LA County Paramedic Accreditation Exam QUESTIONS
AND CORRECT ANSWERS WITH RATIONALES
LATEST THIS YEAR.pdf
Page 1
,Q1. During cardiac arrest resuscitation, a sudden increase in end-tidal carbon dioxide (ETCO2)
from 15 mmHg to 40 mmHg is observed. Which is the most likely cause?
A. Return of spontaneous circulation
B. Effective chest compressions
C. Administration of sodium bicarbonate
D. Ventilator malfunction
Correct Answer: A. Return of spontaneous circulation
Rationale: Return of spontaneous circulation (ROSC) increases cardiac output, delivering more CO2 to
the lungs and causing a sharp rise in ETCO2. Effective compressions typically produce a gradual
increase, not a sudden jump. Sodium bicarbonate may cause a transient increase but is not as
pronounced. Ventilator malfunction would likely cause a decrease, not an increase. Reference: AHA
Guidelines for CPR and ECC, 2020.
Why Wrong:
B - Effective chest compressions maintain or gradually increase ETCO2, but a sudden rise is more
indicative of ROSC.
C - Sodium bicarbonate can increase ETCO2, but the rise is less acute and usually smaller.
D - Ventilator malfunction typically leads to decreased or absent ETCO2, not a sudden rise.
Reference: AHA Guidelines for CPR and ECC, 2020, Part 7: Adult Advanced Cardiovascular Life
Support.
Q2. Which electrocardiographic finding most reliably distinguishes acute pericarditis from
ST-segment elevation myocardial infarction (STEMI)?
A. PR segment depression
B. Pathologic Q waves
C. Reciprocal ST-segment depression
D. T wave inversion
Correct Answer: A. PR segment depression
Rationale: PR segment depression is characteristic of acute pericarditis due to atrial epicardial
inflammation; it is not seen in STEMI. Pathologic Q waves indicate myocardial necrosis and are absent in
pericarditis. Reciprocal ST depression strongly suggests STEMI. T wave inversion can occur in both
conditions. Reference: Goldberger's Clinical Electrocardiography, 10th Edition.
Why Wrong:
B - Pathologic Q waves indicate prior or acute myocardial infarction, not pericarditis.
C - Reciprocal ST depression is typical of STEMI, not pericarditis.
D - T wave inversion is nonspecific and can be seen in both pericarditis and STEMI.
Reference: Goldberger's Clinical Electrocardiography, 10th Edition, Chapter 8.
Page 2
,Q3. In which clinical scenario is application of a tourniquet most clearly indicated?
A. Severe bleeding from a neck wound
B. Hemorrhage from a groin wound controlled with direct pressure
C. Traumatic amputation of the forearm with brisk arterial bleeding
D. Bleeding from a scalp laceration
Correct Answer: C. Traumatic amputation of the forearm with brisk arterial bleeding
Rationale: Tourniquets are indicated for life-threatening extremity hemorrhage that is not controlled by
direct pressure. Neck wounds are not suitable for tourniquets due to anatomical hazards. Bleeding
controlled by pressure does not escalate to tourniquet. Scalp lacerations are typically controlled with
pressure and do not require tourniquets.
Why Wrong:
B - If hemorrhage from a groin wound is controlled by direct pressure, a tourniquet is not yet
indicated.
D - Scalp lacerations have rich blood supply but are usually controlled with direct pressure;
tourniquets are not used on the head.
Reference: Tactical Combat Casualty Care (TCCC) Guidelines, 2021.
Q4. A patient presents with acute urticaria, angioedema, and hypotension. Which medication should
be administered first?
A. Diphenhydramine
B. Epinephrine
C. Methylprednisolone
D. Albuterol
Correct Answer: B. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis due to its rapid vasoconstrictive and
bronchodilatory effects. Antihistamines (diphenhydramine) and corticosteroids (methylprednisolone) are
adjunctive and slower-acting. Albuterol is primarily for bronchospasm, not hypotension or angioedema.
Why Wrong:
C - Methylprednisolone has a delayed onset of action and is not the first-line agent for acute
anaphylaxis.
D - Albuterol addresses bronchospasm but does not treat hypotension or angioedema effectively.
Reference: NIAID Guidelines for Diagnosis and Management of Food Allergy, 2010 (updated 2020).
Page 3
, Q5. In managing a patient with a prolapsed umbilical cord, what is the primary intervention to
relieve cord compression?
A. Trendelenburg position
B. Oxygen by non-rebreather mask
C. Elevating the presenting part off the cord
D. Immediate transport without intervention
Correct Answer: C. Elevating the presenting part off the cord
Rationale: Manual elevation of the presenting part (fetal head or breech) off the cord is essential to
reduce compression and maintain fetal perfusion. Trendelenburg or knee-chest position may help but is
not primary. Oxygen and transport are supportive but do not directly relieve compression.
Why Wrong:
B - Oxygen administration is supportive but does not mechanically relieve cord compression.
D - Transport without intervention would allow ongoing compression and risk fetal hypoxia.
Reference: American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin, 2020.
Q6. In a hypothermic cardiac arrest with a core temperature of 28°C, which rewarming technique
should be initiated concurrently with resuscitation?
A. Passive external rewarming with blankets
B. Active external rewarming using forced air
C. Active internal rewarming with warmed IV fluids
D. Peritoneal lavage with warm fluids
Correct Answer: C. Active internal rewarming with warmed IV fluids
Rationale: Active internal rewarming (e.g., warmed IV fluids, warmed humidified oxygen) is
recommended alongside CPR for severe hypothermic arrest because peripheral vasoconstriction limits
external rewarming. Passive or active external methods are insufficient to raise core temperature rapidly.
Peritoneal lavage is invasive and not typically initiated in the field.
Why Wrong:
B - Active external rewarming is less effective due to vasoconstriction and may cause afterdrop.
D - Peritoneal lavage is a hospital-based intervention and not standard for prehospital care.
Reference: Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and
Treatment of Accidental Hypothermia, 2019.
Page 4
AND CORRECT ANSWERS WITH RATIONALES
LATEST THIS YEAR.pdf
Page 1
,Q1. During cardiac arrest resuscitation, a sudden increase in end-tidal carbon dioxide (ETCO2)
from 15 mmHg to 40 mmHg is observed. Which is the most likely cause?
A. Return of spontaneous circulation
B. Effective chest compressions
C. Administration of sodium bicarbonate
D. Ventilator malfunction
Correct Answer: A. Return of spontaneous circulation
Rationale: Return of spontaneous circulation (ROSC) increases cardiac output, delivering more CO2 to
the lungs and causing a sharp rise in ETCO2. Effective compressions typically produce a gradual
increase, not a sudden jump. Sodium bicarbonate may cause a transient increase but is not as
pronounced. Ventilator malfunction would likely cause a decrease, not an increase. Reference: AHA
Guidelines for CPR and ECC, 2020.
Why Wrong:
B - Effective chest compressions maintain or gradually increase ETCO2, but a sudden rise is more
indicative of ROSC.
C - Sodium bicarbonate can increase ETCO2, but the rise is less acute and usually smaller.
D - Ventilator malfunction typically leads to decreased or absent ETCO2, not a sudden rise.
Reference: AHA Guidelines for CPR and ECC, 2020, Part 7: Adult Advanced Cardiovascular Life
Support.
Q2. Which electrocardiographic finding most reliably distinguishes acute pericarditis from
ST-segment elevation myocardial infarction (STEMI)?
A. PR segment depression
B. Pathologic Q waves
C. Reciprocal ST-segment depression
D. T wave inversion
Correct Answer: A. PR segment depression
Rationale: PR segment depression is characteristic of acute pericarditis due to atrial epicardial
inflammation; it is not seen in STEMI. Pathologic Q waves indicate myocardial necrosis and are absent in
pericarditis. Reciprocal ST depression strongly suggests STEMI. T wave inversion can occur in both
conditions. Reference: Goldberger's Clinical Electrocardiography, 10th Edition.
Why Wrong:
B - Pathologic Q waves indicate prior or acute myocardial infarction, not pericarditis.
C - Reciprocal ST depression is typical of STEMI, not pericarditis.
D - T wave inversion is nonspecific and can be seen in both pericarditis and STEMI.
Reference: Goldberger's Clinical Electrocardiography, 10th Edition, Chapter 8.
Page 2
,Q3. In which clinical scenario is application of a tourniquet most clearly indicated?
A. Severe bleeding from a neck wound
B. Hemorrhage from a groin wound controlled with direct pressure
C. Traumatic amputation of the forearm with brisk arterial bleeding
D. Bleeding from a scalp laceration
Correct Answer: C. Traumatic amputation of the forearm with brisk arterial bleeding
Rationale: Tourniquets are indicated for life-threatening extremity hemorrhage that is not controlled by
direct pressure. Neck wounds are not suitable for tourniquets due to anatomical hazards. Bleeding
controlled by pressure does not escalate to tourniquet. Scalp lacerations are typically controlled with
pressure and do not require tourniquets.
Why Wrong:
B - If hemorrhage from a groin wound is controlled by direct pressure, a tourniquet is not yet
indicated.
D - Scalp lacerations have rich blood supply but are usually controlled with direct pressure;
tourniquets are not used on the head.
Reference: Tactical Combat Casualty Care (TCCC) Guidelines, 2021.
Q4. A patient presents with acute urticaria, angioedema, and hypotension. Which medication should
be administered first?
A. Diphenhydramine
B. Epinephrine
C. Methylprednisolone
D. Albuterol
Correct Answer: B. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis due to its rapid vasoconstrictive and
bronchodilatory effects. Antihistamines (diphenhydramine) and corticosteroids (methylprednisolone) are
adjunctive and slower-acting. Albuterol is primarily for bronchospasm, not hypotension or angioedema.
Why Wrong:
C - Methylprednisolone has a delayed onset of action and is not the first-line agent for acute
anaphylaxis.
D - Albuterol addresses bronchospasm but does not treat hypotension or angioedema effectively.
Reference: NIAID Guidelines for Diagnosis and Management of Food Allergy, 2010 (updated 2020).
Page 3
, Q5. In managing a patient with a prolapsed umbilical cord, what is the primary intervention to
relieve cord compression?
A. Trendelenburg position
B. Oxygen by non-rebreather mask
C. Elevating the presenting part off the cord
D. Immediate transport without intervention
Correct Answer: C. Elevating the presenting part off the cord
Rationale: Manual elevation of the presenting part (fetal head or breech) off the cord is essential to
reduce compression and maintain fetal perfusion. Trendelenburg or knee-chest position may help but is
not primary. Oxygen and transport are supportive but do not directly relieve compression.
Why Wrong:
B - Oxygen administration is supportive but does not mechanically relieve cord compression.
D - Transport without intervention would allow ongoing compression and risk fetal hypoxia.
Reference: American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin, 2020.
Q6. In a hypothermic cardiac arrest with a core temperature of 28°C, which rewarming technique
should be initiated concurrently with resuscitation?
A. Passive external rewarming with blankets
B. Active external rewarming using forced air
C. Active internal rewarming with warmed IV fluids
D. Peritoneal lavage with warm fluids
Correct Answer: C. Active internal rewarming with warmed IV fluids
Rationale: Active internal rewarming (e.g., warmed IV fluids, warmed humidified oxygen) is
recommended alongside CPR for severe hypothermic arrest because peripheral vasoconstriction limits
external rewarming. Passive or active external methods are insufficient to raise core temperature rapidly.
Peritoneal lavage is invasive and not typically initiated in the field.
Why Wrong:
B - Active external rewarming is less effective due to vasoconstriction and may cause afterdrop.
D - Peritoneal lavage is a hospital-based intervention and not standard for prehospital care.
Reference: Wilderness Medical Society Practice Guidelines for the Out-of-Hospital Evaluation and
Treatment of Accidental Hypothermia, 2019.
Page 4
