FISDAP Medical Exam ACTUAL EXAM
2026/2027 | FISDAP Medical | Verified
Q&A | Pass Guaranteed - A+ Graded
SECTION 1: RESPIRATORY EMERGENCIES (Q1–Q15)
Q1: You are dispatched to a 68-year-old male with a history of COPD who reports increased shortness of
breath over the past 3 days. On scene, he is sitting in a tripod position with pursed-lip breathing. Vital
signs: HR 110, BP 148/92, RR 28, SpO₂ 84% on room air, afebrile. Breath sounds reveal diffuse wheezing
with a prolonged expiratory phase. He is alert and oriented. What is your priority intervention?
A. Administer furosemide 40 mg IV for suspected fluid overload
B. Apply CPAP at 10 cmH₂O and administer albuterol via nebulizer *CORRECT+
C. Perform immediate endotracheal intubation due to SpO₂ of 84%
D. Administer naloxone 2 mg IM for possible opioid-induced respiratory depression
Correct Answer: B
Rationale: This patient presents with a COPD exacerbation characterized by tripod positioning, pursed-
lip breathing, prolonged expiratory phase, and hypoxemia. CPAP provides positive end-expiratory
pressure to splint open collapsed alveoli, reduce work of breathing, and improve oxygenation. Albuterol
addresses bronchospasm. The patient remains alert and oriented with intact airway reflexes, making
non-invasive ventilation appropriate before invasive airway management.
Q2: A 24-year-old female with a history of asthma calls 911 for severe wheezing. On arrival, she is
anxious, diaphoretic, and unable to speak in full sentences. Vital signs: HR 132, BP 98/62, RR 36, SpO₂
78% on room air, temp 37.2°C. Breath sounds reveal diffuse wheezing bilaterally. After administering
albuterol and ipratropium nebulizers, her condition worsens. Breath sounds become markedly
diminished. What is the most appropriate next step?
A. Administer magnesium sulfate 2 g IV over 10 minutes [CORRECT]
B. Administer furosemide 80 mg IV for flash pulmonary edema
C. Initiate high-flow nasal cannula at 60 L/min and observe
D. Perform needle decompression at the second intercostal space, midclavicular line
,Correct Answer: A
Rationale: This patient is experiencing status asthmaticus with impending respiratory failure, evidenced
by the transition from audible wheezing to a "silent chest" (markedly diminished breath sounds
indicating severe bronchospasm and minimal air movement). Magnesium sulfate acts as a smooth
muscle relaxant and bronchodilator, serving as a second-line agent in severe asthma refractory to beta-
agonists. The silent chest indicates critical airway narrowing requiring aggressive pharmacologic
intervention.
Q3: You respond to a 45-year-old male involved in a motor vehicle collision. He complains of severe
chest pain and difficulty breathing. On examination, you note absent breath sounds on the right side,
tracheal deviation to the left, jugular venous distension, and hypotension (BP 78/50). HR 128, RR 32,
SpO₂ 82%. What is your immediate intervention?
A. Administer furosemide 40 mg IV to reduce pulmonary congestion
B. Perform needle decompression at the second intercostal space, midclavicular line on the right side
[CORRECT]
C. Initiate CPAP at 10 cmH₂O to improve oxygenation
D. Administer nitroglycerin 0.4 mg sublingual for chest pain
Correct Answer: B
Rationale: This patient presents with the classic triad of tension pneumothorax: absent breath sounds,
tracheal deviation away from the affected side, and hypotension (Beck's triad also includes JVD). The
pathophysiology involves a one-way valve air leak creating increasing intrathoracic pressure, collapsing
the lung, shifting mediastinal structures, and compressing the vena cava causing obstructive shock.
Immediate needle decompression converts the tension pneumothorax to a simple pneumothorax,
relieving life-threatening pressure.
Q4: A 62-year-old female presents with acute onset dyspnea, pink frothy sputum, and orthopnea. Vital
signs: HR 118, BP 186/110, RR 34, SpO₂ 76% on room air. Bilateral crackles are auscultated from the
bases to the apices. She has 2+ pitting edema in bilateral lower extremities and an S3 gallop is present.
Which intervention is most appropriate after ensuring airway patency?
A. Administer albuterol nebulizer for bronchospasm
B. Apply CPAP at 10 cmH₂O and administer nitroglycerin 0.4 mg sublingual *CORRECT+
C. Administer epinephrine 0.3 mg IM 1:1000 for anaphylaxis
D. Perform synchronized cardioversion at 100 J for unstable tachycardia
Correct Answer: B
Rationale: This patient presents with acute cardiogenic pulmonary edema secondary to CHF
exacerbation, evidenced by pink frothy sputum (indicative of alveolar flooding), bilateral crackles, JVD,
, peripheral edema, S3 gallop, and hypertension. CPAP reduces preload and afterload while improving
oxygenation and reducing work of breathing. Nitroglycerin causes venodilation, reducing preload and
pulmonary congestion. Albuterol would worsen cardiac workload; epinephrine is contraindicated;
cardioversion is inappropriate for this sinus tachycardia compensatory to hypoxia.
Q5: You are treating a 55-year-old male with pneumonia. He presents with fever 39.4°C, productive
cough with rusty-colored sputum, and pleuritic chest pain. Vital signs: HR 104, BP 132/84, RR 24, SpO₂
90% on room air. Crackles are heard over the right lower lobe. Which finding would be most concerning
for impending respiratory failure?
A. Temperature of 39.4°C indicating severe infection
B. Altered mental status with confusion and lethargy [CORRECT]
C. Rusty-colored sputum indicating Streptococcus pneumoniae
D. Pleuritic chest pain localized to the right lower chest
Correct Answer: B
Rationale: Altered mental status in a patient with pneumonia indicates hypoxemic or hypercapnic
respiratory failure affecting cerebral perfusion and oxygenation. This represents a critical deterioration
requiring immediate airway intervention and ventilatory support. While fever, characteristic sputum,
and pleuritic pain are expected findings in pneumonia, altered mental status signals decompensation
and is a key indicator of impending respiratory failure per NREMT medical assessment protocols.
Q6: A 70-year-old male with a history of CHF presents with progressive dyspnea over 48 hours. He is
orthopneic and using accessory muscles. Vital signs: HR 112, BP 164/98, RR 30, SpO₂ 82% on 2L nasal
cannula. Bilateral crackles, JVD, and peripheral edema are present. You initiate CPAP. Which parameter
indicates effective CPAP therapy?
A. Increased blood pressure to 180/110 mmHg
B. Decreased respiratory rate and improved SpO₂ with reduced work of breathing *CORRECT+
C. Development of altered mental status requiring intubation
D. Increased heart rate to 140 beats per minute
Correct Answer: B
Rationale: Effective CPAP therapy in cardiogenic pulmonary edema should reduce the work of breathing
by splinting open alveoli, improving oxygenation, and reducing preload/afterload. A decreased
respiratory rate and improved oxygen saturation with visible reduction in accessory muscle use indicate
therapeutic success. Increased blood pressure or heart rate would indicate worsening condition; altered
mental status requiring intubation represents CPAP failure.
2026/2027 | FISDAP Medical | Verified
Q&A | Pass Guaranteed - A+ Graded
SECTION 1: RESPIRATORY EMERGENCIES (Q1–Q15)
Q1: You are dispatched to a 68-year-old male with a history of COPD who reports increased shortness of
breath over the past 3 days. On scene, he is sitting in a tripod position with pursed-lip breathing. Vital
signs: HR 110, BP 148/92, RR 28, SpO₂ 84% on room air, afebrile. Breath sounds reveal diffuse wheezing
with a prolonged expiratory phase. He is alert and oriented. What is your priority intervention?
A. Administer furosemide 40 mg IV for suspected fluid overload
B. Apply CPAP at 10 cmH₂O and administer albuterol via nebulizer *CORRECT+
C. Perform immediate endotracheal intubation due to SpO₂ of 84%
D. Administer naloxone 2 mg IM for possible opioid-induced respiratory depression
Correct Answer: B
Rationale: This patient presents with a COPD exacerbation characterized by tripod positioning, pursed-
lip breathing, prolonged expiratory phase, and hypoxemia. CPAP provides positive end-expiratory
pressure to splint open collapsed alveoli, reduce work of breathing, and improve oxygenation. Albuterol
addresses bronchospasm. The patient remains alert and oriented with intact airway reflexes, making
non-invasive ventilation appropriate before invasive airway management.
Q2: A 24-year-old female with a history of asthma calls 911 for severe wheezing. On arrival, she is
anxious, diaphoretic, and unable to speak in full sentences. Vital signs: HR 132, BP 98/62, RR 36, SpO₂
78% on room air, temp 37.2°C. Breath sounds reveal diffuse wheezing bilaterally. After administering
albuterol and ipratropium nebulizers, her condition worsens. Breath sounds become markedly
diminished. What is the most appropriate next step?
A. Administer magnesium sulfate 2 g IV over 10 minutes [CORRECT]
B. Administer furosemide 80 mg IV for flash pulmonary edema
C. Initiate high-flow nasal cannula at 60 L/min and observe
D. Perform needle decompression at the second intercostal space, midclavicular line
,Correct Answer: A
Rationale: This patient is experiencing status asthmaticus with impending respiratory failure, evidenced
by the transition from audible wheezing to a "silent chest" (markedly diminished breath sounds
indicating severe bronchospasm and minimal air movement). Magnesium sulfate acts as a smooth
muscle relaxant and bronchodilator, serving as a second-line agent in severe asthma refractory to beta-
agonists. The silent chest indicates critical airway narrowing requiring aggressive pharmacologic
intervention.
Q3: You respond to a 45-year-old male involved in a motor vehicle collision. He complains of severe
chest pain and difficulty breathing. On examination, you note absent breath sounds on the right side,
tracheal deviation to the left, jugular venous distension, and hypotension (BP 78/50). HR 128, RR 32,
SpO₂ 82%. What is your immediate intervention?
A. Administer furosemide 40 mg IV to reduce pulmonary congestion
B. Perform needle decompression at the second intercostal space, midclavicular line on the right side
[CORRECT]
C. Initiate CPAP at 10 cmH₂O to improve oxygenation
D. Administer nitroglycerin 0.4 mg sublingual for chest pain
Correct Answer: B
Rationale: This patient presents with the classic triad of tension pneumothorax: absent breath sounds,
tracheal deviation away from the affected side, and hypotension (Beck's triad also includes JVD). The
pathophysiology involves a one-way valve air leak creating increasing intrathoracic pressure, collapsing
the lung, shifting mediastinal structures, and compressing the vena cava causing obstructive shock.
Immediate needle decompression converts the tension pneumothorax to a simple pneumothorax,
relieving life-threatening pressure.
Q4: A 62-year-old female presents with acute onset dyspnea, pink frothy sputum, and orthopnea. Vital
signs: HR 118, BP 186/110, RR 34, SpO₂ 76% on room air. Bilateral crackles are auscultated from the
bases to the apices. She has 2+ pitting edema in bilateral lower extremities and an S3 gallop is present.
Which intervention is most appropriate after ensuring airway patency?
A. Administer albuterol nebulizer for bronchospasm
B. Apply CPAP at 10 cmH₂O and administer nitroglycerin 0.4 mg sublingual *CORRECT+
C. Administer epinephrine 0.3 mg IM 1:1000 for anaphylaxis
D. Perform synchronized cardioversion at 100 J for unstable tachycardia
Correct Answer: B
Rationale: This patient presents with acute cardiogenic pulmonary edema secondary to CHF
exacerbation, evidenced by pink frothy sputum (indicative of alveolar flooding), bilateral crackles, JVD,
, peripheral edema, S3 gallop, and hypertension. CPAP reduces preload and afterload while improving
oxygenation and reducing work of breathing. Nitroglycerin causes venodilation, reducing preload and
pulmonary congestion. Albuterol would worsen cardiac workload; epinephrine is contraindicated;
cardioversion is inappropriate for this sinus tachycardia compensatory to hypoxia.
Q5: You are treating a 55-year-old male with pneumonia. He presents with fever 39.4°C, productive
cough with rusty-colored sputum, and pleuritic chest pain. Vital signs: HR 104, BP 132/84, RR 24, SpO₂
90% on room air. Crackles are heard over the right lower lobe. Which finding would be most concerning
for impending respiratory failure?
A. Temperature of 39.4°C indicating severe infection
B. Altered mental status with confusion and lethargy [CORRECT]
C. Rusty-colored sputum indicating Streptococcus pneumoniae
D. Pleuritic chest pain localized to the right lower chest
Correct Answer: B
Rationale: Altered mental status in a patient with pneumonia indicates hypoxemic or hypercapnic
respiratory failure affecting cerebral perfusion and oxygenation. This represents a critical deterioration
requiring immediate airway intervention and ventilatory support. While fever, characteristic sputum,
and pleuritic pain are expected findings in pneumonia, altered mental status signals decompensation
and is a key indicator of impending respiratory failure per NREMT medical assessment protocols.
Q6: A 70-year-old male with a history of CHF presents with progressive dyspnea over 48 hours. He is
orthopneic and using accessory muscles. Vital signs: HR 112, BP 164/98, RR 30, SpO₂ 82% on 2L nasal
cannula. Bilateral crackles, JVD, and peripheral edema are present. You initiate CPAP. Which parameter
indicates effective CPAP therapy?
A. Increased blood pressure to 180/110 mmHg
B. Decreased respiratory rate and improved SpO₂ with reduced work of breathing *CORRECT+
C. Development of altered mental status requiring intubation
D. Increased heart rate to 140 beats per minute
Correct Answer: B
Rationale: Effective CPAP therapy in cardiogenic pulmonary edema should reduce the work of breathing
by splinting open alveoli, improving oxygenation, and reducing preload/afterload. A decreased
respiratory rate and improved oxygen saturation with visible reduction in accessory muscle use indicate
therapeutic success. Increased blood pressure or heart rate would indicate worsening condition; altered
mental status requiring intubation represents CPAP failure.
