FISDAP Paramedic Medical Module
(FTECH 144 / FISDAP 3 Medical),
updated with current evidence-based
guidelines and covering a broad range
of medical emergencies.2026 updated
1. A 65-year-old male complains of chest pain that started while he was
shoveling snow. The pain is substernal, radiating to his left arm, and
associated with nausea and diaphoresis. Vital signs: BP 150/90, HR 110, RR
22, SpO₂ 95%. Which of the following is the most appropriate initial
medication?
A) Aspirin 325 mg chewable
B) Nitroglycerin 0.4 mg sublingual
C) Morphine 4 mg IV
D) Furosemide 40 mg IV
Answer: A
Rationale: In suspected acute coronary syndrome (ACS), aspirin should be
administered as soon as possible to inhibit platelet aggregation, unless
contraindicated. Nitroglycerin is given after aspirin if pain persists and BP is stable.
Morphine may be considered later but is no longer first-line due to potential harm.
2. A patient with a history of COPD presents with worsening dyspnea,
productive cough, and fever. On assessment, you note increased work of
breathing and SpO₂ of 85% on room air. What is the target SpO₂ for oxygen
therapy in this patient?
A) 100%
, B) 94-99%
C) 88-92%
D) 90-95%
Answer: C
Rationale: Patients with COPD and risk of CO₂ retention should receive titrated
oxygen to maintain SpO₂ between 88-92% to avoid suppressing the hypoxic drive
and worsening hypercapnia. If the patient is not a CO₂ retainer, 94-99% is
appropriate.
3. A 45-year-old female presents with sudden-onset sharp chest pain and
dyspnea. She recently traveled on a long flight and has a history of DVT. Lung
sounds are clear bilaterally. Which of the following is the most likely
diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Spontaneous pneumothorax
D) Pericarditis
Answer: B
Rationale: The combination of sudden dyspnea, pleuritic chest pain, clear lungs,
and risk factors (travel, DVT history) is classic for pulmonary embolism. AMI and
pneumothorax typically have other findings (crackles, absent breath sounds).
4. A 22-year-old asthmatic is in severe respiratory distress. After multiple
albuterol nebulizers, you note a silent chest and decreasing mental status.
What is the most appropriate next intervention?
, A) Administer another albuterol treatment
B) Begin bag-valve-mask ventilation and prepare for intubation
C) Apply CPAP
D) Administer IV magnesium sulfate and wait
Answer: B
Rationale: Silent chest indicates severe obstruction and minimal air movement, a
pre-arrest sign. With altered mental status, the patient is in respiratory failure and
requires immediate ventilation and airway management.
5. A patient with diabetes is found unresponsive. Blood glucose is 30 mg/dL
(1.7 mmol/L). The paramedic should administer:
A) Insulin subcutaneously
B) Dextrose 50% IV (25 grams) or glucagon IM if no IV
C) Oral glucose gel
D) Normal saline bolus
Answer: B
Rationale: Severe hypoglycemia with altered consciousness requires IV dextrose
or IM glucagon. Oral glucose is contraindicated in unresponsive patients due to
aspiration risk.
6. A 60-year-old male with a history of hypertension suddenly develops a
severe headache, slurred speech, and right-sided weakness. Symptoms
started 20 minutes ago. What is the priority?
A) Administer aspirin
B) Perform a Cincinnati Prehospital Stroke Scale and transport to a stroke
, center with time of onset notification
C) Lower blood pressure rapidly
D) Give nitroglycerin
Answer: B
Rationale: Rapid identification and transport to a stroke center are critical for
possible thrombolytic therapy. Aspirin is contraindicated until hemorrhagic stroke
is ruled out. Blood pressure is generally not lowered acutely unless extreme.
7. A patient with a history of heart failure presents with severe dyspnea, pink
frothy sputum, and bilateral crackles. BP is 210/110 mmHg, SpO₂ 82%.
Which intervention is most appropriate?
A) Furosemide 80 mg IV
B) CPAP and nitroglycerin IV/sublingual
C) Albuterol nebulizer
D) Normal saline bolus
Answer: B
Rationale: Hypertensive acute pulmonary edema (SCAPE) responds best to CPAP
and aggressive vasodilation with nitroglycerin. CPAP improves oxygenation and
reduces preload/afterload. Diuretics are secondary.
8. A patient presents with difficulty breathing, stridor, and a history of a severe
allergic reaction to peanuts. He is hypotensive and tachycardic. What is the
first-line drug?
A) Albuterol
B) Epinephrine 1:1,000 IM (0.3-0.5 mg)
(FTECH 144 / FISDAP 3 Medical),
updated with current evidence-based
guidelines and covering a broad range
of medical emergencies.2026 updated
1. A 65-year-old male complains of chest pain that started while he was
shoveling snow. The pain is substernal, radiating to his left arm, and
associated with nausea and diaphoresis. Vital signs: BP 150/90, HR 110, RR
22, SpO₂ 95%. Which of the following is the most appropriate initial
medication?
A) Aspirin 325 mg chewable
B) Nitroglycerin 0.4 mg sublingual
C) Morphine 4 mg IV
D) Furosemide 40 mg IV
Answer: A
Rationale: In suspected acute coronary syndrome (ACS), aspirin should be
administered as soon as possible to inhibit platelet aggregation, unless
contraindicated. Nitroglycerin is given after aspirin if pain persists and BP is stable.
Morphine may be considered later but is no longer first-line due to potential harm.
2. A patient with a history of COPD presents with worsening dyspnea,
productive cough, and fever. On assessment, you note increased work of
breathing and SpO₂ of 85% on room air. What is the target SpO₂ for oxygen
therapy in this patient?
A) 100%
, B) 94-99%
C) 88-92%
D) 90-95%
Answer: C
Rationale: Patients with COPD and risk of CO₂ retention should receive titrated
oxygen to maintain SpO₂ between 88-92% to avoid suppressing the hypoxic drive
and worsening hypercapnia. If the patient is not a CO₂ retainer, 94-99% is
appropriate.
3. A 45-year-old female presents with sudden-onset sharp chest pain and
dyspnea. She recently traveled on a long flight and has a history of DVT. Lung
sounds are clear bilaterally. Which of the following is the most likely
diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Spontaneous pneumothorax
D) Pericarditis
Answer: B
Rationale: The combination of sudden dyspnea, pleuritic chest pain, clear lungs,
and risk factors (travel, DVT history) is classic for pulmonary embolism. AMI and
pneumothorax typically have other findings (crackles, absent breath sounds).
4. A 22-year-old asthmatic is in severe respiratory distress. After multiple
albuterol nebulizers, you note a silent chest and decreasing mental status.
What is the most appropriate next intervention?
, A) Administer another albuterol treatment
B) Begin bag-valve-mask ventilation and prepare for intubation
C) Apply CPAP
D) Administer IV magnesium sulfate and wait
Answer: B
Rationale: Silent chest indicates severe obstruction and minimal air movement, a
pre-arrest sign. With altered mental status, the patient is in respiratory failure and
requires immediate ventilation and airway management.
5. A patient with diabetes is found unresponsive. Blood glucose is 30 mg/dL
(1.7 mmol/L). The paramedic should administer:
A) Insulin subcutaneously
B) Dextrose 50% IV (25 grams) or glucagon IM if no IV
C) Oral glucose gel
D) Normal saline bolus
Answer: B
Rationale: Severe hypoglycemia with altered consciousness requires IV dextrose
or IM glucagon. Oral glucose is contraindicated in unresponsive patients due to
aspiration risk.
6. A 60-year-old male with a history of hypertension suddenly develops a
severe headache, slurred speech, and right-sided weakness. Symptoms
started 20 minutes ago. What is the priority?
A) Administer aspirin
B) Perform a Cincinnati Prehospital Stroke Scale and transport to a stroke
, center with time of onset notification
C) Lower blood pressure rapidly
D) Give nitroglycerin
Answer: B
Rationale: Rapid identification and transport to a stroke center are critical for
possible thrombolytic therapy. Aspirin is contraindicated until hemorrhagic stroke
is ruled out. Blood pressure is generally not lowered acutely unless extreme.
7. A patient with a history of heart failure presents with severe dyspnea, pink
frothy sputum, and bilateral crackles. BP is 210/110 mmHg, SpO₂ 82%.
Which intervention is most appropriate?
A) Furosemide 80 mg IV
B) CPAP and nitroglycerin IV/sublingual
C) Albuterol nebulizer
D) Normal saline bolus
Answer: B
Rationale: Hypertensive acute pulmonary edema (SCAPE) responds best to CPAP
and aggressive vasodilation with nitroglycerin. CPAP improves oxygenation and
reduces preload/afterload. Diuretics are secondary.
8. A patient presents with difficulty breathing, stridor, and a history of a severe
allergic reaction to peanuts. He is hypotensive and tachycardic. What is the
first-line drug?
A) Albuterol
B) Epinephrine 1:1,000 IM (0.3-0.5 mg)
