C O M P R E H E N S I V E P R A C T I C E E X A M I N AT I O N
FISDAP
CARDIOLOGY EXAM
2026/2027
Exactly 100 board-style questions across seven
cardiology domains, each with a flagged correct answer
and an evidence-based rationale written to FISDAP exam
standards, ACLS algorithms, and current emergency
cardiovascular care practice.
100 Questions · 7 Domains · One Best Answer
Aligned with the FISDAP Cardiology Exam Blueprint, NREMT Paramedic
Cardiology Standards, and AHA Guidelines for CPR and Emergency
Cardiovascular Care
E M S & PA R A M E D I C E D U C AT I O N · 2 0 2 0 2 7 S E R I E S
,FISDAP CARDIOLOGY EXAM 2026/2027 100 QUESTIONS | ONE BEST ANSWER
COMPREHENSIVE PRACTICE EXAMINATION | PARAMEDIC LEVEL
FISDAP CARDIOLOGY EXAM
2026/2027 EDITION
This comprehensive practice examination contains exactly 100 multiple-choice questions spanning seven
cardiology content domains aligned with the FISDAP Cardiology Exam blueprint, the National Registry of
Emergency Medical Technicians (NREMT) Paramedic Cardiology standards, and the American Heart
Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Items are
written at three cognitive levels in the proportion used by certification examinations: 20 percent recall, 45
percent application, and 35 percent analysis, including rhythm interpretation, clinical reasoning, treatment
prioritization, and pharmacology application. Seventy-five percent of questions are scenario-based patient
presentations and 25 percent are direct knowledge items. Each question is followed by the correct answer,
flagged inline, and a rationale grounded in FISDAP exam standards, ACLS guidelines, and evidence-based
emergency cardiovascular care practice.
Examination Examination
Specification Specification
Parameter Parameter
Total questions 100 (exactly, no more, no less) Answer format Four options (A-D), one correct
20% recall / 45% application /
Content sections 7 cardiology domains Cognitive mix
35% analysis
75% scenario-based, 25% direct FISDAP blueprint, NREMT
Question style Standards
knowledge Paramedic, AHA CPR and ECC
Section 1: Cardiac Anatomy & Electrophysiology (Questions 1-15)
Q1: A paramedic student is tracing the normal sequence of electrical activation through the healthy heart.
Which pathway correctly represents the order in which the impulse travels?
A. AV node, SA node, bundle of His, Purkinje fibers, bundle branches
B. SA node, bundle of His, AV node, Purkinje fibers, bundle branches
C. SA node, AV node, bundle of His, bundle branches, Purkinje fibers [CORRECT]
D. Bundle of His, SA node, AV node, bundle branches, Purkinje fibers
Correct Answer: C
Rationale: The cardiac conduction system begins at the sinoatrial (SA) node, the primary pacemaker, then
conducts to the atrioventricular (AV) node, through the bundle of His, into the right and left bundle branches, and
finally to the Purkinje fiber network that depolarizes ventricular myocardium. FISDAP and NREMT cardiology
content expect this exact sequence, and any disruption along it predicts the corresponding AV block or bundle
branch block on EKG. The other choices reverse or transpose nodes and pathways that cannot produce normal
sinus rhythm.
1
,FISDAP CARDIOLOGY EXAM 2026/2027 100 QUESTIONS | ONE BEST ANSWER
Q2: If the SA node were to fail, which pacemaker site and intrinsic firing rate would normally take over as
the heart's secondary pacemaker?
A. The ventricular myocardium, at an intrinsic rate of 10 to 20 beats per minute
B. The AV junction, at an intrinsic rate of 40 to 60 beats per minute [CORRECT]
C. The bundle of His, at an intrinsic rate of 60 to 100 beats per minute
D. The Purkinje fibers, at an intrinsic rate of 40 to 60 beats per minute
Correct Answer: B
Rationale: The AV junction is the heart's secondary pacemaker with an intrinsic rate of 40 to 60 beats per
minute, and it reliably escapes if the SA node fails. Purkinje fibers and ventricular tissue are tertiary pacemakers
firing at 20 to 40 beats per minute, which is far too slow to maintain adequate output for long. NREMT expects
candidates to match each pacemaker site to its intrinsic rate because junctional escape rhythms are a classic
finding after sinus node dysfunction.
Q3: A 62-year-old man develops sudden syncope while shoveling snow. In the emergency department a
12-lead EKG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded, and which wall of the left ventricle is involved?
A. Left anterior descending artery, anterior wall
B. Left circumflex artery, lateral wall
C. Diagonal branch, apical wall
D. Right coronary artery, inferior wall [CORRECT]
Correct Answer: D
Rationale: Leads II, III, and aVF view the inferior wall of the left ventricle, which is supplied by the right
coronary artery (RCA) in approximately 80 to 90 percent of patients. The LAD supplies the anterior wall and
septum (V1-V4), while the left circumflex supplies the lateral wall (I, aVL, V5-V6). FISDAP-style testing
frequently pairs inferior STEMI findings with RCA occlusion because the RCA also perfuses the SA and AV
nodes, explaining the bradycardia and heart blocks commonly seen in these patients.
Q4: Which formula correctly defines cardiac output, and what is the normal resting value in an adult?
A. Preload multiplied by afterload, normally 10 to 12 L/min
B. Heart rate multiplied by stroke volume, normally 4 to 8 L/min [CORRECT]
C. Systolic pressure multiplied by heart rate, normally 2 to 4 L/min
D. Stroke volume divided by heart rate, normally 5 to 7 L/min
Correct Answer: B
Rationale: Cardiac output (CO) equals heart rate times stroke volume (CO = HR x SV), producing a normal
resting range of about 4 to 8 L/min in adults. This relationship is the foundation for NREMT-level hemodynamic
reasoning: interventions that change rate, preload, afterload, or contractility all act by modifying one of these two
variables. The distractor formulas describe blood pressure or non-physiologic combinations and should be
discarded immediately.
2
, FISDAP CARDIOLOGY EXAM 2026/2027 100 QUESTIONS | ONE BEST ANSWER
Q5: A trauma patient with a gunshot wound to the abdomen is hypotensive with flat neck veins and rapid,
thready pulses. Regarding his cardiovascular physiology, the primary problem is a marked decrease in which
determinant of stroke volume?
A. Contractility
B. Preload [CORRECT]
C. Afterload
D. Heart rate
Correct Answer: B
Rationale: Preload is the end-diastolic stretch (wall tension) of the ventricular muscle fibers, driven by venous
return; hemorrhage drains the circulating volume and collapses preload, so stroke volume falls despite a
compensatory tachycardia. Flat neck veins are the clinical clue that the ventricles are underfilled rather than
failing to pump. Afterload describes the resistance the ventricle pumps against, and contractility is the intrinsic
force of contraction, neither of which is primarily lost here.
Q6: During phase 2 (the plateau) of the ventricular cardiac action potential, which ionic movement is
primarily responsible for maintaining the prolonged depolarized state?
A. Rapid influx of sodium ions through fast channels
B. Efflux of potassium ions through delayed rectifier channels
C. Efflux of calcium ions from the sarcoplasmic reticulum
D. Slow, sustained influx of calcium ions through L-type channels [CORRECT]
Correct Answer: D
Rationale: Phase 2 is sustained by a balanced current: slow, ongoing calcium entry through L-type (slow)
channels counteracts potassium efflux, holding the membrane near 0 mV and creating the plateau that gives
cardiac muscle its long refractory period. Rapid sodium influx defines phase 0, and potassium efflux defines
phase 3 repolarization. This plateau is why the myocardium cannot be tetanized, a concept NREMT repeatedly
tests in dysrhythmia and pharmacology contexts.
Q7: A patient with an acute stressful illness has a heart rate of 118 with strong peripheral pulses and dilated
pupils. Which division of the autonomic nervous system is dominating cardiac control, and what is its
primary effect on the SA node?
A. The sympathetic division, increasing SA nodal firing rate and AV conduction velocity
[CORRECT]
B. The parasympathetic division, increasing SA nodal firing rate and slowing AV conduction
C. The sympathetic division, decreasing SA nodal firing rate and AV conduction velocity
D. The parasympathetic division, decreasing SA nodal firing rate and AV conduction
Correct Answer: A
Rationale: Sympathetic stimulation releases norepinephrine on beta-1 receptors, which increases the rate of
phase 4 depolarization in the SA node (positive chronotropy), speeds AV conduction (positive dromotropy), and
enhances contractility. Mydriasis and strong pulses in a stressed patient are classic sympathetic signs. The
parasympathetic (vagal) system does the opposite, slowing SA node firing and AV conduction through
acetylcholine, so choices naming parasympathetic dominance or sympathetic slowing are physiologically
impossible.
3
FISDAP
CARDIOLOGY EXAM
2026/2027
Exactly 100 board-style questions across seven
cardiology domains, each with a flagged correct answer
and an evidence-based rationale written to FISDAP exam
standards, ACLS algorithms, and current emergency
cardiovascular care practice.
100 Questions · 7 Domains · One Best Answer
Aligned with the FISDAP Cardiology Exam Blueprint, NREMT Paramedic
Cardiology Standards, and AHA Guidelines for CPR and Emergency
Cardiovascular Care
E M S & PA R A M E D I C E D U C AT I O N · 2 0 2 0 2 7 S E R I E S
,FISDAP CARDIOLOGY EXAM 2026/2027 100 QUESTIONS | ONE BEST ANSWER
COMPREHENSIVE PRACTICE EXAMINATION | PARAMEDIC LEVEL
FISDAP CARDIOLOGY EXAM
2026/2027 EDITION
This comprehensive practice examination contains exactly 100 multiple-choice questions spanning seven
cardiology content domains aligned with the FISDAP Cardiology Exam blueprint, the National Registry of
Emergency Medical Technicians (NREMT) Paramedic Cardiology standards, and the American Heart
Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Items are
written at three cognitive levels in the proportion used by certification examinations: 20 percent recall, 45
percent application, and 35 percent analysis, including rhythm interpretation, clinical reasoning, treatment
prioritization, and pharmacology application. Seventy-five percent of questions are scenario-based patient
presentations and 25 percent are direct knowledge items. Each question is followed by the correct answer,
flagged inline, and a rationale grounded in FISDAP exam standards, ACLS guidelines, and evidence-based
emergency cardiovascular care practice.
Examination Examination
Specification Specification
Parameter Parameter
Total questions 100 (exactly, no more, no less) Answer format Four options (A-D), one correct
20% recall / 45% application /
Content sections 7 cardiology domains Cognitive mix
35% analysis
75% scenario-based, 25% direct FISDAP blueprint, NREMT
Question style Standards
knowledge Paramedic, AHA CPR and ECC
Section 1: Cardiac Anatomy & Electrophysiology (Questions 1-15)
Q1: A paramedic student is tracing the normal sequence of electrical activation through the healthy heart.
Which pathway correctly represents the order in which the impulse travels?
A. AV node, SA node, bundle of His, Purkinje fibers, bundle branches
B. SA node, bundle of His, AV node, Purkinje fibers, bundle branches
C. SA node, AV node, bundle of His, bundle branches, Purkinje fibers [CORRECT]
D. Bundle of His, SA node, AV node, bundle branches, Purkinje fibers
Correct Answer: C
Rationale: The cardiac conduction system begins at the sinoatrial (SA) node, the primary pacemaker, then
conducts to the atrioventricular (AV) node, through the bundle of His, into the right and left bundle branches, and
finally to the Purkinje fiber network that depolarizes ventricular myocardium. FISDAP and NREMT cardiology
content expect this exact sequence, and any disruption along it predicts the corresponding AV block or bundle
branch block on EKG. The other choices reverse or transpose nodes and pathways that cannot produce normal
sinus rhythm.
1
,FISDAP CARDIOLOGY EXAM 2026/2027 100 QUESTIONS | ONE BEST ANSWER
Q2: If the SA node were to fail, which pacemaker site and intrinsic firing rate would normally take over as
the heart's secondary pacemaker?
A. The ventricular myocardium, at an intrinsic rate of 10 to 20 beats per minute
B. The AV junction, at an intrinsic rate of 40 to 60 beats per minute [CORRECT]
C. The bundle of His, at an intrinsic rate of 60 to 100 beats per minute
D. The Purkinje fibers, at an intrinsic rate of 40 to 60 beats per minute
Correct Answer: B
Rationale: The AV junction is the heart's secondary pacemaker with an intrinsic rate of 40 to 60 beats per
minute, and it reliably escapes if the SA node fails. Purkinje fibers and ventricular tissue are tertiary pacemakers
firing at 20 to 40 beats per minute, which is far too slow to maintain adequate output for long. NREMT expects
candidates to match each pacemaker site to its intrinsic rate because junctional escape rhythms are a classic
finding after sinus node dysfunction.
Q3: A 62-year-old man develops sudden syncope while shoveling snow. In the emergency department a
12-lead EKG shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded, and which wall of the left ventricle is involved?
A. Left anterior descending artery, anterior wall
B. Left circumflex artery, lateral wall
C. Diagonal branch, apical wall
D. Right coronary artery, inferior wall [CORRECT]
Correct Answer: D
Rationale: Leads II, III, and aVF view the inferior wall of the left ventricle, which is supplied by the right
coronary artery (RCA) in approximately 80 to 90 percent of patients. The LAD supplies the anterior wall and
septum (V1-V4), while the left circumflex supplies the lateral wall (I, aVL, V5-V6). FISDAP-style testing
frequently pairs inferior STEMI findings with RCA occlusion because the RCA also perfuses the SA and AV
nodes, explaining the bradycardia and heart blocks commonly seen in these patients.
Q4: Which formula correctly defines cardiac output, and what is the normal resting value in an adult?
A. Preload multiplied by afterload, normally 10 to 12 L/min
B. Heart rate multiplied by stroke volume, normally 4 to 8 L/min [CORRECT]
C. Systolic pressure multiplied by heart rate, normally 2 to 4 L/min
D. Stroke volume divided by heart rate, normally 5 to 7 L/min
Correct Answer: B
Rationale: Cardiac output (CO) equals heart rate times stroke volume (CO = HR x SV), producing a normal
resting range of about 4 to 8 L/min in adults. This relationship is the foundation for NREMT-level hemodynamic
reasoning: interventions that change rate, preload, afterload, or contractility all act by modifying one of these two
variables. The distractor formulas describe blood pressure or non-physiologic combinations and should be
discarded immediately.
2
, FISDAP CARDIOLOGY EXAM 2026/2027 100 QUESTIONS | ONE BEST ANSWER
Q5: A trauma patient with a gunshot wound to the abdomen is hypotensive with flat neck veins and rapid,
thready pulses. Regarding his cardiovascular physiology, the primary problem is a marked decrease in which
determinant of stroke volume?
A. Contractility
B. Preload [CORRECT]
C. Afterload
D. Heart rate
Correct Answer: B
Rationale: Preload is the end-diastolic stretch (wall tension) of the ventricular muscle fibers, driven by venous
return; hemorrhage drains the circulating volume and collapses preload, so stroke volume falls despite a
compensatory tachycardia. Flat neck veins are the clinical clue that the ventricles are underfilled rather than
failing to pump. Afterload describes the resistance the ventricle pumps against, and contractility is the intrinsic
force of contraction, neither of which is primarily lost here.
Q6: During phase 2 (the plateau) of the ventricular cardiac action potential, which ionic movement is
primarily responsible for maintaining the prolonged depolarized state?
A. Rapid influx of sodium ions through fast channels
B. Efflux of potassium ions through delayed rectifier channels
C. Efflux of calcium ions from the sarcoplasmic reticulum
D. Slow, sustained influx of calcium ions through L-type channels [CORRECT]
Correct Answer: D
Rationale: Phase 2 is sustained by a balanced current: slow, ongoing calcium entry through L-type (slow)
channels counteracts potassium efflux, holding the membrane near 0 mV and creating the plateau that gives
cardiac muscle its long refractory period. Rapid sodium influx defines phase 0, and potassium efflux defines
phase 3 repolarization. This plateau is why the myocardium cannot be tetanized, a concept NREMT repeatedly
tests in dysrhythmia and pharmacology contexts.
Q7: A patient with an acute stressful illness has a heart rate of 118 with strong peripheral pulses and dilated
pupils. Which division of the autonomic nervous system is dominating cardiac control, and what is its
primary effect on the SA node?
A. The sympathetic division, increasing SA nodal firing rate and AV conduction velocity
[CORRECT]
B. The parasympathetic division, increasing SA nodal firing rate and slowing AV conduction
C. The sympathetic division, decreasing SA nodal firing rate and AV conduction velocity
D. The parasympathetic division, decreasing SA nodal firing rate and AV conduction
Correct Answer: A
Rationale: Sympathetic stimulation releases norepinephrine on beta-1 receptors, which increases the rate of
phase 4 depolarization in the SA node (positive chronotropy), speeds AV conduction (positive dromotropy), and
enhances contractility. Mydriasis and strong pulses in a stressed patient are classic sympathetic signs. The
parasympathetic (vagal) system does the opposite, slowing SA node firing and AV conduction through
acetylcholine, so choices naming parasympathetic dominance or sympathetic slowing are physiologically
impossible.
3
