Paramedic Comprehensive Final Exam
Practice
Following blunt trauma to the anterior chest, a 44-year-old woman presents with
restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment
reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right
side of her chest. You should: - correct answer-perform an immediate needle thoracentesis
to the right side of the chest.
A 40-year-old man presents with difficulty urinating, fever, and tremors. Which of the
following should you suspect? - correct answer-Prostatitis
A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The
patient is found approximately 20 feet from the wreckage. Your primary assessment reveals
that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions
should include: - correct answer-manually stabilizing his head and opening his airway with
the jaw-thrust maneuver.
A 60-year-old man with crushing chest pain has 3 mm of ST elevation in leads V1 through
V4. What should you suspect? - correct answer-Left anterior descending artery occlusion
A patient with a suppressed cough mechanism: - correct answer-is at serious risk for
aspiration.
You are caring for a 33-year-old woman who is 35 weeks pregnant and fell down a flight of
stairs. Full spinal precautions have been taken, the patient is receiving high-flow oxygen, and
a patent IV line is in place. During transport, you reassess her and note that she has become
diaphoretic, tachycardic, and tachypneic. You should: - correct answer-tilt the backboard to
the left side.
Which of the following is the MOST important consideration during a pandemic? - correct
answer-Personal protective equipment
The door-to-balloon time for a patient with an ST elevation myocardial infarction is ___
minutes or less. - correct answer-90
When attempting resuscitation of a child with pulseless electrical activity, you should: -
correct answer-attempt to identify an underlying cause of the arrest.
Which of the following clinical findings would MOST likely differentiate a massive hemothorax
from a tension pneumothorax? - correct answer-Hemoptysis
Which of the following clinical findings is the MOST consistent with hypertrophic
cardiomyopathy? - correct answer-Unexplained syncope
,A 41-year-old woman attempted to kill herself by cutting her wrists. Law enforcement
personnel are at the scene. You have controlled the bleeding with direct pressure and a
pressure bandage. The patient's vital signs are stable and she is conscious and alert;
however, she refuses to go to the hospital. Despite pleas from her family to go to the
hospital, she still refuses. You should: - correct answer-remain with the patient, contact
medical control, and request law enforcement intervention.
Any time a patient with end-stage renal disease is found in cardiac arrest, the paramedic
should strongly consider which of the following as the cause? - correct answer-Kyperkalemia
Which of the following statements regarding Grey Turner sign is correct? - correct
answer-Grey Turner sign is characterized by flank bruising and indicates internal bleeding.
Following decontamination, a patient is presented to you by rescue personnel for transport.
The patient is conscious and alert, and is in no obvious respiratory distress. The patient is
emitting a pungent odor and has an orange chemical on her clothing. You should: - correct
answer-advise the rescuers that the patient has not been adequately decontaminated.
Epiglottitis in children: - correct answer-is uncommon because children are vaccinated
against Haemophilus influenza type b.
A young woman experienced massive facial trauma after being ejected from her car when it
struck a tree. She is semiconscious, has blood draining from her mouth, and has poor
respiratory effort. The MOST appropriate initial airway management for this patient involves:
- correct answer-suctioning her airway until it is clear of blood and other secretions,
administering a sedative and paralytic, and performing endotracheal intubation.
Two MOST important underlying principles of National Incident Management System are: -
correct answer-flexibility and standardization.
The killing of pathogenic agents by directly applying a chemical made for that purpose is
called: - correct answer-disinfection.
You are dispatched to the residence of a 19-year-old man who has a tracheostomy tube and
is on a mechanical ventilator. According to the patient's mother, he began experiencing
difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally
diminished breath sounds, and his oxygen saturation is 80%. You disconnect the patient from
the mechanical ventilator and begin bag-mask ventilations; however, you meet significant
resistance. You should: - correct answer-remove the bag-mask device and suction his
tracheostomy tube.
A 48-year-old man with a history of hypertension presents with a severe headache, tinnitus,
and blurred vision. He is conscious and alert and denies any other symptoms. His BP is
204/120 mm Hg, his pulse rate is 100 beats/min, and his oxygen saturation is 96%. The
closest appropriate facility is 20 minutes away. You should: - correct answer-monitor his
cardiac rhythm and transport.
,Your patient has a blood pressure of 80/60 mm Hg. What is his mean arterial pressure? -
correct answer-66 mm Hg
Which of the following factors would MOST likely produce a falsely normal pulse oximetry
reading? - correct answer-Carboxyhemoglobin
A 30-year-old man presents with jaw and neck stiffness and fever. During your assessment,
he tells you that he cut his hand on a piece of metal about a week ago. You should suspect: -
correct answer-tetanus.
If an EMS agency is providing relief to a neighboring community during a disaster, it is
important to ensure that: - correct answer-it has enough coverage in its home area of
responsibility.
You respond to a residence for a possible overdose. The patient, a young man, is
unresponsive with slow, snoring respirations. There are obvious needle track marks on his
arms. Your FIRST action should be to: - correct answer-manually open his airway.
Triage and emergency medical treatment should be performed: - correct answer-in the cold
zone.
If chest compressions and repositioning of the airway are unsuccessful in removing a severe
airway obstruction in an unconscious patient, you should: - correct answer-perform
laryngoscopy and use Magill forceps.
A young female with experienced trauma to her genitalia and has profuse vaginal bleeding.
She is hypotensive, tachycardic, and tachypneic. You should: - correct answer-transport
immediately.
Physiologic effects of histamine include all of the following, EXCEPT: - correct
answer-increased cardiac contractility
A 33-year-old male presents with chest pain that is alleviated when he sits forward. The
12-lead ECG shows ST elevation of 2 to 3 mm in multiple leads. What should you suspect? -
correct answer-Pericarditis
What 12-lead ECG finding should make you suspect a posterior STEMI? - correct answer-ST
depression in leads V1 and V2
You are evaluating a 60-year-old woman's 12-lead ECG and note that the R wave height in
lead V1 exceeds the S wave depth. What condition would MOST likely cause this? - correct
answer-Pulmonary hypertension
Cardiac symptoms of myocarditis usually appear ______ days after the onset of initial
symptoms. - correct answer-10 to 14
In contrast to a patient in shock, you would expect a patient with increased intracranial
pressure to present with: - correct answer-a widened pulse pressure.
, A 50-year-old woman presents with acute respiratory distress while eating. Upon your arrival,
you note that she is conscious, coughing, and wheezing between coughs. Further
assessment reveals that her skin is pink and moist. In addition to transporting her to the
hospital, you should: - correct answer-encourage her to cough and closely monitor her
condition.
When ventilating an apneic adult with a pulse with a bag-mask device, you should: - correct
answer-deliver each breath over 1 second at a rate of 10 to 12 breaths/min.
You are transferring a 60-year-old man with COPD from a community hospital to a
metropolitan hospital. The patient is mildly dyspneic, but is otherwise stable. He is receiving
oxygen via nasal cannula, has an IV line of normal saline in place, and has an ECG applied.
When reading his chart, you note that he has polycythemia, a history of a prior stroke, and
hypertension. The patient tells you that he feels a fluttering sensation in his chest. You
glance at the cardiac monitor and see a narrow complex tachycardia at a rate of 190
beats/min. The patient's blood pressure is 116/70 mm Hg and he remains conscious and
alert. You should: - correct answer-ensure adequate oxygenation and ventilation, administer
6 mg of adenosine, and reassess his cardiac rhythm.
Takotsubo cardiomyopathy is MOST often associated with: - correct answer-emotional
stress.
A 40-year-old man fell 20 feet from a tree while trimming branches. Your assessment reveals
that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver.
You should: - correct answer-carefully open his airway with the head tilt-chin lift maneuver.
The size of the rescue area is dependent MOSTLY upon the: - correct answer-potential
hazards that exist.
A patient would MOST likely become trapped between the driver's seat and steering wheel
following a: - correct answer-frontal crash.
A 55-year-old man complains of severe pain between his shoulder blades, which he
describes as "ripping" in nature. He tells you that the pain began suddenly and has been
intense and unrelenting since its onset. His medical history includes hypertension, and he
admits to being noncompliant with his antihypertensive medication. Which of the following
assessment findings would MOST likely reinforce your suspicion regarding the cause of his
pain? - correct answer-Difference in blood pressure between the two arms
A right-sided ECG is indicated for patients who present with: - correct answer-ECG evidence
of an inferior infarction.
When looking inside a patient's mouth, you cannot see the posterior pharynx and only the
base of the uvula is exposed. This is indicative of a Mallampati Class: - correct answer-III.
Practice
Following blunt trauma to the anterior chest, a 44-year-old woman presents with
restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment
reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right
side of her chest. You should: - correct answer-perform an immediate needle thoracentesis
to the right side of the chest.
A 40-year-old man presents with difficulty urinating, fever, and tremors. Which of the
following should you suspect? - correct answer-Prostatitis
A 45-year-old unrestrained man was ejected from his small truck when it struck a tree. The
patient is found approximately 20 feet from the wreckage. Your primary assessment reveals
that he is unresponsive and has sonorous respirations and a rapid pulse. Your initial actions
should include: - correct answer-manually stabilizing his head and opening his airway with
the jaw-thrust maneuver.
A 60-year-old man with crushing chest pain has 3 mm of ST elevation in leads V1 through
V4. What should you suspect? - correct answer-Left anterior descending artery occlusion
A patient with a suppressed cough mechanism: - correct answer-is at serious risk for
aspiration.
You are caring for a 33-year-old woman who is 35 weeks pregnant and fell down a flight of
stairs. Full spinal precautions have been taken, the patient is receiving high-flow oxygen, and
a patent IV line is in place. During transport, you reassess her and note that she has become
diaphoretic, tachycardic, and tachypneic. You should: - correct answer-tilt the backboard to
the left side.
Which of the following is the MOST important consideration during a pandemic? - correct
answer-Personal protective equipment
The door-to-balloon time for a patient with an ST elevation myocardial infarction is ___
minutes or less. - correct answer-90
When attempting resuscitation of a child with pulseless electrical activity, you should: -
correct answer-attempt to identify an underlying cause of the arrest.
Which of the following clinical findings would MOST likely differentiate a massive hemothorax
from a tension pneumothorax? - correct answer-Hemoptysis
Which of the following clinical findings is the MOST consistent with hypertrophic
cardiomyopathy? - correct answer-Unexplained syncope
,A 41-year-old woman attempted to kill herself by cutting her wrists. Law enforcement
personnel are at the scene. You have controlled the bleeding with direct pressure and a
pressure bandage. The patient's vital signs are stable and she is conscious and alert;
however, she refuses to go to the hospital. Despite pleas from her family to go to the
hospital, she still refuses. You should: - correct answer-remain with the patient, contact
medical control, and request law enforcement intervention.
Any time a patient with end-stage renal disease is found in cardiac arrest, the paramedic
should strongly consider which of the following as the cause? - correct answer-Kyperkalemia
Which of the following statements regarding Grey Turner sign is correct? - correct
answer-Grey Turner sign is characterized by flank bruising and indicates internal bleeding.
Following decontamination, a patient is presented to you by rescue personnel for transport.
The patient is conscious and alert, and is in no obvious respiratory distress. The patient is
emitting a pungent odor and has an orange chemical on her clothing. You should: - correct
answer-advise the rescuers that the patient has not been adequately decontaminated.
Epiglottitis in children: - correct answer-is uncommon because children are vaccinated
against Haemophilus influenza type b.
A young woman experienced massive facial trauma after being ejected from her car when it
struck a tree. She is semiconscious, has blood draining from her mouth, and has poor
respiratory effort. The MOST appropriate initial airway management for this patient involves:
- correct answer-suctioning her airway until it is clear of blood and other secretions,
administering a sedative and paralytic, and performing endotracheal intubation.
Two MOST important underlying principles of National Incident Management System are: -
correct answer-flexibility and standardization.
The killing of pathogenic agents by directly applying a chemical made for that purpose is
called: - correct answer-disinfection.
You are dispatched to the residence of a 19-year-old man who has a tracheostomy tube and
is on a mechanical ventilator. According to the patient's mother, he began experiencing
difficulty breathing about 30 minutes ago. Auscultation of his lungs reveals bilaterally
diminished breath sounds, and his oxygen saturation is 80%. You disconnect the patient from
the mechanical ventilator and begin bag-mask ventilations; however, you meet significant
resistance. You should: - correct answer-remove the bag-mask device and suction his
tracheostomy tube.
A 48-year-old man with a history of hypertension presents with a severe headache, tinnitus,
and blurred vision. He is conscious and alert and denies any other symptoms. His BP is
204/120 mm Hg, his pulse rate is 100 beats/min, and his oxygen saturation is 96%. The
closest appropriate facility is 20 minutes away. You should: - correct answer-monitor his
cardiac rhythm and transport.
,Your patient has a blood pressure of 80/60 mm Hg. What is his mean arterial pressure? -
correct answer-66 mm Hg
Which of the following factors would MOST likely produce a falsely normal pulse oximetry
reading? - correct answer-Carboxyhemoglobin
A 30-year-old man presents with jaw and neck stiffness and fever. During your assessment,
he tells you that he cut his hand on a piece of metal about a week ago. You should suspect: -
correct answer-tetanus.
If an EMS agency is providing relief to a neighboring community during a disaster, it is
important to ensure that: - correct answer-it has enough coverage in its home area of
responsibility.
You respond to a residence for a possible overdose. The patient, a young man, is
unresponsive with slow, snoring respirations. There are obvious needle track marks on his
arms. Your FIRST action should be to: - correct answer-manually open his airway.
Triage and emergency medical treatment should be performed: - correct answer-in the cold
zone.
If chest compressions and repositioning of the airway are unsuccessful in removing a severe
airway obstruction in an unconscious patient, you should: - correct answer-perform
laryngoscopy and use Magill forceps.
A young female with experienced trauma to her genitalia and has profuse vaginal bleeding.
She is hypotensive, tachycardic, and tachypneic. You should: - correct answer-transport
immediately.
Physiologic effects of histamine include all of the following, EXCEPT: - correct
answer-increased cardiac contractility
A 33-year-old male presents with chest pain that is alleviated when he sits forward. The
12-lead ECG shows ST elevation of 2 to 3 mm in multiple leads. What should you suspect? -
correct answer-Pericarditis
What 12-lead ECG finding should make you suspect a posterior STEMI? - correct answer-ST
depression in leads V1 and V2
You are evaluating a 60-year-old woman's 12-lead ECG and note that the R wave height in
lead V1 exceeds the S wave depth. What condition would MOST likely cause this? - correct
answer-Pulmonary hypertension
Cardiac symptoms of myocarditis usually appear ______ days after the onset of initial
symptoms. - correct answer-10 to 14
In contrast to a patient in shock, you would expect a patient with increased intracranial
pressure to present with: - correct answer-a widened pulse pressure.
, A 50-year-old woman presents with acute respiratory distress while eating. Upon your arrival,
you note that she is conscious, coughing, and wheezing between coughs. Further
assessment reveals that her skin is pink and moist. In addition to transporting her to the
hospital, you should: - correct answer-encourage her to cough and closely monitor her
condition.
When ventilating an apneic adult with a pulse with a bag-mask device, you should: - correct
answer-deliver each breath over 1 second at a rate of 10 to 12 breaths/min.
You are transferring a 60-year-old man with COPD from a community hospital to a
metropolitan hospital. The patient is mildly dyspneic, but is otherwise stable. He is receiving
oxygen via nasal cannula, has an IV line of normal saline in place, and has an ECG applied.
When reading his chart, you note that he has polycythemia, a history of a prior stroke, and
hypertension. The patient tells you that he feels a fluttering sensation in his chest. You
glance at the cardiac monitor and see a narrow complex tachycardia at a rate of 190
beats/min. The patient's blood pressure is 116/70 mm Hg and he remains conscious and
alert. You should: - correct answer-ensure adequate oxygenation and ventilation, administer
6 mg of adenosine, and reassess his cardiac rhythm.
Takotsubo cardiomyopathy is MOST often associated with: - correct answer-emotional
stress.
A 40-year-old man fell 20 feet from a tree while trimming branches. Your assessment reveals
that he is unresponsive. You cannot open his airway effectively with the jaw-thrust maneuver.
You should: - correct answer-carefully open his airway with the head tilt-chin lift maneuver.
The size of the rescue area is dependent MOSTLY upon the: - correct answer-potential
hazards that exist.
A patient would MOST likely become trapped between the driver's seat and steering wheel
following a: - correct answer-frontal crash.
A 55-year-old man complains of severe pain between his shoulder blades, which he
describes as "ripping" in nature. He tells you that the pain began suddenly and has been
intense and unrelenting since its onset. His medical history includes hypertension, and he
admits to being noncompliant with his antihypertensive medication. Which of the following
assessment findings would MOST likely reinforce your suspicion regarding the cause of his
pain? - correct answer-Difference in blood pressure between the two arms
A right-sided ECG is indicated for patients who present with: - correct answer-ECG evidence
of an inferior infarction.
When looking inside a patient's mouth, you cannot see the posterior pharynx and only the
base of the uvula is exposed. This is indicative of a Mallampati Class: - correct answer-III.
