WEST COAST EMT BLOCK 2 REVIEW EXAM ALL
QUESTIONS AND ANSWERS SURE A.pdf - 199 Questions
This rigorous examination assesses advanced understanding of airway management and ventilation principles for
emergency medical services. Topics include oxygen delivery devices, airway adjuncts, capnography interpretation,
ventilation strategies, and management of special populations. The exam reflects current evidence-based
guidelines and national EMS standards. It contains 199 multiple-choice questions, each with four distractors and
a fully worked rationale that explains why the keyed answer is correct. Content is organized into 8 focused
sections: Airway Management and Ventilation, Cardiology and Resuscitation, Medical Emergencies, Trauma
Emergencies, Special Patient Populations (Pediatrics, Geriatrics, Obstetrics), Operations (Ambulance Safety,
Incident Command, Triage), Pharmacology and Medication Administration, Patient Assessment and
Documentation. Targeted learning outcomes include: Analyze and select appropriate airway devices and
ventilation techniques based on patient pathophysiology.; Interpret capnography waveforms to assess ventilation
adequacy and detect complications.; Evaluate risks and benefits of various oxygen delivery systems and airway
maneuvers.; Apply advanced concepts of airway management in complex clinical scenarios.. Every item has been
reviewed for clinical accuracy, current guidelines, and clarity so that students can study with confidence and
self-correct as they work through the bank. Use it as a high-yield review immediately before the exam, or as a
structured practice tool during the unit - the rationales double as concise teaching notes. The recommended
Section 1: Airway Management and Ventilation (Questions 1-25)
1 A patient with severe COPD presents with respiratory acidosis. Which
ventilation strategy minimizes dynamic hyperinflation?
A) High tidal volume with low respiratory rate
B) Low tidal volume with high respiratory rate
C) Low tidal volume with prolonged expiratory time
D) High tidal volume with inverse ratio ventilation
Answer: C
Rationale: In COPD, prolonged expiratory time allows complete exhalation,
reducing air trapping. Low tidal volume further limits overdistention. High
respiratory rates or inverse ratio worsen hyperinflation.
2 A patient with a large flail segment and pulmonary contusion requires
positive pressure ventilation. Which mode minimizes the risk of further lung
injury?
A) Volume-controlled ventilation with high tidal volume
B) Pressure-controlled ventilation with low inspiratory pressure
C) Pressure-support ventilation with high trigger sensitivity
D) Synchronized intermittent mandatory ventilation
Answer: B
,Rationale: Pressure-controlled ventilation limits peak inspiratory pressure,
reducing barotrauma in contused lungs. High tidal volumes or high pressures
can worsen injury. SIMV may not adequately control pressure.
3 During bag-valve-mask ventilation, you note increasing resistance and
decreasing chest rise. What is the most likely cause?
A) Gastric distention
B) Laryngospasm
C) Mainstem bronchus intubation
D) Malfunctioning exhalation valve
Answer: B
Rationale: Laryngospasm causes functional airway obstruction, increasing
resistance and limiting airflow. Gastric distention may cause resistance but not
primarily. Mainstem intubation would cause unequal breath sounds. Valve
malfunction would affect both phases.
4 A patient with a tension pneumothorax has just undergone needle
decompression. Which capnography waveform change confirms successful
decompression?
A) Sudden increase in ETCO2 to normal range
B) Sudden decrease in ETCO2 to zero
C) Gradual increase in ETCO2 over several minutes
D) Disappearance of the alveolar plateau
Answer: A
Rationale: Tension pneumothorax reduces cardiac output and ventilation,
causing low ETCO2. Decompression restores circulation and ventilation,
abruptly raising ETCO2 toward normal. A decrease or absent plateau indicates
worsening or tube dislodgement.
5 Which of the following is a contraindication to the use of a supraglottic
airway in a patient with known esophageal varices?
A) Increased risk of aspiration due to gastric regurgitation
B) Inability to achieve a seal due to anatomical distortion
C) Potential for variceal rupture from cuff pressure
D) Interference with endoscopic visualization
Answer: C
,Rationale: Supraglottic airway cuffs exert pressure on the esophagus, which can
rupture fragile varices, causing life-threatening hemorrhage. While aspiration
risk exists, variceal rupture is an absolute concern. Anatomical distortion is less
specific.
6 A patient with a suspected basilar skull fracture requires airway
management. Which technique is most appropriate?
A) Nasotracheal intubation with a smaller tube
B) Orotracheal intubation with manual inline stabilization
C) Supraglottic airway insertion
D) Cricothyrotomy
Answer: B
Rationale: Orotracheal intubation with inline stabilization avoids nasal passage,
reducing risk of intracranial tube placement. Nasotracheal is contraindicated
due to risk of entering the cranium. Supraglottic airways may not protect the
airway if bleeding is present.
7 Which of the following best describes the effect of a PEEP of 10 cm H2O on
venous return in a hypovolemic patient?
A) Increases venous return by augmenting right atrial pressure
B) Decreases venous return by increasing intrathoracic pressure
C) Has no effect on venous return due to compensatory mechanisms
D) Increases venous return by improving cardiac contractility
Answer: B
Rationale: PEEP increases intrathoracic pressure, which compresses the vena
cava and reduces the pressure gradient for venous return. In hypovolemia, this
effect is pronounced and can cause hypotension. It does not augment
contractility or right atrial pressure.
8 A patient with a high cervical spinal cord injury is breathing spontaneously
but has a weak cough and paradoxical chest movement. The most
appropriate airway intervention is:
A) Noninvasive positive pressure ventilation with a full face mask
B) Supplemental oxygen via nasal cannula
C) Intubation and mechanical ventilation
D) Intermittent positive pressure breathing
, Answer: C
Rationale: High cervical injury impairs diaphragmatic and intercostal function,
leading to ineffective ventilation and secretion clearance. Intubation and
mechanical ventilation provide definitive airway protection and ventilation.
Noninvasive methods are insufficient due to weak cough and bulbar
dysfunction.
9 A patient with a severe asthma exacerbation has a peak expiratory flow rate
of 30% predicted. Which capnography pattern is most likely?
A) Normal square-wave pattern
B) Shark-fin pattern with prolonged upslope
C) Shark-fin pattern with prolonged downslope
D) Flat pattern with low ETCO2
Answer: C
Rationale: Severe asthma causes airflow obstruction during exhalation,
producing a prolonged downslope (shark-fin) on capnography. The upslope
may be normal or slightly prolonged. A flat pattern suggests hypoventilation or
apnea, not typical in asthma.
10 A patient with a suspected tension pneumothorax is being ventilated with a
bag-valve-mask. Which finding indicates the need for immediate
decompression?
A) Decreased breath sounds on the affected side
B) Tracheal deviation away from the affected side
C) Increased peak airway pressure during ventilation
D) Hypotension with distended neck veins
Answer: C
Rationale: In a ventilated patient, tension pneumothorax causes a sudden rise in
airway pressure due to inability to expand the lung. While tracheal deviation
and hypotension are classic signs, increased peak pressure is an early indicator
during positive pressure ventilation. Decreased breath sounds may be present
but less specific.
11 A patient with severe respiratory distress has a respiratory rate of 8
breaths/min and oxygen saturation of 82% on a non-rebreather mask.
Which intervention should be performed first?
QUESTIONS AND ANSWERS SURE A.pdf - 199 Questions
This rigorous examination assesses advanced understanding of airway management and ventilation principles for
emergency medical services. Topics include oxygen delivery devices, airway adjuncts, capnography interpretation,
ventilation strategies, and management of special populations. The exam reflects current evidence-based
guidelines and national EMS standards. It contains 199 multiple-choice questions, each with four distractors and
a fully worked rationale that explains why the keyed answer is correct. Content is organized into 8 focused
sections: Airway Management and Ventilation, Cardiology and Resuscitation, Medical Emergencies, Trauma
Emergencies, Special Patient Populations (Pediatrics, Geriatrics, Obstetrics), Operations (Ambulance Safety,
Incident Command, Triage), Pharmacology and Medication Administration, Patient Assessment and
Documentation. Targeted learning outcomes include: Analyze and select appropriate airway devices and
ventilation techniques based on patient pathophysiology.; Interpret capnography waveforms to assess ventilation
adequacy and detect complications.; Evaluate risks and benefits of various oxygen delivery systems and airway
maneuvers.; Apply advanced concepts of airway management in complex clinical scenarios.. Every item has been
reviewed for clinical accuracy, current guidelines, and clarity so that students can study with confidence and
self-correct as they work through the bank. Use it as a high-yield review immediately before the exam, or as a
structured practice tool during the unit - the rationales double as concise teaching notes. The recommended
Section 1: Airway Management and Ventilation (Questions 1-25)
1 A patient with severe COPD presents with respiratory acidosis. Which
ventilation strategy minimizes dynamic hyperinflation?
A) High tidal volume with low respiratory rate
B) Low tidal volume with high respiratory rate
C) Low tidal volume with prolonged expiratory time
D) High tidal volume with inverse ratio ventilation
Answer: C
Rationale: In COPD, prolonged expiratory time allows complete exhalation,
reducing air trapping. Low tidal volume further limits overdistention. High
respiratory rates or inverse ratio worsen hyperinflation.
2 A patient with a large flail segment and pulmonary contusion requires
positive pressure ventilation. Which mode minimizes the risk of further lung
injury?
A) Volume-controlled ventilation with high tidal volume
B) Pressure-controlled ventilation with low inspiratory pressure
C) Pressure-support ventilation with high trigger sensitivity
D) Synchronized intermittent mandatory ventilation
Answer: B
,Rationale: Pressure-controlled ventilation limits peak inspiratory pressure,
reducing barotrauma in contused lungs. High tidal volumes or high pressures
can worsen injury. SIMV may not adequately control pressure.
3 During bag-valve-mask ventilation, you note increasing resistance and
decreasing chest rise. What is the most likely cause?
A) Gastric distention
B) Laryngospasm
C) Mainstem bronchus intubation
D) Malfunctioning exhalation valve
Answer: B
Rationale: Laryngospasm causes functional airway obstruction, increasing
resistance and limiting airflow. Gastric distention may cause resistance but not
primarily. Mainstem intubation would cause unequal breath sounds. Valve
malfunction would affect both phases.
4 A patient with a tension pneumothorax has just undergone needle
decompression. Which capnography waveform change confirms successful
decompression?
A) Sudden increase in ETCO2 to normal range
B) Sudden decrease in ETCO2 to zero
C) Gradual increase in ETCO2 over several minutes
D) Disappearance of the alveolar plateau
Answer: A
Rationale: Tension pneumothorax reduces cardiac output and ventilation,
causing low ETCO2. Decompression restores circulation and ventilation,
abruptly raising ETCO2 toward normal. A decrease or absent plateau indicates
worsening or tube dislodgement.
5 Which of the following is a contraindication to the use of a supraglottic
airway in a patient with known esophageal varices?
A) Increased risk of aspiration due to gastric regurgitation
B) Inability to achieve a seal due to anatomical distortion
C) Potential for variceal rupture from cuff pressure
D) Interference with endoscopic visualization
Answer: C
,Rationale: Supraglottic airway cuffs exert pressure on the esophagus, which can
rupture fragile varices, causing life-threatening hemorrhage. While aspiration
risk exists, variceal rupture is an absolute concern. Anatomical distortion is less
specific.
6 A patient with a suspected basilar skull fracture requires airway
management. Which technique is most appropriate?
A) Nasotracheal intubation with a smaller tube
B) Orotracheal intubation with manual inline stabilization
C) Supraglottic airway insertion
D) Cricothyrotomy
Answer: B
Rationale: Orotracheal intubation with inline stabilization avoids nasal passage,
reducing risk of intracranial tube placement. Nasotracheal is contraindicated
due to risk of entering the cranium. Supraglottic airways may not protect the
airway if bleeding is present.
7 Which of the following best describes the effect of a PEEP of 10 cm H2O on
venous return in a hypovolemic patient?
A) Increases venous return by augmenting right atrial pressure
B) Decreases venous return by increasing intrathoracic pressure
C) Has no effect on venous return due to compensatory mechanisms
D) Increases venous return by improving cardiac contractility
Answer: B
Rationale: PEEP increases intrathoracic pressure, which compresses the vena
cava and reduces the pressure gradient for venous return. In hypovolemia, this
effect is pronounced and can cause hypotension. It does not augment
contractility or right atrial pressure.
8 A patient with a high cervical spinal cord injury is breathing spontaneously
but has a weak cough and paradoxical chest movement. The most
appropriate airway intervention is:
A) Noninvasive positive pressure ventilation with a full face mask
B) Supplemental oxygen via nasal cannula
C) Intubation and mechanical ventilation
D) Intermittent positive pressure breathing
, Answer: C
Rationale: High cervical injury impairs diaphragmatic and intercostal function,
leading to ineffective ventilation and secretion clearance. Intubation and
mechanical ventilation provide definitive airway protection and ventilation.
Noninvasive methods are insufficient due to weak cough and bulbar
dysfunction.
9 A patient with a severe asthma exacerbation has a peak expiratory flow rate
of 30% predicted. Which capnography pattern is most likely?
A) Normal square-wave pattern
B) Shark-fin pattern with prolonged upslope
C) Shark-fin pattern with prolonged downslope
D) Flat pattern with low ETCO2
Answer: C
Rationale: Severe asthma causes airflow obstruction during exhalation,
producing a prolonged downslope (shark-fin) on capnography. The upslope
may be normal or slightly prolonged. A flat pattern suggests hypoventilation or
apnea, not typical in asthma.
10 A patient with a suspected tension pneumothorax is being ventilated with a
bag-valve-mask. Which finding indicates the need for immediate
decompression?
A) Decreased breath sounds on the affected side
B) Tracheal deviation away from the affected side
C) Increased peak airway pressure during ventilation
D) Hypotension with distended neck veins
Answer: C
Rationale: In a ventilated patient, tension pneumothorax causes a sudden rise in
airway pressure due to inability to expand the lung. While tracheal deviation
and hypotension are classic signs, increased peak pressure is an early indicator
during positive pressure ventilation. Decreased breath sounds may be present
but less specific.
11 A patient with severe respiratory distress has a respiratory rate of 8
breaths/min and oxygen saturation of 82% on a non-rebreather mask.
Which intervention should be performed first?
