FISDAP PARAMEDIC FINAL 2026/2027
|Practice Questions and Rationales | NREMT-
Style | Pass
AIRWAY & RESPIRATORY
Question 1:
A 58-year-old male presents with respiratory distress, stridor, and drooling. He is
sitting upright and leaning forward. What is your priority?
A) Oxygen via non-rebreather mask
B) Establish IV access
C) Immediate airway management (surgical or RSI)
D) Nebulized albuterol
Correct Answer: C
Rationale: Stridor + drooling + tripod positioning is epiglottitis until proven
otherwise. This indicates impending complete airway obstruction. Do not agitate
the patient; prepare for immediate advanced airway control. Albuterol is
ineffective for upper airway obstruction, and a non-rebreather mask cannot
bypass the obstruction.
Question 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 via non-rebreather mask
B) Intubate immediately
C) Increase O2 to achieve SpO2 88–92%
D) Start CPAP
Correct Answer: C
Rationale: In COPD patients, target SpO2 is 88–92% to avoid oxygen-induced
hypercapnia. While hypoxic drive is often discussed, the more clinically relevant
,concern is that high-flow oxygen can worsen V/Q mismatch and CO2 retention.
Do not blast high-flow O2 without ventilatory support.
Question 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
Correct Answer: B
Rationale: This is severe refractory asthma. Magnesium sulfate (2g IV over 20
minutes) acts as a bronchodilator and smooth muscle relaxant. If still failing,
consider CPAP/BiPAP or intubation. Diminished breath sounds in asthma indicate
severe obstruction, not improvement.
Question 4:
A 45-year-old male is found unresponsive with gurgling respirations. What is your
FIRST action?
A) Insert an OPA
B) Suction the oropharynx
C) Bag-valve-mask ventilations
D) Nasotracheal intubation
Correct Answer: B
Rationale: Gurgling indicates fluid/blood in the airway. Suctioning must precede
any airway adjunct or ventilation to prevent aspiration. Airway first: clear the
airway before securing it.
,Question 5:
Post-RSI, your patient's EtCO2 suddenly drops from 38 to 20 mmHg. You confirm
tube placement—it's correct. What is the most likely cause?
A) Mainstem bronchus intubation
B) Esophageal intubation
C) Pulmonary embolism
D) Kinked endotracheal tube
Correct Answer: C
Rationale: A sudden drop in EtCO2 with confirmed tube placement suggests a
sudden decrease in pulmonary blood flow, as seen in pulmonary embolism,
massive hemorrhage, or cardiac arrest. Esophageal intubation shows no
waveform. Mainstem intubation typically causes a gradual decrease.
Question 6:
Which of the following is the MOST reliable indicator of proper endotracheal tube
placement?
A) Chest rise and fall
B) Breath sounds over epigastrium
C) Continuous waveform capnography
D) Fogging in the tube
Correct Answer: C
Rationale: Continuous waveform capnography is the gold standard for confirming
ETT placement. Colorimetric devices are secondary. Chest rise and fogging can be
misleading. Epigastric breath sounds indicate esophageal intubation.
Question 7:
A 6-year-old child is in respiratory distress with audible stridor and a barking
cough. What is the most appropriate treatment?
A) Albuterol nebulizer
B) Racemic epinephrine nebulizer
, C) Oral corticosteroids
D) Immediate intubation
Correct Answer: B
Rationale: Barking cough + stridor = croup. Racemic epinephrine reduces airway
edema via alpha-adrenergic vasoconstriction. Albuterol treats bronchospasm, not
upper airway edema. Corticosteroids are adjunctive but take hours to work.
Question 8:
What is the correct tidal volume for an adult during bag-valve-mask ventilation?
A) 500-600 mL
B) 300-400 mL
C) 700-800 mL
D) 1000 mL
Correct Answer: A
Rationale: Current guidelines recommend 500-600 mL (6-8 mL/kg) to avoid
gastric insufflation and barotrauma. Deliver over 1 second, rate of 10-12
breaths/min.
Question 9:
A patient has a pneumothorax after trauma. Which finding would you expect on
auscultation?
A) Wheezing bilaterally
B) Crackles at the bases
C) Absent breath sounds on the affected side
D) Bronchial breath sounds
Correct Answer: C
Rationale: Pneumothorax results in absent or diminished breath sounds on the
affected side due to air in the pleural space preventing lung expansion. Wheezing
indicates bronchospasm; crackles indicate fluid.
|Practice Questions and Rationales | NREMT-
Style | Pass
AIRWAY & RESPIRATORY
Question 1:
A 58-year-old male presents with respiratory distress, stridor, and drooling. He is
sitting upright and leaning forward. What is your priority?
A) Oxygen via non-rebreather mask
B) Establish IV access
C) Immediate airway management (surgical or RSI)
D) Nebulized albuterol
Correct Answer: C
Rationale: Stridor + drooling + tripod positioning is epiglottitis until proven
otherwise. This indicates impending complete airway obstruction. Do not agitate
the patient; prepare for immediate advanced airway control. Albuterol is
ineffective for upper airway obstruction, and a non-rebreather mask cannot
bypass the obstruction.
Question 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 via non-rebreather mask
B) Intubate immediately
C) Increase O2 to achieve SpO2 88–92%
D) Start CPAP
Correct Answer: C
Rationale: In COPD patients, target SpO2 is 88–92% to avoid oxygen-induced
hypercapnia. While hypoxic drive is often discussed, the more clinically relevant
,concern is that high-flow oxygen can worsen V/Q mismatch and CO2 retention.
Do not blast high-flow O2 without ventilatory support.
Question 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
Correct Answer: B
Rationale: This is severe refractory asthma. Magnesium sulfate (2g IV over 20
minutes) acts as a bronchodilator and smooth muscle relaxant. If still failing,
consider CPAP/BiPAP or intubation. Diminished breath sounds in asthma indicate
severe obstruction, not improvement.
Question 4:
A 45-year-old male is found unresponsive with gurgling respirations. What is your
FIRST action?
A) Insert an OPA
B) Suction the oropharynx
C) Bag-valve-mask ventilations
D) Nasotracheal intubation
Correct Answer: B
Rationale: Gurgling indicates fluid/blood in the airway. Suctioning must precede
any airway adjunct or ventilation to prevent aspiration. Airway first: clear the
airway before securing it.
,Question 5:
Post-RSI, your patient's EtCO2 suddenly drops from 38 to 20 mmHg. You confirm
tube placement—it's correct. What is the most likely cause?
A) Mainstem bronchus intubation
B) Esophageal intubation
C) Pulmonary embolism
D) Kinked endotracheal tube
Correct Answer: C
Rationale: A sudden drop in EtCO2 with confirmed tube placement suggests a
sudden decrease in pulmonary blood flow, as seen in pulmonary embolism,
massive hemorrhage, or cardiac arrest. Esophageal intubation shows no
waveform. Mainstem intubation typically causes a gradual decrease.
Question 6:
Which of the following is the MOST reliable indicator of proper endotracheal tube
placement?
A) Chest rise and fall
B) Breath sounds over epigastrium
C) Continuous waveform capnography
D) Fogging in the tube
Correct Answer: C
Rationale: Continuous waveform capnography is the gold standard for confirming
ETT placement. Colorimetric devices are secondary. Chest rise and fogging can be
misleading. Epigastric breath sounds indicate esophageal intubation.
Question 7:
A 6-year-old child is in respiratory distress with audible stridor and a barking
cough. What is the most appropriate treatment?
A) Albuterol nebulizer
B) Racemic epinephrine nebulizer
, C) Oral corticosteroids
D) Immediate intubation
Correct Answer: B
Rationale: Barking cough + stridor = croup. Racemic epinephrine reduces airway
edema via alpha-adrenergic vasoconstriction. Albuterol treats bronchospasm, not
upper airway edema. Corticosteroids are adjunctive but take hours to work.
Question 8:
What is the correct tidal volume for an adult during bag-valve-mask ventilation?
A) 500-600 mL
B) 300-400 mL
C) 700-800 mL
D) 1000 mL
Correct Answer: A
Rationale: Current guidelines recommend 500-600 mL (6-8 mL/kg) to avoid
gastric insufflation and barotrauma. Deliver over 1 second, rate of 10-12
breaths/min.
Question 9:
A patient has a pneumothorax after trauma. Which finding would you expect on
auscultation?
A) Wheezing bilaterally
B) Crackles at the bases
C) Absent breath sounds on the affected side
D) Bronchial breath sounds
Correct Answer: C
Rationale: Pneumothorax results in absent or diminished breath sounds on the
affected side due to air in the pleural space preventing lung expansion. Wheezing
indicates bronchospasm; crackles indicate fluid.
