1
EMT FISDAP Paramedic Entrance Exam - 200 Questions
and Answers () (Verified by Expert)
1. A 22-year-old male is apneic after a heroin overdose. Bag-valve-mask
ventilations with 100% oxygen are being performed at 12 breaths/min. The
most reliable initial indicator of adequate ventilation is:
• A) a pulse oximetry reading > 95%
• B) visible chest rise and fall
• C) improving skin color
• D) a heart rate returning to normal
• Answer: B) visible chest rise and fall
• Rationale: The most immediate and reliable clinical sign of effective BVM
ventilation is observing the chest rise and fall with each breath.
2. Which finding most strongly predicts a difficult airway?
• A) A Mallampati class I airway
• B) A short thyromental distance
• C) Absence of a beard
• D) A neck circumference of 36 cm
• Answer: B) A short thyromental distance
• Rationale: A short thyromental distance (less than 3 fingerbreadths) is
associated with a high, anterior larynx and difficult intubation. Mallampati
class I is a normal airway.
3. The most appropriate initial step for a patient with a suspected tension
pneumothorax and severe respiratory distress is:
• A) immediate endotracheal intubation
pg. 1
,2
• B) needle decompression
• C) a 12-lead ECG to rule out cardiac ischemia
• D) application of a non-rebreather mask at 15 L/min
• Answer: B) needle decompression
• Rationale: In tension pneumothorax, air accumulation in the pleural space
compresses the lungs and shifts the mediastinum. Needle decompression
releases trapped air and improves ventilation.
4. During orotracheal intubation, the best method to confirm correct
endotracheal tube placement immediately after insertion is:
• A) auscultation of the epigastrium
• B) observing symmetric chest rise
• C) continuous waveform capnography
• D) a chest X-ray
• Answer: C) continuous waveform capnography
• Rationale: Continuous waveform capnography provides a quantitative CO₂
tracing that reliably confirms tracheal placement and allows monitoring for
dislodgment.
5. A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. Their
SpO₂ is 97%. Which statement is most accurate?
• A) The flow rate should be increased to maintain SpO₂ > 98%
• B) The patient is at risk for oxygen toxicity; the flow should be reduced
• C) A high SpO₂ does not suppress the hypoxic drive in COPD patients as
much as previously taught; titrate to relief of dyspnea and 88–92%
• D) The patient requires intubation because SpO₂ > 95% indicates
hypoventilation
pg. 2
,3
• Answer: C) A high SpO₂ does not suppress the hypoxic drive in COPD
patients as much as previously taught; titrate to relief of dyspnea and 88–
92%
• *Rationale: While high oxygen can theoretically suppress the hypoxic drive,
current guidelines recommend titrating oxygen to an SpO₂ of 88–92% in
COPD to avoid hypercapnia from V/Q mismatch changes, while ensuring
adequate oxygenation.*
6. A patient with a stoma and no tube in place requires ventilation. You should:
• A) perform mouth-to-stoma ventilation
• B) apply a pediatric mask over the stoma and ventilate
• C) insert an endotracheal tube into the stoma and inflate the cuff
• D) place a nasopharyngeal airway and ventilate through the nose
• Answer: B) apply a pediatric mask over the stoma and ventilate
• Rationale: A pediatric face mask creates a good seal over a stoma for BVM
ventilation. Bag the stoma directly.
7. The most common cause of upper airway obstruction in an unresponsive
supine patient is:
• A) laryngeal edema
• B) a foreign body
• C) the tongue
• D) mucus plugging
• Answer: C) the tongue
• Rationale: In the unresponsive patient, loss of muscle tone allows the
tongue to fall back and occlude the posterior pharynx.
8. A paramedic performs a cricothyrotomy. The correct anatomical landmark for
the incision is:
• A) between the thyroid cartilage and the hyoid bone
pg. 3
, 4
• B) the cricothyroid membrane, between the thyroid and cricoid cartilages
• C) between the cricoid cartilage and the first tracheal ring
• D) at the level of the sternal notch
• Answer: B) the cricothyroid membrane, between the thyroid and
cricoid cartilages
• Rationale: The cricothyroid membrane is the landmark for emergency
surgical airway access because it is avascular and relatively superficial.
9. A patient with a severe asthma exacerbation is not improving with nebulized
albuterol. Which of the following is the most appropriate next intervention?
• A) Administer a beta-blocker
• B) Start an IV and administer methylprednisolone
• C) Perform immediate endotracheal intubation
• D) Administer high-dose morphine to relieve anxiety
• Answer: B) Start an IV and administer methylprednisolone
• Rationale: Corticosteroids address airway inflammation and are a
cornerstone of severe asthma management, although their onset is
delayed.
10. A patient with a suspected acute pulmonary edema has a SpO₂ of 82% on
room air. The most appropriate immediate therapy is:
• A) 500 mL IV fluid bolus
• B) CPAP/BiPAP
• C) high-flow oxygen and sublingual nitroglycerin
• D) insertion of a chest tube
• Answer: B) CPAP/BiPAP
• Rationale: Non-invasive positive pressure ventilation (CPAP/BiPAP) improves
oxygenation, reduces preload and afterload, and decreases work of
breathing in acute cardiogenic pulmonary edema.
pg. 4
EMT FISDAP Paramedic Entrance Exam - 200 Questions
and Answers () (Verified by Expert)
1. A 22-year-old male is apneic after a heroin overdose. Bag-valve-mask
ventilations with 100% oxygen are being performed at 12 breaths/min. The
most reliable initial indicator of adequate ventilation is:
• A) a pulse oximetry reading > 95%
• B) visible chest rise and fall
• C) improving skin color
• D) a heart rate returning to normal
• Answer: B) visible chest rise and fall
• Rationale: The most immediate and reliable clinical sign of effective BVM
ventilation is observing the chest rise and fall with each breath.
2. Which finding most strongly predicts a difficult airway?
• A) A Mallampati class I airway
• B) A short thyromental distance
• C) Absence of a beard
• D) A neck circumference of 36 cm
• Answer: B) A short thyromental distance
• Rationale: A short thyromental distance (less than 3 fingerbreadths) is
associated with a high, anterior larynx and difficult intubation. Mallampati
class I is a normal airway.
3. The most appropriate initial step for a patient with a suspected tension
pneumothorax and severe respiratory distress is:
• A) immediate endotracheal intubation
pg. 1
,2
• B) needle decompression
• C) a 12-lead ECG to rule out cardiac ischemia
• D) application of a non-rebreather mask at 15 L/min
• Answer: B) needle decompression
• Rationale: In tension pneumothorax, air accumulation in the pleural space
compresses the lungs and shifts the mediastinum. Needle decompression
releases trapped air and improves ventilation.
4. During orotracheal intubation, the best method to confirm correct
endotracheal tube placement immediately after insertion is:
• A) auscultation of the epigastrium
• B) observing symmetric chest rise
• C) continuous waveform capnography
• D) a chest X-ray
• Answer: C) continuous waveform capnography
• Rationale: Continuous waveform capnography provides a quantitative CO₂
tracing that reliably confirms tracheal placement and allows monitoring for
dislodgment.
5. A patient with COPD is receiving oxygen at 4 L/min via nasal cannula. Their
SpO₂ is 97%. Which statement is most accurate?
• A) The flow rate should be increased to maintain SpO₂ > 98%
• B) The patient is at risk for oxygen toxicity; the flow should be reduced
• C) A high SpO₂ does not suppress the hypoxic drive in COPD patients as
much as previously taught; titrate to relief of dyspnea and 88–92%
• D) The patient requires intubation because SpO₂ > 95% indicates
hypoventilation
pg. 2
,3
• Answer: C) A high SpO₂ does not suppress the hypoxic drive in COPD
patients as much as previously taught; titrate to relief of dyspnea and 88–
92%
• *Rationale: While high oxygen can theoretically suppress the hypoxic drive,
current guidelines recommend titrating oxygen to an SpO₂ of 88–92% in
COPD to avoid hypercapnia from V/Q mismatch changes, while ensuring
adequate oxygenation.*
6. A patient with a stoma and no tube in place requires ventilation. You should:
• A) perform mouth-to-stoma ventilation
• B) apply a pediatric mask over the stoma and ventilate
• C) insert an endotracheal tube into the stoma and inflate the cuff
• D) place a nasopharyngeal airway and ventilate through the nose
• Answer: B) apply a pediatric mask over the stoma and ventilate
• Rationale: A pediatric face mask creates a good seal over a stoma for BVM
ventilation. Bag the stoma directly.
7. The most common cause of upper airway obstruction in an unresponsive
supine patient is:
• A) laryngeal edema
• B) a foreign body
• C) the tongue
• D) mucus plugging
• Answer: C) the tongue
• Rationale: In the unresponsive patient, loss of muscle tone allows the
tongue to fall back and occlude the posterior pharynx.
8. A paramedic performs a cricothyrotomy. The correct anatomical landmark for
the incision is:
• A) between the thyroid cartilage and the hyoid bone
pg. 3
, 4
• B) the cricothyroid membrane, between the thyroid and cricoid cartilages
• C) between the cricoid cartilage and the first tracheal ring
• D) at the level of the sternal notch
• Answer: B) the cricothyroid membrane, between the thyroid and
cricoid cartilages
• Rationale: The cricothyroid membrane is the landmark for emergency
surgical airway access because it is avascular and relatively superficial.
9. A patient with a severe asthma exacerbation is not improving with nebulized
albuterol. Which of the following is the most appropriate next intervention?
• A) Administer a beta-blocker
• B) Start an IV and administer methylprednisolone
• C) Perform immediate endotracheal intubation
• D) Administer high-dose morphine to relieve anxiety
• Answer: B) Start an IV and administer methylprednisolone
• Rationale: Corticosteroids address airway inflammation and are a
cornerstone of severe asthma management, although their onset is
delayed.
10. A patient with a suspected acute pulmonary edema has a SpO₂ of 82% on
room air. The most appropriate immediate therapy is:
• A) 500 mL IV fluid bolus
• B) CPAP/BiPAP
• C) high-flow oxygen and sublingual nitroglycerin
• D) insertion of a chest tube
• Answer: B) CPAP/BiPAP
• Rationale: Non-invasive positive pressure ventilation (CPAP/BiPAP) improves
oxygenation, reduces preload and afterload, and decreases work of
breathing in acute cardiogenic pulmonary edema.
pg. 4
