Download [PARAMEDIC] Paramedic Certification Review Guide and more Exams Technology in PDF only on Docsity!
Question 1. Which structure is the most common site of obstruction during endotracheal intubation in an adult? A) Epiglottis B) Vocal cords C) Cricothyroid membrane D) Upper esophageal sphincter Answer: B Explanation: The vocal cords are the narrowest part of the upper airway that the tube must pass through; resistance here is the most frequent cause of difficulty during intubation. Question 2. The capnography waveform that shows a sudden loss of EtCO₂ after a successful intubation most likely indicates: A) Right main‑stem bronchial intubation B) Disconnection of the breathing circuit C) Low cardiac output state D) Hyperventilation Answer: B Explanation: A sudden flat capnography trace after tube placement usually reflects circuit disconnection or leak, not a physiologic change. Question 3. In a patient with severe COPD exacerbation, which ventilatory strategy is preferred to avoid dynamic hyperinflation? A) High tidal volume (10‑ 12 mL/kg) B) Low respiratory rate (≤10 breaths/min) C) Long inspiratory time (I:E = 1:1) D) Short inspiratory time with rapid exhalation (I:E ≈ 1:3) Answer: D Explanation: Short inspiratory time and prolonged expiratory time allow trapped air to exit, minimizing auto‑PEEP and dynamic hyperinflation.
Question 4. Which of the following best describes the pathophysiology of ARDS? A) Increased alveolar surfactant production B) Decreased pulmonary capillary permeability C) Diffuse alveolar damage leading to non‑cardiogenic pulmonary edema D) Bronchoconstriction due to histamine release Answer: C Explanation: ARDS results from diffuse alveolar injury, causing increased capillary permeability and protein‑rich pulmonary edema unrelated to cardiac failure. Question 5. The most reliable bedside method to confirm endotracheal tube placement in a pre‑hospital setting is: A) Auscultation of bilateral breath sounds B) Observation of chest rise C) Capnography showing ≥ 3 % EtCO₂ for at least 7 seconds D) Fogging of the tube Answer: C Explanation: Quantitative capnography is the gold standard; a sustained EtCO₂ waveform confirms tracheal placement even in low perfusion states. Question 6. Which positive‑pressure ventilation device provides the highest fraction of inspired oxygen (FiO₂) when used with a non‑rebreather mask? A) Bag‑valve‑mask (BVM) with reservoir bag B) CPAP machine with 10 cm H₂O C) BiPAP set at IPAP 15 cm H₂O, EPAP 5 cm H₂O D) Simple face mask with 10 L/min flow Answer: A Explanation: A BVM with a reservoir bag and oxygen flow ≥15 L/min can deliver near 100 % FiO₂, higher than the other devices listed.
A) Lidocaine B) Amiodarone C) Procainamide D) Magnesium sulfate Answer: C Explanation: Procainamide can exacerbate the ST elevation characteristic of Brugada syndrome and precipitate ventricular arrhythmias. Question 11. A 68‑year‑old male with acute coronary syndrome receives sublingual nitroglycerin. Which adverse effect should the paramedic monitor for most closely? A) Bradycardia B) Reflex tachycardia C) Hypotension leading to syncope D) Increased myocardial oxygen demand Answer: C Explanation: Nitroglycerin causes venous dilation and may produce significant hypotension, especially in preload‑dependent patients. Question 12. Which of the following best describes the “golden period” in trauma care? A) The first 15 minutes after scene arrival for rapid assessment B) The first hour after injury when definitive care yields greatest survival benefit C) The 30‑minute window for hemorrhage control before transport D) The 24‑hour period for secondary survey completion Answer: B Explanation: The golden period (often referred to as the “golden hour”) is the critical first hour post‑injury when prompt intervention most improves outcomes. Question 13. In a patient with suspected tension pneumothorax, the correct needle decompression site in adults is: A) 2nd intercostal space, mid‑clavicular line
B) 5th intercostal space, anterior axillary line C) 4th intercostal space, mid‑scapular line D) 1st intercostal space, parasternal line Answer: B Explanation: The recommended site for needle thoracostomy in adults is the 5th intercostal space at the anterior axillary line, providing safe access while avoiding vital structures. Question 14. Which of the following is the most accurate method to estimate total body surface area (TBSA) burned in an adult? A) Rule of Nines B) Lund and Browder chart C) Palmar surface method (1% per palm) D) Wallace rule (2% per hand) Answer: A Explanation: The Rule of Nines provides a quick, reasonably accurate TBSA estimate for adults; Lund and Browder is more precise for children. Question 15. A patient with septic shock is receiving a fluid bolus of 30 mL/kg crystalloid. Which of the following is the next best step after the bolus if MAP remains < 65 mm Hg? A) Initiate norepinephrine infusion B) Administer 1 g IV levosimendan C) Give additional 500 mL of normal saline D) Perform emergent endotracheal intubation Answer: A Explanation: In septic shock refractory to adequate fluid resuscitation, norepinephrine is the first‑line vasopressor to achieve target MAP. Question 16. Which toxidrome is most consistent with opioid overdose? A) Anticholinergic (dry, hot, flushed) B) Sympathomimetic (agitation, tachycardia, diaphoresis)
D) Bilateral ovarian cysts without fluid Answer: B Explanation: An adnexal mass with a tubal ring sign and an empty uterus is classic for a tubal ectopic pregnancy. Question 20. Which of the following is the most appropriate method for spinal motion restriction (SMR) in a patient with suspected cervical spine injury who is combative? A) Manual in‑line stabilization only B) Rigid cervical collar with supine log‑roll C) Soft cervical collar and head‑blocks D) No immobilization until patient calms down Answer: B Explanation: A rigid cervical collar combined with a log‑roll (or backboard) provides definitive SMR even in combative patients; manual stabilization alone is insufficient. Question 21. The primary cause of hypothermia in a drowning patient is: A) Metabolic acidosis B) Loss of thermal insulation from wet clothing C) Hyperventilation‑induced vasoconstriction D) Exogenous cold water immersion Answer: D Explanation: Direct exposure to cold water leads to rapid heat loss, the main factor in drowning‑related hypothermia. Question 22. Which of the following statements about permissive hypotension in trauma is correct? A) Target SBP < 80 mm Hg until surgical control of bleeding is achieved B) It is contraindicated in patients with traumatic brain injury (TBI) C) It should be applied to all blunt trauma patients regardless of age D) It requires the use of vasopressors to maintain the low pressure
Answer: B Explanation: Permissive hypotension is avoided in TBI because cerebral perfusion pressure must be maintained; low SBP can worsen brain ischemia. Question 23. The most common cause of a “wide complex tachycardia” on a 12‑lead ECG in a patient with a known left bundle branch block (LBBB)? A) Ventricular tachycardia B) Supraventricular tachycardia with aberrancy C) Atrial fibrillation with rapid ventricular response D) Artifact from patient movement Answer: B Explanation: In patients with pre‑existing LBBB, a supraventricular rhythm can appear wide‑complex due to the underlying conduction abnormality (aberrancy). Question 24. During a mass casualty incident (MCI), the START triage system categorizes patients as: A) Immediate (red), Delayed (yellow), Minimal (green), Expectant (black) B) Critical (red), Stable (yellow), Minor (green), Deceased (black) C) Priority‑1 (red), Priority‑2 (yellow), Priority‑3 (green), Priority‑4 (black) D) Life‑threatening (red), Non‑life‑threatening (yellow), Minor (green), Dead (black) Answer: A Explanation: The START (Simple Triage and Rapid Treatment) algorithm uses the color‑coded categories listed in option A. Question 25. Which of the following legal documents specifically allows a paramedic to withhold resuscitative measures in accordance with a patient’s wishes? A) HIPAA authorization B) Durable Power of Attorney for Health Care (DPOA) C) Do‑Not‑Resuscitate (DNR) order D) Advance Directive for Living Will Answer: C
Question 29. In a patient with suspected acute myocardial infarction (AMI) who is allergic to aspirin, the next best antiplatelet agent is: A) Clopidogrel B) Ticagrelor C) Prasugrel D) All of the above (any P2Y12 inhibitor) Answer: D Explanation: Any P2Y12 inhibitor (clopidogrel, ticagrelor, prasugrel) can be used when aspirin is contraindicated. Question 30. Which of the following is the most appropriate method to assess for an open glottic airway in a trauma patient? A) Auscultate for breath sounds bilaterally B) Observe for chest rise and fall C) Perform a jaw‑thrust maneuver and look for air movement from the mouth and nose D) Palpate the trachea for midline position Answer: C Explanation: Direct observation of air movement from the mouth and nose while performing a jaw‑thrust assesses for an open glottic airway. Question 31. A patient with severe asthma exacerbation is receiving high‑flow oxygen. Which ventilation parameter is most likely to cause auto‑PEEP? A) Low tidal volume (6 mL/kg) B) High inspiratory flow rate C) Prolonged inspiratory time (I:E = 1:1) D) Low respiratory rate (≤ 10 breaths/min) Answer: C Explanation: A prolonged inspiratory time reduces the time available for exhalation, leading to air trapping and intrinsic PEEP.
Question 32. Which of the following is the best indicator of successful bag‑valve‑mask ventilation in a child? A) Presence of a “whoosh” sound from the mask B) Visible chest rise and EtCO₂ > 5 mm Hg C) Increase in heart rate by 20 bpm D) Decrease in respiratory rate to < 12 breaths/min Answer: B Explanation: Visible chest rise together with measurable capnography confirms effective ventilation. Question 33. In the management of a patient with hypertensive emergency and acute pulmonary edema, which medication provides both afterload reduction and venodilation? A) Nitroglycerin IV infusion B) Labetalol IV bolus C) Furosemide IV push D) Hydralazine IV bolus Answer: A Explanation: IV nitroglycerin reduces preload and, at higher doses, afterload, making it ideal for pulmonary edema with severe hypertension. Question 34. Which of the following is the most common cause of a “sudden cardiac arrest” during transport of a patient with known severe traumatic brain injury? A) Hypovolemia from hemorrhage B) Tension pneumothorax C) Cardiac arrhythmia secondary to hypoxia D) Increased intracranial pressure causing brainstem herniation Answer: D Explanation: Elevated ICP can cause brainstem compression leading to respiratory and cardiac arrest. Question 35. A 23‑year‑old female presents after a motor vehicle collision with a “seatbelt sign” across the abdomen. Which intra‑abdominal injury is most likely?
B) Allowing PaCO₂ to rise to 45‑ 55 mm Hg to avoid high tidal volumes C) Maintaining end‑tidal CO₂ at 20 mm Hg during mechanical ventilation D) Using hyperventilation to keep respiratory alkalosis Answer: B Explanation: Permissive hypercapnia accepts higher CO₂ levels to limit tidal volumes and prevent ventilator‑induced lung injury. Question 39. Which of the following is the most appropriate initial step when a patient on a known anticoagulant presents with a suspected intracranial hemorrhage? A) Administer vitamin K 10 mg IV B) Give protamine sulfate 50 mg IV C) Reverse with specific factor concentrate (e.g., idarucizumab for dabigatran) if available D) Provide fresh frozen plasma 2 units Answer: C Explanation: Targeted reversal agents (e.g., idarucizumab for dabigatran, andexanet alfa for factor Xa inhibitors) are preferred when rapidly available. Question 40. In a patient with suspected opioid overdose, which of the following is the correct dose of naloxone for intranasal administration in the pre‑hospital setting? A) 0.4 mg B) 1 mg C) 2 mg D) 4 mg Answer: B Explanation: The standard intranasal naloxone dose for adults is 1 mg (0.1 mL of 10 mg/mL solution). Question 41. Which of the following findings on a 12‑lead ECG is diagnostic for a posterior myocardial infarction? A) ST‑segment elevation in V1‑V B) ST‑segment depression in leads V1‑V3 with tall R waves
C) Q waves in leads II, III, aVF D) ST‑segment elevation in leads V5‑V Answer: B Explanation: Posterior MI often presents with reciprocal ST depression in anterior leads (V1‑V3) and tall R waves. Question 42. The most common cause of hypoglycemia in a patient receiving insulin therapy for type 1 diabetes is: A) Skipping a meal after insulin administration B) Over‑hydration C) Excessive carbohydrate intake D) Use of a continuous glucose monitor Answer: A Explanation: Failure to eat after insulin results in a mismatch between insulin action and glucose availability, leading to hypoglycemia. Question 43. Which of the following is the best method to assess for a cervical spine injury in a conscious, alert patient? A) NEXUS criteria B) Canadian C‑Spine Rule C) Both A and B are acceptable decision tools D) Mandatory cervical spine immobilization in all trauma patients Answer: C Explanation: Both NEXUS and Canadian C‑Spine Rule are validated clinical decision tools for determining the need for cervical spine imaging. Question 44. In a patient with a suspected spinal cord injury, what is the most appropriate method for spinal immobilization during extrication? A) Use of a vacuum mattress only B) Rigid cervical collar with a long spine board and head blocks C) Soft padding and a scoop stretcher without a collar
Answer: A Explanation: Atropine is the first‑line drug for symptomatic bradycardia; it increases heart rate by blocking vagal tone. Question 48. In a patient with severe hyperthermia (heat stroke), which of the following is the most effective method of rapid cooling? A) Ice packs to the axillae only B) Evaporative cooling with mist and fans C) Cold water immersion (20 °C) D) Administration of antipyretics (acetaminophen) Answer: C Explanation: Cold water immersion provides the fastest core temperature reduction in exertional heat stroke. Question 49. Which of the following is the most appropriate method to document a patient’s “scene time” in the pre‑hospital run‑card? A) Record the time of arrival at the scene only B) Record the time of departure from the scene only C) Record both arrival and departure times and calculate the difference D) Estimate the total time based on transport distance Answer: C Explanation: Accurate documentation requires both timestamps; the difference yields the true scene time. Question 50. Which of the following actions is required to maintain HIPAA compliance when transmitting patient data via a mobile device? A) Use of encrypted, password‑protected applications only B) Sending images via standard SMS text messages C) Uploading data to a public cloud storage without access controls D) Discussing patient details loudly on the scene to ensure team awareness Answer: A
Explanation: Encryption and password protection safeguard protected health information during electronic transmission. Question 51. A patient with known COPD presents with a “silent chest” on auscultation. Which of the following is the most likely underlying problem? A) Pulmonary embolism B) Severe bronchospasm leading to airflow obstruction C) Pneumothorax D) Upper airway obstruction Answer: B Explanation: In severe COPD exacerbations, bronchospasm can become so marked that breath sounds are absent, described as a “silent chest.” Question 52. Which of the following is the most appropriate initial therapy for a patient with suspected acute ischemic stroke within the 3‑hour window? A) Intravenous tissue plasminogen activator (tPA) if no contraindications B) Immediate endotracheal intubation and hyperventilation C) High‑dose aspirin 325 mg PO D) Mannitol 1 g/kg IV bolus Answer: A Explanation: IV tPA administered within 3 hours of symptom onset improves outcomes, provided there are no contraindications. Question 53. In a patient with a confirmed diagnosis of myocardial infarction, which of the following is the most appropriate dose of sublingual nitroglycerin for recurrent chest pain? A) 0.2 mg every 5 minutes, up to 3 doses B) 0.4 mg every 10 minutes, up to 2 doses C) 0.6 mg once only D) 0.8 mg every 15 minutes, up to 4 doses Answer: A
Explanation: An initial 40 mg IV dose of furosemide is standard for rapid diuresis in acute pulmonary edema. Question 57. A 30‑year‑old male presents after a high‑speed motorcycle crash with a “seatbelt sign” across the chest and paradoxical chest movement. Which injury is most likely? A) Flail chest B) Simple rib fracture C) Sternal fracture only D) Pulmonary contusion without bony injury Answer: A Explanation: Paradoxical chest movement is classic for flail chest, where a segment of the rib cage moves independently. Question 58. Which of the following best describes the physiological effect of CPAP on a patient with cardiogenic pulmonary edema? A) Increases afterload, worsening edema B) Decreases preload and improves alveolar recruitment C) Causes bronchoconstriction D) Reduces heart rate via vagal stimulation Answer: B Explanation: CPAP provides positive airway pressure that reduces venous return (preload) and recruits collapsed alveoli, improving oxygenation in cardiogenic edema. Question 59. In a patient with suspected sepsis, which of the following is the most appropriate initial lactate threshold to trigger aggressive fluid resuscitation? A) Lactate ≥ 1 mmol/L B) Lactate ≥ 2 mmol/L C) Lactate ≥ 4 mmol/L D) Lactate ≥ 6 mmol/L Answer: C
Explanation: A lactate level of ≥ 4 mmol/L is a marker of tissue hypoperfusion and indicates the need for aggressive resuscitation. Question 60. Which of the following is the most appropriate method for decontaminating a scene contaminated with a chemical irritant (e.g., chlorine gas)? A) Immediate removal of all PPE and continue care B) Use of water spray decontamination while wearing appropriate PPE C) Applying a fire extinguisher to neutralize the chemical D) Covering the patient with a blanket and proceeding without decontamination Answer: B Explanation: Water spray (or appropriate neutralizing agent) while wearing full PPE is the standard method for chemical irritant decontamination. Question 61. Which of the following ECG findings is most suggestive of digitalis toxicity? A) Downsloping ST depression (“scooped”) with PR prolongation B) Tall, peaked T waves C) Horizontal ST depression in V1‑V D) Diffuse ST elevation with PR depression Answer: A Explanation: Digitalis effect produces characteristic “scooped” ST depression and PR interval prolongation. Question 62. A 45‑year‑old female with a known history of systemic lupus erythematosus presents with fever, hypotension, and a diffuse rash. Which of the following is the most likely diagnosis? A) Septic shock B) Anaphylactic shock C) Neurogenic shock D) Cardiogenic shock Answer: A Explanation: SLE patients are immunocompromised; fever, hypotension, and rash in this context most likely represent sepsis.
