapid hypoglycemia by depleting liver glycogen stores

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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

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 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

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

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

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

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 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

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

Correct Incorrect Correct answer

Acute appendicitis with localized right lower quadrant pain

Correct Incorrect Correct answer

Gastroesophageal reflux disease exacerbation

Correct Incorrect Correct answer

Irritable bowel syndrome flare causing diffuse discomfort

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

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

Ipratropium bromide

Correct Incorrect Correct answer

Furosemide

Correct Incorrect Correct answer

Methylprednisolone

Correct Incorrect Correct answer

Amiodarone

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Deliver five abdominal thrusts to clear water from the lungs

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Bronchiolitis with associated hypoxemia

Correct Incorrect Correct answer

Foreign body aspiration during feeding

Correct Incorrect Correct answer

Methemoglobinemia from exposure to a topical anesthetic

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Irritable bowel syndrome flare

Correct Incorrect Correct answer

Acute gastritis from NSAID use

Correct Incorrect Correct answer

Small bowel obstruction

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

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

Correct Incorrect Correct answer

Physically restrain the patient and transport involuntarily for safety

Correct Incorrect Correct answer

Explain that the television cannot watch him and redirect his thinking

Correct Incorrect Correct answer

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

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 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

Correct Incorrect Correct answer

Amiodarone 150 mg IV over 10 minutes

Correct Incorrect Correct answer

Diltiazem 0.25 mg/kg IV over 2 minutes

Correct Incorrect Correct answer

Synchronized cardioversion at 50 joules

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Compartment syndrome limited to the affected extremities only

Correct Incorrect Correct answer

Fat embolism syndrome causing acute respiratory failure

Correct Incorrect Correct answer

Hypothermia from prolonged environmental exposure

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 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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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)

Correct Incorrect Correct answer

Cushing syndrome from excessive cortisol production

Correct Incorrect Correct answer

Thyroid storm from overactive thyroid function

Correct Incorrect Correct answer

Diabetic ketoacidosis from insulin deficiency

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 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 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 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 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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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

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 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 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

Correct Incorrect Correct answer

Oral glucose gel placed under the tongue of the unconscious patient

Correct Incorrect Correct answer

Dextrose 50% administered intranasally

Correct Incorrect Correct answer

Insulin glargine administered intramuscularly to stimulate glucose release

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Measles; airborne precautions with an N95 respirator are indicated

Correct Incorrect Correct answer

Kawasaki disease; standard precautions only are needed

Correct Incorrect Correct answer

Roseola; contact precautions with gown and gloves are indicated

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Midazolam 5 mg intramuscularly

Correct Incorrect Correct answer

Haloperidol 5 mg IV push after establishing vascular access

Correct Incorrect Correct answer

Naloxone 2 mg intranasal

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Ruptured ectopic pregnancy

Correct Incorrect Correct answer

Pelvic inflammatory disease

Correct Incorrect Correct answer

Endometriosis flare

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 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

Correct Incorrect Correct answer

Bradycardia, hypothermia, and facial puffiness

Correct Incorrect Correct answer

Gradual onset over several weeks with mild fatigue only

Correct Incorrect Correct answer

Isolated tachycardia with normal temperature and no psychiatric symptoms

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Aortic dissection from the mechanical valve eroding through the aorta

Correct Incorrect Correct answer

Infective endocarditis from a recent dental procedure

Correct Incorrect Correct answer

Pericardial effusion from an autoimmune reaction to the valve material

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

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

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 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

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

Correct Incorrect Correct answer

It directly neutralizes histamine molecules in the bloodstream through chemical binding

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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

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

Correct Incorrect Correct answer

Urinary retention caused by pain and immobility from the hip fracture

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Dehydration from not drinking enough fluids before the fall occurred

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

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

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 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 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

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 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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Perform orotracheal intubation while the seizure is still active

Correct Incorrect Correct answer

Administer rectal acetaminophen since the seizure is likely febrile in origin

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

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Apply a pressure dressing to the rectal area to control hemorrhage

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 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

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Standing orders that authorize transport of all psychiatric patients

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Heat exhaustion; elevated body temperature causes falsely high SpO2 readings

Correct Incorrect Correct answer

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

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

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

Correct Incorrect Correct answer

Migraine headache with aura

Correct Incorrect Correct answer

Tension-type headache with anxiety

Correct Incorrect Correct answer

Acute ischemic stroke of the posterior circulation

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

The ETCO2 sensor is malfunctioning from humidity in the nebulizer circuit

Correct Incorrect Correct answer

The rising ETCO2 indicates a pneumothorax requiring needle decompression

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Acute psychotic episode from schizophrenia

Correct Incorrect Correct answer

Hypoglycemic seizure

Correct Incorrect Correct answer

Heat exhaustion

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Pure respiratory acidosis from central respiratory depression

Correct Incorrect Correct answer

Pure metabolic alkalosis from excessive bicarbonate generation

Correct Incorrect Correct answer

Respiratory acidosis with compensatory metabolic alkalosis

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

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 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 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

Correct Incorrect Correct answer

Acute appendicitis

Correct Incorrect Correct answer

Ovarian torsion

Correct Incorrect Correct answer

Threatened miscarriage

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Myxedema coma from severe hypothyroidism

Correct Incorrect Correct answer

Thyroid storm from uncontrolled hyperthyroidism

Correct Incorrect Correct answer

Cushing syndrome from cortisol excess

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 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

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

Correct Incorrect Correct answer

Increased cardiac output that overwhelms the coronary circulation

Correct Incorrect Correct answer

Decreased blood viscosity that allows fluid to leak out of vessels

Correct Incorrect Correct answer

Enhanced baroreceptor sensitivity that causes excessive vasoconstriction

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 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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Naloxone to reverse the pupil constriction and bradycardia

Correct Incorrect Correct answer

Epinephrine for the bradycardia followed by diphenhydramine for the secretions

Correct Incorrect Correct answer

Activated charcoal for GI decontamination followed by sodium bicarbonate

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Thyroid storm from excess thyroid hormone

Correct Incorrect Correct answer

Diabetic ketoacidosis from insulin deficiency

Correct Incorrect Correct answer

Adrenal crisis from glucocorticoid withdrawal

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 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

Correct Incorrect Correct answer

Hyponatremia from excessive water intake

Correct Incorrect Correct answer

Hypocalcemia from vitamin D deficiency

Correct Incorrect Correct answer

Hypomagnesemia from malabsorption

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

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

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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

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Physically force the patient onto the stretcher without consulting medical control

Correct Incorrect Correct answer

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

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 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

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

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 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 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

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Naloxone 2 mg IV push

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Magnesium sulfate 2 g IV over 10 minutes

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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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

No supplemental oxygen needed since SpO2 is above 94%

Correct Incorrect Correct answer

Room air only with close monitoring of SpO2 trends

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Acute pancreatitis

Correct Incorrect Correct answer

Ruptured appendix with peritonitis

Correct Incorrect Correct answer

Gastroesophageal reflux disease

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 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

Correct Incorrect Correct answer

Retinal detachment presenting with painless vision loss

Correct Incorrect Correct answer

Acute angle-closure glaucoma requiring emergent treatment

Correct Incorrect Correct answer

Central retinal artery occlusion from an embolus

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

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 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

Correct Incorrect Correct answer

Hyponatremia

Correct Incorrect Correct answer

Hypocalcemia

Correct Incorrect Correct answer

Hypomagnesemia

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Hepatic encephalopathy from liver failure

Correct Incorrect Correct answer

Hyperthyroidism from excessive thyroid hormone production

Correct Incorrect Correct answer

Adrenal insufficiency from cortisol deficiency

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

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Oral glucose 15 g buccally

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Epinephrine 1 mg subcutaneously

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Hemophilia; avoid unnecessary interventions and transport gently

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

The naloxone is expired and should be discarded

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Intranasal naloxone is always ineffective and only IV naloxone works

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

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Creatine kinase (CK-MB)

Correct Incorrect Correct answer

Lactate dehydrogenase (LDH)

Correct Incorrect Correct answer

Brain natriuretic peptide (BNP)

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Epinephrine masks symptoms but does not treat the underlying allergic response

Correct Incorrect Correct answer

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)

Correct Incorrect Correct answer

Myxedema coma from hypothyroidism

Correct Incorrect Correct answer

Pheochromocytoma crisis

Correct Incorrect Correct answer

Adrenal crisis from cortisol deficiency

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

A normal variant caused by iron supplement use only

Correct Incorrect Correct answer

A sign of hepatic encephalopathy from liver failure

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 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

Correct Incorrect Correct answer

Threatened miscarriage requiring bed rest and reassurance

Correct Incorrect Correct answer

Urinary tract infection causing referred abdominal pain

Correct Incorrect Correct answer

Round ligament pain from early pregnancy stretching

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

The patient is likely allergic to warfarin and needs immediate discontinuation

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 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 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

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

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 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 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

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

Polypharmacy

Correct Incorrect Correct answer

Drug tolerance

Correct Incorrect Correct answer

Therapeutic index

Correct Incorrect Correct answer

Bioavailability

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Normal red blood cells are being destroyed by autoimmune antibodies

Correct Incorrect Correct answer

A bacterial infection is directly attacking the bone marrow

Correct Incorrect Correct answer

Excessive iron deposition from repeated blood transfusions is damaging organs

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

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

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

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

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

RACE (Rapid Arterial oCclusion Evaluation) scale

Correct Incorrect Correct answer

Cincinnati Prehospital Stroke Scale

Correct Incorrect Correct answer

Glasgow Coma Scale

Correct Incorrect Correct answer

NIH Stroke Scale

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Restrain the patient to prevent injury if another seizure occurs

Correct Incorrect Correct answer

Administer a benzodiazepine to prevent a second seizure from occurring

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Potassium chloride intravenously

Correct Incorrect Correct answer

Magnesium sulfate intravenously

Correct Incorrect Correct answer

Sodium chloride 0.9% as a rapid bolus

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Pack the vagina with sterile gauze to tamponade the bleeding

Correct Incorrect Correct answer

Apply an abdominal pressure dressing over the uterus

Correct Incorrect Correct answer

Elevate the patient's legs and apply the MAST garment

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

Correct Incorrect Correct answer

Refuse to enter the residence due to infectious disease risk

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Administer antibiotics from your drug kit to treat the respiratory infection

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

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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

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

Correct Incorrect Correct answer

Deficiency of serotonin in the limbic system

Correct Incorrect Correct answer

Excess acetylcholine at the neuromuscular junction

Correct Incorrect Correct answer

Deficiency of norepinephrine in the cerebral cortex

Correct Incorrect Correct answer

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)

Correct Incorrect Correct answer

Acute mesenteric ischemia

Correct Incorrect Correct answer

Perforated duodenal ulcer

Correct Incorrect Correct answer

Acute pancreatitis

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

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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

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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

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

Correct Incorrect Correct answer

Croup; administer nebulized epinephrine and humidified oxygen

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

Allergic reaction; administer epinephrine 0.15 mg IM immediately

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 patient with stable monomorphic ventricular tachycardia who has not responded to amiodarone. The medical direction physician orders procainamide. What is the most important adverse effect to monitor for during procainamide administration?

Hypotension due to vasodilation and negative inotropic effects

Correct Incorrect Correct answer

Bronchospasm due to histamine release from mast cells

Correct Incorrect Correct answer

Hyperglycemia due to stimulation of hepatic glucose production

Correct Incorrect Correct answer

Seizures due to central nervous system excitation

Correct Incorrect Correct answer

Which AV block is characterized by a progressive lengthening of the PR interval until a P wave fails to conduct, followed by a return to a shorter PR interval?

Second-degree type I (Wenckebach) AV block

Correct Incorrect Correct answer

First-degree AV block

Correct Incorrect Correct answer

Second-degree type II (Mobitz) AV block

Correct Incorrect Correct answer

Third-degree (complete) AV block

Correct Incorrect Correct answer

On a standard 12-lead ECG, which leads view the lateral wall of the left ventricle?

Leads I, aVL, V5, and V6

Correct Incorrect Correct answer

Leads II, III, and aVF

Correct Incorrect Correct answer

Leads V1, V2, V3, and V4

Correct Incorrect Correct answer

Leads aVR, V1, and V2

Correct Incorrect Correct answer

A 72-year-old male with end-stage renal disease presents with generalized weakness. His ECG shows tall, peaked, narrow-based T waves, a widened QRS complex, and a flattened P wave. His potassium level from a recent lab draw is reported as 7.2 mEq/L. Which ECG change indicates the most imminent risk of cardiac arrest?

The widened QRS complex, which can progress to a sine wave pattern and cardiac arrest

Correct Incorrect Correct answer

The peaked T waves, which are a benign early finding that rarely progresses

Correct Incorrect Correct answer

The flattened P waves, which indicate atrial standstill without ventricular risk

Correct Incorrect Correct answer

The elevated potassium level alone, since ECG changes do not correlate with arrhythmia risk

Correct Incorrect Correct answer

What is the recommended compression-to-ventilation ratio for two-rescuer CPR in an infant?

15 compressions to 2 ventilations

Correct Incorrect Correct answer

30 compressions to 2 ventilations

Correct Incorrect Correct answer

5 compressions to 1 ventilation

Correct Incorrect Correct answer

Continuous compressions with asynchronous ventilations

Correct Incorrect Correct answer

A 48-year-old male presents with palpitations and lightheadedness. His ECG shows a short PR interval, a slurred upstroke at the beginning of the QRS complex, and a widened QRS. Which condition does this ECG pattern represent?

Wolff-Parkinson-White (WPW) syndrome

Correct Incorrect Correct answer

Left bundle branch block

Correct Incorrect Correct answer

First-degree AV block

Correct Incorrect Correct answer

Brugada syndrome

Correct Incorrect Correct answer

What is the correct compression-to-ventilation ratio for two-rescuer infant CPR performed by healthcare providers?

15:2

Correct Incorrect Correct answer

30:2

Correct Incorrect Correct answer

5:1

Correct Incorrect Correct answer

10:2

Correct Incorrect Correct answer

Which of the following is a key component of targeted temperature management (TTM) in post-cardiac arrest care?

Maintaining a target core temperature between 32 C and 36 C for at least 24 hours

Correct Incorrect Correct answer

Actively rewarming the patient to 38 C as quickly as possible

Correct Incorrect Correct answer

Applying ice packs only to the groin and axillae for 6 hours

Correct Incorrect Correct answer

Cooling the patient only if they regain consciousness within 30 minutes of ROSC

Correct Incorrect Correct answer

A paramedic prepares to cardiovert a conscious patient with unstable SVT. What should be administered before delivering the shock?

Procedural sedation with a medication such as midazolam or etomidate to reduce pain and anxiety

Correct Incorrect Correct answer

Adenosine 12 mg IV push as a final pharmacological attempt before electricity

Correct Incorrect Correct answer

Aspirin 324 mg chewed as a cardioprotective measure before the shock

Correct Incorrect Correct answer

Atropine 0.5 mg IV to prevent the heart rate from dropping too low after cardioversion

Correct Incorrect Correct answer

What is the recommended compression depth for an infant during CPR?

Approximately 1.5 inches (4 cm)

Correct Incorrect Correct answer

Approximately 1 inch (2.5 cm)

Correct Incorrect Correct answer

Approximately 2 inches (5 cm)

Correct Incorrect Correct answer

Approximately 2.5 inches (6 cm)

Correct Incorrect Correct answer

Why must the defibrillator be placed in ‘sync’ mode before performing cardioversion on a patient with an organized tachyarrhythmia?

Sync mode times the shock to the R wave to avoid delivering energy during the vulnerable period of the cardiac cycle, which could induce ventricular fibrillation

Correct Incorrect Correct answer

Sync mode reduces the energy output by half to protect the myocardium from damage

Correct Incorrect Correct answer

Sync mode ensures the shock is delivered during the T wave for maximum effectiveness

Correct Incorrect Correct answer

Sync mode pauses the shock delivery for 10 seconds to allow for patient sedation

Correct Incorrect Correct answer

A 12-lead ECG shows ST elevation in leads V1 through V4 with reciprocal ST depression in leads II, III, and aVF. Which type of myocardial infarction is indicated?

Anterior wall STEMI, most likely from left anterior descending artery occlusion

Correct Incorrect Correct answer

Inferior wall STEMI from right coronary artery occlusion

Correct Incorrect Correct answer

Lateral wall STEMI from left circumflex artery occlusion

Correct Incorrect Correct answer

Posterior wall STEMI from posterior descending artery occlusion

Correct Incorrect Correct answer

A patient with atrial fibrillation and rapid ventricular response has a heart rate of 170 bpm, blood pressure of 80/50 mmHg, and altered mental status. The paramedic prepares for synchronized cardioversion. What is the recommended initial energy setting for a biphasic defibrillator?

120 to 200 joules biphasic (or follow the manufacturer's recommendation)

Correct Incorrect Correct answer

50 joules biphasic for all supraventricular rhythms

Correct Incorrect Correct answer

360 joules biphasic as the standard first energy setting

Correct Incorrect Correct answer

10 joules biphasic starting at the lowest available setting

Correct Incorrect Correct answer

Which 12-lead ECG finding meets the standard criteria for STEMI activation in a patient with chest pain?

ST elevation of 1 mm or greater in two or more contiguous leads

Correct Incorrect Correct answer

ST elevation in any single lead regardless of amplitude

Correct Incorrect Correct answer

ST depression of 2 mm or greater in leads V1 through V3

Correct Incorrect Correct answer

T-wave inversion in three or more noncontiguous leads

Correct Incorrect Correct answer

Which ECG finding is most consistent with left ventricular hypertrophy?

Tall R waves in the left-sided leads (V5, V6) and deep S waves in the right-sided leads (V1, V2) meeting voltage criteria

Correct Incorrect Correct answer

Tall, peaked P waves in lead II exceeding 2.5 mm

Correct Incorrect Correct answer

RSR' pattern in lead V1 with a widened QRS

Correct Incorrect Correct answer

Low voltage QRS complexes across all leads

Correct Incorrect Correct answer

Following ROSC in a cardiac arrest patient, the 12-lead ECG shows ST elevation in leads V1 through V4. The patient remains comatose. What is the most appropriate transport destination and why?

A hospital with both PCI capability and targeted temperature management, because the patient needs emergent catheterization and neuroprotective cooling

Correct Incorrect Correct answer

The closest emergency department regardless of capabilities for immediate stabilization

Correct Incorrect Correct answer

A hospital with a neurology department for brain injury evaluation only

Correct Incorrect Correct answer

A cardiac rehabilitation center for post-arrest recovery planning

Correct Incorrect Correct answer

What is the most common initial rhythm in pediatric cardiac arrest?

Asystole or pulseless electrical activity (non-shockable rhythms)

Correct Incorrect Correct answer

Ventricular fibrillation

Correct Incorrect Correct answer

Pulseless ventricular tachycardia

Correct Incorrect Correct answer

Supraventricular tachycardia with loss of pulses

Correct Incorrect Correct answer

On a 12-lead ECG, ST segment elevation in leads V1 through V4 is most consistent with which finding?

Anterior wall STEMI

Correct Incorrect Correct answer

Inferior wall STEMI

Correct Incorrect Correct answer

Lateral wall STEMI

Correct Incorrect Correct answer

Right ventricular MI

Correct Incorrect Correct answer

You are transporting a patient with a known new LBBB and acute chest pain. The standard 12-lead ECG shows ST elevation in leads with a predominantly positive QRS complex (V5, V6, I, aVL). Per the Sgarbossa criteria, when is ST elevation in the setting of LBBB most suggestive of an acute MI?

When there is concordant ST elevation of 1 mm or greater (ST elevation in the same direction as the QRS complex)

Correct Incorrect Correct answer

When there is discordant ST elevation of any amount in leads with a negative QRS

Correct Incorrect Correct answer

When the ST segment is isoelectric in all precordial leads

Correct Incorrect Correct answer

When the T waves are upright in leads with a predominantly negative QRS

Correct Incorrect Correct answer

On a 12-lead ECG, T-wave inversions in the precordial leads of a patient with recent chest pain are most suggestive of which condition?

Myocardial ischemia

Correct Incorrect Correct answer

Acute pericarditis

Correct Incorrect Correct answer

Hyperkalemia

Correct Incorrect Correct answer

Digitalis toxicity

Correct Incorrect Correct answer

On a 12-lead ECG, which set of leads are considered contiguous leads representing the inferior wall of the heart?

Leads II, III, and aVF

Correct Incorrect Correct answer

Leads I, aVL, and V6

Correct Incorrect Correct answer

Leads V1, V2, and V3

Correct Incorrect Correct answer

Leads V4, V5, and V6

Correct Incorrect Correct answer

During the resuscitation of a 5-year-old child, peripheral IV access cannot be obtained after two attempts. What is the most appropriate next step for vascular access?

Establish intraosseous (IO) access in the proximal tibia

Correct Incorrect Correct answer

Attempt a central venous catheter in the internal jugular vein

Correct Incorrect Correct answer

Continue peripheral IV attempts in the upper extremity for up to 10 minutes

Correct Incorrect Correct answer

Administer all medications via the endotracheal tube route

Correct Incorrect Correct answer

A 28-year-old female presents with palpitations after drinking multiple energy drinks. Her ECG shows a normal sinus rhythm with a QTc interval of 540 ms. She has a family history of sudden cardiac death. Which risk does this ECG finding primarily indicate?

Increased risk of torsades de pointes and ventricular fibrillation

Correct Incorrect Correct answer

Increased risk of atrial fibrillation with rapid ventricular response

Correct Incorrect Correct answer

Increased risk of complete heart block

Correct Incorrect Correct answer

Increased risk of aortic dissection

Correct Incorrect Correct answer

Which ECG finding is characteristic of a left bundle branch block (LBBB)?

Wide QRS complex greater than 120 ms with a broad, notched R wave in leads I and V6

Correct Incorrect Correct answer

Narrow QRS complex with a short PR interval and delta wave

Correct Incorrect Correct answer

Wide QRS complex with an RSR' pattern in lead V1

Correct Incorrect Correct answer

Normal QRS width with ST elevation in leads V1 through V4

Correct Incorrect Correct answer

On a 12-lead ECG, P-wave amplitude greater than 2.5 mm in lead II or a biphasic P wave with a prominent initial positive deflection in V1 is most consistent with which finding?

Right atrial enlargement

Correct Incorrect Correct answer

Left atrial enlargement

Correct Incorrect Correct answer

First-degree AV block

Correct Incorrect Correct answer

Junctional rhythm

Correct Incorrect Correct answer

Which ECG finding is most characteristic of hyperkalemia?

Tall, peaked, narrow-based T waves

Correct Incorrect Correct answer

ST elevation with concave morphology in all leads

Correct Incorrect Correct answer

Prolonged QT interval with flattened T waves

Correct Incorrect Correct answer

Delta waves with a shortened PR interval

Correct Incorrect Correct answer

A cardiac monitor shows a regular, narrow-complex tachycardia at a rate of 180 bpm with no visible P waves. The patient is stable with a blood pressure of 120/80 mmHg. What is the most likely rhythm?

Supraventricular tachycardia (SVT)

Correct Incorrect Correct answer

Ventricular tachycardia

Correct Incorrect Correct answer

Sinus tachycardia

Correct Incorrect Correct answer

Atrial flutter with 1:1 conduction

Correct Incorrect Correct answer

In post-cardiac arrest care, why should hyperoxia be avoided in the patient who has achieved ROSC?

Excessive oxygen administration after ROSC can increase free radical production and worsen reperfusion injury to the brain and myocardium

Correct Incorrect Correct answer

High-flow oxygen causes bronchospasm in all post-arrest patients

Correct Incorrect Correct answer

Supplemental oxygen interferes with the effectiveness of vasopressor medications

Correct Incorrect Correct answer

Hyperoxia causes the pulse oximeter to malfunction and give falsely low readings

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, and aVF with ST depression in leads I and aVL. What do the ST changes in leads I and aVL represent?

Reciprocal changes confirming an acute inferior STEMI

Correct Incorrect Correct answer

A concurrent lateral wall infarction

Correct Incorrect Correct answer

Artifact from poor lead placement

Correct Incorrect Correct answer

Evidence of a prior anterior MI

Correct Incorrect Correct answer

A patient presents with dizziness, a heart rate of 34 bpm, and a blood pressure of 78/50 mmHg. The ECG shows P waves and QRS complexes occurring independently of each other, with a regular P-P interval and a regular R-R interval. What rhythm is present?

Third-degree (complete) AV block

Correct Incorrect Correct answer

Second-degree type I (Wenckebach) AV block

Correct Incorrect Correct answer

Second-degree type II (Mobitz) AV block

Correct Incorrect Correct answer

Sinus bradycardia with first-degree AV block

Correct Incorrect Correct answer

According to the ACLS bradycardia algorithm, what is the first-line medication for symptomatic bradycardia?

Atropine 1 mg IV, repeated every 3 to 5 minutes to a maximum of 3 mg

Correct Incorrect Correct answer

Epinephrine 1 mg IV push, repeated every 3 to 5 minutes

Correct Incorrect Correct answer

Amiodarone 300 mg IV bolus

Correct Incorrect Correct answer

Lidocaine 1 to 1.5 mg/kg IV push

Correct Incorrect Correct answer

A patient presents with a wide-complex tachycardia at 160 bpm. The patient is diaphoretic, confused, and has a blood pressure of 74/40 mmHg. What is the most appropriate immediate intervention?

Immediate synchronized cardioversion, with sedation if the patient's condition permits a brief delay

Correct Incorrect Correct answer

Adenosine 6 mg rapid IV push to differentiate SVT with aberrancy from VT

Correct Incorrect Correct answer

Amiodarone 150 mg IV over 10 minutes while continuing to monitor

Correct Incorrect Correct answer

Vagal maneuvers followed by procainamide infusion if unsuccessful

Correct Incorrect Correct answer

Left axis deviation on a 12-lead ECG is defined as a QRS axis between which values?

Negative 30 degrees to negative 90 degrees

Correct Incorrect Correct answer

0 degrees to positive 90 degrees

Correct Incorrect Correct answer

Positive 90 degrees to positive 180 degrees

Correct Incorrect Correct answer

Negative 90 degrees to negative 180 degrees

Correct Incorrect Correct answer

A 59-year-old female presents with chest pain and nausea. Her standard 12-lead ECG shows ST depression in leads V1 through V3 with tall R waves in V1 and V2. You suspect a posterior MI. Which additional leads should be placed to evaluate this?

Leads V7, V8, and V9 placed on the posterior chest wall

Correct Incorrect Correct answer

Right-sided leads V3R through V6R

Correct Incorrect Correct answer

High lateral leads placed one intercostal space above V1 and V2

Correct Incorrect Correct answer

Lewis lead placed at the right sternal border

Correct Incorrect Correct answer

A 66-year-old female presents with chest pressure lasting 3 hours. Her 12-lead ECG shows ST depression in leads V1 through V4 and T-wave inversions in leads I and aVL, without any ST elevation. She has ongoing pain and a troponin level reported from the sending facility as elevated. How should the paramedic differentiate this presentation from a STEMI?

This presentation is consistent with NSTEMI (ischemia without ST elevation), which does not meet criteria for emergent catheterization lab activation but still requires urgent transport and treatment

Correct Incorrect Correct answer

ST depression is equivalent to ST elevation, so this should be treated identically as a STEMI

Correct Incorrect Correct answer

The absence of ST elevation rules out any form of acute coronary syndrome

Correct Incorrect Correct answer

T-wave inversions with ST depression always indicate a chronic, stable condition that is not time-sensitive

Correct Incorrect Correct answer

On a 12-lead ECG, what does J-point elevation refer to?

Elevation of the junction between the end of the QRS complex and the beginning of the ST segment

Correct Incorrect Correct answer

Elevation of the peak of the T wave above the baseline

Correct Incorrect Correct answer

Elevation of the PR segment above the isoelectric line

Correct Incorrect Correct answer

Elevation of the P wave amplitude above normal limits

Correct Incorrect Correct answer

Which mnemonic identifies the reversible causes of cardiac arrest that should be systematically evaluated during a resuscitation?

The Hs and Ts

Correct Incorrect Correct answer

The ABCDEs of primary survey

Correct Incorrect Correct answer

The SAMPLE history mnemonic

Correct Incorrect Correct answer

The OPQRST pain assessment

Correct Incorrect Correct answer

A patient presents with a regular, narrow-complex tachycardia at 190 bpm. The patient is stable with a blood pressure of 118/76 mmHg. Vagal maneuvers have been attempted without success. What is the next recommended treatment per ACLS guidelines?

Adenosine 6 mg rapid IV push followed by a 20 mL saline flush, administered at the most proximal IV site available

Correct Incorrect Correct answer

Immediate synchronized cardioversion at 50 joules

Correct Incorrect Correct answer

Amiodarone 150 mg IV over 10 minutes

Correct Incorrect Correct answer

Diltiazem 0.25 mg/kg slow IV push over 2 minutes

Correct Incorrect Correct answer

Which of the following is an indication for transcutaneous pacing in the prehospital setting?

Symptomatic bradycardia unresponsive to atropine

Correct Incorrect Correct answer

Stable sinus bradycardia at 55 bpm in an asymptomatic athlete

Correct Incorrect Correct answer

Atrial fibrillation with rapid ventricular response and hypotension

Correct Incorrect Correct answer

Ventricular fibrillation refractory to defibrillation and epinephrine

Correct Incorrect Correct answer

A 3-year-old child is in cardiac arrest with a shockable rhythm (ventricular fibrillation). What is the correct initial defibrillation energy dose?

2 joules per kilogram of body weight

Correct Incorrect Correct answer

4 joules per kilogram of body weight

Correct Incorrect Correct answer

50 joules regardless of weight

Correct Incorrect Correct answer

120 joules as the standard biphasic dose

Correct Incorrect Correct answer

A patient in cardiac arrest has been receiving high-quality CPR with an ETCO2 of 18 mmHg. During the next rhythm check, the ETCO2 suddenly rises to 52 mmHg. What is the most likely explanation?

Return of spontaneous circulation (ROSC)

Correct Incorrect Correct answer

The endotracheal tube has become dislodged from the trachea

Correct Incorrect Correct answer

The patient has developed a tension pneumothorax

Correct Incorrect Correct answer

The capnography equipment is malfunctioning

Correct Incorrect Correct answer

A 55-year-old male with a history of COPD and cor pulmonale has a 12-lead ECG showing right axis deviation with a dominant R wave in V1 and a deep S wave in V6. Which underlying condition is most likely responsible for these findings?

Right ventricular hypertrophy secondary to chronic pulmonary disease

Correct Incorrect Correct answer

Left ventricular hypertrophy from chronic hypertension

Correct Incorrect Correct answer

Wolff-Parkinson-White syndrome with right-sided accessory pathway

Correct Incorrect Correct answer

Anterior septal MI with Q waves in V1

Correct Incorrect Correct answer

A 32-year-old male with no cardiac history presents after a syncopal episode. His ECG shows a coved ST segment elevation in leads V1 through V3 with T-wave inversion, and normal QRS duration. He is currently asymptomatic with normal vital signs. Which condition should the paramedic suspect?

Brugada syndrome

Correct Incorrect Correct answer

Anterior STEMI

Correct Incorrect Correct answer

Right bundle branch block

Correct Incorrect Correct answer

Early repolarization

Correct Incorrect Correct answer

A 22-year-old athletic male presents for an unrelated complaint. His 12-lead ECG shows J-point elevation with concave upward ST segments in the precordial leads, no reciprocal changes, and a normal heart rate. He is completely asymptomatic. Which interpretation is most likely?

Early repolarization, a benign normal variant commonly seen in young adults

Correct Incorrect Correct answer

Acute anterior STEMI requiring emergent catheterization lab activation

Correct Incorrect Correct answer

Acute pericarditis requiring anti-inflammatory therapy

Correct Incorrect Correct answer

Brugada pattern requiring immediate defibrillator evaluation

Correct Incorrect Correct answer

A patient’s 12-lead ECG shows ST depression in leads V1 through V3. The paramedic suspects a posterior MI. Which additional action would confirm this suspicion?

Obtain posterior leads (V7, V8, V9) looking for ST elevation

Correct Incorrect Correct answer

Obtain right-sided leads (V3R, V4R) looking for ST elevation

Correct Incorrect Correct answer

Repeat the standard 12-lead ECG in 15 minutes to confirm the findings

Correct Incorrect Correct answer

Administer nitroglycerin and reassess the ECG for changes

Correct Incorrect Correct answer

What is the mechanism of action of adenosine when used to treat supraventricular tachycardia?

It transiently blocks conduction through the AV node, interrupting the reentrant circuit

Correct Incorrect Correct answer

It directly stimulates the vagus nerve to slow the heart rate

Correct Incorrect Correct answer

It blocks calcium channels in the sinoatrial node to reduce automaticity

Correct Incorrect Correct answer

It inhibits sodium channels to slow ventricular conduction velocity

Correct Incorrect Correct answer

What is the standard dose and route of epinephrine administered during adult cardiac arrest?

1 mg of the 1:10,000 (0.1 mg/mL) concentration IV/IO every 3 to 5 minutes

Correct Incorrect Correct answer

0.3 mg of the 1:1,000 (1 mg/mL) concentration intramuscularly every 15 minutes

Correct Incorrect Correct answer

0.5 mg of the 1:10,000 (0.1 mg/mL) concentration subcutaneously every 5 minutes

Correct Incorrect Correct answer

2 mg of the 1:1,000 (1 mg/mL) concentration IV push every 10 minutes

Correct Incorrect Correct answer

A paramedic crew achieves ROSC on a 70-year-old female after 25 minutes of resuscitation for PEA arrest. She remains comatose with fixed, dilated pupils, no corneal reflexes, and no motor response. Vitals are stable on vasopressors. The family asks about her chances of recovery. What is the most appropriate response?

Explain that neurological prognostication cannot be reliably determined in the field and should be performed by the hospital team after at least 72 hours

Correct Incorrect Correct answer

Inform the family that fixed, dilated pupils after arrest indicate brain death and recovery is impossible

Correct Incorrect Correct answer

Tell the family that most cardiac arrest patients who achieve ROSC make a full neurological recovery

Correct Incorrect Correct answer

Advise the family that resuscitation should be discontinued since the prolonged downtime makes survival unlikely

Correct Incorrect Correct answer

When using a length-based resuscitation tape to estimate the weight of a pediatric patient, which body landmark determines the correct measurement zone?

The tape is measured from the top of the head to the heel with the child lying supine

Correct Incorrect Correct answer

The tape is measured from the chin to the navel with the child lying supine

Correct Incorrect Correct answer

The tape is wrapped around the child's mid-upper arm circumference

Correct Incorrect Correct answer

The tape is measured from the shoulder to the fingertip with the arm extended

Correct Incorrect Correct answer

A patient achieves ROSC after a prolonged cardiac arrest. The blood pressure is 82/50 mmHg despite a 500 mL normal saline bolus. What vasopressor is most appropriate to maintain hemodynamic stability?

Initiate a vasopressor infusion (such as norepinephrine or dopamine) per local protocol

Correct Incorrect Correct answer

Administer another 1 mg epinephrine IV push per the cardiac arrest protocol

Correct Incorrect Correct answer

Start a low-dose dopamine infusion at 2 mcg/kg/min for renal protection

Correct Incorrect Correct answer

Administer a 1-liter crystalloid bolus and reassess blood pressure

Correct Incorrect Correct answer

A patient with ROSC after cardiac arrest is being transported. The monitor shows a new onset of a wide complex tachycardia at 160 bpm. The patient has a palpable pulse and blood pressure of 82/54 mmHg. He is comatose. What is the most appropriate intervention?

Perform synchronized cardioversion

Correct Incorrect Correct answer

Administer adenosine 6 mg rapid IV push

Correct Incorrect Correct answer

Deliver an unsynchronized defibrillation shock

Correct Incorrect Correct answer

Administer atropine 0.5 mg IV

Correct Incorrect Correct answer

What is the typical starting milliampere (mA) output when initiating transcutaneous pacing for symptomatic bradycardia?

Start at the minimum output and increase until electrical capture is achieved

Correct Incorrect Correct answer

Set the output to 200 mA and maintain that level throughout transport

Correct Incorrect Correct answer

Begin at 100 mA and decrease until the patient reports reduced discomfort

Correct Incorrect Correct answer

Set the output at 50 mA regardless of whether capture is observed

Correct Incorrect Correct answer

A 72-year-old male presents with dizziness, a heart rate of 34, and a blood pressure of 78/50 mmHg. The monitor shows a complete AV dissociation with no relationship between P waves and QRS complexes. Atropine has been administered without improvement. What is the most appropriate next intervention?

Initiate transcutaneous pacing

Correct Incorrect Correct answer

Perform synchronized cardioversion at 100 joules

Correct Incorrect Correct answer

Administer a second dose of atropine 1 mg IV

Correct Incorrect Correct answer

Start a dopamine infusion at 2 mcg/kg/min

Correct Incorrect Correct answer

A paramedic is managing a patient with an anterior STEMI and a blood pressure of 160/100 mmHg. After aspirin has been administered, which medication should be given next, assuming no contraindications?

Nitroglycerin 0.4 mg sublingual to reduce preload and relieve chest pain

Correct Incorrect Correct answer

Metoprolol 5 mg IV to immediately reduce heart rate and myocardial oxygen demand

Correct Incorrect Correct answer

Morphine 4 mg IV as the first-line analgesic for acute MI pain

Correct Incorrect Correct answer

Amiodarone 150 mg IV prophylactically to prevent ventricular arrhythmias

Correct Incorrect Correct answer

A paramedic is transporting a 68-year-old patient with a stable second-degree type II AV block at a rate of 52 beats per minute. The blood pressure is 118/74 mmHg and the patient is asymptomatic. Medical control advises standby pacing. What does this directive mean?

Apply pacing pads and have the pacer ready but do not initiate pacing unless the patient becomes symptomatic or hemodynamically unstable

Correct Incorrect Correct answer

Initiate pacing at 60 beats per minute and titrate to maintain a systolic blood pressure above 100 mmHg

Correct Incorrect Correct answer

Apply pacing pads and begin pacing at the lowest mA output to maintain demand sensing

Correct Incorrect Correct answer

Place the pacing pads but set the device to fixed mode at 80 beats per minute in case of sudden deterioration

Correct Incorrect Correct answer

A 64-year-old male with chest pain has a 12-lead ECG showing ST elevation in leads II, III, and aVF. You suspect right ventricular involvement. Which additional lead placement should you obtain to confirm this suspicion?

Right-sided V4R lead

Correct Incorrect Correct answer

Posterior leads V7 through V9

Correct Incorrect Correct answer

Repeat standard 12-lead with limb leads repositioned

Correct Incorrect Correct answer

Lewis lead configuration

Correct Incorrect Correct answer

During a cardiac arrest resuscitation, the patient is in pulseless ventricular tachycardia. Two defibrillation attempts and epinephrine have been administered. What antiarrhythmic should be considered next?

Amiodarone 300 mg IV/IO bolus

Correct Incorrect Correct answer

Atropine 1 mg IV push

Correct Incorrect Correct answer

Adenosine 6 mg rapid IV push

Correct Incorrect Correct answer

Diltiazem 20 mg slow IV push

Correct Incorrect Correct answer

A patient with symptomatic third-degree heart block is unresponsive to atropine. The paramedic initiates transcutaneous pacing at a rate of 70 bpm. The milliamp output is gradually increased from 0 mA. At 65 mA, pacer spikes appear on the monitor with corresponding wide QRS complexes, but the patient has no palpable pulse. What should the paramedic do?

Continue increasing the milliamp output because electrical capture has occurred but mechanical capture has not yet been achieved

Correct Incorrect Correct answer

Stop pacing because the presence of QRS complexes confirms adequate cardiac output

Correct Incorrect Correct answer

Decrease the pacing rate to 40 bpm to allow the heart's native rhythm to take over

Correct Incorrect Correct answer

Discontinue pacing and begin CPR because pulseless electrical activity is present

Correct Incorrect Correct answer

A 60-year-old female presents with acute chest pain. Her 12-lead ECG shows ST elevation in leads V3 and V4, with ST depression in leads II, III, and aVF. A colleague suggests the ST depression is simply a baseline artifact. How should you interpret the ST depression?

The ST depression represents reciprocal changes that support the diagnosis of an acute anterior STEMI

Correct Incorrect Correct answer

The ST depression is a normal finding unrelated to the anterior ST elevation

Correct Incorrect Correct answer

The ST depression indicates a concurrent inferior NSTEMI requiring additional treatment

Correct Incorrect Correct answer

The ST depression is caused by lead misplacement and the ECG should be repeated before any interpretation

Correct Incorrect Correct answer

During high-performance CPR, what is the recommended compression fraction goal, and why is it important?

At least 80%, to maintain coronary and cerebral perfusion

Correct Incorrect Correct answer

At least 60%, as this allows adequate time for rhythm analysis

Correct Incorrect Correct answer

At least 90%, to maximize continuous blood flow to the brain

Correct Incorrect Correct answer

At least 50%, as frequent ventilation pauses are equally important

Correct Incorrect Correct answer

An ECG rhythm strip shows an irregularly irregular rhythm with no discernible P waves and a ventricular rate of 130 bpm. Which rhythm is this most consistent with?

Atrial fibrillation with rapid ventricular response

Correct Incorrect Correct answer

Atrial flutter with variable block

Correct Incorrect Correct answer

Multifocal atrial tachycardia

Correct Incorrect Correct answer

Sinus arrhythmia with premature atrial complexes

Correct Incorrect Correct answer

A 24-year-old male presents with sharp chest pain that worsens with deep breathing and lying flat but improves when leaning forward. His ECG shows diffuse ST elevation in multiple lead groups that do not follow a single coronary artery distribution, along with PR segment depression in lead II. Which diagnosis is most consistent with these findings?

Acute pericarditis

Correct Incorrect Correct answer

Multivessel STEMI

Correct Incorrect Correct answer

Aortic dissection with coronary involvement

Correct Incorrect Correct answer

Takotsubo cardiomyopathy

Correct Incorrect Correct answer

Which of the following is a primary goal of post-resuscitation hemodynamic optimization?

Maintain a systolic blood pressure of at least 90 mmHg or a mean arterial pressure of at least 65 mmHg

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Achieve a systolic blood pressure above 180 mmHg to ensure cerebral perfusion

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Maintain a heart rate below 60 bpm with beta-blocker therapy

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Target a central venous pressure above 20 mmHg with aggressive fluid loading

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A 58-year-old female with a history of heart failure presents with worsening dyspnea, bilateral crackles, and a blood pressure of 110/72 mmHg. The monitor shows sinus tachycardia at 118 bpm. She has an IV established and the paramedic is considering inotropic support. Why is dobutamine preferred over dopamine in this patient?

Dobutamine increases cardiac contractility with less vasoconstriction and tachycardia than dopamine

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Dobutamine raises blood pressure more effectively through peripheral vasoconstriction

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Dobutamine has a longer half-life that provides more sustained hemodynamic support

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Dobutamine stimulates dopaminergic receptors to improve renal perfusion

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Which ECG characteristics define a normal sinus rhythm?

Regular rhythm with a rate of 60 to 100 bpm, upright P waves before each QRS, and a consistent PR interval of 0.12 to 0.20 seconds

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Regular rhythm with a rate of 40 to 60 bpm, upright P waves, and a PR interval greater than 0.20 seconds

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Irregular rhythm with a rate of 60 to 100 bpm, variable P wave morphology, and narrow QRS complexes

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Regular rhythm with a rate of 100 to 150 bpm, absent P waves, and a QRS duration greater than 0.12 seconds

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A patient in cardiac arrest has been in refractory ventricular fibrillation despite three defibrillation attempts, epinephrine, and amiodarone. The paramedic suspects hyperkalemia based on the patient’s dialysis history and peaked T waves noted before arrest. Which medication should be administered?

Sodium bicarbonate 1 mEq/kg IV

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Lidocaine 1.5 mg/kg IV

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Magnesium sulfate 2 g IV

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Procainamide 20 mg/min IV infusion

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A paramedic has initiated transcutaneous pacing at a rate of 70 bpm on a patient with third-degree heart block. The monitor shows pacing spikes followed by wide QRS complexes. However, the patient remains pulseless. What is the most appropriate action?

Increase the milliampere output until mechanical capture is confirmed by a palpable pulse

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Increase the pacing rate to 120 bpm to improve cardiac output

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Accept the current settings since electrical capture has been achieved

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Discontinue pacing and begin CPR with standard cardiac arrest protocols

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During post-ROSC care of a 65-year-old male, the paramedic notes the following: BP 110/70 mmHg, HR 88 bpm, SpO2 96% on 40% FiO2, EtCO2 40 mmHg, and blood glucose of 48 mg/dL. Which intervention should be performed next?

Administer dextrose 50% (D50) intravenously to correct hypoglycemia

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Increase the FiO2 to 100% to improve cerebral oxygenation

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Administer an amiodarone bolus for rhythm stabilization

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Begin rapid cooling with cold IV saline boluses

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A newborn is delivered at 39 weeks gestation. The infant is not breathing, has a heart rate of 50 beats per minute, and appears cyanotic. Initial steps of warming, drying, and stimulation have been performed without improvement. After 30 seconds of effective positive pressure ventilation, the heart rate remains at 50 bpm. What is the most appropriate next intervention?

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

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Administer epinephrine 0.01 mg/kg via umbilical vein catheter

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Perform endotracheal intubation before any other intervention

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Increase the ventilation rate to 60 breaths per minute

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A paramedic is managing a patient in cardiogenic shock with a blood pressure of 78/50 mmHg and bilateral rales. The patient has IV access established. Which vasopressor is most appropriate for this presentation?

Norepinephrine infusion at 0.1 to 0.5 mcg/kg/min

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Dopamine infusion at 2 to 5 mcg/kg/min

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Epinephrine 1 mg IV push every 3 to 5 minutes

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Phenylephrine 100 mcg IV bolus

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A 9-month-old infant presents with a heart rate of 260 beats per minute on the cardiac monitor. The QRS complex is narrow, and P waves are not identifiable. The infant is irritable but has adequate perfusion and a blood pressure of 78/50 mmHg. What is the first pharmacologic intervention?

Adenosine 0.1 mg/kg rapid IV push followed by a saline flush

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Amiodarone 5 mg/kg IV over 20 minutes

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Synchronized cardioversion at 0.5 J/kg

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Verapamil 0.1 mg/kg slow IV push

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You are resuscitating a newborn who remains apneic and bradycardic at 45 bpm despite 60 seconds of coordinated chest compressions and ventilation through an endotracheal tube. IV access has not been established. What is the most appropriate next action?

Obtain emergency umbilical venous catheter access and administer epinephrine 0.01 to 0.03 mg/kg IV

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Administer epinephrine 0.1 mg/kg via the endotracheal tube

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Increase the compression rate to 150 per minute

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Administer atropine 0.02 mg/kg via the endotracheal tube

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A 62-year-old female has ROSC after cardiac arrest. She is intubated and being ventilated. Her end-tidal CO2 reads 28 mmHg. Blood pressure is 88/56 mmHg. Which adjustment should the paramedic prioritize?

Decrease the ventilation rate to allow EtCO2 to rise to 35 to 45 mmHg

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Increase the ventilation rate to further lower EtCO2 and reduce intracranial pressure

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Administer sodium bicarbonate to correct the low EtCO2

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Maintain the current ventilation rate since low EtCO2 indicates adequate ventilation

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A paramedic is treating a 72-year-old male with atrial fibrillation and a rapid ventricular response at 156 bpm. His blood pressure is 88/54 mmHg and he is confused with cool, diaphoretic skin. Why is verapamil contraindicated in this patient?

Verapamil causes vasodilation and myocardial depression that will worsen the existing hypotension

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Verapamil has no effect on atrial fibrillation with rapid ventricular response

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Verapamil is only available in oral form and cannot be given intravenously

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Verapamil converts atrial fibrillation to ventricular fibrillation

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A 6-year-old child weighing 20 kg is in cardiac arrest with pulseless ventricular tachycardia. What is the correct initial dose of epinephrine for this patient?

0.2 mg (0.01 mg/kg) of 1:10,000 concentration IV/IO

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1.0 mg of 1:10,000 concentration IV/IO

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0.2 mg (0.01 mg/kg) of 1:1,000 concentration IV/IO

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0.02 mg (0.001 mg/kg) of 1:10,000 concentration IV/IO

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During neonatal resuscitation, a full-term newborn has a heart rate of 80 bpm and irregular respiratory effort after initial steps. You are providing positive pressure ventilation with a bag-mask device. What ventilation rate should be delivered?

40 to 60 breaths per minute

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12 to 20 breaths per minute

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20 to 30 breaths per minute

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60 to 80 breaths per minute

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What is the typical intrinsic rate of a junctional escape rhythm?

40 to 60 beats per minute

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20 to 40 beats per minute

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60 to 80 beats per minute

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80 to 100 beats per minute

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A 72-year-old patient presents with syncope and a heart rate of 34 beats per minute. The ECG shows regular P waves and regular QRS complexes, but the P waves and QRS complexes have no consistent relationship to each other. Which rhythm is most likely?

Third-degree (complete) heart block

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Second-degree type I (Wenckebach)

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Second-degree type II

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Sinus bradycardia

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A 2-year-old child presents with a heart rate of 40 beats per minute, poor perfusion, altered mental status, and hypotension. The cardiac monitor shows a narrow QRS bradycardia. Bag-valve-mask ventilation with supplemental oxygen has been provided for 2 minutes without improvement. What is the most appropriate next step?

Initiate CPR and prepare epinephrine 0.01 mg/kg IV/IO

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Administer atropine 0.02 mg/kg IV/IO

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Perform immediate transcutaneous pacing

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Administer adenosine 0.1 mg/kg rapid IV push

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What is the initial defibrillation energy dose for a pediatric patient in ventricular fibrillation?

2 J/kg

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1 J/kg

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4 J/kg

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0.5 J/kg

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Which pacing mode delivers electrical impulses only when the patient’s intrinsic heart rate falls below the set rate?

Demand mode

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Fixed (asynchronous) mode

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Overdrive mode

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Capture mode

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A 58-year-old male achieves return of spontaneous circulation (ROSC) after 12 minutes of CPR for ventricular fibrillation. His blood pressure is 92/64 mmHg, heart rate is 110 bpm, and SpO2 is 99% on 100% oxygen via BVM. What is the most appropriate next intervention regarding oxygenation?

Titrate the FiO2 down to maintain SpO2 between 92% and 98%

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Continue 100% oxygen to maximize cerebral perfusion

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Switch to a nasal cannula at 2 L/min immediately

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Discontinue supplemental oxygen since SpO2 is above 94%

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Which ECG rhythm is characterized by the complete absence of electrical activity, appearing as a flat line on the monitor?

Asystole

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Ventricular fibrillation

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Pulseless electrical activity

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Fine atrial fibrillation

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Which ECG leads are the augmented limb leads?

aVR, aVL, and aVF

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I, II, and III

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V1, V2, and V3

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V4, V5, and V6

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A newborn delivered in the field has thick meconium-stained amniotic fluid. The baby is limp and not crying. After initial warming and positioning, what is the recommended approach?

Begin positive pressure ventilation if the infant is not breathing effectively

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Perform immediate endotracheal intubation and suction the trachea before any ventilation

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Suction the oropharynx and nasopharynx aggressively before stimulating the infant

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Withhold ventilation until the airway is cleared by direct laryngoscopy

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What is the purpose of the 2-minute CPR cycle between rhythm checks during cardiac arrest resuscitation?

To build and maintain coronary perfusion pressure, which requires uninterrupted compressions to generate sufficient pressure gradients for cardiac and cerebral blood flow

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To allow medications adequate time to circulate before the next defibrillation attempt

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To give the compressor adequate rest before switching roles

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To provide time for the defibrillator to recharge between shocks

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A paramedic is treating a patient with torsades de pointes who has a palpable pulse and a blood pressure of 94/58 mmHg. Which medication is the specific pharmacological treatment for this rhythm?

Magnesium sulfate 2 g IV over 5 to 10 minutes

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Amiodarone 300 mg IV push

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Procainamide 20 mg/min IV infusion

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Lidocaine 1 mg/kg IV push

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During cardiac arrest management, the rhythm check after the second shock reveals persistent ventricular fibrillation. CPR is resumed. According to the ACLS algorithm, what medication should be administered during this cycle?

Epinephrine 1 mg IV/IO

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Amiodarone 300 mg IV/IO

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Atropine 1 mg IV/IO

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Lidocaine 100 mg IV/IO

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A 58-year-old patient on a cardiac monitor displays a regular rhythm at 32 beats per minute with wide QRS complexes (>0.12 seconds) and no identifiable P waves. Which rhythm does this represent?

Idioventricular rhythm

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Junctional bradycardia

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Sinus bradycardia

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Second-degree AV block type II

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A paramedic is treating a patient with renal failure who presents with weakness and a heart rate of 40 bpm. The ECG shows peaked T waves, a prolonged PR interval, and a widened QRS complex. These findings are most consistent with which condition?

Hyperkalemia ECG changes due to elevated serum potassium levels

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Acute anterior wall myocardial infarction

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Digitalis toxicity with AV block

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Hypothermia with Osborn waves

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When using fixed (asynchronous) mode transcutaneous pacing, what is the primary risk that differentiates it from demand mode?

A pacing impulse may land on the T wave of an intrinsic beat, potentially causing ventricular fibrillation

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The pacer will not deliver impulses if the patient has any intrinsic rhythm

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Fixed mode requires significantly higher milliampere settings to achieve capture

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The pacing electrodes are more likely to cause skin burns in fixed mode

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A 48-year-old male has ROSC after VF arrest. He is comatose and intubated. His 12-lead ECG shows ST elevation in leads II, III, and aVF. Blood pressure is 96/62 mmHg on a norepinephrine drip. What is the most important consideration for transport destination?

Transport to a facility with cardiac catheterization capability for emergent coronary intervention

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Transport to the nearest emergency department regardless of PCI capability

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Request air medical transport to a trauma center for surgical intervention

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Transport to the nearest hospital for CT imaging of the head to evaluate the coma

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A patient on a beta-blocker for hypertension develops symptomatic bradycardia at 38 bpm with hypotension. Atropine 0.5 mg IV has been given twice without improvement. The paramedic suspects the bradycardia is refractory due to the beta-blocker. Which medication addresses this specific drug interaction by bypassing beta-receptor blockade?

Glucagon 3 to 5 mg IV

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Epinephrine 0.3 mg IM

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Naloxone 2 mg IV

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Calcium chloride 1 g IV

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A 50-year-old male presents with palpitations and lightheadedness. His heart rate is 186 and the monitor shows a regular, narrow complex tachycardia. Blood pressure is 78/50 and he is diaphoretic. Vagal maneuvers and adenosine have been unsuccessful. What is the next appropriate intervention?

Synchronized cardioversion starting at 50 to 100 joules

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Unsynchronized defibrillation at 200 joules

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Amiodarone 150 mg IV over 10 minutes

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A second dose of adenosine 12 mg rapid IV push

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A patient in cardiac arrest has an organized rhythm on the monitor at 84 bpm with narrow QRS complexes. The paramedic confirms no pulse. After two rounds of epinephrine and CPR, the rhythm remains unchanged but the patient remains pulseless. Which reversible cause should the paramedic consider if the patient has distended neck veins, muffled heart tones, and hypotension prior to the arrest?

Cardiac tamponade

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Tension pneumothorax

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Hypovolemia

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Hyperkalemia

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Why is it critical to use the synchronization function when cardioverting a patient with an organized tachyarrhythmia who has a pulse?

Synchronization times the shock to the R wave, avoiding the vulnerable T wave period that could cause ventricular fibrillation

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Synchronization reduces the energy required to convert the rhythm by half

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Synchronization prevents the defibrillator from delivering a shock if the rhythm is normal sinus

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Synchronization allows for multiple sequential shocks to be delivered automatically

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A patient presents with weakness and muscle cramps. A 12-lead ECG reveals tall, peaked, narrow T waves, widened QRS complexes, and flattened P waves. Which electrolyte abnormality is most consistent with these findings?

Hyperkalemia

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Hypokalemia

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Hypercalcemia

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Hypomagnesemia

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A 3-year-old child is in cardiac arrest. You are unable to establish IV access after two attempts. What is the preferred alternative route for epinephrine administration?

Intraosseous (IO) access in the proximal tibia

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Endotracheal tube administration at 10 times the IV dose

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Intramuscular injection in the vastus lateralis

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Subcutaneous injection in the deltoid region

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A patient with symptomatic third-degree AV block has not responded to atropine. You initiate transcutaneous pacing at a rate of 70 bpm. The monitor shows pacing spikes followed by wide QRS complexes, but the patient remains hypotensive and unresponsive. What should you assess next?

Palpate for a pulse to confirm mechanical capture, as electrical capture does not guarantee effective cardiac output

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Increase the pacing rate to 120 bpm to overcome the block

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Decrease the pacing output since the QRS complexes indicate the current is too high

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Discontinue pacing since the presence of QRS complexes confirms adequate perfusion

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When initiating transcutaneous pacing on a conscious patient with symptomatic bradycardia, what should the paramedic do to manage patient discomfort?

Administer sedation or analgesia such as midazolam or fentanyl prior to or during pacing

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Apply the pacing pads over thick clothing to reduce skin stimulation

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Start pacing at the maximum output and gradually decrease to threshold

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Instruct the patient to hold their breath during each pacing impulse

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A paramedic applies the cardiac monitor to a pulseless, apneic patient and observes a chaotic, irregular waveform with no identifiable P waves, QRS complexes, or T waves. The amplitude of the waveform varies continuously. What rhythm is displayed?

Ventricular fibrillation

Correct Incorrect Correct answer

Ventricular tachycardia

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Atrial fibrillation with rapid ventricular response

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Torsades de pointes

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Which cardiac medication acts by inhibiting thrombin and preventing the conversion of fibrinogen to fibrin?

Heparin

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Aspirin

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Clopidogrel

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Nitroglycerin

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At what compression-to-ventilation ratio should a single paramedic perform CPR on an infant in cardiac arrest?

30:2

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15:2

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5:1

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30:1

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After placing a supraglottic airway in a cardiac arrest patient, the paramedic needs to confirm ventilation adequacy. Which finding would indicate that the device is functioning properly?

Bilateral chest rise with bag-valve ventilation and an ETCO2 waveform present on capnography

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The ability to ventilate with low resistance and no audible air leak around the device

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Improvement in the patient's skin color from cyanotic to pink within 30 seconds

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A rising SpO2 reading on pulse oximetry within the first minute of ventilation

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During transport, a paramedic notices that the peak airway pressure on the ventilator has increased from 22 cmH2O to 38 cmH2O over 15 minutes, but the plateau pressure remains unchanged at 18 cmH2O. This pattern most likely indicates which of the following?

Increased airway resistance from bronchospasm or secretion accumulation

Correct Incorrect Correct answer

Decreased lung compliance from developing pulmonary edema

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Development of a tension pneumothorax on the ventilated side

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Improper ventilator calibration requiring a system reset

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Which formula is used to estimate the appropriate uncuffed endotracheal tube size for a pediatric patient?

(Age in years / 4) + 4

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(Age in years / 4) + 3

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(Age in years + 16) / 4

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(Weight in kg / 10) + 3

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In volume-controlled ventilation mode, which parameter remains constant with each delivered breath regardless of changes in patient lung compliance?

The set tidal volume delivered to the patient

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The peak inspiratory pressure generated during each breath

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The inspiratory flow rate adjusted for patient effort

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The plateau pressure measured at end-inspiration

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A 52-year-old asthmatic is being treated with a nebulized albuterol treatment. His SpO2 is 97% on room air, but during the nebulizer treatment his SpO2 drops to 91%. Which explanation best accounts for this finding?

Ventilation-perfusion mismatch from bronchodilator-induced pulmonary vasodilation

Correct Incorrect Correct answer

The nebulizer is diluting the inspired oxygen concentration

Correct Incorrect Correct answer

The albuterol is causing bronchospasm rather than bronchodilation

Correct Incorrect Correct answer

The pulse oximeter is malfunctioning due to electromagnetic interference from the nebulizer

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After performing endotracheal intubation, the paramedic notes that breath sounds are present on the right side but absent on the left. ETCO2 waveform is present. What is the most likely cause and appropriate corrective action?

Right mainstem bronchus intubation; deflate the cuff and withdraw the tube 1 to 2 cm, then reassess

Correct Incorrect Correct answer

Esophageal intubation; remove the tube immediately and reoxygenate

Correct Incorrect Correct answer

Left-sided tension pneumothorax; perform needle decompression

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Equipment malfunction; replace the endotracheal tube with a new one

Correct Incorrect Correct answer

Which laryngoscope blade is designed to fit into the vallecula to indirectly lift the epiglottis during intubation?

Macintosh (curved) blade

Correct Incorrect Correct answer

Miller (straight) blade

Correct Incorrect Correct answer

Phillips blade

Correct Incorrect Correct answer

Wisconsin blade

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What is the primary anatomical landmark used to identify the correct incision site for a surgical cricothyrotomy?

The cricothyroid membrane, located between the thyroid cartilage and the cricoid cartilage

Correct Incorrect Correct answer

The tracheal rings below the cricoid cartilage

Correct Incorrect Correct answer

The thyrohyoid membrane between the hyoid bone and thyroid cartilage

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The sternal notch at the base of the neck

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An intubated asthmatic patient on a transport ventilator has an ETCO2 of 65 mmHg and progressively worsening breath sounds bilaterally with prolonged expiratory wheezing. Peak pressures are climbing. What ventilator adjustment is most appropriate?

Decrease the respiratory rate to allow longer expiratory time, preventing air trapping and auto-PEEP

Correct Incorrect Correct answer

Increase the respiratory rate to blow off more CO2

Correct Incorrect Correct answer

Increase the tidal volume to deliver more air past the bronchospasm

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Add PEEP of 10 cmH2O to splint the airways open

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A paramedic is preparing to use a portable oxygen cylinder for a patient transfer. The D-cylinder gauge reads 1,000 psi and the patient requires 10 LPM. Approximately how many minutes of oxygen are available?

Approximately 16 minutes

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Approximately 8 minutes

Correct Incorrect Correct answer

Approximately 32 minutes

Correct Incorrect Correct answer

Approximately 48 minutes

Correct Incorrect Correct answer

Minute ventilation is calculated by multiplying which two parameters?

Tidal volume multiplied by respiratory rate

Correct Incorrect Correct answer

FiO2 multiplied by peak inspiratory pressure

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Respiratory rate multiplied by inspiratory time

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Tidal volume multiplied by FiO2 percentage

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A paramedic is unable to intubate a 2-year-old child who is in respiratory failure. The decision is made to place a pediatric SGA. Which consideration is most important when selecting and placing this device in a young child?

Select the appropriate size based on the child's weight, and ensure the device forms an adequate seal over the glottic opening

Correct Incorrect Correct answer

Inflate the cuff to maximum volume to ensure a tight seal regardless of patient size

Correct Incorrect Correct answer

Use the same insertion technique as in adults, including 180-degree rotation

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Insert the device only after confirming that the child has no gag reflex

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What is the normal range for end-tidal CO2 (ETCO2) in a healthy adult with adequate ventilation?

35 to 45 mmHg

Correct Incorrect Correct answer

20 to 30 mmHg

Correct Incorrect Correct answer

50 to 60 mmHg

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10 to 20 mmHg

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What is the primary purpose of preoxygenation before endotracheal intubation?

To establish an oxygen reserve in the functional residual capacity, extending the safe apnea time

Correct Incorrect Correct answer

To confirm adequate lung compliance before paralytic administration

Correct Incorrect Correct answer

To dilate the bronchioles and improve visualization of the vocal cords

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To reduce the risk of laryngospasm during blade insertion

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A paramedic is managing a 35-year-old male with a gunshot wound to the face and massive oral hemorrhage. The patient is unresponsive with agonal respirations. Suctioning cannot keep up with bleeding, and the airway is completely obscured. Which approach is most appropriate?

Proceed directly to surgical cricothyrotomy without attempting orotracheal intubation

Correct Incorrect Correct answer

Attempt rapid sequence intubation with continuous suctioning

Correct Incorrect Correct answer

Insert a supraglottic airway device to tamponade the bleeding

Correct Incorrect Correct answer

Position the patient prone to allow blood to drain and attempt BVM ventilation

Correct Incorrect Correct answer

During procedural sedation for a fracture reduction, a patient’s capnography waveform suddenly shows a decreasing ETCO2 value from 40 mmHg to 15 mmHg over 30 seconds. The patient’s SpO2 remains at 98%. The respiratory rate has dropped from 14 to 6 breaths per minute. Which statement best explains why capnography detected this deterioration before pulse oximetry?

Capnography reflects ventilatory changes in real time, while pulse oximetry has a lag time and reflects oxygenation reserves already present in the blood

Correct Incorrect Correct answer

Pulse oximetry is less accurate during procedural sedation than capnography

Correct Incorrect Correct answer

The patient's supplemental oxygen is masking the true SpO2 decline

Correct Incorrect Correct answer

Capnography measures arterial blood gases directly, providing faster feedback

Correct Incorrect Correct answer

A paramedic initiates CPAP on a patient with an acute COPD exacerbation. After 5 minutes, the patient becomes more agitated, SpO2 drops from 88% to 84%, and the capnography reading shows a sharp decline in ETCO2. The mask appears to have significant air leak around the bridge of the nose. What is the most likely cause of the deterioration?

Poor mask fit is preventing adequate pressure delivery to the airways

Correct Incorrect Correct answer

The CPAP pressure is too high, causing barotrauma and pneumothorax

Correct Incorrect Correct answer

The patient has developed auto-PEEP from excessive expiratory pressure

Correct Incorrect Correct answer

The CPAP device is malfunctioning and delivering room air instead of oxygen

Correct Incorrect Correct answer

An intubated patient has an ETCO2 reading of 55 mmHg that has been steadily increasing over the past 10 minutes. The patient’s respiratory rate on the ventilator is set at 12 breaths per minute. Breath sounds are equal bilaterally. What is the most appropriate action?

Increase the ventilatory rate to reduce CO2 levels

Correct Incorrect Correct answer

Reconfirm endotracheal tube placement with direct laryngoscopy

Correct Incorrect Correct answer

Administer a bronchodilator via the endotracheal tube

Correct Incorrect Correct answer

Decrease the tidal volume to prevent barotrauma

Correct Incorrect Correct answer

What is the maximum recommended vacuum pressure for suctioning an adult patient’s oropharynx in the prehospital setting?

300 mmHg

Correct Incorrect Correct answer

Approximately 150 mmHg

Correct Incorrect Correct answer

Approximately 50 mmHg

Correct Incorrect Correct answer

Approximately 500 mmHg

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A paramedic is called for a patient in cardiac arrest who was found face down. On arrival, the patient is pulseless with agonal respirations. Initial BVM ventilation is ineffective due to significant facial trauma and an inability to maintain a mask seal. Two intubation attempts with direct laryngoscopy have failed due to blood and edema. SpO2 is unreadable. What is the most appropriate next action?

Perform a surgical cricothyrotomy to establish a definitive airway

Correct Incorrect Correct answer

Place a supraglottic airway device and resume CPR

Correct Incorrect Correct answer

Attempt a third intubation using a video laryngoscope

Correct Incorrect Correct answer

Continue BVM ventilation with two-person technique while transporting

Correct Incorrect Correct answer

A paramedic cannot intubate or ventilate a 42-year-old male with massive facial trauma. Bag-valve mask ventilation is ineffective due to extensive mandibular fractures, and a supraglottic airway cannot be placed. What is the most appropriate next intervention?

Perform a surgical cricothyrotomy

Correct Incorrect Correct answer

Attempt nasotracheal intubation using a blind technique

Correct Incorrect Correct answer

Insert an oropharyngeal airway and reattempt bag-valve mask ventilation

Correct Incorrect Correct answer

Perform needle decompression of the chest bilaterally

Correct Incorrect Correct answer

When performing direct laryngoscopy on a pediatric patient, the paramedic notes that the anterior larynx makes visualization of the vocal cords difficult. Which blade type and technique is preferred for this anatomical challenge in young children?

A straight (Miller) blade used to directly lift the epiglottis

Correct Incorrect Correct answer

A curved (Macintosh) blade placed in the vallecula to indirectly lift the epiglottis

Correct Incorrect Correct answer

A curved (Macintosh) blade used to directly lift the epiglottis

Correct Incorrect Correct answer

A straight (Miller) blade placed in the vallecula without lifting the epiglottis

Correct Incorrect Correct answer

Which medication used in rapid sequence intubation is a depolarizing neuromuscular blocker with a rapid onset of approximately 45 to 60 seconds?

Succinylcholine

Correct Incorrect Correct answer

Rocuronium

Correct Incorrect Correct answer

Etomidate

Correct Incorrect Correct answer

Ketamine

Correct Incorrect Correct answer

In which patient population is surgical cricothyrotomy contraindicated, requiring needle cricothyrotomy with jet ventilation instead?

Children generally younger than 8 to 10 years of age

Correct Incorrect Correct answer

Adults with suspected cervical spine injuries

Correct Incorrect Correct answer

Patients with laryngeal fractures at any age

Correct Incorrect Correct answer

Patients older than 65 years with anatomical changes

Correct Incorrect Correct answer

You are monitoring a patient with a history of asthma who is in moderate respiratory distress. The capnography waveform shows a characteristic “shark fin” or upsloping appearance during the expiratory phase. What does this pattern indicate?

Bronchospasm causing uneven alveolar emptying

Correct Incorrect Correct answer

Esophageal intubation with gastric CO2

Correct Incorrect Correct answer

Right mainstem bronchus intubation

Correct Incorrect Correct answer

Hyperventilation from anxiety

Correct Incorrect Correct answer

You have successfully intubated a 70 kg adult male with a 7.5 mm endotracheal tube. The tube depth marking at the teeth is 23 cm. After confirming placement with ETCO2 and bilateral breath sounds, what is the most reliable method to secure the tube and prevent accidental dislodgement during transport?

Apply a commercial tube holder device and note the depth marking at the teeth for ongoing monitoring

Correct Incorrect Correct answer

Hold the tube manually throughout transport without any securing device

Correct Incorrect Correct answer

Tape the tube to the patient's forehead to keep it out of the way

Correct Incorrect Correct answer

Inflate the cuff to maximum pressure to prevent any tube movement

Correct Incorrect Correct answer

A paramedic is preparing to place a 78 kg male patient on a transport ventilator following endotracheal intubation for respiratory failure. Using ideal body weight calculations, what is the most appropriate initial tidal volume setting?

6 to 8 mL/kg ideal body weight, approximately 470 to 625 mL

Correct Incorrect Correct answer

10 to 12 mL/kg actual body weight, approximately 780 to 936 mL

Correct Incorrect Correct answer

3 to 4 mL/kg ideal body weight, approximately 235 to 310 mL

Correct Incorrect Correct answer

15 mL/kg actual body weight, approximately 1,170 mL

Correct Incorrect Correct answer

Compared to the adult airway, which anatomic feature of the infant airway creates the narrowest point at the cricoid ring rather than at the vocal cords?

The funnel-shaped subglottic area with the cricoid cartilage forming the narrowest diameter

Correct Incorrect Correct answer

A longer epiglottis that extends further into the pharynx

Correct Incorrect Correct answer

Vocal cords that are positioned more anteriorly and superiorly

Correct Incorrect Correct answer

A wider tracheal diameter relative to body size

Correct Incorrect Correct answer

A 3-year-old child presents with high fever (105 F), drooling, tripod positioning, muffled voice, and inspiratory stridor. The child appears toxic and is refusing to swallow. What critical airway condition should be suspected, and what action should the paramedic avoid?

Epiglottitis; avoid direct visualization of the airway (no tongue depressor or laryngoscopy) as it may precipitate complete airway obstruction

Correct Incorrect Correct answer

Croup; avoid humidified oxygen as it will worsen the swelling

Correct Incorrect Correct answer

Foreign body aspiration; avoid positioning the child upright

Correct Incorrect Correct answer

Retropharyngeal abscess; avoid administering any IV fluids

Correct Incorrect Correct answer

A paramedic is managing the airway of a 2-year-old child in respiratory failure. Which anatomical difference between pediatric and adult patients requires the paramedic to avoid hyperextension of the neck during airway positioning?

The large occiput naturally flexes the neck, and the trachea is short and compressible

Correct Incorrect Correct answer

The epiglottis is firmly attached and does not respond to jaw thrust

Correct Incorrect Correct answer

The thyroid cartilage is calcified and does not allow neck extension

Correct Incorrect Correct answer

The cricoid ring is located at the level of C3, making extension unnecessary

Correct Incorrect Correct answer

A paramedic has identified the cricothyroid membrane and made a horizontal incision through the skin and membrane. The next step is to insert an airway device. Which is the most appropriate action?

Insert a tracheal hook or bougie to maintain the opening, then place a 6.0 mm cuffed endotracheal or Shiley tracheostomy tube

Correct Incorrect Correct answer

Insert the largest available endotracheal tube (8.0 mm) to maximize airflow

Correct Incorrect Correct answer

Leave the incision open and ventilate through the wound using a bag-valve device

Correct Incorrect Correct answer

Insert a supraglottic airway device through the surgical incision

Correct Incorrect Correct answer

A patient is undergoing procedural sedation with ketamine for a dislocated shoulder reduction. Capnography monitoring shows a gradual decrease in ETCO2 from 38 mmHg to 22 mmHg over 3 minutes, with a decreasing respiratory rate. What does this trend suggest?

Respiratory depression with decreasing tidal volume requiring closer monitoring and possible ventilatory support

Correct Incorrect Correct answer

Adequate sedation with no intervention needed

Correct Incorrect Correct answer

The patient is hyperventilating due to pain from the procedure

Correct Incorrect Correct answer

Equipment malfunction from moisture in the sampling line

Correct Incorrect Correct answer

A paramedic needs to suction copious amounts of blood and vomitus from the oropharynx of an unresponsive trauma patient. Which suction device is most appropriate?

Rigid-tip (Yankauer) suction catheter connected to a portable or onboard suction unit

Correct Incorrect Correct answer

Flexible (French) suction catheter inserted through the nose

Correct Incorrect Correct answer

Bulb syringe for gentle suctioning of the oral cavity

Correct Incorrect Correct answer

Inline suction catheter attached to the endotracheal tube

Correct Incorrect Correct answer

Which anatomical difference in the pediatric airway makes children more susceptible to airway obstruction compared to adults?

The tongue is proportionally larger relative to the oral cavity

Correct Incorrect Correct answer

The trachea is more rigid and less compressible

Correct Incorrect Correct answer

The epiglottis is shorter and less flexible

Correct Incorrect Correct answer

The vocal cords are positioned lower in the neck

Correct Incorrect Correct answer

In the pediatric airway, where is the narrowest point located in children younger than 8 years of age?

At the cricoid cartilage (subglottic area)

Correct Incorrect Correct answer

At the level of the vocal cords

Correct Incorrect Correct answer

At the thoracic inlet where the trachea enters the chest

Correct Incorrect Correct answer

At the junction of the nasopharynx and oropharynx

Correct Incorrect Correct answer

A paramedic is applying CPAP to a patient with acute congestive heart failure. After applying the mask, the patient becomes increasingly agitated and attempts to remove it. SpO2 is 82% without the device. What is the best approach?

Coach the patient calmly, hold the mask gently to the face to allow acclimation, and reassess tolerance after 30 to 60 seconds

Correct Incorrect Correct answer

Restrain the patient's hands and force the CPAP mask in place for their own safety

Correct Incorrect Correct answer

Abandon CPAP entirely and switch to high-flow oxygen via non-rebreather mask

Correct Incorrect Correct answer

Sedate the patient with midazolam to improve CPAP compliance

Correct Incorrect Correct answer

A morbidly obese patient (estimated weight 180 kg) requires intubation for respiratory failure. You anticipate a difficult airway due to body habitus. Which positioning modification will best facilitate laryngoscopy in this patient?

Ramped positioning with blankets or towels under the shoulders and head to align the external auditory meatus with the sternal notch

Correct Incorrect Correct answer

Flat supine position with no elevation, which provides the most stable platform

Correct Incorrect Correct answer

Trendelenburg position to move abdominal contents away from the diaphragm

Correct Incorrect Correct answer

Left lateral decubitus position to improve venous return during the procedure

Correct Incorrect Correct answer

A patient on a transport ventilator in assist control mode is set at a rate of 12. The ventilator display shows an actual rate of 22. The patient appears anxious and is triggering additional breaths. ETCO2 reads 24 mmHg. What is the best course of action?

Assess for the cause of the patient's distress, address pain or anxiety, and consider sedation to prevent respiratory alkalosis

Correct Incorrect Correct answer

Increase the set rate to 22 to match the patient's demand

Correct Incorrect Correct answer

Switch to SIMV mode and increase the tidal volume to compensate

Correct Incorrect Correct answer

Disconnect the ventilator and manually ventilate with a BVM at a rate of 22

Correct Incorrect Correct answer

A 68-year-old male with a history of COPD presents with increased work of breathing, pursed-lip breathing, and an SpO2 of 86% on room air. He is alert and speaking in short sentences. What is the most appropriate initial oxygen delivery device and flow rate?

Nasal cannula at 2 to 4 L/min, titrating to an SpO2 of 88% to 92%

Correct Incorrect Correct answer

Non-rebreather mask at 15 L/min targeting SpO2 of 100%

Correct Incorrect Correct answer

Blow-by oxygen at 6 L/min held near the patient's face

Correct Incorrect Correct answer

Venturi mask at 24% FiO2 only if SpO2 drops below 80%

Correct Incorrect Correct answer

When performing needle jet insufflation through a 14-gauge catheter in the cricothyroid membrane, what is a critical limitation the paramedic must anticipate?

Exhalation is passive and incomplete, creating a risk of progressive air trapping and barotrauma

Correct Incorrect Correct answer

The catheter allows tidal volumes equivalent to bag-valve-mask ventilation

Correct Incorrect Correct answer

Jet insufflation provides both adequate oxygenation and ventilation indefinitely

Correct Incorrect Correct answer

The procedure eliminates the need for a definitive surgical airway

Correct Incorrect Correct answer

A mechanically ventilated patient develops breath stacking (auto-PEEP). The patient is becoming increasingly difficult to ventilate and hypotensive. What is the immediate management?

Disconnect the patient from the ventilator briefly to allow complete exhalation, then adjust the respiratory rate and inspiratory-to-expiratory ratio to allow more expiratory time

Correct Incorrect Correct answer

Increase the respiratory rate to compensate for the reduced tidal volume

Correct Incorrect Correct answer

Add 10 cm H2O of PEEP to match the intrinsic PEEP and improve ventilation

Correct Incorrect Correct answer

Administer a rapid IV fluid bolus to treat the hypotension without addressing the ventilator

Correct Incorrect Correct answer

A 68-year-old male with severe COPD is in respiratory distress with an SpO2 of 84% and labored breathing at 28 breaths per minute. He is alert and able to speak in short phrases. What is the most appropriate initial oxygen therapy?

Titrate oxygen via nasal cannula to achieve an SpO2 of 88% to 92%

Correct Incorrect Correct answer

Withhold oxygen to avoid suppressing his hypoxic drive

Correct Incorrect Correct answer

Apply a nonrebreather mask at 15 LPM targeting SpO2 of 100%

Correct Incorrect Correct answer

Immediately apply CPAP at 10 cmH2O without supplemental oxygen

Correct Incorrect Correct answer

A patient with chronic COPD presents with mild respiratory distress, SpO2 of 89%, and a respiratory rate of 20. The patient is alert and speaking in full sentences. What is the most appropriate initial oxygen delivery device and target SpO2?

Nasal cannula at 1 to 2 L/min, titrating to an SpO2 target of 88% to 92%

Correct Incorrect Correct answer

Non-rebreather mask at 15 L/min, targeting SpO2 of 99% to 100%

Correct Incorrect Correct answer

Venturi mask at 60% FiO2, targeting SpO2 of 95% to 100%

Correct Incorrect Correct answer

Withhold supplemental oxygen since the SpO2 is above 85%

Correct Incorrect Correct answer

What is the maximum number of endotracheal intubation attempts recommended before the paramedic should move to an alternative airway device such as a supraglottic airway?

Two attempts, after which a rescue airway (supraglottic airway) should be placed

Correct Incorrect Correct answer

One attempt only, with immediate surgical cricothyrotomy after failure

Correct Incorrect Correct answer

Four attempts, with technique modifications between each attempt

Correct Incorrect Correct answer

Unlimited attempts as long as the paramedic can maintain oxygenation between attempts

Correct Incorrect Correct answer

You are transporting an intubated asthma patient on a portable ventilator. The patient was intubated for respiratory failure from severe bronchospasm. The ventilator is set at a rate of 14 breaths per minute. You notice the patient is not fully exhaling before the next breath is delivered, and the airway pressure alarm keeps triggering. What ventilator adjustment is needed?

Decrease the respiratory rate and increase the expiratory time (I:E ratio) to allow complete exhalation and prevent air trapping

Correct Incorrect Correct answer

Increase the respiratory rate to improve minute ventilation and blow off CO2

Correct Incorrect Correct answer

Increase the tidal volume to overcome the bronchospasm resistance

Correct Incorrect Correct answer

Set the ventilator to deliver continuous mandatory ventilation without pauses

Correct Incorrect Correct answer

Which ventilator mode delivers a set number of mandatory breaths but allows the patient to take spontaneous breaths between them at their own tidal volume?

Synchronized intermittent mandatory ventilation (SIMV)

Correct Incorrect Correct answer

Assist control (AC), which delivers a full set volume with every patient breath

Correct Incorrect Correct answer

Pressure support ventilation (PSV), which augments every spontaneous breath

Correct Incorrect Correct answer

Continuous positive airway pressure (CPAP), which provides constant pressure without mandatory breaths

Correct Incorrect Correct answer

You have inserted an iGel supraglottic airway in an unconscious patient. After placement, you ventilate with a BVM and note adequate chest rise, bilateral breath sounds, and an ETCO2 waveform of 38 mmHg with a normal morphology. However, you hear a significant air leak around the device with each ventilation. What should you do?

Verify the correct device size for the patient's weight, and if undersized, replace with the next larger size

Correct Incorrect Correct answer

Inflate the cuff of the iGel to create a tighter seal

Correct Incorrect Correct answer

Remove the iGel and switch to BVM ventilation without an airway adjunct

Correct Incorrect Correct answer

Ignore the air leak since adequate chest rise and ETCO2 confirm the device is working

Correct Incorrect Correct answer

A patient with a severe asthma exacerbation has been intubated and placed on a transport ventilator. The paramedic sets assist control with a rate of 10, tidal volume of 450 mL, and FiO2 of 1.0. Which additional ventilator adjustment is most important for this patient population?

Extend the expiratory time (lower I:E ratio) to allow complete exhalation and prevent air trapping

Correct Incorrect Correct answer

Increase the respiratory rate to 20 to compensate for the patient's pre-intubation tachypnea

Correct Incorrect Correct answer

Set a high level of PEEP at 15 cmH2O to splint open the airways

Correct Incorrect Correct answer

Use a higher tidal volume of 10 mL/kg to overcome airway resistance

Correct Incorrect Correct answer

A paramedic needs to calculate a weight-based medication dose for a 5-year-old child but no scale or length-based tape is available. Using the standard pediatric weight estimation formula (2 x age in years) + 8, what is the estimated weight?

18 kg

Correct Incorrect Correct answer

15 kg

Correct Incorrect Correct answer

20 kg

Correct Incorrect Correct answer

24 kg

Correct Incorrect Correct answer

A COPD patient on CPAP begins vomiting while the mask is still applied. The patient is too obtunded to remove the mask independently. What is the immediate danger and required action?

The sealed mask traps vomitus, creating aspiration risk; immediately remove the mask, suction the airway, and reassess

Correct Incorrect Correct answer

The CPAP pressure will force the vomitus into the stomach, preventing aspiration

Correct Incorrect Correct answer

Continue CPAP with the mask on while turning the patient to the side

Correct Incorrect Correct answer

Increase the CPAP pressure to push the vomitus away from the airway

Correct Incorrect Correct answer

What is the approximate FiO2 delivered by a nasal cannula set at 4 liters per minute?

36%

Correct Incorrect Correct answer

24%

Correct Incorrect Correct answer

50%

Correct Incorrect Correct answer

80%

Correct Incorrect Correct answer

Which type of suction catheter is best suited for clearing large volumes of fluid and particulate matter from the oropharynx?

Rigid tip (Yankauer) catheter

Correct Incorrect Correct answer

Flexible (French) catheter

Correct Incorrect Correct answer

Closed-system inline suction catheter

Correct Incorrect Correct answer

Bulb syringe aspirator

Correct Incorrect Correct answer

What is the approximate oxygen concentration delivered by a nasal cannula at 4 liters per minute?

36%

Correct Incorrect Correct answer

24%

Correct Incorrect Correct answer

50%

Correct Incorrect Correct answer

60%

Correct Incorrect Correct answer

Compared to adult anatomy, which characteristic of the pediatric airway makes it more susceptible to obstruction from swelling?

The narrowest point is at the cricoid cartilage (subglottic region), creating a funnel shape

Correct Incorrect Correct answer

The trachea bifurcates at a lower level, increasing dead space

Correct Incorrect Correct answer

The epiglottis is shorter and more rigid than in adults

Correct Incorrect Correct answer

The vocal cords are angled more anteriorly, widening the subglottic space

Correct Incorrect Correct answer

A post-cardiac arrest patient has return of spontaneous circulation with a blood pressure of 110/70 and SpO2 of 100% on a non-rebreather mask. What adjustment to oxygen therapy is recommended based on current resuscitation guidelines?

Titrate down the FiO2 to maintain SpO2 of 94% to 99%, as hyperoxia may worsen neurological outcomes

Correct Incorrect Correct answer

Continue the non-rebreather at 15 L/min to maximize oxygen delivery to recovering tissues

Correct Incorrect Correct answer

Immediately remove all supplemental oxygen since the SpO2 is 100%

Correct Incorrect Correct answer

Switch to room air and only reapply oxygen if SpO2 drops below 90%

Correct Incorrect Correct answer

A paramedic successfully intubates a 5-year-old child with a 5.0 mm uncuffed ETT. After securing the tube, the paramedic notices a significant audible air leak around the tube during positive pressure ventilation. ETCO2 waveform is present but the colorimetric detector shows inconsistent color change. What is the most appropriate action?

Replace the tube with a 5.5 mm ETT or a 4.5 mm cuffed ETT to achieve a better seal

Correct Incorrect Correct answer

Pack gauze around the tube at the lip line to reduce the air leak

Correct Incorrect Correct answer

Accept the air leak and increase ventilation volume to compensate for the lost tidal volume

Correct Incorrect Correct answer

Remove the ETT and manage the airway with BVM ventilation only for the remainder of transport

Correct Incorrect Correct answer

A paramedic needs to select the correct uncuffed endotracheal tube for a 6-year-old child. Using the standard tube size formula, what is the appropriate internal diameter?

5.5 mm internal diameter

Correct Incorrect Correct answer

4.0 mm internal diameter

Correct Incorrect Correct answer

6.5 mm internal diameter

Correct Incorrect Correct answer

4.5 mm internal diameter

Correct Incorrect Correct answer

A paramedic is managing the airway of an unresponsive 2-year-old child. After placing a shoulder roll and positioning the head, the paramedic selects a BVM for ventilation. What is the correct technique for BVM ventilation in this patient?

Use an appropriately sized pediatric mask, create a C-E clamp seal, and deliver gentle breaths just sufficient to produce visible chest rise

Correct Incorrect Correct answer

Use an adult BVM with a pediatric mask and deliver breaths over two seconds to ensure adequate tidal volume

Correct Incorrect Correct answer

Use a pediatric BVM, hyperextend the neck to open the airway, and deliver breaths until the abdomen rises

Correct Incorrect Correct answer

Use a pediatric BVM with a tight two-hand seal and deliver rapid breaths to maintain SpO2 above 99%

Correct Incorrect Correct answer

After inserting a King LT supraglottic airway in a cardiac arrest patient, the paramedic begins ventilations but notices significant air leak and poor chest rise. What should the paramedic do first?

Add air to the cuff to improve the pharyngeal seal

Correct Incorrect Correct answer

Remove the device and attempt endotracheal intubation immediately

Correct Incorrect Correct answer

Increase the ventilation volume by squeezing the bag more forcefully

Correct Incorrect Correct answer

Withdraw the device 2 cm and reattempt ventilation

Correct Incorrect Correct answer

During an interfacility transport, a ventilated patient with ARDS suddenly becomes hypotensive with BP dropping from 112/72 to 68/40. The ventilator shows no alarms, ETCO2 drops from 38 to 22 mmHg, and the patient has bilateral breath sounds present but diminished. Heart rate increases from 88 to 134. The paramedic should first consider which ventilator-related complication?

Decreased venous return from excessive positive pressure ventilation reducing cardiac preload

Correct Incorrect Correct answer

Ventilator-associated pneumonia developing during the transport

Correct Incorrect Correct answer

Oxygen toxicity from prolonged exposure to high FiO2 settings

Correct Incorrect Correct answer

Endotracheal tube cuff leak allowing air to escape around the tube

Correct Incorrect Correct answer

Which method is considered the most reliable for confirming endotracheal tube placement in a patient with a perfusing rhythm?

Continuous waveform capnography

Correct Incorrect Correct answer

Auscultation of bilateral breath sounds over the lung fields

Correct Incorrect Correct answer

Observation of chest rise during ventilation

Correct Incorrect Correct answer

Fogging of the endotracheal tube during exhalation

Correct Incorrect Correct answer

A paramedic is managing a mechanically ventilated patient during an interfacility transport. The ventilator is set to assist control mode with a rate of 14, tidal volume of 500 mL, and FiO2 of 0.6. The high-pressure alarm activates repeatedly. Which of the following is the most likely cause?

Kinked endotracheal tube or secretions obstructing the airway

Correct Incorrect Correct answer

A leak in the ventilator circuit reducing delivered volume

Correct Incorrect Correct answer

The tidal volume is set too low for the patient's body weight

Correct Incorrect Correct answer

The FiO2 is insufficient to meet the patient's oxygen demands

Correct Incorrect Correct answer

You place a colorimetric CO2 detector on an endotracheal tube after intubation. The device remains purple after six ventilations. What does this finding indicate?

The tube is likely in the esophagus and should be removed immediately

Correct Incorrect Correct answer

The tube is correctly placed but the patient has severe bronchospasm

Correct Incorrect Correct answer

The detector is malfunctioning and a second device should be tried

Correct Incorrect Correct answer

The patient has low tidal volumes requiring an increase in ventilation pressure

Correct Incorrect Correct answer

During CPR, the ETCO2 reading consistently remains below 10 mmHg despite proper tube placement. The paramedic uses this value to assess CPR quality. What does this low ETCO2 most likely indicate?

The quality of chest compressions is inadequate and compression depth or rate should be improved

Correct Incorrect Correct answer

The patient has achieved ROSC and should have a pulse check

Correct Incorrect Correct answer

The endotracheal tube is in the esophagus and needs to be repositioned

Correct Incorrect Correct answer

The ventilation rate is too low and should be increased to 20 breaths per minute

Correct Incorrect Correct answer

A 42-year-old male involved in a house fire presents with extensive facial burns, stridor, and progressive airway edema. Orotracheal intubation fails after two attempts, and a supraglottic airway cannot achieve ventilation. SpO2 is dropping to 78%. What is the most appropriate next step?

Perform a surgical cricothyrotomy

Correct Incorrect Correct answer

Attempt a third orotracheal intubation with a smaller endotracheal tube

Correct Incorrect Correct answer

Perform a nasotracheal intubation

Correct Incorrect Correct answer

Apply a nonrebreather mask at 15 L/min and transport immediately

Correct Incorrect Correct answer

A paramedic arrives on scene to find an unresponsive patient with sonorous respirations and a GCS of 4. The patient has no gag reflex, trismus is absent, and the airway is full of vomitus. After suctioning, the paramedic must rapidly secure the airway. No IV access has been established. Which approach represents the best initial airway management strategy?

Place a supraglottic airway as a bridge device while preparing for endotracheal intubation

Correct Incorrect Correct answer

Perform immediate surgical cricothyrotomy due to the contaminated airway

Correct Incorrect Correct answer

Insert a nasopharyngeal airway and ventilate with BVM until IV access is obtained

Correct Incorrect Correct answer

Administer intramuscular ketamine for sedation before attempting intubation

Correct Incorrect Correct answer

During a surgical cricothyrotomy, after making the vertical skin incision and horizontal membrane incision, the paramedic has difficulty inserting the tracheostomy tube. What technique facilitates tube insertion?

Use a tracheal hook or the handle of the scalpel to stabilize the incision opening, then insert the tube with a slight rotating motion

Correct Incorrect Correct answer

Enlarge the incision by cutting vertically through the cricoid cartilage

Correct Incorrect Correct answer

Abandon the surgical airway and attempt orotracheal intubation again

Correct Incorrect Correct answer

Use forceful pressure to push the tube through the membrane without stabilization

Correct Incorrect Correct answer

A paramedic is preparing to manage the airway of a 3-year-old child in respiratory failure. After two failed intubation attempts, which device is the most appropriate next step?

Appropriately sized pediatric supraglottic airway device

Correct Incorrect Correct answer

A third intubation attempt with a smaller endotracheal tube

Correct Incorrect Correct answer

Surgical cricothyrotomy with a 6.0 mm tracheostomy tube

Correct Incorrect Correct answer

Nasopharyngeal airway with bag-valve mask ventilation only

Correct Incorrect Correct answer

After intubating a patient, the paramedic inflates the ET tube cuff. What is the primary purpose of cuff inflation?

To seal the trachea and prevent aspiration of gastric contents around the tube

Correct Incorrect Correct answer

To anchor the tube in place and prevent accidental extubation

Correct Incorrect Correct answer

To increase the tidal volume delivered by the ventilator

Correct Incorrect Correct answer

To stimulate the cough reflex and verify tube placement

Correct Incorrect Correct answer

You are performing CPR on a 62-year-old patient in cardiac arrest. The ETCO2 reading has been stable at 15 mmHg during compressions. Suddenly, the ETCO2 value rises sharply to 40 mmHg. What does this finding most likely indicate?

Return of spontaneous circulation (ROSC)

Correct Incorrect Correct answer

The endotracheal tube has become displaced into the esophagus

Correct Incorrect Correct answer

The patient has developed a tension pneumothorax

Correct Incorrect Correct answer

The ventilation rate has decreased, causing CO2 retention

Correct Incorrect Correct answer

A paramedic attempts to intubate a 3-year-old child and encounters difficulty visualizing the vocal cords. The larynx appears to be positioned more anteriorly and superiorly than expected. After two failed intubation attempts, SpO2 has dropped to 88%. What is the most appropriate next step?

Abandon intubation, ventilate with BVM to restore oxygenation, and insert an appropriately sized supraglottic airway device

Correct Incorrect Correct answer

Attempt a third intubation using a larger laryngoscope blade and apply posterior cricoid pressure

Correct Incorrect Correct answer

Perform a needle cricothyrotomy to establish a surgical airway

Correct Incorrect Correct answer

Continue BVM ventilation indefinitely and avoid any advanced airway placement

Correct Incorrect Correct answer

A paramedic has placed a patient with acute CHF on CPAP at 10 cmH2O. After 8 minutes, the patient’s blood pressure drops from 148/92 mmHg to 86/54 mmHg, heart rate increases from 100 to 128 bpm, and the patient appears diaphoretic. SpO2 has improved from 84% to 93%. What should the paramedic do?

Reduce the CPAP pressure and administer an IV fluid bolus while reassessing

Correct Incorrect Correct answer

Increase the CPAP pressure to 15 cmH2O to further improve oxygenation

Correct Incorrect Correct answer

Remove CPAP entirely and place the patient on a non-rebreather mask

Correct Incorrect Correct answer

Maintain current CPAP settings because the SpO2 is improving

Correct Incorrect Correct answer

When initiating mechanical ventilation on a transport ventilator, what is the standard initial FiO2 setting for a patient in respiratory failure?

100% (FiO2 of 1.0), titrated down based on SpO2 and arterial blood gas results

Correct Incorrect Correct answer

21% (room air), increased only if SpO2 drops below 90%

Correct Incorrect Correct answer

40%, which provides adequate oxygenation for most patients

Correct Incorrect Correct answer

60%, the maximum setting available on most transport ventilators

Correct Incorrect Correct answer

Pressure support ventilation (PSV) is primarily used to accomplish which goal in mechanically ventilated patients?

Augment the patient's spontaneous breaths by providing additional inspiratory pressure to reduce the work of breathing

Correct Incorrect Correct answer

Deliver a guaranteed tidal volume regardless of the patient's respiratory effort

Correct Incorrect Correct answer

Provide a set number of mandatory breaths to patients who are not triggering the ventilator

Correct Incorrect Correct answer

Generate continuous negative pressure to mimic normal physiologic breathing

Correct Incorrect Correct answer

A paramedic is treating a patient in severe respiratory distress with a history of asthma. The patient is alert and sitting upright with accessory muscle use, SpO2 of 86%, and minimal air movement on auscultation. After administering a nebulized bronchodilator with minimal improvement, which ventilatory support strategy should the paramedic consider next?

Apply BiPAP to provide inspiratory pressure support along with PEEP

Correct Incorrect Correct answer

Continue nebulized treatments and withhold positive pressure ventilation

Correct Incorrect Correct answer

Apply a nasal cannula at 6 L/min to avoid worsening bronchospasm

Correct Incorrect Correct answer

Immediately perform endotracheal intubation for definitive airway control

Correct Incorrect Correct answer

You are ventilating an intubated patient with a BVM. The capnography waveform shows a normal rectangular morphology, but the ETCO2 value has been steadily increasing from 40 mmHg to 55 mmHg to 68 mmHg over the past 15 minutes. SpO2 remains at 97%. What does this trend indicate?

Hypoventilation: the patient is not being ventilated at an adequate rate or tidal volume to eliminate CO2

Correct Incorrect Correct answer

Hyperventilation causing respiratory alkalosis

Correct Incorrect Correct answer

Improving cardiac output following ROSC

Correct Incorrect Correct answer

The endotracheal tube has migrated to the right mainstem bronchus

Correct Incorrect Correct answer

You are monitoring an intubated patient during transport. The ETCO2 waveform suddenly drops from a normal rectangular pattern with a value of 38 mmHg to a flat line at 0 mmHg. The ventilator is still cycling and the SpO2 is dropping rapidly. What is the most likely cause of this sudden change?

The endotracheal tube has become dislodged or the circuit has disconnected

Correct Incorrect Correct answer

The patient has developed a mucus plug in the right mainstem bronchus

Correct Incorrect Correct answer

The capnography sensor has a condensation buildup affecting the reading

Correct Incorrect Correct answer

The patient has transitioned from sinus rhythm to cardiac arrest

Correct Incorrect Correct answer

A paramedic is choosing between an i-gel and a King LT for airway management during cardiac arrest. Which advantage does the i-gel offer over the King LT?

The i-gel does not require cuff inflation, which speeds insertion time and eliminates the risk of cuff over-inflation

Correct Incorrect Correct answer

The i-gel provides a more reliable seal in patients with significant airway edema

Correct Incorrect Correct answer

The i-gel can be used as a conduit for endotracheal intubation in all sizes

Correct Incorrect Correct answer

The i-gel is the only supraglottic airway approved for pediatric patients

Correct Incorrect Correct answer

You attempt to intubate a trauma patient with a GCS of 4 and significant facial trauma including mandibular instability and oropharyngeal hemorrhage. Your first intubation attempt fails due to inability to visualize the vocal cords despite optimal positioning and suction. Blood continues to fill the oropharynx. What is the most appropriate next step in your airway management algorithm?

Attempt intubation using a bougie introducer as an adjunct to guide the tube past the cords

Correct Incorrect Correct answer

Perform a blind nasotracheal intubation

Correct Incorrect Correct answer

Continue repeated direct laryngoscopy attempts until successful

Correct Incorrect Correct answer

Place an oropharyngeal airway and continue BVM ventilation indefinitely

Correct Incorrect Correct answer

A paramedic is preparing for medication-assisted intubation of a combative head injury patient with a GCS of 7. After administering sedation and a neuromuscular blocking agent, the paramedic attempts intubation but cannot visualize the vocal cords due to blood in the oropharynx. What is the most appropriate next step?

Insert a bougie blindly toward the anticipated glottic opening and attempt to pass the ET tube over it

Correct Incorrect Correct answer

Wait 30 seconds for the blood to clear and reattempt direct laryngoscopy

Correct Incorrect Correct answer

Immediately perform a surgical cricothyrotomy

Correct Incorrect Correct answer

Ventilate with a bag-valve-mask and allow the paralytic to wear off before reattempting

Correct Incorrect Correct answer

A paramedic encounters a patient in severe anaphylaxis with complete upper airway obstruction. Multiple intubation attempts and supraglottic airway placement have failed. The paramedic must establish an emergency airway. Which statement about surgical cricothyrotomy in this situation is correct?

A vertical skin incision followed by a horizontal incision through the cricothyroid membrane reduces the risk of bleeding from anterior jugular veins

Correct Incorrect Correct answer

The procedure is contraindicated in patients with significant neck swelling from anaphylaxis

Correct Incorrect Correct answer

A tracheostomy is preferred over cricothyrotomy in the prehospital setting

Correct Incorrect Correct answer

The paramedic should use a standard endotracheal tube size 8.0 for all adult patients

Correct Incorrect Correct answer

A paramedic attempts intubation and obtains a Cormack-Lehane Grade III view on direct laryngoscopy. After one failed attempt, what is the most appropriate next step?

Switch to a video laryngoscope to obtain an improved glottic view

Correct Incorrect Correct answer

Make three additional attempts with direct laryngoscopy using a larger blade

Correct Incorrect Correct answer

Proceed with blind nasotracheal intubation

Correct Incorrect Correct answer

Perform an immediate surgical cricothyrotomy

Correct Incorrect Correct answer

A paramedic is performing RSI and administers etomidate followed by succinylcholine. After 60 seconds, the patient’s jaw is relaxed and the mouth opens easily. The first intubation attempt fails because the paramedic cannot visualize the glottic opening due to blood in the airway. A second attempt with suction also fails. The patient’s SpO2 is dropping rapidly to 78%. What is the most appropriate next step?

Insert a supraglottic airway device as a rescue airway and ventilate the patient

Correct Incorrect Correct answer

Make a third intubation attempt using a different blade size

Correct Incorrect Correct answer

Perform a surgical cricothyrotomy immediately without attempting other devices

Correct Incorrect Correct answer

Resume bag-valve mask ventilation while waiting for the paralytic to wear off before trying again

Correct Incorrect Correct answer

During endotracheal intubation, the capnography device shows a complete loss of the CO2 waveform immediately after tube placement. What is the most likely cause?

Esophageal intubation

Correct Incorrect Correct answer

Right mainstem bronchus intubation

Correct Incorrect Correct answer

Tension pneumothorax

Correct Incorrect Correct answer

Equipment malfunction in the ventilator circuit

Correct Incorrect Correct answer

A paramedic needs to suction secretions from an endotracheal tube in an intubated patient. Which catheter type and technique is most appropriate?

A flexible (French) catheter inserted to the level of the carina or until resistance is met, then suctioning while withdrawing

Correct Incorrect Correct answer

A rigid Yankauer catheter inserted into the endotracheal tube and suctioned during advancement

Correct Incorrect Correct answer

A flexible catheter inserted with continuous suction applied during both insertion and withdrawal

Correct Incorrect Correct answer

A rigid tip catheter inserted past the carina into the right mainstem bronchus for deep suctioning

Correct Incorrect Correct answer

A patient with severe angioedema has progressive tongue and uvula swelling. SpO2 is 90% and dropping. Two attempts at orotracheal intubation have failed due to massive tongue edema obscuring the glottic opening. The patient is becoming cyanotic. What is the most appropriate next action?

Perform an immediate surgical cricothyrotomy to establish a definitive airway

Correct Incorrect Correct answer

Attempt a third orotracheal intubation using a larger blade for better tongue displacement

Correct Incorrect Correct answer

Insert a nasopharyngeal airway and continue bag-valve-mask ventilation

Correct Incorrect Correct answer

Administer epinephrine IV and wait for the swelling to decrease before another intubation attempt

Correct Incorrect Correct answer

You are dispatched to a motor vehicle collision with a patient who has a suspected aortic dissection based on tearing chest pain radiating to the back, unequal bilateral blood pressures, and a widened mediastinum on assessment. Which facility is most appropriate for this patient?

A hospital with cardiothoracic surgery capability

Correct Incorrect Correct answer

The closest emergency department for stabilization

Correct Incorrect Correct answer

A STEMI receiving center for cardiac catheterization

Correct Incorrect Correct answer

A Level III trauma center with general surgery availability

Correct Incorrect Correct answer

In EMS quality improvement, what does benchmarking refer to?

Comparing an agency's performance metrics against established standards or the performance of similar high-performing EMS systems

Correct Incorrect Correct answer

Setting a fixed number of calls each paramedic must complete per shift

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Establishing the minimum educational requirements for new paramedic hires

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Determining the maximum number of patients a single ambulance can transport simultaneously

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What is an electronic patient care report (ePCR)?

A digital documentation system used to record patient assessment findings, treatments, and outcomes in the prehospital setting

Correct Incorrect Correct answer

A telemetry device that transmits ECG rhythms to the emergency department in real time

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A hospital-based electronic health record system used exclusively by emergency physicians

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A computer-aided dispatch tool that generates run reports based on GPS and unit tracking data

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Which organizational strategy is most effective at supporting long-term provider wellness and reducing cumulative stress injury among EMS professionals?

Implementing a comprehensive peer support program with regular check-ins and access to mental health professionals

Correct Incorrect Correct answer

Mandating a single critical incident stress debriefing after every traumatic call

Correct Incorrect Correct answer

Requiring annual fitness testing as the sole wellness intervention

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Discouraging providers from discussing stressful calls to prevent retraumatization

Correct Incorrect Correct answer

A paramedic has responded to three consecutive pediatric death calls over two weeks and is experiencing intrusive thoughts, difficulty sleeping, and emotional numbness. Which component of a comprehensive CISM program is most appropriate at this stage?

Individual crisis intervention with a trained peer counselor or mental health professional

Correct Incorrect Correct answer

A large group defusing session with the entire station

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Mandatory fitness-for-duty evaluation by the medical director

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Administrative leave pending a formal psychological assessment

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Paramedics arrive at an industrial facility where workers report a chemical spill of an unknown substance. Several workers are ambulatory with eye irritation and coughing. Where should the paramedic unit stage and begin patient assessment?

In the cold zone, upwind and uphill from the spill, after patients have been moved through decontamination

Correct Incorrect Correct answer

In the warm zone to begin triage and decontamination simultaneously

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At the entrance to the hot zone to provide the fastest patient access

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Directly adjacent to the spill to perform rapid primary assessments

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EMS is dispatched to a chemical plant where multiple workers are reporting difficulty breathing, tearing eyes, and excessive salivation. The paramedic identifies this as a cholinergic toxidrome. Before treating patients, what must occur first?

Patients must undergo decontamination before receiving medical treatment to protect providers from secondary contamination

Correct Incorrect Correct answer

Paramedics should immediately administer atropine to all patients in the hot zone

Correct Incorrect Correct answer

All patients should be transported to the hospital in the ambulance without decontamination

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Medical treatment should be withheld until the specific chemical agent is identified by the hazmat team

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Which resource should a paramedic consult to identify an unknown hazardous material based on the four-digit UN identification number on a placard?

The Emergency Response Guidebook (ERG)

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The Physicians' Desk Reference (PDR)

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The National Drug Code Directory

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The International Classification of Diseases (ICD) manual

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A paramedic is called to a scene where a patient has been shot. Law enforcement has not yet arrived. The patient has a handgun on the ground next to them. What is the paramedic’s most appropriate action regarding the scene?

Ensure scene safety, provide patient care, avoid disturbing evidence, and note the position of items for law enforcement

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Move the weapon to a safe location and begin patient care immediately

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Refuse to enter the scene until law enforcement secures the weapon

Correct Incorrect Correct answer

Collect the weapon and give it to law enforcement when they arrive

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During a monthly CQI meeting, a quality assurance coordinator presents data showing that 30% of intubation attempts in the past quarter failed on the first pass. Which step in the CQI cycle should the team take next?

Conduct a root cause analysis to identify factors contributing to first-pass failure before implementing changes

Correct Incorrect Correct answer

Immediately restrict intubation privileges for all paramedics until retraining is completed

Correct Incorrect Correct answer

Switch entirely to supraglottic airway devices and eliminate endotracheal intubation from the protocol

Correct Incorrect Correct answer

Increase the number of required continuing education hours for all providers regardless of their individual performance

Correct Incorrect Correct answer

A paramedic responds to a call for an elderly patient in cardiac arrest. Family members present a physician-signed document that specifically addresses only the patient’s resuscitation status, indicating the patient does not wish to receive CPR. What is this document?

A Do Not Resuscitate (DNR) order

Correct Incorrect Correct answer

A living will

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A durable power of attorney for healthcare

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A POLST form

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A paramedic arrives at the scene of a motor vehicle collision. The 14-year-old patient has a deformed femur and is in significant pain. No parent or guardian is present. Under which legal principle can the paramedic provide treatment?

Implied consent for a minor in an emergency

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Expressed consent from the patient

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Involuntary consent under state mental health statutes

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Informed consent obtained from bystanders

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Which of the following best describes evidence-based practice in EMS?

Integrating the best available research evidence with clinical expertise and patient values to guide clinical decisions

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Following only protocols established by local medical directors without considering published research

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Adopting any new treatment technique immediately after a single study shows positive results

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Relying exclusively on personal clinical experience to determine the best treatment approach

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Under which circumstance is a paramedic legally required to breach patient confidentiality?

When reporting suspected child abuse to the appropriate authorities

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When a family member requests information about the patient's condition

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When the patient's employer asks about the nature of the emergency

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When a bystander who witnessed the incident asks for an update

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A paramedic transports a patient to the emergency department and verbally shares the patient’s HIV status with a nurse who is not involved in the patient’s care. Which law has the paramedic most likely violated?

HIPAA (Health Insurance Portability and Accountability Act)

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EMTALA (Emergency Medical Treatment and Labor Act)

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Good Samaritan law

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Ryan White CARE Act

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What is the role of the EMS medical director in an EMS system?

A physician who provides medical oversight, develops protocols, ensures quality of care, and is responsible for the medical aspects of the EMS system

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An EMS administrator who manages the operational budget and staffing schedules

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A hospital emergency physician who only provides online medical control during patient calls

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A government official who licenses individual paramedics and EMTs

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Which factor is most important when determining whether to bypass a closer hospital in favor of a specialty receiving center?

Whether the patient's condition requires time-sensitive specialty resources not available at the closer facility

Correct Incorrect Correct answer

The patient's stated preference for a particular hospital

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The time of day and likely emergency department wait times

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Whether the paramedic has a professional relationship with physicians at either facility

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A paramedic caring for a cardiac arrest patient finds a POLST (Physician Orders for Life-Sustaining Treatment) form on the refrigerator. The form indicates ‘comfort measures only.’ How does a POLST differ from a standard advance directive?

A POLST is a physician-signed medical order that is actionable by EMS, while an advance directive expresses patient wishes and may require interpretation

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A POLST only applies in the hospital setting, while advance directives apply in the field

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A POLST can be created without a physician, while an advance directive requires one

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A POLST replaces the need for any other advance planning documents

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Your EMS agency is reviewing its cardiac arrest protocol. The medical director presents AHA guidelines updated based on ILCOR recommendations. What is the primary role of ILCOR in shaping these resuscitation guidelines?

ILCOR conducts systematic evidence reviews of resuscitation science that national organizations use to develop clinical guidelines

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ILCOR directly writes and enforces resuscitation protocols for all EMS agencies worldwide

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ILCOR certifies individual paramedics in advanced cardiac life support skills

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ILCOR funds and conducts original clinical trials on resuscitation interventions

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A paramedic is operating the ambulance under emergency response conditions on a wet roadway. As the unit approaches an intersection with a red traffic signal, which action is most appropriate?

Come to a complete stop, verify that all lanes of traffic have yielded, then proceed through the intersection

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Slow down and proceed through the intersection if no vehicles are visible

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Activate the air horn and proceed through at reduced speed

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Maintain speed since emergency lights and sirens provide the right of way

Correct Incorrect Correct answer

A 4-year-old child is found unresponsive after a submersion incident. After initial resuscitation, the child has a pulse but remains apneic and requires assisted ventilation. The closest emergency department is 10 minutes away, and a pediatric specialty center is 35 minutes away. Which transport decision is most appropriate?

Transport to the closest emergency department for stabilization with plans for pediatric center transfer

Correct Incorrect Correct answer

Transport directly to the pediatric specialty center regardless of transport time

Correct Incorrect Correct answer

Remain on scene until the child begins breathing independently

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Request a pediatric transport team to respond to the scene

Correct Incorrect Correct answer

CHEMTREC (Chemical Transportation Emergency Center) provides what type of assistance to emergency responders at a hazardous materials incident?

24-hour telephone guidance on chemical hazards, product identification, and initial response recommendations

Correct Incorrect Correct answer

On-site decontamination teams deployed within 30 minutes of notification

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Legal authorization for EMS to administer antidotes at hazmat incidents

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Mandatory incident command structure assignments for all responding agencies

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What is the fundamental difference between online (direct) medical control and offline (indirect) medical control in the EMS system?

Online medical control involves real-time communication with a physician for specific patient care orders, while offline medical control consists of standing orders, protocols, and policies developed prospectively by the medical director

Correct Incorrect Correct answer

Online medical control uses internet-based video consultation, while offline uses radio communication

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Online medical control is for ALS providers only, while offline is for BLS providers only

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Online medical control requires a physician on scene, while offline allows physicians to remain at the hospital

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Your agency is considering adopting a new prehospital sepsis screening tool. Two studies are available: Study A is a single-center retrospective chart review of 200 patients, and Study B is a multicenter prospective observational study of 3,000 patients. Which factor most strengthens Study B’s applicability to your system?

Its prospective multicenter design with a larger sample size increases generalizability and reduces selection bias

Correct Incorrect Correct answer

Retrospective studies are inherently invalid and should never be used to guide clinical decisions

Correct Incorrect Correct answer

The larger number of study sites guarantees that the screening tool will work in any EMS system

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Prospective studies always produce statistically significant results compared to retrospective studies

Correct Incorrect Correct answer

Intelligence reports indicate a possible radiological dispersal device (dirty bomb) has detonated in a downtown area. Multiple patients with blast injuries are presenting. What differentiates a dirty bomb from a nuclear detonation in terms of the primary threat to patients and responders?

A dirty bomb uses conventional explosives to disperse radioactive material; the blast and contamination are the primary threats, not a nuclear chain reaction or massive radiation dose

Correct Incorrect Correct answer

A dirty bomb produces the same level of radiation as a nuclear weapon but over a smaller area

Correct Incorrect Correct answer

A dirty bomb creates an electromagnetic pulse that disables medical equipment within the blast radius

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A dirty bomb generates fallout patterns identical to a nuclear detonation requiring the same evacuation zones

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An EMS provider responds to a fatal motor vehicle collision involving a child the same age as their own. Over the following weeks, they experience intrusive thoughts about the call, difficulty sleeping, emotional numbness, and avoidance of similar call types. What condition do these symptoms suggest?

Post-traumatic stress disorder (PTSD) or acute stress disorder requiring professional mental health support

Correct Incorrect Correct answer

Normal adjustment that will resolve without any intervention within a few days

Correct Incorrect Correct answer

Burnout from excessive work hours that can be fixed with time off

Correct Incorrect Correct answer

A physical illness causing the sleep disturbance and emotional changes

Correct Incorrect Correct answer

In EMS quality improvement, what type of performance metric measures the percentage of STEMI patients who receive aspirin within 10 minutes of EMS contact?

A process measure that evaluates adherence to a specific evidence-based intervention

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An outcome measure that evaluates patient survival rates

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A structural measure that evaluates equipment availability

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A balancing measure that evaluates unintended consequences of treatment

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Which of the following best describes the legal concept of assault in the EMS setting?

Placing a patient in fear of being touched or harmed without consent

Correct Incorrect Correct answer

Physically restraining a combative patient without medical direction

Correct Incorrect Correct answer

Performing a procedure on a patient who has given verbal consent

Correct Incorrect Correct answer

Transporting a patient to a facility not of their choosing

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What is the primary purpose of closed-loop communication during a cardiac arrest resuscitation?

To ensure that orders are received, understood, and acknowledged by confirming them back to the team leader

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To reduce the total number of verbal communications during the resuscitation

Correct Incorrect Correct answer

To allow the team leader to manage the resuscitation without input from team members

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To document all verbal orders in real time on the patient care report

Correct Incorrect Correct answer

A paramedic notices that a colleague has been increasingly irritable, withdrawing from social interactions, and calling in sick frequently after responding to a pediatric cardiac arrest two weeks ago. Which action is most appropriate?

Privately express concern and encourage the colleague to contact a peer support or CISM resource

Correct Incorrect Correct answer

Report the colleague to the supervisor for disciplinary review

Correct Incorrect Correct answer

Avoid discussing the issue to respect the colleague's privacy

Correct Incorrect Correct answer

Tell the colleague to take vacation time until feeling better

Correct Incorrect Correct answer

Which of the following is a recognized sign of substance abuse in an EMS provider?

Frequent unexplained absences and changes in work performance

Correct Incorrect Correct answer

Consistently arriving early for shifts

Correct Incorrect Correct answer

Volunteering for additional training opportunities

Correct Incorrect Correct answer

Requesting schedule changes for family commitments

Correct Incorrect Correct answer

A new paramedic asks about the role of the EMS medical director. Which statement best describes the scope of physician oversight in an EMS system?

The medical director provides oversight through protocol development, quality improvement, training, and real-time online medical direction

Correct Incorrect Correct answer

The medical director only provides online medical direction during active patient encounters

Correct Incorrect Correct answer

The medical director is responsible solely for disciplinary actions against paramedics

Correct Incorrect Correct answer

The medical director reviews charts but has no authority over treatment protocols

Correct Incorrect Correct answer

A paramedic is reviewing a meta-analysis that pooled data from 12 randomized controlled trials on epinephrine use in cardiac arrest. The overall finding shows improved return of spontaneous circulation but no improvement in neurologically intact survival. How should this finding best inform clinical practice?

Recognize that epinephrine improves short-term outcomes but that current evidence does not demonstrate long-term neurological benefit, and follow current guideline recommendations while monitoring evolving evidence

Correct Incorrect Correct answer

Discontinue epinephrine use entirely since it does not improve the outcome that matters most to patients

Correct Incorrect Correct answer

Continue administering epinephrine without considering the meta-analysis because it has always been part of the cardiac arrest algorithm

Correct Incorrect Correct answer

Administer higher doses of epinephrine to achieve both ROSC and neurological benefit simultaneously

Correct Incorrect Correct answer

At a hazardous materials incident, the paramedic is operating at the awareness level. Which action is within the paramedic’s scope at this level?

Recognize the presence of hazardous materials, isolate the area, deny entry, and call for specialized hazmat resources

Correct Incorrect Correct answer

Enter the hot zone wearing Level A protective equipment to rescue victims

Correct Incorrect Correct answer

Perform decontamination of exposed patients using water and soap

Correct Incorrect Correct answer

Identify the specific chemical agent using direct sampling and testing equipment

Correct Incorrect Correct answer

In the hierarchy of evidence used to guide EMS clinical practice, which type of study provides the strongest level of evidence?

Systematic review or meta-analysis of randomized controlled trials

Correct Incorrect Correct answer

A single large randomized controlled trial

Correct Incorrect Correct answer

A well-designed prospective cohort study

Correct Incorrect Correct answer

Expert consensus opinion from a national medical organization

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A paramedic is evaluating a clinical study that found no statistically significant difference in survival between two airway management techniques. The study’s p-value was 0.42. What does this p-value indicate?

There is a 42% probability that the observed difference occurred by chance, suggesting insufficient evidence to conclude a real difference exists

Correct Incorrect Correct answer

There is a 42% probability that the null hypothesis is true, confirming equivalent effectiveness

Correct Incorrect Correct answer

The treatment was effective in 42% of cases, which falls below the threshold for clinical significance

Correct Incorrect Correct answer

There is a 58% chance the study results are correct and applicable to prehospital care

Correct Incorrect Correct answer

When is fixed-wing air medical transport typically preferred over rotor-wing (helicopter) transport?

When the transport distance exceeds approximately 150 miles

Correct Incorrect Correct answer

When the patient requires transport during inclement weather

Correct Incorrect Correct answer

When the patient is hemodynamically unstable and needs immediate intervention

Correct Incorrect Correct answer

When the transport distance is less than 50 miles to a specialty center

Correct Incorrect Correct answer

A paramedic crew is dispatched to a patient on the third floor of a building with no elevator. The patient weighs approximately 300 pounds and needs to be carried down the stairs on a stair chair. Which lifting technique principle is most important to prevent provider injury?

Keep the back straight and lift with the legs while maintaining a firm grip on the stair chair

Correct Incorrect Correct answer

Bend at the waist to get closer to the load and use arm strength

Correct Incorrect Correct answer

Lift quickly in one smooth motion to minimize time under strain

Correct Incorrect Correct answer

Keep feet close together for better balance on the stairs

Correct Incorrect Correct answer

A trauma patient is located in a rural area 90 minutes by ground from the nearest trauma center. The patient has a GCS of 10, a blood pressure of 82/58 mmHg, and a suspected pelvic fracture. A helicopter is available with a 15-minute response time and a 20-minute flight to the trauma center. What is the most appropriate transport decision?

Request rotor-wing air medical transport to the trauma center

Correct Incorrect Correct answer

Begin ground transport to the nearest community hospital for stabilization

Correct Incorrect Correct answer

Wait for a second ground ambulance to provide an ALS intercept

Correct Incorrect Correct answer

Begin ground transport directly to the trauma center 90 minutes away

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Which type of air medical transport is most appropriate for transferring a stable patient from a rural hospital to a specialty center 400 miles away?

Fixed-wing aircraft

Correct Incorrect Correct answer

Rotor-wing helicopter

Correct Incorrect Correct answer

Ground ambulance with lights and sirens

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Critical care ground transport unit

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What is the purpose of peer review in an EMS quality improvement program?

To provide objective evaluation of clinical care by fellow providers in order to identify learning opportunities and system improvements

Correct Incorrect Correct answer

To rank paramedics from best to worst performers for annual evaluations

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To replace the need for medical director oversight of clinical care

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To allow paramedics to review and modify their own patient care reports before submission

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Multiple patients from a chemical plant explosion present with pinpoint pupils, excessive salivation, bradycardia, and muscle fasciculations. After decontamination, what is the most appropriate antidote combination for these patients?

Atropine and pralidoxime (2-PAM), available as the DuoDote auto-injector

Correct Incorrect Correct answer

Hydroxocobalamin and sodium thiosulfate

Correct Incorrect Correct answer

Naloxone and flumazenil

Correct Incorrect Correct answer

Calcium gluconate and sodium bicarbonate

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Which of the following best defines the legal term ‘battery’ in the context of emergency medical services?

Providing treatment to a competent patient who has refused care

Correct Incorrect Correct answer

Threatening a patient with physical harm if they refuse transport

Correct Incorrect Correct answer

Failing to provide the accepted standard of care

Correct Incorrect Correct answer

Disclosing protected patient health information without authorization

Correct Incorrect Correct answer

A paramedic arrives at a scene where a patient is experiencing a severe allergic reaction with hypotension and stridor. The local protocol states to administer 0.3 mg epinephrine intramuscularly, but the patient’s condition is rapidly deteriorating despite two IM doses. The paramedic believes IV epinephrine is needed. What is the most appropriate course of action?

Contact medical direction to request authorization for IV epinephrine while continuing supportive care

Correct Incorrect Correct answer

Administer IV epinephrine independently since the patient's life is in danger

Correct Incorrect Correct answer

Administer a third IM dose since it is within protocol

Correct Incorrect Correct answer

Withhold further epinephrine and focus solely on IV fluid resuscitation

Correct Incorrect Correct answer

Which of the following is a primary indication for requesting rotor-wing (helicopter) air medical transport?

Prolonged ground transport time to an appropriate specialty center exceeding 30 to 45 minutes

Correct Incorrect Correct answer

Any patient with a GCS of less than 15

Correct Incorrect Correct answer

Stable patients who request the fastest transport available

Correct Incorrect Correct answer

Scenes in urban areas with multiple trauma centers nearby

Correct Incorrect Correct answer

Which coping strategy is most recommended for EMS providers to manage cumulative occupational stress?

Regular physical exercise, adequate sleep, and proactive use of peer support programs

Correct Incorrect Correct answer

Avoiding discussion of stressful calls to prevent reliving traumatic events

Correct Incorrect Correct answer

Working additional overtime shifts to stay busy and distracted

Correct Incorrect Correct answer

Relying primarily on critical incident debriefings after every call

Correct Incorrect Correct answer

A paramedic’s agency protocol specifies adenosine as the first-line treatment for stable SVT. However, the paramedic recently attended a conference where a physician recommended diltiazem as an alternative first-line agent. How should the paramedic proceed when treating a patient with stable SVT?

Follow the agency's established protocol and administer adenosine; contact medical direction if the protocol-directed treatment fails

Correct Incorrect Correct answer

Administer diltiazem based on the conference recommendation since it was presented by a physician

Correct Incorrect Correct answer

Administer both medications simultaneously to cover all treatment options

Correct Incorrect Correct answer

Withhold both medications and transport the patient without pharmacological intervention

Correct Incorrect Correct answer

In the Incident Command System (ICS), what is the recommended span of control for a supervisor?

3 to 7 subordinates, with an optimal ratio of 1 supervisor to 5 subordinates

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1 supervisor to 2 subordinates maximum

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1 supervisor to 10 to 15 subordinates

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There is no recommended span of control in ICS

Correct Incorrect Correct answer

A paramedic on scene is unable to reach the base station hospital directly using a portable radio due to terrain interference. Which device would best extend the communication range by receiving the signal and retransmitting it at a higher power?

A repeater

Correct Incorrect Correct answer

A dedicated encoder

Correct Incorrect Correct answer

A digital scanner

Correct Incorrect Correct answer

A frequency modulator

Correct Incorrect Correct answer

You arrive at an industrial facility where workers are experiencing respiratory distress after a chemical release. The facility safety officer identifies the substance as hydrogen cyanide. Multiple patients are symptomatic with altered mental status and cherry-red skin color. Which antidote should the paramedic prepare to administer?

Hydroxocobalamin (Cyanokit)

Correct Incorrect Correct answer

Atropine sulfate

Correct Incorrect Correct answer

Pralidoxime (2-PAM)

Correct Incorrect Correct answer

Calcium gluconate

Correct Incorrect Correct answer

Which of the following is a recognized indication for requesting air medical (helicopter) transport?

Prolonged ground transport time to an appropriate facility when the patient has a time-sensitive condition such as STEMI, stroke, or major trauma

Correct Incorrect Correct answer

Any patient with a fracture who lives more than 15 minutes from the hospital

Correct Incorrect Correct answer

A patient requesting helicopter transport due to personal preference

Correct Incorrect Correct answer

All motor vehicle collisions regardless of patient condition or transport time

Correct Incorrect Correct answer

What does the legal concept of “due regard” require when operating an emergency vehicle with lights and sirens?

The operator must drive with consideration for the safety of other motorists and pedestrians despite exemptions from normal traffic laws

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The operator is fully exempt from liability for any collisions during emergency responses

Correct Incorrect Correct answer

The operator must follow all posted speed limits regardless of the emergency

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The operator may disregard traffic signals only when directed by law enforcement

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At a hazmat incident, the incident commander informs EMS that the atmosphere contains a known chemical with an identified concentration. The hazmat team determines an air-purifying respirator (APR) with appropriate cartridges will provide adequate respiratory protection. What level of PPE does this describe?

Level C

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Level A

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Level B

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Level D

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A paramedic notices that a colleague consistently documents medication administration times that precede the times recorded by the cardiac monitor for the same medications. During a quality improvement review, what type of issue does this discrepancy most likely represent?

A documentation accuracy concern that warrants further investigation and remediation

Correct Incorrect Correct answer

A minor clerical error that does not affect patient care quality

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Evidence of a monitor malfunction requiring biomedical engineering review

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A protocol violation that requires immediate suspension of the provider

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At an active shooter incident, the paramedic is part of a Rescue Task Force operating in the warm zone with law enforcement protection. What is the primary medical intervention focus in this zone?

Rapid hemorrhage control (tourniquet application and wound packing) and immediate evacuation to the cold zone for further treatment

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Full ACLS resuscitation including intubation and IV medications

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Detailed patient assessment with comprehensive secondary surveys

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Triage of all victims using the START algorithm before any treatment

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During an MCI, a patient triaged as Yellow (Delayed) begins to show signs of respiratory distress with falling SpO2 and increasing work of breathing. The treatment area is overwhelmed. What is the appropriate response?

Re-triage the patient to Red (Immediate) and prioritize them for treatment and transport ahead of other Yellow patients

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Maintain the Yellow category because re-triage disrupts the system during an MCI

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Upgrade the patient to Black (Expectant) since resources are overwhelmed

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Send the patient directly to the hospital without any intervention to free up resources

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Which type of air medical transport is most appropriate for interfacility transfers over distances greater than 150 miles?

Fixed-wing aircraft

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Rotor-wing helicopter

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Ground critical care transport unit

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Standard ALS ground ambulance

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In crew resource management, what does ‘closed-loop communication’ mean during a resuscitation?

The team leader gives an order, the team member repeats the order back to confirm understanding, and reports completion when done

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The team leader gives all orders in writing to prevent miscommunication

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Only the team leader speaks during the resuscitation to prevent confusion

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Team members communicate only through hand signals in noisy environments

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You are transporting a stable patient with an isolated distal radius fracture. The patient requests that you use lights and sirens to get to the hospital faster. How should you respond?

Explain that lights and sirens are not indicated for this injury and transport at normal speed

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Comply with the patient's request since they have the right to determine their care

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Use lights and sirens because any fracture constitutes an emergency

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Contact medical direction for permission to use lights and sirens

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A paramedic responds to a call for an intoxicated patient who fell and has a large scalp laceration with active bleeding. The patient is belligerent and repeatedly states he does not want to be treated. His speech is slurred, he cannot stand, and his GCS is 12. What is the most appropriate course of action?

Treat the patient under implied consent because his intoxication impairs his ability to make a competent decision

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Honor the patient's refusal and have him sign an AMA form

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Physically restrain the patient without attempting further communication

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Leave the scene and document the patient's verbal refusal

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You are en route to a Level I trauma center with a patient who has sustained a penetrating abdominal injury. Dispatch informs you the trauma center has gone on diversion due to hospital capacity. What is the most appropriate action?

Contact medical direction to determine the next most appropriate receiving facility

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Continue to the trauma center on diversion since trauma patients cannot be refused

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Divert to the closest emergency department regardless of trauma designation

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Return to the scene and wait for the trauma center to come off diversion

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Your EMS agency conducts a chart review and finds that only 62% of intubated patients had continuous ETCO2 monitoring documented during transport. The established protocol requires 100% compliance. Which quality improvement approach is most appropriate to address this finding?

Implement a systems-based approach: identify barriers to compliance, provide targeted education, and re-audit after interventions

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Discipline the providers who did not document ETCO2 monitoring

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Remove ETCO2 monitoring from the protocol since compliance is too low to enforce

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Assume the monitoring was performed but not documented and take no action

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Which of the following best describes the concept of ‘scene safety’ as the first priority of every EMS response?

Ensuring the scene is safe for providers before approaching or entering, because an injured provider cannot help patients and becomes an additional patient

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Making the scene safe for bystanders before beginning any patient assessment

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Waiting for law enforcement to clear every scene before EMS approaches any patient

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Ensuring the patient is in a safe location before beginning treatment

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During a post-cardiac arrest debriefing, the team identifies that chest compressions were interrupted for 45 seconds during an intubation attempt. This exceeds the recommended 10-second pause limit. Using the Plan-Do-Study-Act (PDSA) quality improvement model, what would be the appropriate next step?

Plan an intervention (such as using video laryngoscopy with continuous compressions or setting a timer), implement it on the next call, and measure the results

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File a formal complaint against the paramedic who performed the intubation

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Remove intubation from the scope of practice for that paramedic until recertified

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Accept that compression interruptions are inevitable during intubation and make no changes

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A paramedic working under an expanded scope protocol performs a point-of-care ultrasound on a trauma patient and identifies free fluid in the abdomen. The protocol authorizes the ultrasound but does not specify treatment modifications based on findings. How should the paramedic proceed?

Communicate the findings to the receiving facility and medical direction to guide transport and treatment decisions

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Initiate aggressive fluid resuscitation based on the presumptive diagnosis of internal hemorrhage

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Repeat the ultrasound at five-minute intervals to monitor for changes

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Document the findings but do not alter the treatment plan since the protocol does not specify

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A 4-year-old child has sustained a severe traumatic brain injury with a GCS of 6 after a fall from a second-story window. The closest community hospital is 10 minutes away. A pediatric trauma center is 35 minutes by ground. What is the most appropriate transport decision?

Transport directly to the pediatric trauma center

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Transport to the closest community hospital for stabilization and transfer

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Transport to the closest community hospital and call for a helicopter from there

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Call for helicopter transport from the scene to the community hospital

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A paramedic is caring for a mechanically ventilated patient on multiple vasopressor infusions who requires interfacility transfer from a community hospital to a tertiary care center 45 miles away. Which transport resource is most appropriate for this patient?

Critical care transport team with a paramedic and critical care nurse

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Standard ALS ambulance with two paramedics

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BLS ambulance with a registered nurse from the sending facility

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Rotor-wing helicopter with a flight paramedic only

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During a JumpSTART triage assessment of a 4-year-old child at a mass casualty incident, the child is not walking, is breathing at 12 breaths per minute, has a palpable peripheral pulse, and does not respond to a simple command such as ‘squeeze my hand.’ According to JumpSTART, how should this child be triaged?

Red (immediate) because the child has an altered mental status despite adequate breathing and perfusion

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Yellow (delayed) because the child is breathing adequately and has a peripheral pulse

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Green (minor) because the respiratory rate is within normal limits

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Black (expectant) because the child is unresponsive

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A paramedic administers the wrong medication dose to a patient. No adverse outcome results, but the error is identified during chart review. What is the most appropriate quality improvement response?

File an error report, conduct a root cause analysis to identify contributing factors, and implement system changes to prevent similar errors

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Take no action because the patient was not harmed and reporting would only create unnecessary documentation

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Immediately terminate the paramedic to prevent future medication errors from occurring

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Modify the patient care report to reflect the correct dose so the error is not documented

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What is the difference between online (direct) medical direction and offline (indirect) medical direction?

Online medical direction involves real-time communication with a physician for specific patient care orders, while offline medical direction encompasses standing orders, protocols, and training established before the call

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Online medical direction uses internet-based telemedicine exclusively, while offline uses radio communication

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Online medical direction applies only to paramedics, while offline direction applies to EMTs

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Online medical direction is provided by emergency physicians, while offline direction is provided by nurses

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In the Incident Command System (ICS), which individual has overall authority and responsibility for managing the incident?

Incident Commander

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Operations Section Chief

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Safety Officer

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Liaison Officer

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Which of the following best describes evidence-based medicine (EBM) in the context of prehospital care?

Integrating the best available research evidence with clinical expertise and patient values to guide treatment decisions

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Following local protocols exactly as written regardless of new research findings

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Relying primarily on personal field experience to determine the most effective treatments

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Adopting treatment strategies based on recommendations from the most senior paramedic on scene

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In the National Incident Management System (NIMS), which section is responsible for managing all tactical operations at an incident?

Operations Section

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Planning Section

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Logistics Section

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Finance/Administration Section

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During a multi-patient incident, a paramedic notices that the team leader is fixated on a single critical patient while other patients are deteriorating. The paramedic has been assigned to triage. What is the most appropriate action?

Assertively communicate the concern to the team leader using structured language such as 'I am concerned that other patients need attention'

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Remain silent and continue assigned duties, as questioning the team leader undermines authority

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Take over the team leader role without discussion to redirect priorities

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Wait until after the incident to mention the concern during the debriefing

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A paramedic receives online medical direction from a physician to administer a medication that the paramedic believes is contraindicated for the patient based on the patient’s medical history. What is the appropriate action?

Respectfully express the concern and the specific contraindication to the physician, provide additional clinical information, and seek clarification before proceeding

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Administer the medication as ordered because the physician has ultimate authority over all medical decisions

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Refuse the order without explanation and document that the physician made an error

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Administer half the ordered dose as a compromise between the order and the paramedic's concern

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An EMS agency implements a continuous quality improvement (CQI) program. Which characteristic best distinguishes CQI from traditional quality assurance?

CQI is an ongoing, proactive process that seeks to continuously improve care delivery, rather than a retrospective review that only identifies problems after they occur

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CQI only reviews calls that resulted in patient complaints, while QA reviews all calls

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CQI focuses exclusively on response times, while QA evaluates clinical care quality

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CQI eliminates the need for data collection because it relies on provider self-assessment

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In the Incident Command System (ICS), what is the primary function of the transport area (also called the transport sector) at a mass casualty incident?

Coordinating the movement of triaged patients to appropriate receiving hospitals based on capacity and capability

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Providing definitive treatment to patients before they are moved from the scene

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Staging incoming ambulances and other emergency vehicles

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Establishing the incident command post and communications center

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An EMS agency’s cardiac arrest survival rate is significantly lower than the national benchmark. A root cause analysis reveals that CPR compression rates are consistently below 100 per minute and compression fraction is below 60%. Which quality improvement intervention would most directly address the identified root cause?

Implement real-time CPR feedback devices and conduct targeted high-performance CPR training with measurable competency standards

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Purchase newer defibrillators with higher energy output to compensate for suboptimal CPR quality

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Increase the number of paramedics responding to cardiac arrest calls without addressing CPR technique

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Reduce the geographic service area so that response times are shorter for all cardiac arrest calls

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An EMS system tracks outcome measures for cardiac arrest patients and finds that their survival-to-discharge rate is 8%, while a national benchmark is 12%. The medical director wants to identify areas for improvement. Which outcome measure would be most useful to analyze first?

Rate of bystander CPR and time to first defibrillation for witnessed shockable rhythms

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Total number of cardiac arrests responded to per year by the agency

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Average transport time from scene to the nearest emergency department

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Percentage of cardiac arrest patients who received an advanced airway device

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A paramedic sustains a needlestick injury while starting an IV on a patient with unknown medical history. What is the most important immediate action?

Wash the wound immediately with soap and water, report the exposure to a supervisor, and seek post-exposure evaluation and testing per the agency's exposure control plan

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Apply a bandage to the wound site and continue patient care without reporting

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Request that the patient's blood be tested for infections before seeking medical evaluation

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Document the incident in the patient care report and follow up at the next scheduled physical examination

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A 35-year-old patient has sustained 45% total body surface area burns including circumferential burns to both lower extremities and inhalation injury. The closest hospital is 15 minutes away. A verified burn center is 90 minutes by ground or 35 minutes by helicopter. What is the most appropriate transport plan?

Request helicopter transport to the verified burn center

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Transport by ground to the closest hospital for initial stabilization

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Transport by ground directly to the burn center

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Transport to the closest hospital and arrange fixed-wing transfer to the burn center

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What is the difference between online and offline medical direction?

Online medical direction involves real-time communication with a physician; offline medical direction consists of standing orders, protocols, and training

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Online medical direction uses internet-based communication; offline medical direction uses radio

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Online medical direction applies to ALS providers; offline medical direction applies to BLS providers

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Online medical direction is mandatory for all patient contacts; offline medical direction is optional

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What is the primary purpose of a Critical Incident Stress Debriefing (CISD)?

To provide a structured group discussion after a traumatic event to help process emotional reactions

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To determine if any protocols were violated during the call

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To assign accountability for errors made during patient care

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To evaluate the clinical performance of individual crew members

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A paramedic is completing an ePCR and wants to ensure the patient care data is available to the receiving emergency department before arrival. Which feature of modern ePCR systems supports this goal?

Real-time data sharing that transmits ePCR information electronically to the receiving facility while still en route

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A printed paper copy of the report generated automatically by the cardiac monitor upon arrival

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A verbal radio report that replaces the need for any written or electronic documentation

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A faxed copy of the report sent from the EMS station to the hospital after the call is completed

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In EMS quality improvement, what does the term “sentinel event” refer to?

An unexpected occurrence involving death or serious harm that signals the need for immediate investigation

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A routine call that meets all quality benchmarks and serves as a positive example

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The first cardiac arrest call handled by a newly certified paramedic

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A scheduled audit of medication inventory and equipment readiness

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A paramedic encounters a clinical situation not covered by the agency’s standing orders or protocols. The patient is deteriorating and needs intervention. What is the appropriate action?

Contact online medical direction for physician orders specific to the clinical situation while continuing to provide supportive care

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Improvise treatment based on personal clinical judgment without contacting medical direction

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Withhold all treatment because it is not covered by standing orders

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Transport the patient immediately without any intervention and let the hospital manage the situation

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A paramedic is treating a trauma patient with suspected internal hemorrhage and a systolic blood pressure of 84 mmHg. What is the appropriate fluid resuscitation strategy?

Administer crystalloid fluid boluses targeting a systolic blood pressure of 80 to 90 mmHg (permissive hypotension), avoiding aggressive resuscitation to normal blood pressure

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Administer 2 liters of normal saline as rapidly as possible to restore a systolic blood pressure of 120 mmHg

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Withhold all IV fluids because fluid resuscitation worsens hemorrhage in all cases

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Administer colloid solutions preferentially because they stay in the intravascular space longer

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Which type of fracture involves the bone breaking into multiple fragments at the fracture site?

Comminuted fracture

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Greenstick fracture

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Oblique fracture

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Transverse fracture

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A head trauma patient has clear fluid draining from the right ear. The paramedic should recognize this as a potential sign of which condition?

Basilar skull fracture with CSF otorrhea

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Ruptured tympanic membrane from blast injury

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Acute otitis media with effusion

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Hemotympanum from mandibular fracture

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A patient with a stab wound to the chest has a large open chest wound that was initially managed with a three-sided occlusive dressing. What is the advantage of a three-sided dressing compared to a fully occlusive (four-sided) dressing for an open pneumothorax?

The open fourth side acts as a flutter valve, allowing air to escape on exhalation while preventing air entry on inhalation, reducing the risk of tension pneumothorax

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It allows the paramedic to visualize the wound for ongoing hemorrhage assessment

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It provides better adhesion to the skin than a fully occlusive dressing

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It allows medications to be applied directly to the wound through the open side

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A 30-year-old male was punched in the temple during an altercation and lost consciousness briefly. He regained consciousness and appeared lucid, talking with police for 20 minutes. He then suddenly becomes confused, develops a left-sided headache, and his right pupil begins to dilate. What type of intracranial hemorrhage does this ‘lucid interval’ presentation most likely represent?

Epidural hematoma from a torn middle meningeal artery

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Subdural hematoma from torn bridging veins

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Subarachnoid hemorrhage from a ruptured aneurysm

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Intracerebral hemorrhage from hypertensive crisis

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In multisystem trauma management, what does the ‘stay and play’ approach refer to?

Extended on-scene time performing advanced interventions before transport

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Staging at a safe location and waiting for scene clearance

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Treating the patient at the closest emergency department before transfer

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Having multiple agencies respond and divide patient care responsibilities

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A 32-year-old male is involved in a high-speed motorcycle collision with obvious bilateral femur fractures, an open abdominal wound, and altered mental status. Which criteria support trauma activation at a Level I trauma center?

High-energy mechanism, multiple anatomical injuries, and altered mental status meet criteria for trauma activation at a Level I trauma center

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The patient should be transported to the nearest emergency department regardless of trauma center availability

Correct Incorrect Correct answer

Bilateral femur fractures alone require only a community hospital evaluation

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Trauma activation criteria are based solely on vital sign abnormalities, not mechanism or injuries

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An 8-month-old infant is involved in a motor vehicle collision while in a rear-facing car seat. The infant is crying but has a large hematoma on the occiput. Vital signs show HR 180, RR 52, BP 68/40. Which of the following findings most strongly suggests a skull fracture?

Palpable step-off deformity over the occipital bone

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A large scalp hematoma without deformity

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Crying with a high-pitched tone

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A heart rate of 180 beats per minute

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The Cushing triad, a late sign of critically elevated intracranial pressure, consists of which three findings?

Hypertension, bradycardia, and irregular respirations

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Hypotension, tachycardia, and tachypnea

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Hypertension, tachycardia, and apnea

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Hypotension, bradycardia, and Cheyne-Stokes respirations

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A 4-year-old child presents after a fall from playground equipment approximately 8 feet high. He is alert but complaining of neck pain. His vital signs are: HR 100 bpm, RR 22, BP 94/62 mmHg, SpO2 98%. He has no focal neurological deficits, but he is tender to palpation over the upper cervical spine. Why are pediatric patients more susceptible to upper cervical spine injuries compared to adults?

Children have a proportionally larger and heavier head relative to their body, creating a fulcrum effect at the upper cervical spine

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Children have fully ossified cervical vertebrae that fracture more easily than adult cartilaginous structures

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The pediatric spinal cord is shorter and terminates higher in the spinal canal than in adults

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Pediatric cervical ligaments are stiffer and less elastic, transmitting more force to the vertebrae

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A 6-year-old child was struck by a vehicle while crossing the street. The child has paradoxical chest wall movement on the right side with diminished breath sounds bilaterally. SpO2 is 84% on high-flow oxygen. What is the most likely injury pattern?

Flail chest with bilateral pulmonary contusions

Correct Incorrect Correct answer

Isolated right-sided pneumothorax

Correct Incorrect Correct answer

Diaphragmatic rupture

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Cardiac tamponade

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A critically ill patient in the field requires a vasopressor infusion, but peripheral IV access in the arms has been difficult to maintain. The paramedic needs to establish alternative large-bore venous access. Which vessel is most commonly used for emergent alternative access in the prehospital setting?

External jugular vein

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Subclavian vein

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Femoral artery

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Internal jugular vein

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A paramedic is treating multiple casualties from a pipe bomb detonation at an outdoor event. A 28-year-old female has a large metallic fragment embedded in her left thigh with active arterial bleeding. What is the most appropriate initial hemorrhage control measure?

Apply a tourniquet proximal to the wound

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Remove the embedded fragment and apply direct pressure

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Apply a hemostatic dressing directly over the embedded fragment

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Clamp the bleeding vessel with a hemostat

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After an explosion in a subway tunnel, a 45-year-old male presents with hemoptysis, subcutaneous emphysema in the neck and chest, and rapidly declining SpO2 despite high-flow oxygen. Breath sounds are present bilaterally. What is the most likely diagnosis?

Blast lung injury with alveolar hemorrhage and air embolism risk

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Bilateral tension pneumothorax requiring bilateral needle decompression

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Tracheal rupture requiring surgical airway placement

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Smoke inhalation with upper airway edema

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A 3-year-old child has sustained blunt abdominal trauma from a bicycle handlebar. The child is pale, tachycardic at 160, and has a rigid abdomen. Blood pressure is 70/50 mmHg. In pediatric patients, hypotension as a sign of hemorrhagic shock typically indicates what?

A loss of approximately 30% or more of the child's blood volume

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A loss of approximately 10% of blood volume

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An early compensatory response to pain

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A normal physiologic response in a frightened child

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In the prehospital setting, which blood products may paramedics administer to hemorrhaging trauma patients in systems that permit it?

Packed red blood cells and, in some systems, whole blood or plasma, per local protocol authorization

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Platelet concentrates and cryoprecipitate, which are standard prehospital blood products

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Blood products are never administered in the prehospital setting under any protocol

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Autologous blood collection and reinfusion from the patient's chest cavity

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A restrained driver in a frontal collision presents with left shoulder pain (Kehr sign), left upper quadrant tenderness, and progressive tachycardia. Breath sounds are diminished in the left lower lobe. A chest X-ray at the hospital shows the stomach herniated into the left chest. What injury has occurred?

Traumatic diaphragmatic rupture

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Splenic laceration with referred pain

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Left-sided tension pneumothorax

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Traumatic aortic dissection

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A paramedic arrives at the scene of a pedestrian struck by a vehicle at high speed. The patient has an open femur fracture, facial trauma with active bleeding, and is becoming increasingly combative. What transport philosophy is most appropriate?

Scoop and run to the nearest trauma center, performing only critical interventions en route such as hemorrhage control and airway management

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Remain on scene to fully splint the femur fracture and control all bleeding before transport

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Wait for aeromedical transport since ground ambulance is insufficient for this patient

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Perform a complete head-to-toe secondary survey before initiating transport

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A head-injured patient with a GCS of 6 has one pupil that is 6 mm and non-reactive while the other is 3 mm and reactive. This finding most likely indicates which intracranial process?

Uncal herniation compressing the ipsilateral oculomotor nerve (CN III)

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Bilateral cerebral contusions with diffuse axonal injury

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Epidural hematoma without significant mass effect

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Elevated intracranial pressure that is evenly distributed

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What is the concept of ‘balanced resuscitation’ in the management of hemorrhagic shock?

Using a combination of crystalloid, blood products, and hemorrhage control while avoiding excessive clear fluid administration

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Administering equal volumes of crystalloid and colloid solutions simultaneously

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Maintaining a fluid infusion rate that matches the estimated rate of blood loss exactly

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Alternating between warm and cold IV fluids to maintain core temperature

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A patient involved in a motor vehicle collision presents with bilateral periorbital ecchymosis and clear fluid draining from the nose. The paramedic suspects this fluid may be cerebrospinal fluid. What finding would support this suspicion?

The fluid produces a halo or ring sign when dropped on a gauze pad

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The fluid is thick and has a yellowish color

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The fluid stops draining when the patient sits upright

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The fluid tests positive for hemoglobin on a glucose strip

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What does REBOA stand for, and what is its primary function in hemorrhagic shock management?

Resuscitative Endovascular Balloon Occlusion of the Aorta; it occludes the aorta to reduce distal hemorrhage and maintain proximal perfusion

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Rapid External Bilateral Occlusive Arterial device; it applies external compression to major vessels

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Resuscitative Emergency Bypass and Oxygenation of the Aorta; it provides cardiopulmonary bypass

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Regional Endovascular Blood Optimization and Analysis; it analyzes blood flow patterns

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A paramedic assessing a head trauma patient notes clear fluid draining from both the nose and the right ear. Which of the following actions is contraindicated in this patient?

Inserting a nasopharyngeal airway

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Administering supplemental oxygen via non-rebreather mask

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Applying cervical spine stabilization

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Elevating the head of the stretcher to 30 degrees

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A patient involved in a motor vehicle collision with steering wheel impact presents with chest pain, an irregular heart rhythm, and hypotension. A 12-lead ECG shows ST segment changes. What thoracic trauma should the paramedic suspect?

Cardiac contusion (blunt cardiac injury) from direct steering wheel impact to the sternum

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Aortic transection, which always presents with absent femoral pulses

Correct Incorrect Correct answer

Simple rib fractures, which typically cause ECG changes and hypotension

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Diaphragmatic rupture, which is the most common cause of post-collision arrhythmia

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A 25-year-old male dove into a shallow pool and is found with weak biceps and wrist extension bilaterally but no motor or sensory function below the mid-chest level. Rectal tone is absent. How would you classify this spinal cord injury?

Incomplete tetraplegia at the C5-C6 level, because some motor function is preserved below the injury

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Complete spinal cord injury with total loss of function below the level

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Central cord syndrome with upper extremity deficit worse than lower

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Spinal shock that will fully resolve within 24 hours

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At what age does the anterior fontanelle typically close in a pediatric patient?

12 to 18 months

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3 to 6 months

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6 to 9 months

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24 to 36 months

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A 4-month-old infant is brought to you after being found unresponsive. The caregiver states the child ‘rolled off the couch.’ Physical exam reveals bilateral retinal hemorrhages, a bulging fontanelle, and bruising on the upper arms at different stages of healing. What is your primary clinical impression?

Non-accidental trauma (child abuse)

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Accidental fall from a low height

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Congenital coagulopathy

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Viral meningitis

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A trauma patient presents with absent breath sounds on the left, tracheal deviation to the right, jugular venous distention, and progressive hypotension. What is the immediate intervention?

Needle decompression of the left chest at the second intercostal space, midclavicular line, or the fourth to fifth intercostal space, anterior axillary line

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Immediate endotracheal intubation to secure the airway

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Application of a vented chest seal over the left chest wall

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Rapid infusion of 1 liter of normal saline to treat the hypotension

Correct Incorrect Correct answer

A 30-year-old male with a stab wound to the left chest presents with hypotension, JVD, and muffled heart sounds. Which type of shock is present and what is the definitive treatment?

Obstructive shock from cardiac tamponade; definitive treatment is pericardiocentesis or surgical repair at the hospital

Correct Incorrect Correct answer

Hypovolemic shock from hemorrhage into the pleural space; definitive treatment is chest tube insertion

Correct Incorrect Correct answer

Cardiogenic shock from direct myocardial damage; definitive treatment is inotropic medication support

Correct Incorrect Correct answer

Distributive shock from spinal cord injury; definitive treatment is vasopressor administration

Correct Incorrect Correct answer

A 22-year-old male involved in a high-speed motorcycle collision presents with weakness in his upper extremities that is worse than his lower extremities. He can move his legs but has minimal grip strength bilaterally. Sensation to pain is diminished in the upper extremities but preserved in the lower extremities. What spinal cord injury syndrome does this pattern suggest?

Central cord syndrome

Correct Incorrect Correct answer

Anterior cord syndrome

Correct Incorrect Correct answer

Brown-Sequard syndrome (lateral cord syndrome)

Correct Incorrect Correct answer

Cauda equina syndrome

Correct Incorrect Correct answer

A 25-year-old male presents with a stab wound to the left upper quadrant of the abdomen. He is alert with HR 108, BP 100/70, and mild abdominal tenderness with guarding. There is no evisceration. What is the most appropriate prehospital management?

Cover the wound with an occlusive dressing, establish IV access, and transport rapidly to a trauma center

Correct Incorrect Correct answer

Pack the wound with hemostatic gauze and apply a pressure dressing

Correct Incorrect Correct answer

Explore the wound depth to determine if peritoneal penetration occurred

Correct Incorrect Correct answer

Apply a moist sterile dressing and transport to the nearest community hospital

Correct Incorrect Correct answer

A patient has a deep laceration to the groin area with arterial hemorrhage that cannot be controlled with direct pressure. A tourniquet cannot be applied due to the anatomical location. What is the most appropriate hemorrhage control technique?

Pack the wound tightly with hemostatic gauze and maintain firm, sustained pressure for a minimum of 3 minutes

Correct Incorrect Correct answer

Apply a standard tourniquet above the laceration on the upper thigh

Correct Incorrect Correct answer

Elevate the affected limb above the level of the heart

Correct Incorrect Correct answer

Apply a pressure dressing loosely over the wound and reassess in 10 minutes

Correct Incorrect Correct answer

When placing a pediatric patient on a backboard, the paramedic should place padding under which area to maintain neutral cervical spine alignment?

Under the torso from shoulders to pelvis

Correct Incorrect Correct answer

Under the occiput to elevate the head

Correct Incorrect Correct answer

Under the knees to relieve lower back pressure

Correct Incorrect Correct answer

Under the cervical spine to maintain lordosis

Correct Incorrect Correct answer

A 55-year-old unrestrained driver presents after a high-speed frontal collision with severe chest pain radiating to the back, a blood pressure of 180/110 mmHg in the right arm and 140/80 mmHg in the left arm, and a widened mediastinum noted on the prehospital ultrasound. What is the most likely injury?

Traumatic aortic injury

Correct Incorrect Correct answer

Myocardial contusion

Correct Incorrect Correct answer

Flail chest with pulmonary contusion

Correct Incorrect Correct answer

Diaphragmatic rupture

Correct Incorrect Correct answer

A patient involved in a building collapse has been trapped under a concrete slab with compression of the right thigh for approximately 4 hours. Rescuers are preparing to lift the slab. As the paramedic, what life-threatening complication should you anticipate when the compressive force is released?

Crush syndrome with hyperkalemia, metabolic acidosis, and potential cardiac arrest upon reperfusion

Correct Incorrect Correct answer

Compartment syndrome limited to the affected extremity only

Correct Incorrect Correct answer

Arterial air embolism from the crushed tissues

Correct Incorrect Correct answer

Hypothermia from prolonged contact with cold concrete

Correct Incorrect Correct answer

A paramedic responds to a scene where an improvised explosive device has detonated in an enclosed space. Multiple casualties are present. A patient 15 feet from the blast point has no visible external injuries but is developing progressive respiratory distress, hemoptysis, and decreasing SpO2. What is the most likely injury pattern?

Primary blast lung injury from the overpressure wave causing alveolar hemorrhage and pneumothorax

Correct Incorrect Correct answer

Tension pneumothorax from a rib fracture caused by being thrown against a wall

Correct Incorrect Correct answer

Smoke inhalation injury causing upper airway edema and bronchospasm

Correct Incorrect Correct answer

Cardiac contusion from blunt chest trauma against nearby objects

Correct Incorrect Correct answer

Which anatomic feature of infants makes them more susceptible to traumatic brain injury from relatively minor mechanisms compared to adults?

A proportionally larger and heavier head relative to body size

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A thicker skull with more developed suture lines

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A higher cerebrospinal fluid volume acting as a cushion

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A more developed blood-brain barrier

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A nuclear plant worker presents after accidental exposure to a gamma radiation source. He is alert, complaining of nausea and vomiting that began 30 minutes after exposure. What does the rapid onset of gastrointestinal symptoms suggest about the radiation dose?

A high radiation dose was received, indicating a potentially lethal exposure

Correct Incorrect Correct answer

A low dose was received, and symptoms are psychosomatic

Correct Incorrect Correct answer

The exposure was limited to surface contamination only

Correct Incorrect Correct answer

The nausea is unrelated to the radiation exposure

Correct Incorrect Correct answer

A 70-year-old patient fell down stairs and presents with complete loss of motor function and pain/temperature sensation below T8, but proprioception and vibration sense are intact in the lower extremities. This presentation is most consistent with which spinal cord syndrome?

Anterior cord syndrome

Correct Incorrect Correct answer

Central cord syndrome

Correct Incorrect Correct answer

Brown-Sequard syndrome

Correct Incorrect Correct answer

Posterior cord syndrome

Correct Incorrect Correct answer

A 22-year-old male is brought to EMS after a motorcycle crash with a straddle-type impact on the fuel tank. He reports perineal pain and is unable to urinate. The paramedic notes blood at the urethral meatus and a high-riding prostate is suspected based on the mechanism. What is the most important prehospital consideration?

Do not attempt urinary catheter insertion and notify the receiving facility of suspected urethral injury

Correct Incorrect Correct answer

Insert a Foley catheter to decompress the bladder and monitor urine output

Correct Incorrect Correct answer

Apply direct pressure to the perineum to control bleeding

Correct Incorrect Correct answer

Administer 1 liter of normal saline to promote urinary output and flush the urethra

Correct Incorrect Correct answer

After splinting a fracture, the paramedic should assess the distal extremity for which findings?

Pulse, motor function, and sensation (PMS) distal to the injury and splint

Correct Incorrect Correct answer

Capillary refill time at the fracture site only

Correct Incorrect Correct answer

Range of motion of the fractured extremity

Correct Incorrect Correct answer

Skin temperature of the entire affected limb compared to the uninjured side

Correct Incorrect Correct answer

A 40-year-old patient who fell from a ladder presents with a declining level of consciousness, projectile vomiting, and a blood pressure of 198/110 mmHg with a heart rate of 48 beats per minute. What do these findings suggest?

Increased intracranial pressure

Correct Incorrect Correct answer

Hypovolemic shock from internal bleeding

Correct Incorrect Correct answer

Spinal cord injury with neurogenic shock

Correct Incorrect Correct answer

Acute myocardial infarction

Correct Incorrect Correct answer

A patient with a deep laceration to the right forearm has bright red, spurting arterial bleeding. You apply a commercial tourniquet to the proximal forearm. After tightening, the spurting stops but there is still steady venous oozing from the wound. What adjustment should be made?

Tighten the tourniquet further or apply a second tourniquet proximal to the first to achieve complete hemorrhage control

Correct Incorrect Correct answer

Remove the tourniquet since it has stopped the arterial bleeding, which was the primary concern

Correct Incorrect Correct answer

Loosen the tourniquet slightly since it may be causing venous congestion and worsening the oozing

Correct Incorrect Correct answer

Leave the tourniquet as is and apply direct pressure to the wound for the venous component

Correct Incorrect Correct answer

What advantage does the Lund-Browder chart offer over the Rule of Nines for burn assessment?

It accounts for body proportion changes across different age groups

Correct Incorrect Correct answer

It provides a faster estimation in the field

Correct Incorrect Correct answer

It measures burn depth more accurately than clinical assessment

Correct Incorrect Correct answer

It eliminates the need for fluid resuscitation calculations

Correct Incorrect Correct answer

The concept of the “golden hour” in trauma care refers to which principle?

Critically injured patients have the best outcomes when definitive surgical care is received within 60 minutes of injury

Correct Incorrect Correct answer

All trauma patients must have IV access established within 60 minutes of EMS contact

Correct Incorrect Correct answer

The first hour of hospital admission is the most important for diagnostic imaging

Correct Incorrect Correct answer

Trauma team activation must occur within 60 minutes of the 911 call

Correct Incorrect Correct answer

A patient has a flail chest segment (three adjacent ribs fractured in two places each) on the right side. The patient is in respiratory distress with an SpO2 of 84%. What is the primary cause of respiratory compromise in flail chest?

The underlying pulmonary contusion, which causes impaired gas exchange in the bruised lung tissue

Correct Incorrect Correct answer

The paradoxical chest wall movement itself, which prevents effective ventilation

Correct Incorrect Correct answer

Pain from the rib fractures causing voluntary splinting and hypoventilation exclusively

Correct Incorrect Correct answer

Air trapping in the pleural space from an associated pneumothorax only

Correct Incorrect Correct answer

A patient has sustained a closed fracture of the mid-shaft humerus. On initial assessment, the radial pulse is present but weak, and the patient can wiggle fingers with intact sensation. After splinting the arm, you reassess and find the radial pulse is now absent and the patient reports tingling in the fingers. What is the most appropriate action?

Loosen the splint, reposition the extremity, and reassess pulse, motor function, and sensation

Correct Incorrect Correct answer

Apply a tighter bandage over the splint to provide additional compression

Correct Incorrect Correct answer

Remove the splint entirely and do not re-splint for the remainder of transport

Correct Incorrect Correct answer

Continue transport without changes since some circulation compromise is expected with fractures

Correct Incorrect Correct answer

A patient touches a hot stove and develops a painful, red area on the palm without blistering. How should the paramedic classify this first degree burn?

Superficial (first degree) burn involving only the epidermis, characterized by pain, redness, and absence of blisters

Correct Incorrect Correct answer

Superficial partial-thickness burn requiring sterile dressing and pain management

Correct Incorrect Correct answer

Deep partial-thickness burn that will likely require skin grafting

Correct Incorrect Correct answer

Full-thickness burn with destruction of all skin layers

Correct Incorrect Correct answer

Tranexamic acid (TXA) is indicated for a trauma patient with significant hemorrhage. Within what time window from injury should TXA ideally be administered to provide the greatest survival benefit?

Within 3 hours of injury

Correct Incorrect Correct answer

Within 1 hour of injury only

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Within 6 hours of injury

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Within 12 hours of injury

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A 45-year-old female is involved in a rear-end collision and complains of neck pain. She has no neurological deficits, is alert and oriented, has no distracting injuries, and is not intoxicated. Based on the NEXUS criteria, what is the appropriate course of action?

The patient does not meet NEXUS criteria for imaging clearance due to midline cervical tenderness; maintain spinal precautions

Correct Incorrect Correct answer

The cervical spine can be clinically cleared and the collar removed

Correct Incorrect Correct answer

Spinal immobilization is not indicated because there are no neurological deficits

Correct Incorrect Correct answer

Obtain a portable lateral cervical spine X-ray before removing the collar

Correct Incorrect Correct answer

A patient presents with increasing pain in the anterior lower leg following a tibial fracture. The calf is tense and swollen, and pain worsens with passive dorsiflexion of the foot. Distal pulses are still present. What condition is developing?

Acute compartment syndrome

Correct Incorrect Correct answer

Deep vein thrombosis

Correct Incorrect Correct answer

Cellulitis from wound contamination

Correct Incorrect Correct answer

Simple muscle strain adjacent to the fracture

Correct Incorrect Correct answer

A greenstick fracture is most commonly seen in which patient population?

Pediatric patients

Correct Incorrect Correct answer

Elderly patients with osteoporosis

Correct Incorrect Correct answer

Young adult athletes

Correct Incorrect Correct answer

Middle-aged patients with metabolic bone disease

Correct Incorrect Correct answer

A patient has a mid-shaft femur fracture with significant deformity and shortening of the leg. What type of splint is indicated for this injury?

A traction splint (such as a Hare or Sager device)

Correct Incorrect Correct answer

A pneumatic anti-shock garment (PASG) applied to the affected leg

Correct Incorrect Correct answer

A rigid board splint secured with cravats above and below the fracture

Correct Incorrect Correct answer

A vacuum splint molded around the entire leg

Correct Incorrect Correct answer

A victim of an explosion presents with hemoptysis, dyspnea, and bilateral crackles. The SpO2 is 78% on high-flow oxygen. The patient was near the detonation point. What condition should the paramedic suspect and what ventilation concern exists?

Blast lung injury; positive pressure ventilation should be used cautiously because damaged alveoli are at high risk for pneumothorax and air embolism

Correct Incorrect Correct answer

Smoke inhalation injury; aggressive positive pressure ventilation should be initiated immediately

Correct Incorrect Correct answer

Pulmonary contusion from secondary blast; standard BVM ventilation without any modifications

Correct Incorrect Correct answer

Simple pneumothorax from tertiary blast; needle decompression should be performed bilaterally

Correct Incorrect Correct answer

Priapism in a male trauma patient is a clinical indicator of which type of injury?

Spinal cord injury

Correct Incorrect Correct answer

Pelvic fracture with vascular disruption

Correct Incorrect Correct answer

Urethral injury from blunt trauma

Correct Incorrect Correct answer

Retroperitoneal hemorrhage

Correct Incorrect Correct answer

A 40-year-old male involved in a motorcycle collision has cervical spine tenderness and is placed on a long backboard with a cervical collar. During transport, he vomits. What is the immediate action to prevent aspiration?

Log-roll the entire backboard to the side while maintaining spinal alignment, then suction the airway

Correct Incorrect Correct answer

Remove the cervical collar and turn only the head to the side

Correct Incorrect Correct answer

Tilt the head of the backboard up to a 45-degree angle

Correct Incorrect Correct answer

Place the patient in Trendelenburg position to allow gravity drainage

Correct Incorrect Correct answer

A patient reports tingling and numbness in a band-like pattern around the chest at the level of the umbilicus. This paresthesia corresponds to which dermatome level?

T10

Correct Incorrect Correct answer

T4

Correct Incorrect Correct answer

T6

Correct Incorrect Correct answer

L1

Correct Incorrect Correct answer

A 4-year-old child was an unrestrained passenger in a frontal collision. The child has paradoxical chest wall movement on the left side with diminished breath sounds. SpO2 is 88% on room air. HR is 160 and RR is 40 with increased work of breathing. Which intervention should the paramedic perform first?

Provide positive pressure ventilation with supplemental oxygen

Correct Incorrect Correct answer

Perform needle decompression of the left chest

Correct Incorrect Correct answer

Stabilize the flail segment with a bulky dressing and tape

Correct Incorrect Correct answer

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

Correct Incorrect Correct answer

A 35-year-old male motorcyclist presents after a high-speed crash with severe pelvic pain, hemodynamic instability (BP 74/48, HR 134), and bilateral lower extremity numbness. On examination, the pelvis appears asymmetric with lateral compression noted. What is the most critical prehospital intervention for this patient?

Apply a pelvic binder to stabilize the fracture and reduce the pelvic volume

Correct Incorrect Correct answer

Perform bilateral femoral traction splinting

Correct Incorrect Correct answer

Logroll the patient to assess for posterior pelvic deformity

Correct Incorrect Correct answer

Establish bilateral large-bore IV access before any other intervention

Correct Incorrect Correct answer

A trauma patient is receiving a massive transfusion of packed red blood cells, fresh frozen plasma, and platelets in a 1:1:1 ratio. The paramedic notes the patient developing new onset of facial flushing, urticaria, and mild hypotension. Which action is most appropriate?

Slow the transfusion rate, administer diphenhydramine, and monitor closely

Correct Incorrect Correct answer

Stop the transfusion immediately and administer epinephrine 0.3 mg IM

Correct Incorrect Correct answer

Continue the transfusion at the current rate and treat symptoms with normal saline

Correct Incorrect Correct answer

Stop the transfusion and return the blood products to the sending facility

Correct Incorrect Correct answer

A paramedic is preparing to administer IV fluids to a trauma patient in hemorrhagic shock. Which isotonic crystalloid solution is preferred for trauma resuscitation due to its physiologic electrolyte composition?

Lactated Ringer's solution

Correct Incorrect Correct answer

D5W (5% dextrose in water)

Correct Incorrect Correct answer

Half-normal saline (0.45% NaCl)

Correct Incorrect Correct answer

D5 half-normal saline

Correct Incorrect Correct answer

A patient with a known T6 spinal cord injury presents with a severe headache, flushing and sweating above the level of injury, and a blood pressure of 220/130. Heart rate is 48 bpm. The paramedic identifies a kinked urinary catheter. What is the most appropriate initial intervention?

Sit the patient upright and straighten the kinked catheter to relieve the stimulus

Correct Incorrect Correct answer

Administer labetalol IV to rapidly lower the blood pressure

Correct Incorrect Correct answer

Lay the patient flat and administer IV fluids for suspected neurogenic shock

Correct Incorrect Correct answer

Administer atropine for the bradycardia

Correct Incorrect Correct answer

A 5-year-old pedestrian was struck by a car. The child has a GCS of 12 with altered mental status and a swollen abdomen. Blood pressure is 90/60 mmHg and heart rate is 150 bpm. What is important to understand about the child’s hemodynamic status?

Children compensate for hemorrhage longer than adults, so tachycardia with a near-normal blood pressure may represent significant blood loss; hypotension is a late and ominous finding

Correct Incorrect Correct answer

The blood pressure of 90/60 mmHg is normal for this age and does not indicate hemorrhage

Correct Incorrect Correct answer

Children do not develop compensatory tachycardia in response to hemorrhage

Correct Incorrect Correct answer

A heart rate of 150 bpm in a 5-year-old is normal and does not suggest shock

Correct Incorrect Correct answer

Which class of hemorrhagic shock is characterized by blood loss of 750 to 1,500 mL (15 to 30% of blood volume), tachycardia, normal or slightly decreased blood pressure, and anxiety?

Class II hemorrhagic shock

Correct Incorrect Correct answer

Class I hemorrhagic shock

Correct Incorrect Correct answer

Class III hemorrhagic shock

Correct Incorrect Correct answer

Class IV hemorrhagic shock

Correct Incorrect Correct answer

A 25-year-old male falls 20 feet from a construction scaffold and complains of midback pain and bilateral lower extremity weakness. The paramedic suspects a spinal injury at the thoracic spine level. What is the most appropriate management?

Maintain spinal motion restriction, logroll onto a longboard with cervical collar application, and transport emergently to a trauma center with spinal surgery capability

Correct Incorrect Correct answer

Assess only the cervical spine since thoracic spine injuries are rarely clinically significant

Correct Incorrect Correct answer

Allow the patient to walk to the stretcher if lower extremity pulses are present

Correct Incorrect Correct answer

Perform a detailed neurological exam for 15 minutes before initiating any movement or transport

Correct Incorrect Correct answer

A 40-year-old male presents after a stabbing to the right groin with dark, steady blood flow from the wound. Vital signs are HR 110, BP 90/60, RR 22. Which type of hemorrhage is most consistent with these findings, and what is the priority intervention?

Venous bleeding; pack the wound with hemostatic gauze and apply direct pressure

Correct Incorrect Correct answer

Arterial bleeding; apply a tourniquet to the proximal thigh

Correct Incorrect Correct answer

Capillary bleeding; apply a standard gauze dressing with gentle pressure

Correct Incorrect Correct answer

Venous bleeding; apply a tourniquet to the proximal thigh

Correct Incorrect Correct answer

An 18-month-old child is brought to you by EMS from a home where the caregiver reports the child ‘fell off the bed.’ The child has spiral fractures of the left femur and right humerus, as well as circular burn marks on the buttocks consistent with cigarette burns. What pattern of injuries does this presentation represent?

Injuries highly suspicious for non-accidental trauma (child abuse) with a mechanism inconsistent with the injury pattern

Correct Incorrect Correct answer

Accidental injuries consistent with a fall from a bed in a toddler

Correct Incorrect Correct answer

Osteogenesis imperfecta causing pathologic fractures with minor trauma

Correct Incorrect Correct answer

Normal childhood injuries from an active toddler learning to walk

Correct Incorrect Correct answer

A 70 kg patient has partial and full thickness burns covering the entire anterior trunk and both arms. Using the Rule of Nines for an adult, what is the estimated total body surface area (TBSA) burned, and what is the 8-hour fluid requirement using the Parkland formula?

36% TBSA (18% anterior trunk + 9% each arm); Parkland formula: 4 mL x 70 kg x 36% = 10,080 mL total over 24 hours, with half (5,040 mL) given in the first 8 hours

Correct Incorrect Correct answer

18% TBSA; 2,520 mL in the first 8 hours

Correct Incorrect Correct answer

45% TBSA; 12,600 mL in the first 8 hours

Correct Incorrect Correct answer

27% TBSA; 7,560 mL in the first 8 hours

Correct Incorrect Correct answer

Quinary blast injuries refer to which type of harm associated with explosive events?

Illnesses caused by chemical, biological, or radiological contaminants added to the explosive device

Correct Incorrect Correct answer

Injuries from being thrown by the blast wind

Correct Incorrect Correct answer

Burns and inhalation injuries from the explosion

Correct Incorrect Correct answer

Psychological trauma and hyperarousal following the blast

Correct Incorrect Correct answer

NREMT Paramedic – Full Practice Exam

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