Paramedic National Test Prep: Medical
Questions and Answers
Question 1
During your assessment of a patient with a suspected neurologic disorder, you ask
him to shrug his shoulders and turn his head from side to side. Which of the following
cranial nerves are you assessing?
A: Glossopharyngeal
B: Spinal accessory
C: Trigeminal
D: Vestibulocochlear
Correct Answer
B: Spinal accessory
Reason:
If time and patient condition permits, assessment of the 12 pairs of cranial nerves
should be performed. The spinal accessory nerve (XI), a motor nerve, controls
shoulder and neck movements. Asking the patient to shrug his shoulders and turn
his head from side to side assesses cranial nerve XI. The trigeminal nerve (V)
provides motor control to the muscles of chewing and sensory control to the face,
sinuses, and teeth. Asking the patient to clench his teeth and then lightly stroking
your finger over his forehead and cheeks and asking him to identify where he is
being touched assesses cranial nerve V. The vestibulocochlear nerve (VIII), a sensory
nerve, controls hearing and balance perception. Checking a patient's hearing and
asking him to stand on one leg (if safe to do so) assesses cranial nerve VIII. The
glossopharyngeal nerve (IX) provides motor control to the throat and swallowing
mechanism and sensory control to the tongue, throat and ear. Asking the patient to
swallow assesses cranial nerve IX. Refer to your paramedic textbook regarding
assessment of all of the cranial nerves.
Page 1 of 127
,Question 2
An older woman presents with severe weakness, hypotension, lower back pain, and
vomiting. Her husband tells you that she has not taken her prednisone in several days
because she has not been feeling well. Which of the following should you suspect?
A: Thyrotoxic crisis
B: Pheochromocytoma
C: Cushing syndrome
D: Addisonian crisis
Correct Answer
D: Addisonian crisis
Reason:
Signs and symptoms of acute adrenal insufficiency can manifest suddenly in what is
called an addisonian crisis. Abrupt cessation of corticosteroid therapy (ie,
prednisone, hydrocortisone) is the most common cause of an addisonian crisis. It
may also be triggered by acute exacerbation of chronic adrenal insufficiency
(Addison disease), usually brought on by stress, trauma, surgery, or a severe
infection. In either case, cardiovascular collapse occurs due to a lack of the hormone
cortisol; therefore, the chief clinical manifestation of an addisonian crisis is shock.
Other signs and symptoms may include weakness; lethargy; fever; severe pain in the
lower back, legs, or abdomen; and severe vomiting and diarrhea. Cushing syndrome
is caused by excessive cortisol production by the adrenal cortex; it may also occur if
large amounts of corticosteroids are administered. Pheochromocytoma is an
adrenal tumor that causes excessive release of epinephrine and norepinephrine;
patients with this condition present with hypertension and tachycardia. Thyrotoxic
crisis (thyroid storm) is a condition caused by critically high thyroid hormone levels,
resulting in a hypermetabolic state. Signs and symptoms include severe tachycardia,
hypertension, fever, altered mental status, and possibly heart failure.
Page 2 of 127
,Question 3
Which of the following patients is at greatest risk for hypothermia?
A: 65-year-old man with coronary artery disease
B: 45-year-old man with hyperglycemia
C: 60-year-old woman with Cushing syndrome
D: 55-year-old woman with hypothyroidism
Correct Answer
D: 55-year-old woman with hypothyroidism
Reason:
Hypothyroidism is a condition in which the thyroid gland produces too little T3
(triiodothyronine) and T4 (thyroxine), resulting in a decrease in the metabolic rate.
Any time the metabolic rate decreases, heat energy production is reduced;
therefore, the patient is prone to hypothermia. Cushing syndrome is caused by
excessive cortisol production by the adrenal glands or by excessive use of cortisol or
other similar glucocorticoid hormones (ie, prednisone, hydrocortisone,
methylprednisolone). This increase in cortisol would cause an increase in the
metabolic rate. Patient's with Cushing syndrome are not at risk for hypothermia, nor
are patients with hyperglycemia or coronary artery disease.
Page 3 of 127
, Question 4
You are called to the residence of an elderly man whose daughter states that he is not
acting right. The patient becomes combative when you attempt to assess him. He
refuses supplemental oxygen and states that you are not taking him anywhere. What
is the MOST appropriate course of action?
A: Start an IV line and administer 25 gm of 50% dextrose.
B: Gently restrain him and transport him to the hospital.
C: Administer 5 mg diazepam IM to calm and sedate him.
D: Calmly talk to him and try to obtain a glucose reading.
Correct Answer
D: Calmly talk to him and try to obtain a glucose reading
Reason:
Any patient with an altered mental status should be ruled out for hypoglycemia by
obtaining a blood glucose reading. Administering IV dextrose without assessing his
blood glucose level first is not advisable. If he is experiencing an intracranial
hemorrhage, dextrose may exacerbate his condition. Conversely, if you discover that
he is hypoglycemic, this must be corrected. It is important to calmly approach any
patient, regardless of his or her mental status. The assumption of a psychiatric crisis
is not in the best interest of the patient. Focus on ruling out medical problems first.
Page 4 of 127
Questions and Answers
Question 1
During your assessment of a patient with a suspected neurologic disorder, you ask
him to shrug his shoulders and turn his head from side to side. Which of the following
cranial nerves are you assessing?
A: Glossopharyngeal
B: Spinal accessory
C: Trigeminal
D: Vestibulocochlear
Correct Answer
B: Spinal accessory
Reason:
If time and patient condition permits, assessment of the 12 pairs of cranial nerves
should be performed. The spinal accessory nerve (XI), a motor nerve, controls
shoulder and neck movements. Asking the patient to shrug his shoulders and turn
his head from side to side assesses cranial nerve XI. The trigeminal nerve (V)
provides motor control to the muscles of chewing and sensory control to the face,
sinuses, and teeth. Asking the patient to clench his teeth and then lightly stroking
your finger over his forehead and cheeks and asking him to identify where he is
being touched assesses cranial nerve V. The vestibulocochlear nerve (VIII), a sensory
nerve, controls hearing and balance perception. Checking a patient's hearing and
asking him to stand on one leg (if safe to do so) assesses cranial nerve VIII. The
glossopharyngeal nerve (IX) provides motor control to the throat and swallowing
mechanism and sensory control to the tongue, throat and ear. Asking the patient to
swallow assesses cranial nerve IX. Refer to your paramedic textbook regarding
assessment of all of the cranial nerves.
Page 1 of 127
,Question 2
An older woman presents with severe weakness, hypotension, lower back pain, and
vomiting. Her husband tells you that she has not taken her prednisone in several days
because she has not been feeling well. Which of the following should you suspect?
A: Thyrotoxic crisis
B: Pheochromocytoma
C: Cushing syndrome
D: Addisonian crisis
Correct Answer
D: Addisonian crisis
Reason:
Signs and symptoms of acute adrenal insufficiency can manifest suddenly in what is
called an addisonian crisis. Abrupt cessation of corticosteroid therapy (ie,
prednisone, hydrocortisone) is the most common cause of an addisonian crisis. It
may also be triggered by acute exacerbation of chronic adrenal insufficiency
(Addison disease), usually brought on by stress, trauma, surgery, or a severe
infection. In either case, cardiovascular collapse occurs due to a lack of the hormone
cortisol; therefore, the chief clinical manifestation of an addisonian crisis is shock.
Other signs and symptoms may include weakness; lethargy; fever; severe pain in the
lower back, legs, or abdomen; and severe vomiting and diarrhea. Cushing syndrome
is caused by excessive cortisol production by the adrenal cortex; it may also occur if
large amounts of corticosteroids are administered. Pheochromocytoma is an
adrenal tumor that causes excessive release of epinephrine and norepinephrine;
patients with this condition present with hypertension and tachycardia. Thyrotoxic
crisis (thyroid storm) is a condition caused by critically high thyroid hormone levels,
resulting in a hypermetabolic state. Signs and symptoms include severe tachycardia,
hypertension, fever, altered mental status, and possibly heart failure.
Page 2 of 127
,Question 3
Which of the following patients is at greatest risk for hypothermia?
A: 65-year-old man with coronary artery disease
B: 45-year-old man with hyperglycemia
C: 60-year-old woman with Cushing syndrome
D: 55-year-old woman with hypothyroidism
Correct Answer
D: 55-year-old woman with hypothyroidism
Reason:
Hypothyroidism is a condition in which the thyroid gland produces too little T3
(triiodothyronine) and T4 (thyroxine), resulting in a decrease in the metabolic rate.
Any time the metabolic rate decreases, heat energy production is reduced;
therefore, the patient is prone to hypothermia. Cushing syndrome is caused by
excessive cortisol production by the adrenal glands or by excessive use of cortisol or
other similar glucocorticoid hormones (ie, prednisone, hydrocortisone,
methylprednisolone). This increase in cortisol would cause an increase in the
metabolic rate. Patient's with Cushing syndrome are not at risk for hypothermia, nor
are patients with hyperglycemia or coronary artery disease.
Page 3 of 127
, Question 4
You are called to the residence of an elderly man whose daughter states that he is not
acting right. The patient becomes combative when you attempt to assess him. He
refuses supplemental oxygen and states that you are not taking him anywhere. What
is the MOST appropriate course of action?
A: Start an IV line and administer 25 gm of 50% dextrose.
B: Gently restrain him and transport him to the hospital.
C: Administer 5 mg diazepam IM to calm and sedate him.
D: Calmly talk to him and try to obtain a glucose reading.
Correct Answer
D: Calmly talk to him and try to obtain a glucose reading
Reason:
Any patient with an altered mental status should be ruled out for hypoglycemia by
obtaining a blood glucose reading. Administering IV dextrose without assessing his
blood glucose level first is not advisable. If he is experiencing an intracranial
hemorrhage, dextrose may exacerbate his condition. Conversely, if you discover that
he is hypoglycemic, this must be corrected. It is important to calmly approach any
patient, regardless of his or her mental status. The assumption of a psychiatric crisis
is not in the best interest of the patient. Focus on ruling out medical problems first.
Page 4 of 127
