FISDAP PARAMEDIC FINAL
2026/2027 |Practice Questions and
Rationales | NREMT-Style | Pass |
Graded A+
AIRWAY & RESPIRATORY (1–8)
1. A 58-year-old male is in respiratory distress with stridor and
drooling. He is sitting upright and leaning forward. What is your
priority?
A) Oxygen via NRB
B) IV access
C) Immediate airway management (surgical or RSI) ✅
D) Nebulized albuterol
Rationale: Stridor + drooling + tripod positioning = epiglottitis or upper
airway obstruction. This is an impending airway closure. Do not agitate the
patient; prepare for immediate advanced airway control. Albuterol won't
help; NRB won't bypass the obstruction.
2. A 72-year-old with COPD has an SpO2 of 82% on 2 L/min nasal
cannula. He is lethargic. What should you do?
A) Increase to 15 L/min NRB
B) Intubate immediately
C) Increase O2 to achieve SpO2 88–92% ✅
D) Start CPAP
, Rationale: COPD patients rely on hypoxic drive, but that's less common
than taught. The real issue is oxygen-induced hypercapnia. Target SpO2
88–92% in COPD. Don't blast high-flow O2 without ventilatory support.
3. A 34-year-old asthmatic is tachypneic with diminished breath
sounds and accessory muscle use. He is not responding to albuterol.
What is the next step?
A) Repeat albuterol
B) Magnesium sulfate IV ✅
C) Epinephrine IM
D) BVM ventilation
Rationale: Severe refractory asthma — magnesium sulfate is a
bronchodilator and smooth muscle relaxant. Give 2g IV over 20 min. If still
failing, consider CPAP/BiPAP or intubation.
4. During CPAP application, the patient becomes hypotensive. What
should you do?
A) Increase CPAP pressure
B) Decrease CPAP pressure and administer fluid bolus ✅
C) Remove CPAP immediately
D) Start dopamine
Rationale: CPAP decreases preload by increasing intrathoracic pressure. If
hypotensive, reduce pressure and give fluids. Do not remove CPAP abruptly
unless airway is lost.
, 5. Which capnography waveform finding indicates bronchospasm?
A) Shark-fin shape ✅
B) Flat line
C) Sudden drop to zero
D) Elevated baseline
Rationale: Shark-fin (sloping upstroke) = obstructive lung disease
(asthma/COPD). Normal waveform is rectangular.
6. A patient has a tension pneumothorax after trauma. You should
perform:
A) Needle decompression at 2nd intercostal space, midclavicular line ✅
B) Needle decompression at 5th intercostal space, anterior axillary line
C) Chest tube insertion
D) Occlusive dressing
Rationale: Tension pneumothorax = tracheal deviation, absent breath
sounds, hypotension, distended neck veins. Decompress immediately at
2nd ICS midclavicular.
7. A 66-year-old with pulmonary edema has pink frothy sputum,
crackles, and hypertension. Which treatment is MOST appropriate?
A) Nitroglycerin SL and CPAP ✅
B) Albuterol nebulizer
C) Normal saline bolus
D) Epinephrine IM
, Rationale: Cardiogenic pulmonary edema. NTG reduces preload, CPAP
pushes fluid out of alveoli. Do not give fluids.
8. A patient with a tracheostomy tube is in respiratory distress. The
inner cannula is clogged. What should you do?
A) Remove the inner cannula and replace it ✅
B) Suction through the tracheostomy
C) Ventilate over the stoma
D) Intubate orally
Rationale: Clogged inner cannula is the most common cause of acute
distress. Remove and replace it first. If that fails, ventilate over stoma with a
pediatric mask.
CARDIOLOGY & DYSRHYTHMIAS (9–18)
9. A 55-year-old male has chest pain, diaphoresis, and nausea. ECG
shows ST elevation in leads II, III, and aVF. What artery is likely
occluded?
A) Left anterior descending
B) Right coronary artery ✅
C) Left circumflex
D) Left main
Rationale: Inferior STEMI (II, III, aVF) = RCA occlusion. Be prepared for
bradycardia and hypotension due to right ventricular involvement.
2026/2027 |Practice Questions and
Rationales | NREMT-Style | Pass |
Graded A+
AIRWAY & RESPIRATORY (1–8)
1. A 58-year-old male is in respiratory distress with stridor and
drooling. He is sitting upright and leaning forward. What is your
priority?
A) Oxygen via NRB
B) IV access
C) Immediate airway management (surgical or RSI) ✅
D) Nebulized albuterol
Rationale: Stridor + drooling + tripod positioning = epiglottitis or upper
airway obstruction. This is an impending airway closure. Do not agitate the
patient; prepare for immediate advanced airway control. Albuterol won't
help; NRB won't bypass the obstruction.
2. A 72-year-old with COPD has an SpO2 of 82% on 2 L/min nasal
cannula. He is lethargic. What should you do?
A) Increase to 15 L/min NRB
B) Intubate immediately
C) Increase O2 to achieve SpO2 88–92% ✅
D) Start CPAP
, Rationale: COPD patients rely on hypoxic drive, but that's less common
than taught. The real issue is oxygen-induced hypercapnia. Target SpO2
88–92% in COPD. Don't blast high-flow O2 without ventilatory support.
3. A 34-year-old asthmatic is tachypneic with diminished breath
sounds and accessory muscle use. He is not responding to albuterol.
What is the next step?
A) Repeat albuterol
B) Magnesium sulfate IV ✅
C) Epinephrine IM
D) BVM ventilation
Rationale: Severe refractory asthma — magnesium sulfate is a
bronchodilator and smooth muscle relaxant. Give 2g IV over 20 min. If still
failing, consider CPAP/BiPAP or intubation.
4. During CPAP application, the patient becomes hypotensive. What
should you do?
A) Increase CPAP pressure
B) Decrease CPAP pressure and administer fluid bolus ✅
C) Remove CPAP immediately
D) Start dopamine
Rationale: CPAP decreases preload by increasing intrathoracic pressure. If
hypotensive, reduce pressure and give fluids. Do not remove CPAP abruptly
unless airway is lost.
, 5. Which capnography waveform finding indicates bronchospasm?
A) Shark-fin shape ✅
B) Flat line
C) Sudden drop to zero
D) Elevated baseline
Rationale: Shark-fin (sloping upstroke) = obstructive lung disease
(asthma/COPD). Normal waveform is rectangular.
6. A patient has a tension pneumothorax after trauma. You should
perform:
A) Needle decompression at 2nd intercostal space, midclavicular line ✅
B) Needle decompression at 5th intercostal space, anterior axillary line
C) Chest tube insertion
D) Occlusive dressing
Rationale: Tension pneumothorax = tracheal deviation, absent breath
sounds, hypotension, distended neck veins. Decompress immediately at
2nd ICS midclavicular.
7. A 66-year-old with pulmonary edema has pink frothy sputum,
crackles, and hypertension. Which treatment is MOST appropriate?
A) Nitroglycerin SL and CPAP ✅
B) Albuterol nebulizer
C) Normal saline bolus
D) Epinephrine IM
, Rationale: Cardiogenic pulmonary edema. NTG reduces preload, CPAP
pushes fluid out of alveoli. Do not give fluids.
8. A patient with a tracheostomy tube is in respiratory distress. The
inner cannula is clogged. What should you do?
A) Remove the inner cannula and replace it ✅
B) Suction through the tracheostomy
C) Ventilate over the stoma
D) Intubate orally
Rationale: Clogged inner cannula is the most common cause of acute
distress. Remove and replace it first. If that fails, ventilate over stoma with a
pediatric mask.
CARDIOLOGY & DYSRHYTHMIAS (9–18)
9. A 55-year-old male has chest pain, diaphoresis, and nausea. ECG
shows ST elevation in leads II, III, and aVF. What artery is likely
occluded?
A) Left anterior descending
B) Right coronary artery ✅
C) Left circumflex
D) Left main
Rationale: Inferior STEMI (II, III, aVF) = RCA occlusion. Be prepared for
bradycardia and hypotension due to right ventricular involvement.
