FINAL PARAMEDIC FISDAP COMPLETE Actual Exam 2026/2027
Trauma, Medical, Airway, Cardiology, OBGYN, Operations Complete
Certification Exam | Actual Questions & Verified Answers | All
Domains Covered | Pass Guarantee
SECTION I: TRAUMA (Questions 1-30)
Question 1
You are dispatched to a motor vehicle collision on the interstate. Dispatch reports a
single vehicle versus guardrail at highway speed with significant front-end damage.
Upon arrival, you find a 28-year-old male driver who self-extricated and is ambulatory at
the scene. He presents with a Glasgow Coma Scale score of 15, complaining of severe
chest pain and difficulty breathing. His skin is pale and diaphoretic. Primary assessment
reveals absent breath sounds on the right side, jugular venous distension, and tracheal
deviation to the left. Vital signs: HR 128, BP 82/54, RR 32 and labored, SpO₂ 84% on
room air.
What is the most appropriate immediate intervention?
A) Immediate needle decompression of the right chest at the 5th intercostal space,
mid-axillary line
B) High-flow oxygen via non-rebreather mask and rapid transport to the nearest trauma
center
C) Immediate needle decompression of the right chest at the 2nd intercostal space,
midclavicular line
D) Immediate bilateral needle decompression and initiation of massive transfusion
protocol
,Correct Answer: C
Rationale: This patient presents with the classic Beck's triad (hypotension, JVD, muffled
heart sounds—though here we see tension pneumothorax signs with tracheal deviation
and absent breath sounds). The combination of absent breath sounds, JVD, tracheal
deviation to the contralateral side, and hemodynamic compromise constitutes a tension
pneumothorax, which is a true immediate life threat requiring immediate
decompression. The 2nd intercostal space at the midclavicular line is the traditional and
widely accepted site for needle decompression. While the 5th intercostal space
mid-axillary line (Option A) is an acceptable alternative site taught in some protocols,
the midclavicular approach is most commonly referenced in NREMT and PHTLS
standards. Option B delays definitive treatment for a condition that will rapidly progress
to cardiac arrest. Option D is excessive as there is no indication for bilateral
decompression or massive transfusion at this time.
Question 2
You respond to a construction site where a 34-year-old male fell approximately 20 feet
from scaffolding, landing on his feet on concrete. He is conscious but confused.
Assessment reveals bilateral heel deformities with open fractures, pelvic instability, and
Tenderness, Instability, and Crepitus (TIC) in the lumbar spine. Vital signs: HR 118, BP
96/62, RR 24, SpO₂ 94% on 4L NC. He has a 16-gauge IV established with crystalloid
bolus in progress.
Based on the mechanism of injury and findings, which injury pattern should you suspect
that poses the greatest immediate threat to life?
A) Bilateral femur fractures with fat embolism
B) Intra-abdominal hemorrhage from liver or spleen laceration
,C) Retroperitoneal hemorrhage from pelvic fracture
D) Traumatic brain injury with elevated intracranial pressure
Correct Answer: C
Rationale: The "feet-first" fall from height mechanism classically produces axial loading
injuries including calcaneal fractures (bilateral in this case), acetabular fractures, pelvic
fractures, and spinal compression fractures. The combination of pelvic instability with
hemodynamic instability (tachycardia, borderline hypotension despite fluid
resuscitation) strongly suggests retroperitoneal hemorrhage. The pelvis can
accommodate several liters of blood in the retroperitoneal space without external signs
of bleeding. While intra-abdominal bleeding (Option B) is possible, the pelvic fracture
with instability is more immediately concerning given the hemodynamic profile. Bilateral
calcaneal fractures are highly associated with pelvic and spinal injuries. Option A is
incorrect as the injury is to the heels (calcaneus), not femurs. Option D is possible given
the confusion, but the vital signs point more toward hemorrhagic shock than isolated
head injury.
Question 3
You are managing a 19-year-old male who sustained a gunshot wound to the abdomen.
He is combative, tachycardic at 142, hypotensive at 74/40, with cool, clammy skin. You
have established two large-bore IVs and initiated warmed normal saline. His mental
status is deteriorating despite fluid administration.
What is the most appropriate next intervention regarding fluid resuscitation?
A) Continue crystalloid bolus to achieve a systolic BP of 100 mmHg
B) Switch to hypertonic saline to reduce fluid volume
, C) Initiate permissive hypotension strategy with limited fluid boluses
D) Immediately begin blood product administration if available
Correct Answer: D
Rationale: This patient presents in hemorrhagic shock (Class III/IV) from penetrating
torso trauma with signs of ongoing severe bleeding and deteriorating mental status.
Current trauma guidelines (PHTLS 9th Edition, ACS Committee on Trauma) emphasize
that for patients in severe hemorrhagic shock, especially those with penetrating trauma,
blood products are the resuscitation fluid of choice when available. Crystalloid
resuscitation (Option A) can dilute clotting factors, worsen coagulopathy, and cause
hypothermia. While permissive hypotension (Option C) is appropriate in the early stages
of care before hospital arrival, this patient is demonstrating end-organ hypoperfusion
(altered mental status) and requires definitive resuscitation. The goal should be
balanced blood product administration (1:1:1 ratio of PRBCs:FFP:Platelets if following
massive transfusion protocols) to restore oxygen-carrying capacity and correct
coagulopathy.
Question 4
A 45-year-old unrestrained driver was involved in a head-on collision at 45 mph. The
steering wheel is bent, and there is a "bull's-eye" pattern on the windshield consistent
with forehead impact. The patient is unconscious with snoring respirations, slow
gurgling breaths at 8/min, and a palpable radial pulse. You note significant facial trauma
with oral bleeding.
What is your immediate priority in airway management?
A) Immediate orotracheal intubation with cervical spine immobilization
Trauma, Medical, Airway, Cardiology, OBGYN, Operations Complete
Certification Exam | Actual Questions & Verified Answers | All
Domains Covered | Pass Guarantee
SECTION I: TRAUMA (Questions 1-30)
Question 1
You are dispatched to a motor vehicle collision on the interstate. Dispatch reports a
single vehicle versus guardrail at highway speed with significant front-end damage.
Upon arrival, you find a 28-year-old male driver who self-extricated and is ambulatory at
the scene. He presents with a Glasgow Coma Scale score of 15, complaining of severe
chest pain and difficulty breathing. His skin is pale and diaphoretic. Primary assessment
reveals absent breath sounds on the right side, jugular venous distension, and tracheal
deviation to the left. Vital signs: HR 128, BP 82/54, RR 32 and labored, SpO₂ 84% on
room air.
What is the most appropriate immediate intervention?
A) Immediate needle decompression of the right chest at the 5th intercostal space,
mid-axillary line
B) High-flow oxygen via non-rebreather mask and rapid transport to the nearest trauma
center
C) Immediate needle decompression of the right chest at the 2nd intercostal space,
midclavicular line
D) Immediate bilateral needle decompression and initiation of massive transfusion
protocol
,Correct Answer: C
Rationale: This patient presents with the classic Beck's triad (hypotension, JVD, muffled
heart sounds—though here we see tension pneumothorax signs with tracheal deviation
and absent breath sounds). The combination of absent breath sounds, JVD, tracheal
deviation to the contralateral side, and hemodynamic compromise constitutes a tension
pneumothorax, which is a true immediate life threat requiring immediate
decompression. The 2nd intercostal space at the midclavicular line is the traditional and
widely accepted site for needle decompression. While the 5th intercostal space
mid-axillary line (Option A) is an acceptable alternative site taught in some protocols,
the midclavicular approach is most commonly referenced in NREMT and PHTLS
standards. Option B delays definitive treatment for a condition that will rapidly progress
to cardiac arrest. Option D is excessive as there is no indication for bilateral
decompression or massive transfusion at this time.
Question 2
You respond to a construction site where a 34-year-old male fell approximately 20 feet
from scaffolding, landing on his feet on concrete. He is conscious but confused.
Assessment reveals bilateral heel deformities with open fractures, pelvic instability, and
Tenderness, Instability, and Crepitus (TIC) in the lumbar spine. Vital signs: HR 118, BP
96/62, RR 24, SpO₂ 94% on 4L NC. He has a 16-gauge IV established with crystalloid
bolus in progress.
Based on the mechanism of injury and findings, which injury pattern should you suspect
that poses the greatest immediate threat to life?
A) Bilateral femur fractures with fat embolism
B) Intra-abdominal hemorrhage from liver or spleen laceration
,C) Retroperitoneal hemorrhage from pelvic fracture
D) Traumatic brain injury with elevated intracranial pressure
Correct Answer: C
Rationale: The "feet-first" fall from height mechanism classically produces axial loading
injuries including calcaneal fractures (bilateral in this case), acetabular fractures, pelvic
fractures, and spinal compression fractures. The combination of pelvic instability with
hemodynamic instability (tachycardia, borderline hypotension despite fluid
resuscitation) strongly suggests retroperitoneal hemorrhage. The pelvis can
accommodate several liters of blood in the retroperitoneal space without external signs
of bleeding. While intra-abdominal bleeding (Option B) is possible, the pelvic fracture
with instability is more immediately concerning given the hemodynamic profile. Bilateral
calcaneal fractures are highly associated with pelvic and spinal injuries. Option A is
incorrect as the injury is to the heels (calcaneus), not femurs. Option D is possible given
the confusion, but the vital signs point more toward hemorrhagic shock than isolated
head injury.
Question 3
You are managing a 19-year-old male who sustained a gunshot wound to the abdomen.
He is combative, tachycardic at 142, hypotensive at 74/40, with cool, clammy skin. You
have established two large-bore IVs and initiated warmed normal saline. His mental
status is deteriorating despite fluid administration.
What is the most appropriate next intervention regarding fluid resuscitation?
A) Continue crystalloid bolus to achieve a systolic BP of 100 mmHg
B) Switch to hypertonic saline to reduce fluid volume
, C) Initiate permissive hypotension strategy with limited fluid boluses
D) Immediately begin blood product administration if available
Correct Answer: D
Rationale: This patient presents in hemorrhagic shock (Class III/IV) from penetrating
torso trauma with signs of ongoing severe bleeding and deteriorating mental status.
Current trauma guidelines (PHTLS 9th Edition, ACS Committee on Trauma) emphasize
that for patients in severe hemorrhagic shock, especially those with penetrating trauma,
blood products are the resuscitation fluid of choice when available. Crystalloid
resuscitation (Option A) can dilute clotting factors, worsen coagulopathy, and cause
hypothermia. While permissive hypotension (Option C) is appropriate in the early stages
of care before hospital arrival, this patient is demonstrating end-organ hypoperfusion
(altered mental status) and requires definitive resuscitation. The goal should be
balanced blood product administration (1:1:1 ratio of PRBCs:FFP:Platelets if following
massive transfusion protocols) to restore oxygen-carrying capacity and correct
coagulopathy.
Question 4
A 45-year-old unrestrained driver was involved in a head-on collision at 45 mph. The
steering wheel is bent, and there is a "bull's-eye" pattern on the windshield consistent
with forehead impact. The patient is unconscious with snoring respirations, slow
gurgling breaths at 8/min, and a palpable radial pulse. You note significant facial trauma
with oral bleeding.
What is your immediate priority in airway management?
A) Immediate orotracheal intubation with cervical spine immobilization
