ILLINOIS PARAMEDIC
CERTIFICATION EXAM
PRACTICE QUESTIONS
.
1. A 58-year-old male presents with crushing chest pressure radiating to his jaw,
diaphoresis, and nausea. Vital signs: BP 148/92, HR 108, RR 22, SpO₂ 96%. A 12-
lead ECG reveals ST-segment elevation of 2 mm in leads II, III, and aVF. Which
intervention is the highest priority?
A. Administer nitroglycerin 0.4 mg sublingual
B. Administer aspirin 324 mg chewed
C. Obtain intravenous access and administer fentanyl for pain
D. Apply supplemental oxygen via non-rebreather mask
Rationale: Aspirin inhibits platelet aggregation by blocking thromboxane A2, reducing
mortality in acute myocardial infarction. In inferior STEMI (leads II, III, aVF), right
ventricular involvement is possible, making nitroglycerin relatively contraindicated due
to preload reduction and hypotension risk. Oxygen is not indicated with SpO₂ at 96%.
2. A paramedic is intubating a patient in cardiac arrest. After passing the
endotracheal tube, capnography shows a flat waveform with no detectable CO₂.
Chest rise is minimal. Which action should be taken immediately?
A. Advance the tube 2 cm and reassess
B. Remove the tube and ventilate with a bag-valve mask
C. Inflate the cuff with an additional 5 mL of air
D. Perform needle cricothyrotomy
Rationale: Absence of waveform capnography after initial placement indicates
esophageal intubation until proven otherwise. Immediate removal and bag-valve-mask
ventilation prevent hypoxia and gastric insufflation. Advancing the tube blindly or
performing a surgical airway without first confirming dislodgement is inappropriate.
,3. A 20-year-old male sustains a gunshot wound to the left chest. He is agitated,
tachypneic, and has distended neck veins. Breath sounds are absent on the left,
and the trachea is shifted to the right. What is the most likely diagnosis?
A. Simple pneumothorax
B. Pericardial tamponade
C. Tension pneumothorax
D. Massive hemothorax
Rationale: The triad of unilateral breath sounds, tracheal deviation away from the
affected side, and distended neck veins in a hypotensive patient indicates tension
pneumothorax. This is a life-threatening condition requiring immediate needle
decompression. Pericardial tamponade presents with Beck‘s triad (muffled heart tones,
hypotension, JVD) without tracheal deviation.
4. During a pediatric respiratory arrest, an 8-year-old child is intubated with a 6.0
mm cuffed endotracheal tube. Proper placement is confirmed. The cuff pressure
should be maintained at what maximum level?
A. 15 cm H₂O
B. 20 cm H₂O
C. 30 cm H₂O
D. 40 cm H₂O
Rationale: Cuff pressure should be kept below 20 cm H₂O in children to prevent
tracheal mucosal ischemia. Pediatric tracheal cartilage is softer and more susceptible to
pressure necrosis. Pressures above 20 cm H₂O can cause subglottic stenosis.
5. A 34-year-old pregnant patient at 32 weeks gestation is in a motor vehicle
crash. She is complaining of abdominal pain but her vital signs are stable. Which
position is best for transport?
A. Supine with legs elevated
B. Left lateral recumbent
C. Right lateral recumbent
D. Trendelenburg
Rationale: Left lateral recumbent position prevents aortocaval compression by the
gravid uterus, which can cause supine hypotensive syndrome. This position optimizes
venous return and cardiac output for both mother and fetus.
,6. During a mass casualty incident, you encounter a patient who is walking and
talking but has a large, bleeding arm laceration. According to START triage, what
color tag should this patient receive?
A. Black
B. Red
C. Yellow
D. Green
Rationale: Green (minor) patients are those who can walk and have non-life-threatening
injuries. Walking is the first triage filter in the START system. Red patients require
immediate intervention, yellow patients have delayed but serious injuries, and black
patients are deceased or expectant.
7. A 2-year-old child is in respiratory distress with stridor and a barking cough.
What is the most appropriate initial treatment?
A. Epinephrine 1:10,000 IV
B. Nebulized racemic epinephrine
C. Oral dexamethasone
D. High-flow oxygen via non-rebreather
Rationale: This presentation is classic for croup (laryngotracheobronchitis). Nebulized
racemic epinephrine reduces airway edema and is first-line for moderate to severe
croup. Corticosteroids are also indicated but have a slower onset of action.
8. A patient in cardiac arrest has a rhythm of fine ventricular fibrillation. What is
the immediate treatment?
A. Defibrillation at 200 joules only
B. Defibrillation at 360 joules (monophasic) or 200 joules (biphasic)
C. Epinephrine 1 mg IV
D. Amiodarone 300 mg IV
Rationale: VF is a shockable rhythm. Immediate defibrillation is the priority; energy
levels follow current AHA guidelines (monophasic 360 J, biphasic 120-200 J). CPR should
be resumed immediately after shock delivery. Epinephrine and antiarrhythmics are
administered after initial defibrillation attempts.
9. A 56-year-old man complains of chest pressure radiating to his left arm. He is
diaphoretic and nauseated. His ECG shows ST elevation in leads II, III, and aVF.
Which vessel is most likely occluded?
, A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Rationale: Inferior wall ST elevation (II, III, aVF) is typically caused by right coronary
artery occlusion. The right coronary artery supplies the inferior wall of the left ventricle
in most individuals. This is important because right ventricular involvement may
complicate management with nitrates.
10. A patient with a history of COPD is found unresponsive. ECG shows sinus
bradycardia at 38 bpm, BP 68/40. The patient is intubated and being ventilated.
Which of the following is the most likely cause of the bradycardia?
A. Hypoxia
B. Hypercapnia
C. Hypocapnia
D. Metabolic alkalosis
Rationale: In patients with chronic CO₂ retention, the central chemoreceptors become
insensitive to CO₂, and the hypoxic drive from peripheral chemoreceptors maintains
ventilation. However, severe hypercapnia can also depress cardiac function. In this
scenario, the bradycardia with hypotension suggests inadequate ventilation and CO₂
retention. Hypercapnia can cause bradycardia and decreased myocardial contractility.
11. A paramedic is assessing a patient with suspected acute coronary syndrome.
The ECG reveals ST-segment elevation in leads II, III, and aVF with reciprocal
changes in I and aVL. However, the patient has a history of left bundle branch
block (LBBB) on baseline ECG. Which of the following criteria would best confirm
that the ST elevation is due to acute myocardial infarction rather than LBBB?
A. ST elevation >1 mm that is concordant with the QRS complex
B. ST depression in leads V1-V3 of at least 1 mm
C. ST elevation >5 mm in at least two contiguous leads
D. Presence of Q waves in the inferior leads
Rationale: In the presence of LBBB, the Sgarbossa criteria are used to identify acute MI.
ST depression of at least 1 mm in leads V1-V3 (discordant) is highly specific for acute MI
in the setting of LBBB. Concordant ST elevation is also specific but less common.
CERTIFICATION EXAM
PRACTICE QUESTIONS
.
1. A 58-year-old male presents with crushing chest pressure radiating to his jaw,
diaphoresis, and nausea. Vital signs: BP 148/92, HR 108, RR 22, SpO₂ 96%. A 12-
lead ECG reveals ST-segment elevation of 2 mm in leads II, III, and aVF. Which
intervention is the highest priority?
A. Administer nitroglycerin 0.4 mg sublingual
B. Administer aspirin 324 mg chewed
C. Obtain intravenous access and administer fentanyl for pain
D. Apply supplemental oxygen via non-rebreather mask
Rationale: Aspirin inhibits platelet aggregation by blocking thromboxane A2, reducing
mortality in acute myocardial infarction. In inferior STEMI (leads II, III, aVF), right
ventricular involvement is possible, making nitroglycerin relatively contraindicated due
to preload reduction and hypotension risk. Oxygen is not indicated with SpO₂ at 96%.
2. A paramedic is intubating a patient in cardiac arrest. After passing the
endotracheal tube, capnography shows a flat waveform with no detectable CO₂.
Chest rise is minimal. Which action should be taken immediately?
A. Advance the tube 2 cm and reassess
B. Remove the tube and ventilate with a bag-valve mask
C. Inflate the cuff with an additional 5 mL of air
D. Perform needle cricothyrotomy
Rationale: Absence of waveform capnography after initial placement indicates
esophageal intubation until proven otherwise. Immediate removal and bag-valve-mask
ventilation prevent hypoxia and gastric insufflation. Advancing the tube blindly or
performing a surgical airway without first confirming dislodgement is inappropriate.
,3. A 20-year-old male sustains a gunshot wound to the left chest. He is agitated,
tachypneic, and has distended neck veins. Breath sounds are absent on the left,
and the trachea is shifted to the right. What is the most likely diagnosis?
A. Simple pneumothorax
B. Pericardial tamponade
C. Tension pneumothorax
D. Massive hemothorax
Rationale: The triad of unilateral breath sounds, tracheal deviation away from the
affected side, and distended neck veins in a hypotensive patient indicates tension
pneumothorax. This is a life-threatening condition requiring immediate needle
decompression. Pericardial tamponade presents with Beck‘s triad (muffled heart tones,
hypotension, JVD) without tracheal deviation.
4. During a pediatric respiratory arrest, an 8-year-old child is intubated with a 6.0
mm cuffed endotracheal tube. Proper placement is confirmed. The cuff pressure
should be maintained at what maximum level?
A. 15 cm H₂O
B. 20 cm H₂O
C. 30 cm H₂O
D. 40 cm H₂O
Rationale: Cuff pressure should be kept below 20 cm H₂O in children to prevent
tracheal mucosal ischemia. Pediatric tracheal cartilage is softer and more susceptible to
pressure necrosis. Pressures above 20 cm H₂O can cause subglottic stenosis.
5. A 34-year-old pregnant patient at 32 weeks gestation is in a motor vehicle
crash. She is complaining of abdominal pain but her vital signs are stable. Which
position is best for transport?
A. Supine with legs elevated
B. Left lateral recumbent
C. Right lateral recumbent
D. Trendelenburg
Rationale: Left lateral recumbent position prevents aortocaval compression by the
gravid uterus, which can cause supine hypotensive syndrome. This position optimizes
venous return and cardiac output for both mother and fetus.
,6. During a mass casualty incident, you encounter a patient who is walking and
talking but has a large, bleeding arm laceration. According to START triage, what
color tag should this patient receive?
A. Black
B. Red
C. Yellow
D. Green
Rationale: Green (minor) patients are those who can walk and have non-life-threatening
injuries. Walking is the first triage filter in the START system. Red patients require
immediate intervention, yellow patients have delayed but serious injuries, and black
patients are deceased or expectant.
7. A 2-year-old child is in respiratory distress with stridor and a barking cough.
What is the most appropriate initial treatment?
A. Epinephrine 1:10,000 IV
B. Nebulized racemic epinephrine
C. Oral dexamethasone
D. High-flow oxygen via non-rebreather
Rationale: This presentation is classic for croup (laryngotracheobronchitis). Nebulized
racemic epinephrine reduces airway edema and is first-line for moderate to severe
croup. Corticosteroids are also indicated but have a slower onset of action.
8. A patient in cardiac arrest has a rhythm of fine ventricular fibrillation. What is
the immediate treatment?
A. Defibrillation at 200 joules only
B. Defibrillation at 360 joules (monophasic) or 200 joules (biphasic)
C. Epinephrine 1 mg IV
D. Amiodarone 300 mg IV
Rationale: VF is a shockable rhythm. Immediate defibrillation is the priority; energy
levels follow current AHA guidelines (monophasic 360 J, biphasic 120-200 J). CPR should
be resumed immediately after shock delivery. Epinephrine and antiarrhythmics are
administered after initial defibrillation attempts.
9. A 56-year-old man complains of chest pressure radiating to his left arm. He is
diaphoretic and nauseated. His ECG shows ST elevation in leads II, III, and aVF.
Which vessel is most likely occluded?
, A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Rationale: Inferior wall ST elevation (II, III, aVF) is typically caused by right coronary
artery occlusion. The right coronary artery supplies the inferior wall of the left ventricle
in most individuals. This is important because right ventricular involvement may
complicate management with nitrates.
10. A patient with a history of COPD is found unresponsive. ECG shows sinus
bradycardia at 38 bpm, BP 68/40. The patient is intubated and being ventilated.
Which of the following is the most likely cause of the bradycardia?
A. Hypoxia
B. Hypercapnia
C. Hypocapnia
D. Metabolic alkalosis
Rationale: In patients with chronic CO₂ retention, the central chemoreceptors become
insensitive to CO₂, and the hypoxic drive from peripheral chemoreceptors maintains
ventilation. However, severe hypercapnia can also depress cardiac function. In this
scenario, the bradycardia with hypotension suggests inadequate ventilation and CO₂
retention. Hypercapnia can cause bradycardia and decreased myocardial contractility.
11. A paramedic is assessing a patient with suspected acute coronary syndrome.
The ECG reveals ST-segment elevation in leads II, III, and aVF with reciprocal
changes in I and aVL. However, the patient has a history of left bundle branch
block (LBBB) on baseline ECG. Which of the following criteria would best confirm
that the ST elevation is due to acute myocardial infarction rather than LBBB?
A. ST elevation >1 mm that is concordant with the QRS complex
B. ST depression in leads V1-V3 of at least 1 mm
C. ST elevation >5 mm in at least two contiguous leads
D. Presence of Q waves in the inferior leads
Rationale: In the presence of LBBB, the Sgarbossa criteria are used to identify acute MI.
ST depression of at least 1 mm in leads V1-V3 (discordant) is highly specific for acute MI
in the setting of LBBB. Concordant ST elevation is also specific but less common.
