LOYOLA EMS SYSTEM ENTRY EXAM 2026/2027 75 VERIFIED
QUESTIONS & ANSWERS LOYOLA UNIVERSITY MEDICAL CENTER
EMS PREP 5 CORE DOMAINS INSTANT DOWNLOAD
98 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Integrate pathophysiologic reasoning with current AHA/ACLS and ITLS/PHTLS guidelines to select
time-critical interventions in high-acuity prehospital scenarios
2 Differentiate subtle presentations of cardiogenic, obstructive, distributive, and hypovolemic shock and
justify vasopressor, fluid, or blood-product strategies accordingly
3 Apply Illinois EMS and Loyola System protocols for destination determination, refusals, and
scope-of-practice boundaries using sound legal and ethical reasoning
4 Interpret capnography, 12-lead ECG, and point-of-care data to titrate ventilation and perfusion targets in
real time
5 Demonstrate pharmacologic decision-making that accounts for receptor physiology, contraindications, and
prehospital drug interactions
6 Loyola EMS System Entry Exam 2026
7 2027 75 Verified Questions & Answers Loyola University Medical Center EMS Prep 5 Core Domains
Instant Download
8 Foundations of Emergency Medical Services - Loyola University Medical Center EMS System Entry
Standards
9 Applied Emergency Medical Services - Loyola University Medical Center EMS System Entry Standards
10 Advanced Emergency Medical Services - Loyola University Medical Center EMS System Entry Standards
11 Emergency Medical Services - Loyola University Medical Center EMS System Entry Standards Review
ABSTRACT
Page 1
,This study document brings together 98 carefully worded exam questions drawn from Loyola EMS
System Entry Exam 2026/2027 75 Verified Questions & Answers Loyola University Medical Center
EMS Prep 5 Core Domains Instant Download, with the strongest emphasis placed on Integrate
pathophysiologic reasoning with current AHA/ACLS and ITLS/PHTLS guidelines to select
time-critical interventions in high-acuity prehospital scenarios, Differentiate subtle presentations of
cardiogenic, obstructive, distributive, and hypovolemic shock and justify vasopressor, fluid, or
blood-product strategies accordingly, Apply Illinois EMS and Loyola System protocols for
destination determination, refusals and and scope-of-practice boundaries using sound legal and
ethical reasoning. Every item follows the wording style and level of reasoning you meet in the real
paper, and each one is paired with a clear rationale so the correct choice is never a guess. Work
through the set at your own pace, mark the questions that slow you down, then come back to them
until the reasoning feels automatic. Learners who revise this way walk into the exam room
recognising the pattern behind the questions instead of meeting them for the first time. Keep going
- steady, honest practice is what turns a difficult paper into a comfortable pass.
Q1 INTEGRATE PATHOPHYSIOLOGIC REASONING WITH CURRENT AHA/ACLS AND
ITLS/PHTLS GUIDELINES TO SELECT TIME-CRITICAL INTERVENTIONS IN HIGH-ACUITY
PREHOSPITAL SCENARIOS
A patient with severe metabolic acidosis is being ventilated at 10 breaths/min with
a tidal volume that maintains normocarbia. The capnogram shows a gradually
rising ETCO2 with an upsloping phase III. Which intervention best addresses the
underlying physiologic derangement?
A. Increase the respiratory rate to normalize ETCO2 to 35-45 mmHg.
B. Increase tidal volume and inspiratory time to improve alveolar recruitment.
C. Maintain current minute ventilation and reassess perfusion, as the upsloping phase III reflects
V/Q mismatch rather than hypoventilation. CORRECT
D. Decrease PEEP and hyperventilate to compensate for the metabolic acidosis.
RATIONALE: An upsloping phase III (curare cleft or obstructive pattern) indicates uneven
alveolar emptying/V-Q mismatch, not global hypoventilation; increasing rate or volume risks
overventilation and further acidosis if perfusion is the driver. The correct action is to preserve
minute ventilation and treat the perfusion or obstructive cause. Option A and D would worsen
hypocarbia and cerebral vasoconstriction; B addresses a recruitment problem not supported by
the waveform.
Page 2
,Q2 INTEGRATE PATHOPHYSIOLOGIC REASONING WITH CURRENT AHA/ACLS AND
ITLS/PHTLS GUIDELINES TO SELECT TIME-CRITICAL INTERVENTIONS IN HIGH-ACUITY
PREHOSPITAL SCENARIOS
Which finding most reliably distinguishes obstructive shock from cardiogenic
shock in the prehospital setting when bedside ultrasound is unavailable?
A. Jugular venous distension with clear lungs and hypotension refractory to a 500 mL fluid bolus.
CORRECT
B. Bilateral crackles with an S3 gallop and elevated BNP.
C. Warm extremities with bounding pulses and a widened pulse pressure.
D. Flat neck veins with a narrow pulse pressure and a positive passive leg raise.
RATIONALE: Obstructive shock (tension pneumothorax, tamponade, massive PE) classically
presents with elevated JVP, clear lung fields, and hypotension that does not respond to fluid; the
combination of distended neck veins with clear lungs is the key discriminator from cardiogenic
pulmonary edema. B describes cardiogenic failure, C describes distributive shock, and D
describes hypovolemic shock.
Q3 INTEGRATE PATHOPHYSIOLOGIC REASONING WITH CURRENT AHA/ACLS AND
ITLS/PHTLS GUIDELINES TO SELECT TIME-CRITICAL INTERVENTIONS IN HIGH-ACUITY
PREHOSPITAL SCENARIOS
A patient in refractory ventricular fibrillation has received three shocks,
epinephrine, and amiodarone per ACLS. Which intervention is most consistent
with current AHA 2023-2025 guidance for refractory VF?
A. Sodium bicarbonate 1 mEq/kg to correct presumed acidosis.
B. Double sequential external defibrillation (DSED) or vector change defibrillation. CORRECT
C. High-dose epinephrine 0.2 mg/kg to overcome catecholamine downregulation.
D. Immediate termination of resuscitation given three failed shocks.
RATIONALE: Recent AHA and international resuscitation consensus supports DSED or
vector-change defibrillation as a reasonable rescue strategy for refractory VF after standard
shocks and antiarrhythmics have failed. Routine bicarbonate (A) is not recommended, high-dose
epinephrine (C) has been associated with worse neurologic outcomes, and (D) is premature
without consideration of reversible causes and ECPR candidacy.
Page 3
, Q4 INTEGRATE PATHOPHYSIOLOGIC REASONING WITH CURRENT AHA/ACLS AND
ITLS/PHTLS GUIDELINES TO SELECT TIME-CRITICAL INTERVENTIONS IN HIGH-ACUITY
PREHOSPITAL SCENARIOS
A patient with a suspected pelvic fracture is hypotensive despite 1 L crystalloid
and has a positive FAST. Per current prehospital hemorrhage control doctrine,
which action is most appropriate?
A. Administer a second liter of crystalloid to maintain a systolic BP above 110 mmHg.
B. Apply a pelvic binder at the greater trochanters and initiate a balanced resuscitation strategy
with early tranexamic acid and blood products when available. CORRECT
C. Withhold all fluids until arrival at a Level I trauma center to avoid clot disruption.
D. Administer 1 g calcium chloride to counteract citrate toxicity before any transfusion.
RATIONALE: Current damage-control resuscitation emphasizes hemorrhage control (pelvic
binder at the greater trochanters), permissive hypotension, early TXA within 3 hours of injury, and
balanced blood-product resuscitation rather than crystalloid. A increases dilutional coagulopathy
and mortality; C risks profound hypoperfusion; D is not indicated pre-transfusion.
Q5 INTEGRATE PATHOPHYSIOLOGIC REASONING WITH CURRENT AHA/ACLS AND
ITLS/PHTLS GUIDELINES TO SELECT TIME-CRITICAL INTERVENTIONS IN HIGH-ACUITY
PREHOSPITAL SCENARIOS
A patient with anaphylaxis receives IM epinephrine 0.3 mg and improves, then
develops recurrent hypotension and wheezing 10 minutes later. Which
pharmacologic explanation best accounts for this biphasic response?
A. Epinephrine's alpha-1 effects are transient while beta-2 bronchodilation persists longer,
causing late vasodilation.
B. The IM dose was inadequate because epinephrine has poor bioavailability in the deltoid.
C. Mast-cell mediator release continues from the initial trigger, and epinephrine's short half-life
allows recurrent vasodilation and bronchoconstriction. CORRECT
D. The patient developed tachyphylaxis to epinephrine due to beta-receptor downregulation.
RATIONALE: Anaphylaxis is a dynamic process where ongoing mast-cell degranulation
continues to release histamine, leukotrienes, and tryptase; epinephrine's short half-life (~2-3
minutes) permits recurrence, making repeat dosing or an infusion necessary. A misstates
receptor kinetics, B is inaccurate (IM deltoid absorption is reliable), and D occurs over hours to
days, not minutes.
Page 4
QUESTIONS & ANSWERS LOYOLA UNIVERSITY MEDICAL CENTER
EMS PREP 5 CORE DOMAINS INSTANT DOWNLOAD
98 QUESTIONS
TABLE OF CONTENTS
# TOPIC
1 Integrate pathophysiologic reasoning with current AHA/ACLS and ITLS/PHTLS guidelines to select
time-critical interventions in high-acuity prehospital scenarios
2 Differentiate subtle presentations of cardiogenic, obstructive, distributive, and hypovolemic shock and
justify vasopressor, fluid, or blood-product strategies accordingly
3 Apply Illinois EMS and Loyola System protocols for destination determination, refusals, and
scope-of-practice boundaries using sound legal and ethical reasoning
4 Interpret capnography, 12-lead ECG, and point-of-care data to titrate ventilation and perfusion targets in
real time
5 Demonstrate pharmacologic decision-making that accounts for receptor physiology, contraindications, and
prehospital drug interactions
6 Loyola EMS System Entry Exam 2026
7 2027 75 Verified Questions & Answers Loyola University Medical Center EMS Prep 5 Core Domains
Instant Download
8 Foundations of Emergency Medical Services - Loyola University Medical Center EMS System Entry
Standards
9 Applied Emergency Medical Services - Loyola University Medical Center EMS System Entry Standards
10 Advanced Emergency Medical Services - Loyola University Medical Center EMS System Entry Standards
11 Emergency Medical Services - Loyola University Medical Center EMS System Entry Standards Review
ABSTRACT
Page 1
,This study document brings together 98 carefully worded exam questions drawn from Loyola EMS
System Entry Exam 2026/2027 75 Verified Questions & Answers Loyola University Medical Center
EMS Prep 5 Core Domains Instant Download, with the strongest emphasis placed on Integrate
pathophysiologic reasoning with current AHA/ACLS and ITLS/PHTLS guidelines to select
time-critical interventions in high-acuity prehospital scenarios, Differentiate subtle presentations of
cardiogenic, obstructive, distributive, and hypovolemic shock and justify vasopressor, fluid, or
blood-product strategies accordingly, Apply Illinois EMS and Loyola System protocols for
destination determination, refusals and and scope-of-practice boundaries using sound legal and
ethical reasoning. Every item follows the wording style and level of reasoning you meet in the real
paper, and each one is paired with a clear rationale so the correct choice is never a guess. Work
through the set at your own pace, mark the questions that slow you down, then come back to them
until the reasoning feels automatic. Learners who revise this way walk into the exam room
recognising the pattern behind the questions instead of meeting them for the first time. Keep going
- steady, honest practice is what turns a difficult paper into a comfortable pass.
Q1 INTEGRATE PATHOPHYSIOLOGIC REASONING WITH CURRENT AHA/ACLS AND
ITLS/PHTLS GUIDELINES TO SELECT TIME-CRITICAL INTERVENTIONS IN HIGH-ACUITY
PREHOSPITAL SCENARIOS
A patient with severe metabolic acidosis is being ventilated at 10 breaths/min with
a tidal volume that maintains normocarbia. The capnogram shows a gradually
rising ETCO2 with an upsloping phase III. Which intervention best addresses the
underlying physiologic derangement?
A. Increase the respiratory rate to normalize ETCO2 to 35-45 mmHg.
B. Increase tidal volume and inspiratory time to improve alveolar recruitment.
C. Maintain current minute ventilation and reassess perfusion, as the upsloping phase III reflects
V/Q mismatch rather than hypoventilation. CORRECT
D. Decrease PEEP and hyperventilate to compensate for the metabolic acidosis.
RATIONALE: An upsloping phase III (curare cleft or obstructive pattern) indicates uneven
alveolar emptying/V-Q mismatch, not global hypoventilation; increasing rate or volume risks
overventilation and further acidosis if perfusion is the driver. The correct action is to preserve
minute ventilation and treat the perfusion or obstructive cause. Option A and D would worsen
hypocarbia and cerebral vasoconstriction; B addresses a recruitment problem not supported by
the waveform.
Page 2
,Q2 INTEGRATE PATHOPHYSIOLOGIC REASONING WITH CURRENT AHA/ACLS AND
ITLS/PHTLS GUIDELINES TO SELECT TIME-CRITICAL INTERVENTIONS IN HIGH-ACUITY
PREHOSPITAL SCENARIOS
Which finding most reliably distinguishes obstructive shock from cardiogenic
shock in the prehospital setting when bedside ultrasound is unavailable?
A. Jugular venous distension with clear lungs and hypotension refractory to a 500 mL fluid bolus.
CORRECT
B. Bilateral crackles with an S3 gallop and elevated BNP.
C. Warm extremities with bounding pulses and a widened pulse pressure.
D. Flat neck veins with a narrow pulse pressure and a positive passive leg raise.
RATIONALE: Obstructive shock (tension pneumothorax, tamponade, massive PE) classically
presents with elevated JVP, clear lung fields, and hypotension that does not respond to fluid; the
combination of distended neck veins with clear lungs is the key discriminator from cardiogenic
pulmonary edema. B describes cardiogenic failure, C describes distributive shock, and D
describes hypovolemic shock.
Q3 INTEGRATE PATHOPHYSIOLOGIC REASONING WITH CURRENT AHA/ACLS AND
ITLS/PHTLS GUIDELINES TO SELECT TIME-CRITICAL INTERVENTIONS IN HIGH-ACUITY
PREHOSPITAL SCENARIOS
A patient in refractory ventricular fibrillation has received three shocks,
epinephrine, and amiodarone per ACLS. Which intervention is most consistent
with current AHA 2023-2025 guidance for refractory VF?
A. Sodium bicarbonate 1 mEq/kg to correct presumed acidosis.
B. Double sequential external defibrillation (DSED) or vector change defibrillation. CORRECT
C. High-dose epinephrine 0.2 mg/kg to overcome catecholamine downregulation.
D. Immediate termination of resuscitation given three failed shocks.
RATIONALE: Recent AHA and international resuscitation consensus supports DSED or
vector-change defibrillation as a reasonable rescue strategy for refractory VF after standard
shocks and antiarrhythmics have failed. Routine bicarbonate (A) is not recommended, high-dose
epinephrine (C) has been associated with worse neurologic outcomes, and (D) is premature
without consideration of reversible causes and ECPR candidacy.
Page 3
, Q4 INTEGRATE PATHOPHYSIOLOGIC REASONING WITH CURRENT AHA/ACLS AND
ITLS/PHTLS GUIDELINES TO SELECT TIME-CRITICAL INTERVENTIONS IN HIGH-ACUITY
PREHOSPITAL SCENARIOS
A patient with a suspected pelvic fracture is hypotensive despite 1 L crystalloid
and has a positive FAST. Per current prehospital hemorrhage control doctrine,
which action is most appropriate?
A. Administer a second liter of crystalloid to maintain a systolic BP above 110 mmHg.
B. Apply a pelvic binder at the greater trochanters and initiate a balanced resuscitation strategy
with early tranexamic acid and blood products when available. CORRECT
C. Withhold all fluids until arrival at a Level I trauma center to avoid clot disruption.
D. Administer 1 g calcium chloride to counteract citrate toxicity before any transfusion.
RATIONALE: Current damage-control resuscitation emphasizes hemorrhage control (pelvic
binder at the greater trochanters), permissive hypotension, early TXA within 3 hours of injury, and
balanced blood-product resuscitation rather than crystalloid. A increases dilutional coagulopathy
and mortality; C risks profound hypoperfusion; D is not indicated pre-transfusion.
Q5 INTEGRATE PATHOPHYSIOLOGIC REASONING WITH CURRENT AHA/ACLS AND
ITLS/PHTLS GUIDELINES TO SELECT TIME-CRITICAL INTERVENTIONS IN HIGH-ACUITY
PREHOSPITAL SCENARIOS
A patient with anaphylaxis receives IM epinephrine 0.3 mg and improves, then
develops recurrent hypotension and wheezing 10 minutes later. Which
pharmacologic explanation best accounts for this biphasic response?
A. Epinephrine's alpha-1 effects are transient while beta-2 bronchodilation persists longer,
causing late vasodilation.
B. The IM dose was inadequate because epinephrine has poor bioavailability in the deltoid.
C. Mast-cell mediator release continues from the initial trigger, and epinephrine's short half-life
allows recurrent vasodilation and bronchoconstriction. CORRECT
D. The patient developed tachyphylaxis to epinephrine due to beta-receptor downregulation.
RATIONALE: Anaphylaxis is a dynamic process where ongoing mast-cell degranulation
continues to release histamine, leukotrienes, and tryptase; epinephrine's short half-life (~2-3
minutes) permits recurrence, making repeat dosing or an infusion necessary. A misstates
receptor kinetics, B is inaccurate (IM deltoid absorption is reliable), and D occurs over hours to
days, not minutes.
Page 4
