FISDAP PARAMEDIC FINAL EXAM| NEWEST EXAM
PREPARATION WITH COMPLETE QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED
A+||BRAND NEW VERSION!!
SECTION 1: AIRWAY & RESPIRATORY (Questions 1–60)
1. A 45-year-old male is found unresponsive with gurgling respirations. What is
your FIRST action?
A) Insert an oropharyngeal airway
B) Suction the oropharynx
C) Bag-valve-mask ventilations
D) Nasotracheal intubation
Answer: B – Gurgling indicates fluid in the airway. Suctioning must precede
any airway adjunct or ventilation to prevent aspiration.
2. A 56-year-old male is in severe respiratory distress. He has diminished lung
sounds on the right side and tracheal deviation to the left. What is the MOST
appropriate immediate intervention?
A) Assist ventilations with a BVM
B) Perform needle decompression of the right chest
C) Intubate with a 7.5 ETT
D) Apply a non-rebreather mask at 15 LPM
Answer: B – Tracheal deviation away from the affected side indicates a
tension pneumothorax. Needle decompression (14ga, 2nd intercostal space,
mid-clavicular line) is the immediate life-saving intervention.
3. Which capnography waveform is MOST indicative of bronchospasm (e.g.,
asthma)?
A) A normal rectangular waveform
B) A "shark fin" appearance (sloping upstroke and downstroke)
C) A sudden drop to zero
D) An elevated baseline
Answer: B – The "shark fin" or sloping waveform indicates a prolonged
expiratory phase due to air trapping and obstruction in the lower airways.
4. You are preparing to intubate a 75 kg adult male. What size endotracheal tube
is MOST appropriate?
1
, A) 6.0 mm
B) 7.0 mm
C) 8.0 mm
D) 9.0 mm
Answer: C – For an adult male, 8.0–8.5 mm is standard. 7.0 is typical for a
female; 6.0 for a child.
5. Which of the following is a CONTRAINDICATION to nasotracheal intubation?
A) Apnea
B) Facial trauma with suspected basilar skull fracture
C) Respiratory arrest
D) Inability to open the mouth
Answer: B – Basilar skull fracture is a contraindication due to risk of
intracranial placement. Apnea and respiratory arrest are indications for
orotracheal intubation; inability to open mouth may favour nasotracheal if
not contraindicated.
6. A patient with a tracheostomy tube has a sudden onset of respiratory distress
and the tube appears dislodged. What is your FIRST action?
A) Insert a smaller tracheostomy tube
B) Ventilate through the stoma with a pediatric BVM mask
C) Occlude the stoma and ventilate via the mouth
D) Suction the stoma
Answer: B – If the tube is dislodged, you can place a pediatric mask over the
stoma and ventilate directly. Do not attempt to blindly reinsert.
7. During BVM ventilation, you note that the patient's stomach is distending.
What is the BEST way to minimize this?
A) Increase the ventilation rate
B) Use a nasogastric tube
C) Apply cricoid pressure during ventilation
D) Ventilate at a slower rate with smaller tidal volumes
Answer: D – Gastric distention is caused by excessive pressure/volume and
rate. Slower rate with smaller tidal volumes (just to see chest rise) reduces
the risk.
8. What is the primary advantage of using a supraglottic airway device (e.g.,
King LT or LMA) compared to an endotracheal tube?
2
, A) It provides a definitive airway
B) It can be placed without visualization of the vocal cords
C) It protects against aspiration better
D) It allows for measurement of end-tidal CO2 more reliably
Answer: B – Supraglottic devices are easier and faster to place blindly, but
they do not provide definitive airway protection against aspiration like ETT.
9. You are ventilating a 6-year-old child with a BVM. What is the appropriate
ventilation rate?
A) 8–10 breaths/min
B) 12–20 breaths/min
C) 20–25 breaths/min
D) 30–40 breaths/min
Answer: C – For a child (1–8 years), the rate is 20–25 breaths/min. Adult is
10–12; infant is 25–30.
10. A patient has a flail chest segment. What is the MOST serious underlying
complication?
A) Pneumothorax
B) Pulmonary contusion
C) Hemothorax
D) Subcutaneous emphysema
Answer: B – Flail chest is almost always associated with underlying pulmonary
contusion, which can lead to respiratory failure even after the chest wall is
stabilized.
11. You are suctioning a patient with copious secretions. What is the MAXIMUM
recommended suction time?
A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 20 seconds
Answer: C – Suctioning should not exceed 15 seconds in adults (10 seconds in
children/infants) to avoid hypoxia.
12. Which of the following drugs is MOST commonly used to facilitate
endotracheal intubation in a patient with a suspected head injury?
A) Succinylcholine
3
, B) Rocuronium
C) Etomidate
D) Midazolam
Answer: C – Etomidate provides sedation with minimal hemodynamic effects
and
does not increase intracranial pressure. Succinylcholine may increase ICP
but is often used with a defasciculating dose; however, etomidate is the
preferred induction agent in head injury.
13. In a patient with asthma, what is the expected initial capnography reading
during an acute exacerbation?
A) Low EtCO2 (hypocapnia)
B) Normal EtCO2 (35–45 mmHg)
C) High EtCO2 (hypercapnia)
D) Absent waveform
Answer: A – Early asthma exacerbation causes hyperventilation, leading to low
EtCO2. Rising EtCO2 toward normal or elevated indicates impending respiratory
failure.
14. A patient is on a ventilator with a tidal volume of 500 mL. The plateau
pressure is 35 cm H2O. What is the MOST important interpretation?
A) This is normal
B) This indicates high airway resistance
C) This indicates decreased lung compliance
D) This indicates a leak in the circuit
Answer: C – Plateau pressure reflects alveolar pressure and compliance. Normal
is <30 cm H2O; >30 suggests poor compliance (e.g., ARDS, pulmonary edema).
15. What is the MOST reliable method to confirm correct endotracheal tube
placement in a prehospital setting?
A) Auscultation of bilateral breath sounds
B) End-tidal CO2 detection (capnography)
C) Chest rise and fall
D) Colorimetric CO2 detector
Answer: B – Continuous waveform capnography is the gold standard; it
confirms
placement and monitors throughout transport. Auscultation can be misleading.
4
PREPARATION WITH COMPLETE QUESTIONS AND
CORRECT ANSWERS WITH RATIONALES | ALREADY GRADED
A+||BRAND NEW VERSION!!
SECTION 1: AIRWAY & RESPIRATORY (Questions 1–60)
1. A 45-year-old male is found unresponsive with gurgling respirations. What is
your FIRST action?
A) Insert an oropharyngeal airway
B) Suction the oropharynx
C) Bag-valve-mask ventilations
D) Nasotracheal intubation
Answer: B – Gurgling indicates fluid in the airway. Suctioning must precede
any airway adjunct or ventilation to prevent aspiration.
2. A 56-year-old male is in severe respiratory distress. He has diminished lung
sounds on the right side and tracheal deviation to the left. What is the MOST
appropriate immediate intervention?
A) Assist ventilations with a BVM
B) Perform needle decompression of the right chest
C) Intubate with a 7.5 ETT
D) Apply a non-rebreather mask at 15 LPM
Answer: B – Tracheal deviation away from the affected side indicates a
tension pneumothorax. Needle decompression (14ga, 2nd intercostal space,
mid-clavicular line) is the immediate life-saving intervention.
3. Which capnography waveform is MOST indicative of bronchospasm (e.g.,
asthma)?
A) A normal rectangular waveform
B) A "shark fin" appearance (sloping upstroke and downstroke)
C) A sudden drop to zero
D) An elevated baseline
Answer: B – The "shark fin" or sloping waveform indicates a prolonged
expiratory phase due to air trapping and obstruction in the lower airways.
4. You are preparing to intubate a 75 kg adult male. What size endotracheal tube
is MOST appropriate?
1
, A) 6.0 mm
B) 7.0 mm
C) 8.0 mm
D) 9.0 mm
Answer: C – For an adult male, 8.0–8.5 mm is standard. 7.0 is typical for a
female; 6.0 for a child.
5. Which of the following is a CONTRAINDICATION to nasotracheal intubation?
A) Apnea
B) Facial trauma with suspected basilar skull fracture
C) Respiratory arrest
D) Inability to open the mouth
Answer: B – Basilar skull fracture is a contraindication due to risk of
intracranial placement. Apnea and respiratory arrest are indications for
orotracheal intubation; inability to open mouth may favour nasotracheal if
not contraindicated.
6. A patient with a tracheostomy tube has a sudden onset of respiratory distress
and the tube appears dislodged. What is your FIRST action?
A) Insert a smaller tracheostomy tube
B) Ventilate through the stoma with a pediatric BVM mask
C) Occlude the stoma and ventilate via the mouth
D) Suction the stoma
Answer: B – If the tube is dislodged, you can place a pediatric mask over the
stoma and ventilate directly. Do not attempt to blindly reinsert.
7. During BVM ventilation, you note that the patient's stomach is distending.
What is the BEST way to minimize this?
A) Increase the ventilation rate
B) Use a nasogastric tube
C) Apply cricoid pressure during ventilation
D) Ventilate at a slower rate with smaller tidal volumes
Answer: D – Gastric distention is caused by excessive pressure/volume and
rate. Slower rate with smaller tidal volumes (just to see chest rise) reduces
the risk.
8. What is the primary advantage of using a supraglottic airway device (e.g.,
King LT or LMA) compared to an endotracheal tube?
2
, A) It provides a definitive airway
B) It can be placed without visualization of the vocal cords
C) It protects against aspiration better
D) It allows for measurement of end-tidal CO2 more reliably
Answer: B – Supraglottic devices are easier and faster to place blindly, but
they do not provide definitive airway protection against aspiration like ETT.
9. You are ventilating a 6-year-old child with a BVM. What is the appropriate
ventilation rate?
A) 8–10 breaths/min
B) 12–20 breaths/min
C) 20–25 breaths/min
D) 30–40 breaths/min
Answer: C – For a child (1–8 years), the rate is 20–25 breaths/min. Adult is
10–12; infant is 25–30.
10. A patient has a flail chest segment. What is the MOST serious underlying
complication?
A) Pneumothorax
B) Pulmonary contusion
C) Hemothorax
D) Subcutaneous emphysema
Answer: B – Flail chest is almost always associated with underlying pulmonary
contusion, which can lead to respiratory failure even after the chest wall is
stabilized.
11. You are suctioning a patient with copious secretions. What is the MAXIMUM
recommended suction time?
A) 5 seconds
B) 10 seconds
C) 15 seconds
D) 20 seconds
Answer: C – Suctioning should not exceed 15 seconds in adults (10 seconds in
children/infants) to avoid hypoxia.
12. Which of the following drugs is MOST commonly used to facilitate
endotracheal intubation in a patient with a suspected head injury?
A) Succinylcholine
3
, B) Rocuronium
C) Etomidate
D) Midazolam
Answer: C – Etomidate provides sedation with minimal hemodynamic effects
and
does not increase intracranial pressure. Succinylcholine may increase ICP
but is often used with a defasciculating dose; however, etomidate is the
preferred induction agent in head injury.
13. In a patient with asthma, what is the expected initial capnography reading
during an acute exacerbation?
A) Low EtCO2 (hypocapnia)
B) Normal EtCO2 (35–45 mmHg)
C) High EtCO2 (hypercapnia)
D) Absent waveform
Answer: A – Early asthma exacerbation causes hyperventilation, leading to low
EtCO2. Rising EtCO2 toward normal or elevated indicates impending respiratory
failure.
14. A patient is on a ventilator with a tidal volume of 500 mL. The plateau
pressure is 35 cm H2O. What is the MOST important interpretation?
A) This is normal
B) This indicates high airway resistance
C) This indicates decreased lung compliance
D) This indicates a leak in the circuit
Answer: C – Plateau pressure reflects alveolar pressure and compliance. Normal
is <30 cm H2O; >30 suggests poor compliance (e.g., ARDS, pulmonary edema).
15. What is the MOST reliable method to confirm correct endotracheal tube
placement in a prehospital setting?
A) Auscultation of bilateral breath sounds
B) End-tidal CO2 detection (capnography)
C) Chest rise and fall
D) Colorimetric CO2 detector
Answer: B – Continuous waveform capnography is the gold standard; it
confirms
placement and monitors throughout transport. Auscultation can be misleading.
4
