Paramedic - Medical - Practice Exam
Questions and Answers All Graded A+.
You are called to the residence of an elderly man whose daughter states that he is not acting
right. The patient becomes combative when you attempt to assess him. He refuses
supplemental oxygen and states that you are not taking him anywhere. What is the MOST
appropriate course of action?
A. Gently restrain him and transport him to the hospital.
B. Calmly talk to him and try to obtain a glucose reading.
C. Administer 5 mg of diazepam IM to calm and sedate him.
D. Start an IV line and administer - Answer B. Calmly talk to him and try to obtain a glucose
reading.
Rationale:
Any patient with an altered mental status should be ruled out for hypoglycemia by obtaining a
blood glucose reading. Administering IV dextrose without assessing his blood glucose level first
is not advisable. If he is experiencing an intracranial hemorrhage, dextrose may exacerbate his
condition. Conversely, if you discover that he is hypoglycemic, this must be corrected. It is
important to calmly approach any patient, regardless of his or her mental status. The
assumption of a psychiatric crisis is not in the best interest of the patient. Focus on ruling out
medical problems first.
Which of the following clinical presentations is consistent with significant insecticide exposure?
A. Extreme hyperactivity and pupillary dilation
B. Acute urinary retention and abdominal pain
C. Excessive salivation and severe bradycardia
D. A dry cough, tachycardia, and hypertension - Answer C. Excessive salivation and severe
bradycardia
Rationale:
Organophosphates, such as what is found in pesticides/insecticides and chemical nerve agents
(VX, sarin, tabun, soman), deactivate acetylcholinesterase (AChE), an enzyme that regulates the
degradation of acetylcholine (ACh). ACh is the chemical neurotransmitter of the
parasympathetic nervous system. Without AChE, there is nothing to regulate ACh degradation;
this would cause cardiovascular collapse secondary to massive parasympathetic stimulation.
The clinical presentation of severe organophosphate toxicity can be recalled using the
mnemonic DUMBELS, which stands for defecation, urination, miosis (pupillary constriction),
bronchorrhea and bradycardia, emesis, lacrimation, and salivation. Treatment includes atropine
sulfate, which blocks the effects of ACh, and pralidoxime chloride (2-PAM, Protopam), which
,reactivates AChE. A commercial auto-injector (DuoDote) is available; it contains both
pralidoxime and atropine.
A 59-year-old female complains of a headache. She is conscious and alert, has a patent airway,
and is breathing adequately. You should:
A. inquire about the history of a stroke.
B. ask her is she takes any medications.
C. determine when her headache began.
D. assess her pupils for equality and reactivity. - Answer C. determine when her headache
began.
Rationale:
After performing your primary assessment and treatment of a responsive medical patient, you
should perform a secondary assessment. This begins by assessing the history of the present
illness, which is an elaboration of the chief complaint. The OPQRST mnemonic is a helpful
template to use for this purpose. Ask her when her headache began--that is, when was its
onset? Did it begin acutely, or has it progressively been getting worse? An acute onset of a
headache suggests a more serious problem that one that has gradually progressed. Next,
determine if anything provokes or palliates the headache, ask the patient to describe the pain
(e.g. dull or sharp), assess the severity of her pain (0 - 10 pain scale), and determine the time
frame of the pain. Further history information can be obtained using the SAMPLE mnemonic,
during which you can inquire about her past medical history (stroke, migraines). The secondary
assessment is driven by inform
Paramedics are assessing a man who reportedly overdosed. The patient is agitated, his BP is
180/100 mm Hg, his pulse rate is 150 beats/min, and his skin is hot to the touch. Which of the
following drugs would MOST likely cause these signs and symptoms?
A. Heroin
B. Valium
C. Alcohol
D. Cocaine - Answer D. Cocaine
Rationale:
The patient's clinical presentation of agitation, hypertension, tachycardia, and hyperthermia are
consistent with overdose of a sympathomimetic drug. Of the options listed, cocaine is the only
sympathomimetic. Heroin, diazepam (Valium), and alcohol are all central nervous system
depressants; signs and symptoms of central nervous system depressant overdose include
lethargy or coma, hypotension, bradycardia, and hypoventilation.
,Which of the following describes the typical sequence of events that precedes cardiac arrest in
a drowning episode?
A. Dysrhythmias, laryngospasm, hypoxia
B. Laryngospasm, hypoxia, dysrhythmias
C. Laryngospasm, dysrhythmias, hypoxia
D. Hypoxia, laryngospasm, dysrhythmias - Answer B. Laryngospasm, hypoxia, dysrhythmias
Rationale:
Typically, when a swimmer becomes panicked, he or she starts swallowing large amounts of
water. Even a small volume of aspirated water (fresh or salt) can cause laryngospasm, which
leads to hypoxia and unconsciousness. As the hypoxia worsens, cardiac dysrhythmias can
develop, which leads to cardiac arrest.
Which of the following patients is at greatest risk for hypothermia?
A. 45-year-old man with hyperglycemia
B. 55-year-old woman with hypothyroidism
C. 60-year-old woman with Cushing syndrome
D. 65-year-old man with coronary artery disease - Answer B. 55-year-old woman with
hypothyroidism
Rationale:
Hypothyroidism is a condition in which the thyroid gland produces too little T3
(triiodothyronine) and T4 (thyroxine), resulting in a decrease in the metabolic rate. Any time the
metabolic rate decreases, heat energy production is reduced; therefore, the patient is prone to
hypothermia. Cushing syndrome is caused by excessive cortisol production by the adrenal
glands or by excessive use of cortisol or other similar glucocorticoid hormones (i.e. prednisone,
hydrocortisone, methylprednisolone). This increase in cortisol would cause an increase in the
metabolic rate. Patients with Cushing syndrome are not at risk for hypothermia, nor are patients
with hyperglycemia or coronary artery disease.
Which of the following statements regarding hypoglycemia is correct?
A. A patient with prolonged hypoglycemia may require more than one dose of IV dextrose.
B. Most diabetic patients develop symptoms when their blood glucose level falls below 90
mg/dL.
C. The skin of a hypoglycemic patient is typically warm and dry secondary to severe
dehydration.
, D. Hypoglycemia typically occurs within 4 to 6 hours after inadvertently taking too much insulin.
- Answer A. A patient with prolonged hypoglycemia may require more than one dose of IV
dextrose.
Rationale:
12.5 to 25 g (25 to 50 mL) of 50% dextrose (D50) is usually sufficient to restore adequate
circulating blood glucose levels and improve the patient's condition. However, if the
hypoglycemic event is severe or prolonged, the patient's response to treatment may be delayed,
thus requiring additional dosing. It is important to assess the patient's blood glucose level (BGL)
and mental status after administering dextrose; doing so will help determine if additional
dextrose is needed. Normal serum glucose levels range from 70 to 120 mg/dL. Hypoglycemia
following an inadvertent overdose of insulin typically develops within seconds to minutes. The
point at which a hypoglycemic patient becomes symptomatic varies. Some patients may
develop symptoms when their BGL falls below 40 or 50 mg/dL. Diabetic patients with severe
hypoglycemia typically have cool, clammy skin. Patients with severe hyperglycem
A 49-year-old man with type I diabetes has not taken his insulin in the past 2 days. Which of the
following signs and symptoms would the paramedic MOST likely encounter?
A. Decreased urination; muscle tremors; diaphoresis
B. Rapid, shallow breathing; headache; hypoglycemia
C. Dehydration; deep, rapid breathing; warm, dry skin
D. Loss of appetite; pale, clammy skin; slurred speech - Answer C. Dehydration; deep, rapid
breathing; warm, dry skin
Rationale:
Insulin lowers serum glucose levels; therefore, if a patient did not take his or her insulin, you
would expect the blood glucose level to be high (hyperglycemia). Hyperglycemia causes an
osmotic diuresis, which often leads to significant dehydration. Signs and symptoms of
dehydration include tachycardia; warm, dry skin; poor skin turgor; and dry mucous membranes.
As glucose pools in the blood, less is allowed into the cells; as a result, fat metabolism ensues
and the patient develops ketoacidosis. As a compensatory mechanism, the respiratory system
attempts to eliminate these ketoacids, so the patient's breathing becomes deep and rapid
(Kussmaul breathing). In contrast to ketoacidosis (caused by hyperglycemia), hypoglycemia,
which can rapidly progress to insulin shock, occurs when a patient takes too much of his or her
prescribed insulin, or takes a regular dose of insulin but does not eat. Signs and symptoms of
hypoglyc
A young male intentionally ingested unknown quantities of ibuprofen, aspirin, codeine, and
Anafranil. He is unresponsive, and is hypoventilating, bradycardic, and hypotensive. Which of
these drugs is the MOST likely cause of his clinical presentation?
A. Ibuprofen
Questions and Answers All Graded A+.
You are called to the residence of an elderly man whose daughter states that he is not acting
right. The patient becomes combative when you attempt to assess him. He refuses
supplemental oxygen and states that you are not taking him anywhere. What is the MOST
appropriate course of action?
A. Gently restrain him and transport him to the hospital.
B. Calmly talk to him and try to obtain a glucose reading.
C. Administer 5 mg of diazepam IM to calm and sedate him.
D. Start an IV line and administer - Answer B. Calmly talk to him and try to obtain a glucose
reading.
Rationale:
Any patient with an altered mental status should be ruled out for hypoglycemia by obtaining a
blood glucose reading. Administering IV dextrose without assessing his blood glucose level first
is not advisable. If he is experiencing an intracranial hemorrhage, dextrose may exacerbate his
condition. Conversely, if you discover that he is hypoglycemic, this must be corrected. It is
important to calmly approach any patient, regardless of his or her mental status. The
assumption of a psychiatric crisis is not in the best interest of the patient. Focus on ruling out
medical problems first.
Which of the following clinical presentations is consistent with significant insecticide exposure?
A. Extreme hyperactivity and pupillary dilation
B. Acute urinary retention and abdominal pain
C. Excessive salivation and severe bradycardia
D. A dry cough, tachycardia, and hypertension - Answer C. Excessive salivation and severe
bradycardia
Rationale:
Organophosphates, such as what is found in pesticides/insecticides and chemical nerve agents
(VX, sarin, tabun, soman), deactivate acetylcholinesterase (AChE), an enzyme that regulates the
degradation of acetylcholine (ACh). ACh is the chemical neurotransmitter of the
parasympathetic nervous system. Without AChE, there is nothing to regulate ACh degradation;
this would cause cardiovascular collapse secondary to massive parasympathetic stimulation.
The clinical presentation of severe organophosphate toxicity can be recalled using the
mnemonic DUMBELS, which stands for defecation, urination, miosis (pupillary constriction),
bronchorrhea and bradycardia, emesis, lacrimation, and salivation. Treatment includes atropine
sulfate, which blocks the effects of ACh, and pralidoxime chloride (2-PAM, Protopam), which
,reactivates AChE. A commercial auto-injector (DuoDote) is available; it contains both
pralidoxime and atropine.
A 59-year-old female complains of a headache. She is conscious and alert, has a patent airway,
and is breathing adequately. You should:
A. inquire about the history of a stroke.
B. ask her is she takes any medications.
C. determine when her headache began.
D. assess her pupils for equality and reactivity. - Answer C. determine when her headache
began.
Rationale:
After performing your primary assessment and treatment of a responsive medical patient, you
should perform a secondary assessment. This begins by assessing the history of the present
illness, which is an elaboration of the chief complaint. The OPQRST mnemonic is a helpful
template to use for this purpose. Ask her when her headache began--that is, when was its
onset? Did it begin acutely, or has it progressively been getting worse? An acute onset of a
headache suggests a more serious problem that one that has gradually progressed. Next,
determine if anything provokes or palliates the headache, ask the patient to describe the pain
(e.g. dull or sharp), assess the severity of her pain (0 - 10 pain scale), and determine the time
frame of the pain. Further history information can be obtained using the SAMPLE mnemonic,
during which you can inquire about her past medical history (stroke, migraines). The secondary
assessment is driven by inform
Paramedics are assessing a man who reportedly overdosed. The patient is agitated, his BP is
180/100 mm Hg, his pulse rate is 150 beats/min, and his skin is hot to the touch. Which of the
following drugs would MOST likely cause these signs and symptoms?
A. Heroin
B. Valium
C. Alcohol
D. Cocaine - Answer D. Cocaine
Rationale:
The patient's clinical presentation of agitation, hypertension, tachycardia, and hyperthermia are
consistent with overdose of a sympathomimetic drug. Of the options listed, cocaine is the only
sympathomimetic. Heroin, diazepam (Valium), and alcohol are all central nervous system
depressants; signs and symptoms of central nervous system depressant overdose include
lethargy or coma, hypotension, bradycardia, and hypoventilation.
,Which of the following describes the typical sequence of events that precedes cardiac arrest in
a drowning episode?
A. Dysrhythmias, laryngospasm, hypoxia
B. Laryngospasm, hypoxia, dysrhythmias
C. Laryngospasm, dysrhythmias, hypoxia
D. Hypoxia, laryngospasm, dysrhythmias - Answer B. Laryngospasm, hypoxia, dysrhythmias
Rationale:
Typically, when a swimmer becomes panicked, he or she starts swallowing large amounts of
water. Even a small volume of aspirated water (fresh or salt) can cause laryngospasm, which
leads to hypoxia and unconsciousness. As the hypoxia worsens, cardiac dysrhythmias can
develop, which leads to cardiac arrest.
Which of the following patients is at greatest risk for hypothermia?
A. 45-year-old man with hyperglycemia
B. 55-year-old woman with hypothyroidism
C. 60-year-old woman with Cushing syndrome
D. 65-year-old man with coronary artery disease - Answer B. 55-year-old woman with
hypothyroidism
Rationale:
Hypothyroidism is a condition in which the thyroid gland produces too little T3
(triiodothyronine) and T4 (thyroxine), resulting in a decrease in the metabolic rate. Any time the
metabolic rate decreases, heat energy production is reduced; therefore, the patient is prone to
hypothermia. Cushing syndrome is caused by excessive cortisol production by the adrenal
glands or by excessive use of cortisol or other similar glucocorticoid hormones (i.e. prednisone,
hydrocortisone, methylprednisolone). This increase in cortisol would cause an increase in the
metabolic rate. Patients with Cushing syndrome are not at risk for hypothermia, nor are patients
with hyperglycemia or coronary artery disease.
Which of the following statements regarding hypoglycemia is correct?
A. A patient with prolonged hypoglycemia may require more than one dose of IV dextrose.
B. Most diabetic patients develop symptoms when their blood glucose level falls below 90
mg/dL.
C. The skin of a hypoglycemic patient is typically warm and dry secondary to severe
dehydration.
, D. Hypoglycemia typically occurs within 4 to 6 hours after inadvertently taking too much insulin.
- Answer A. A patient with prolonged hypoglycemia may require more than one dose of IV
dextrose.
Rationale:
12.5 to 25 g (25 to 50 mL) of 50% dextrose (D50) is usually sufficient to restore adequate
circulating blood glucose levels and improve the patient's condition. However, if the
hypoglycemic event is severe or prolonged, the patient's response to treatment may be delayed,
thus requiring additional dosing. It is important to assess the patient's blood glucose level (BGL)
and mental status after administering dextrose; doing so will help determine if additional
dextrose is needed. Normal serum glucose levels range from 70 to 120 mg/dL. Hypoglycemia
following an inadvertent overdose of insulin typically develops within seconds to minutes. The
point at which a hypoglycemic patient becomes symptomatic varies. Some patients may
develop symptoms when their BGL falls below 40 or 50 mg/dL. Diabetic patients with severe
hypoglycemia typically have cool, clammy skin. Patients with severe hyperglycem
A 49-year-old man with type I diabetes has not taken his insulin in the past 2 days. Which of the
following signs and symptoms would the paramedic MOST likely encounter?
A. Decreased urination; muscle tremors; diaphoresis
B. Rapid, shallow breathing; headache; hypoglycemia
C. Dehydration; deep, rapid breathing; warm, dry skin
D. Loss of appetite; pale, clammy skin; slurred speech - Answer C. Dehydration; deep, rapid
breathing; warm, dry skin
Rationale:
Insulin lowers serum glucose levels; therefore, if a patient did not take his or her insulin, you
would expect the blood glucose level to be high (hyperglycemia). Hyperglycemia causes an
osmotic diuresis, which often leads to significant dehydration. Signs and symptoms of
dehydration include tachycardia; warm, dry skin; poor skin turgor; and dry mucous membranes.
As glucose pools in the blood, less is allowed into the cells; as a result, fat metabolism ensues
and the patient develops ketoacidosis. As a compensatory mechanism, the respiratory system
attempts to eliminate these ketoacids, so the patient's breathing becomes deep and rapid
(Kussmaul breathing). In contrast to ketoacidosis (caused by hyperglycemia), hypoglycemia,
which can rapidly progress to insulin shock, occurs when a patient takes too much of his or her
prescribed insulin, or takes a regular dose of insulin but does not eat. Signs and symptoms of
hypoglyc
A young male intentionally ingested unknown quantities of ibuprofen, aspirin, codeine, and
Anafranil. He is unresponsive, and is hypoventilating, bradycardic, and hypotensive. Which of
these drugs is the MOST likely cause of his clinical presentation?
A. Ibuprofen
