Airway
Which of the following has the potential to cause a perfusion derangement in ventilation/perfusion matching?
Narcotic overdose
Emphysema
Pulmonary embolus
Asthma
Pulmonary embolus
Which of the following is the most accurate chest compression rate and depth for adult, single-rescuer CPR?
A: At least 100/minute and at least 2 inches
B: 100 to 120/minute and 2 to 2.4 inches
C: 100 to 120/minute and at least 2 inches
D: At least 100/minute and 2 to 2.4 inches
B: 100 to 120/minute and 2 to 2.4 inches
A patient fell into a campfire. They have superficial Burns to posterior back. They have partial thickness burns to the face, the anterior surface of both arms, and their anterior chest. What is the percentage of body surface area burned?
22.5
Face = 4.5%
Anterior surface of both arms = 9%
Anterior chest = 9%
Superficial do not count towards BSA Burns
A 56-year-old patient has a sudden onset of nausea and intense, burning abdominal pain in the epigastric area that decreases when lying in the fetal position. The vital signs are P 104, R 18, BP 142/86, SpO₂ 95% on room air, and the blood glucose level is 282 mg/dL. The paramedic should suspect:
A. ruptured esophageal varices.
B. pancreatitis.
C. gastrointestinal flu.
D. bowel obstruction.
B. pancreatitis.
Epigastric burning pain with nausea that improves when the patient curls forward or lies in a fetal-type position is a classic pancreatitis clue. The elevated blood glucose also supports pancreatic involvement because the pancreas is tied to insulin production and glucose regulation.
What is the minimum systolic blood pressure before considering shock in a 2-year-old?
A: 42
B: 62
C: 74
D: 86
C: 74 ( 70 + (2 × age) )
Which of the following is caused by bronchial mucosa scarring, goblet cell hyperplasia, hypertrophy of goblet cells, and bronchial cell wall thickening?
A. Panacinar emphysema
B. Intrinsic asthma
C. H. influenzae bronchiectasis
D. Chronic bronchitis
D. Chronic bronchitis
Because those structural changes describe chronic bronchitis: long-term irritation of the bronchi causes the airway lining to become inflamed, scarred, thicker, and packed with enlarged mucus-producing goblet cells.
That leads to the classic problem:
too much mucus + narrowed airways = chronic productive cough and obstructive breathing difficulty.
A 61-year-old patient complains of chest pain. The initial vital signs were P 90, R 14, BP 120/70, and SpO₂ 89% on room air. Three minutes after administering oxygen and nitroglycerin, the vital signs are P 104, R 14, BP 94/76, and SpO₂ is 93% on oxygen by nasal cannula. The Paramedic should:
A. administer a fluid bolus.
B. assist ventilation with a BVM.
C. increase the oxygen flow rate.
D. attach the AED.
A. administer a fluid bolus.
After nitroglycerin, the patient’s blood pressure dropped from 120/70 to 94/76 with an increased pulse, suggesting hypotension after nitrate administration. NASEMSO notes that nitroglycerin requires caution when blood pressure is marginal and EMS should be ready to respond to hypotension with a fluid bolus or pressor.
A 5-year-old patient is screaming in pain after being struck by a car. Their pelvis is unstable. En route to the hospital, the vital signs are P 140, R 30, BP 86/74, and SpO₂ is 98% on oxygen by non-rebreather mask. After the AEMT establishes venous access, they should:
A. target fluid administration to a systolic pressure of 100 mmHg.
B. target fluid administration to maintain the patient’s current systolic pressure.
C. assist ventilation with a BVM.
D. administer a fluid bolus until the patient’s pulse rate is below 100.
B. target fluid administration to maintain the patient’s current systolic pressure.
This child has suspected pelvic hemorrhage, but their systolic BP of 86 mmHg is within the normal range for a 5-year-old. According to NASEMSOOO it says pediatric trauma fluid resuscitation should target normal BP for age, and that pediatric fluid boluses are for tachycardia with poor perfusion signs such as low BP, delayed capillary refill, altered mental status, weak pulses, pallor, or mottled/cool skin.
An 18-year-old lying on a couch has snoring respirations. Their friends suspect they took fentanyl. You should first:
A: ventilate them.
B: administer naloxone.
C: attempt to wake them.
D: assess their vital signs.
C: attempt to wake themmmm ( F I R S T )
Which of the following is an appropriate adult dose of epinephrine in severe anaphylaxis?
A: 0.15 mg
B: 0.5 mg
C: 1 mg
D: 0.1 mg/kg
B: 0.5 mg ( use 0.3 mg IM for adult anaphylaxis unless the local protocol says otherwise. Be aware that many allergy and international guidelines dose epinephrine at 0.01 mg/kg IM up to 0.5 mg in adults. )
A patient has a history of COPD. They report that their pedal edema is worsening. You observe jugular venous distention. You should suspect:
A: left heart failure.
B: pulmonary embolus.
C: septic shock.
D: cor pulmonale.
D. cor pulmonale.
COPD can chronically increase pressure in the pulmonary vessels.
That increased pressure makes the right ventricle work harder to push blood through the lungs.
Over time, the right side of the heart can weaken and fail.
When the right side backs up, you see JVD and pedal edema.
Cor pulmonale is a condition that causes the right side of the heart to fail
What changes to continuous waveform end-tidal capnography should a paramedic expect in a patient who has a worsening pericardial tamponade?
A camelback waveform would be noted
The end-tidal CO2 level would decrease
A shark fin waveform would be noted
The end-tidal CO2 level would increase
The end-tidal CO2 level would decrease
Worsening pericardial tamponade compresses the heart, decreases ventricular filling, lowers stroke volume, and reduces cardiac output. Less cardiac output means less CO₂ is delivered from the tissues to the lungs, so the EtCO₂ number drops even if ventilation has not changed.
Family reports an 82-year-old appears confused. They fell and had a minor rib fracture about 1 week ago and have developed a productive cough over the last 3–4 days. Coarse crackles are heard in the left lung. P 96, R 22, BP 82/56, SpO₂ 93%, skin warm and dry. You should suspect:
A. sepsis.
B. heart failure.
C. pulmonary embolus.
D. flail segment.
A. sepsisssss
You arrive and find that a 28-year-old has just delivered a full-term male infant at home. You should first:
A: suction his nose.
B: suction his mouth.
C: dry and stimulate him.
D: clamp and cut the umbilical cord.
C: dry and stimulate him.
Updated guidelines ( AHA ) state that if no immediate resuscitation is required, you should “warm/dry/stimulate the newborn” and then clamp/cut the cord after 60 seconds or when the cord stops pulsating. It also mentions routine suctioning is not recommended and suctioning should be reserved for signs of airway obstruction or need for positive pressure ventilation.
A pulse pressure below which percentage of the systolic blood pressure indicates narrowing of the pulse pressure?
A: 10
B: 17.5
C: 25
D: 40
C. 25
Normal: about 30–40 mmHg
Narrow pulse pressure: usually less than 25% of systolic BP
Wide pulse pressure: often greater than 40–50 mmHg, depending on the situation
An unresponsive 21-year-old patient is experiencing tonic-clonic movements. Bystanders report they have been moving like this for 20 minutes. They are wearing a medical identification bracelet that indicates a history of epilepsy. The paramedic estimates the patient weighs 130 pounds. If the paramedic is unable to obtain IV access, they should first administer:
A. diazepam, 60 mg, PR.
B. midazolam, 10 mg, IN.
C. lorazepam, 6 mg, IM.
D. phenytoin, 400 mg, IO.
B. midazolam, 10 mg, IN.
NASEMSO states that if vascular access is absent, midazolam 0.2 mg/kg, maximum dose 10 mg, IM preferred or IN should be used. Since 130 lb is about 59 kg, 0.2 mg/kg would be about 12 mg, but the max dose is 10 mg, so 10 mg IN is the best answer.
Hypovolemic patients frequently do not appear cyanotic. Which of the following mechanisms is responsible for this?
A: Reduced red blood cells
B: Acidosis
C: Decreased vascular tone
D: Hypercapnia
A. Reduced red blood cells ( Cyanosis depends on the amount of deoxygenated hemoglobin present. In hypovolemia, especially from blood loss, the patient may have fewer circulating red blood cells/hemoglobin available, so cyanosis may not be obvious even when perfusion and oxygen delivery are poor. )
An alert 66-year-old male complains of trouble breathing after he fell and injured his left chest. His skin is slightly cyanotic, and you palpate crepitus over his left ribs. His vital signs are P 108, R 26 and shallow, BP 138/74, and SpO2 is 93% on room air. After administering oxygen, you should
stabilize the fracture using bulky dressings.
administer pain medication.
administer positive pressure ventilation.
position the patient in a lateral recumbent position on the injured side.
administer pain medication.
Pain from a rib fracture often causes the patient to breathe too shallowly, interfering with gas exchange. Pain medication will allow him to breathe more comfortably and increase air movement.
A 26-year-old complains of increased breathing difficulty over the past two days. They have been coughing frequently. Their vital signs are P 108, R 18, BP 124/88, and SpO₂ is 91%. You suspect the SpO₂ reading is low because they have:
A. inadequate tidal volume.
B. many collapsed alveoli in their lungs.
C. lower airway constriction.
D. bacteria in their lungs.
D. bacteria in their lungs. (Pneumoniaaa)
What is the mean arterial pressure (MAP) if the patient’s blood pressure is 120/80?
A: 40
B: 85
C: 93
D: 112
Answer: C. 93
Formula: MAP = DBP + 1/3(SBP − DBP)
A patient with pneumonia has worsening shortness of breath. They are on oxygen by non-rebreather mask, but their SpO₂ remains low. Your partner says, “This is dead space because oxygen is not getting into the blood.” Which response best evaluates your partner’s statement?
A. “Correct, this is dead space because blood reaches the alveoli but oxygen does not.”
B. “Correct, this is dead space because perfusion increases while ventilation decreases.”
C. “Incorrect, this is shunting because blood reaches alveoli that are poorly ventilated.”
D. “Incorrect, this is shunting because air reaches alveoli that are poorly perfused.”
C. “Incorrect, this is shunting because blood reaches alveoli that are poorly ventilated.”
In pneumonia, fluid/infection fills or blocks alveoli. Blood still flows past those alveoli, but oxygen cannot enter effectively. That is shunting.
Dead space is the opposite: air reaches the alveoli, but blood flow is reduced or absent, like with a pulmonary embolism.
Shunt = blood without air.
Dead space = air without blood.
The parasympathetic nervous system is activated when I put pressure on a baroreceptor.
True or False
True
When baroreceptors sense increased pressure or stretch, they signal the brainstem to increase parasympathetic activity through the vagus nerve. This slows the heart rate and helps lower blood pressure.
A 17-year-old patient was thrown off a horse, landed on their back, and hyperflexed their neck. The patient complains of neck pain, is struggling to breathe, and you notice no intercostal muscle contraction with each breath. Lung sounds are clear, and the paramedic does not observe any thoracic injury. At what level should the paramedic suspect the patient’s spinal cord to be injured?
A. C3
B. T1
C. T12
D. L2
T1
The key clue is no intercostal muscle contraction. The intercostal muscles are controlled by the thoracic spinal nerves, especially around T1–T11. If the diaphragm is still working but the intercostals are not, the injury is likely below the phrenic nerve level but high enough to affect thoracic breathing muscles.
Which of the following refers to slurred speech during a stroke?
A: Dysphoria
B: Dystaxia
C: Dysarthria
D: Dysphasia
C: Dysarthria ( art-iculationnn)
If a patient has dyschiria, the patient:
A: can’t speak a full sentence.
B: can’t identify which side of their body has been touched.
C: has weakness or numbness on one entire side of the body.
D: has an inability to urinate.
B. can’t identify which side of their body has been touched.
Dyschiria = “wrong side” sensory recognition.