FISDAP Paramedic Final Exam (2026)
Q1–Q20: AIRWAY MANAGEMENT
Q1: You arrive on scene to find a 58-year-old male unconscious in bed. His wife states he was
snoring loudly, then became silent. He is unresponsive with sonorous respirations and a
palpable carotid pulse. What is your immediate priority?
A. Insert a nasopharyngeal airway and apply high-flow oxygen
B. Perform a head-tilt chin-lift maneuver and insert an oropharyngeal airway
C. Begin bag-valve-mask ventilation at a rate of 20 breaths per minute
D. Initiate rapid sequence intubation immediately
Correct Answer: B [CORRECT]
Rationale: The head-tilt chin-lift maneuver opens the airway in an unconscious patient without
suspected trauma, and the oropharyngeal airway (OPA) prevents the tongue from obstructing
the oropharynx. Sonorous respirations indicate upper airway obstruction, most commonly from
the tongue. Per NREMT and AHA guidelines, airway opening maneuvers come before adjunct
placement or assisted ventilation.
Q2: A 34-year-old trauma patient with a suspected basilar skull fracture is unconscious and
requires an airway adjunct. Which device is most appropriate?
A. A properly sized oropharyngeal airway inserted with a tongue depressor
B. A nasopharyngeal airway inserted into the right naris with water-soluble lubricant
C. A nasopharyngeal airway inserted into the left naris after assessing patency
D. An oropharyngeal airway inserted using the 180-degree rotation technique
Correct Answer: A [CORRECT]
Rationale: In patients with suspected basilar skull fracture, nasopharyngeal airway insertion
risks intracranial penetration through a fractured cribriform plate. The oropharyngeal airway is
the safer choice. The tongue depressor technique provides better visualization and reduces
dental trauma during insertion in an unconscious patient.
,Q3: You are preparing to intubate a 72-year-old female in respiratory failure. Her SpO2 is 84%
on a non-rebreather mask. What is the most critical preoxygenation step before attempting
endotracheal intubation?
A. Administer 1 mg of atropine IV to prevent bradycardia
B. Provide 3 minutes of high-flow oxygen via BVM with a PEEP valve at 15 L/min
C. Apply CPAP at 10 cmH2O to recruit alveoli
D. Position the patient in left lateral recumbent to prevent aspiration
Correct Answer: B [CORRECT]
Rationale: Preoxygenation with high-flow oxygen via BVM for 3 minutes (or 8 vital capacity
breaths) denitrogenates the lungs and extends the safe apneic period during intubation
attempts. This is critical in respiratory failure patients who desaturate rapidly. Per Difficult
Airway Society and NAEMT guidelines, adequate preoxygenation reduces hypoxemia risk during
laryngoscopy.
Q4: After successful endotracheal intubation of a cardiac arrest patient, which method provides
the most reliable confirmation of correct tube placement in the trachea?
A. Auscultation of bilateral breath sounds and epigastrium
B. Continuous waveform capnography showing consistent EtCO2 readings
C. Visualization of the tube passing through the vocal cords
D. Chest rise observed during positive pressure ventilation
Correct Answer: B [CORRECT]
Rationale: While direct visualization and auscultation are important, continuous waveform
capnography is the gold standard for confirming tracheal placement and monitoring tube
dislodgement. The American Heart Association ACLS guidelines require waveform capnography
as the primary confirmation method. It also provides real-time feedback on CPR quality and
ROSC detection.
Q5: During CPR, your EtCO2 waveform suddenly rises from 15 mmHg to 45 mmHg with the
return of a palpable pulse. What does this indicate?
A. Worsening airway obstruction requiring immediate suctioning
B. Return of spontaneous circulation (ROSC) with improved perfusion
C. Esophageal intubation with gastric distension
D. Tension pneumothorax causing decreased cardiac output
,Correct Answer: B [CORRECT]
Rationale: A sudden sustained increase in EtCO2 during CPR is a highly sensitive indicator of
ROSC. During cardiac arrest, low cardiac output produces low EtCO2 (typically <20 mmHg). With
ROSC, pulmonary blood flow increases, delivering more CO2 to the lungs and raising EtCO2.
ACLS protocols use EtCO2 >40 mmHg as a strong predictor of ROSC.
Q6: A 6-year-old patient with status asthmaticus requires definitive airway management. You
attempt endotracheal intubation. What is the appropriate uncuffed endotracheal tube size?
A. 4.5 mm
B. 5.0 mm
C. 5.5 mm
D. 6.0 mm
Correct Answer: C [CORRECT]
Rationale: Using the pediatric formula (age/4) + 4: (6/4) + 4 = 1.5 + 4 = 5.5 mm. This is the
standard calculation for uncuffed endotracheal tubes in children. Always have one size larger
and one size smaller available. Cuffed tubes in children require a 0.5 mm reduction in size.
Q7: You are managing a 45-year-old male with a complete foreign body airway obstruction. He
is conscious but unable to speak or cough. What is your immediate intervention?
A. Deliver 5 back blows followed by 5 abdominal thrusts
B. Perform a blind finger sweep to remove the obstruction
C. Administer high-flow oxygen via non-rebreather mask
D. Encourage the patient to cough forcefully
Correct Answer: A [CORRECT]
Rationale: For a conscious adult with complete airway obstruction, the AHA BLS protocol
recommends alternating 5 back blows with 5 abdominal thrusts (Heimlich maneuver). Blind
finger sweeps are contraindicated as they may push the object deeper or cause airway trauma.
Coughing is ineffective in complete obstruction.
Q8: A patient with severe COPD presents with acute respiratory distress. Breath sounds are
diminished bilaterally, and the patient is using accessory muscles. SpO2 is 88% on 2 L/min nasal
cannula. What is the most appropriate oxygen delivery adjustment?
, A. Increase nasal cannula to 6 L/min to achieve SpO2 >94%
B. Apply a non-rebreather mask at 15 L/min
C. Apply CPAP at 5–10 cmH2O with supplemental O2
D. Withhold oxygen to maintain hypoxic drive
Correct Answer: C [CORRECT]
Rationale: CPAP is indicated for COPD exacerbations and pulmonary edema as it recruits alveoli,
reduces work of breathing, and improves oxygenation. The outdated "hypoxic drive" theory is
not a reason to withhold oxygen in acute respiratory distress. Target SpO2 of 88–92% in COPD
patients per GOLD guidelines, but CPAP addresses the underlying pathophysiology.
Q9: During intubation of a trauma patient, you visualize the vocal cords but cannot pass the
endotracheal tube. The patient is desaturating. What is your next best action?
A. Continue attempting to force the tube past the obstruction
B. Withdraw the laryngoscope and perform a surgical cricothyrotomy
C. Insert a bougie, railroad the endotracheal tube over it, and confirm placement
D. Remove the laryngoscope and ventilate with a BVM for 5 minutes
Correct Answer: C [CORRECT]
Rationale: A bougie (endotracheal tube introducer) is the standard rescue device when the
glottic opening is visualized but tube passage is difficult. It has a higher success rate than
repeated direct attempts and is recommended by the Difficult Airway Society. Surgical
cricothyrotomy is reserved for "can't intubate, can't ventilate" scenarios.
Q10: A 28-year-old male was struck in the face with a baseball bat. He has significant oral
bleeding, missing teeth, and a unstable midface. He is maintaining his airway but is drowsy.
What is your primary airway concern?
A. Laryngeal fracture requiring immediate surgical airway
B. Aspiration of blood, teeth, or bone fragments
C. Tension pneumothorax from associated chest trauma
D. Epiglottitis secondary to blunt trauma
Correct Answer: B [CORRECT]
Rationale: Facial trauma with oral bleeding and missing teeth creates a high aspiration risk.
Blood, teeth, and bone fragments can obstruct the airway or cause aspiration pneumonia. Early
Q1–Q20: AIRWAY MANAGEMENT
Q1: You arrive on scene to find a 58-year-old male unconscious in bed. His wife states he was
snoring loudly, then became silent. He is unresponsive with sonorous respirations and a
palpable carotid pulse. What is your immediate priority?
A. Insert a nasopharyngeal airway and apply high-flow oxygen
B. Perform a head-tilt chin-lift maneuver and insert an oropharyngeal airway
C. Begin bag-valve-mask ventilation at a rate of 20 breaths per minute
D. Initiate rapid sequence intubation immediately
Correct Answer: B [CORRECT]
Rationale: The head-tilt chin-lift maneuver opens the airway in an unconscious patient without
suspected trauma, and the oropharyngeal airway (OPA) prevents the tongue from obstructing
the oropharynx. Sonorous respirations indicate upper airway obstruction, most commonly from
the tongue. Per NREMT and AHA guidelines, airway opening maneuvers come before adjunct
placement or assisted ventilation.
Q2: A 34-year-old trauma patient with a suspected basilar skull fracture is unconscious and
requires an airway adjunct. Which device is most appropriate?
A. A properly sized oropharyngeal airway inserted with a tongue depressor
B. A nasopharyngeal airway inserted into the right naris with water-soluble lubricant
C. A nasopharyngeal airway inserted into the left naris after assessing patency
D. An oropharyngeal airway inserted using the 180-degree rotation technique
Correct Answer: A [CORRECT]
Rationale: In patients with suspected basilar skull fracture, nasopharyngeal airway insertion
risks intracranial penetration through a fractured cribriform plate. The oropharyngeal airway is
the safer choice. The tongue depressor technique provides better visualization and reduces
dental trauma during insertion in an unconscious patient.
,Q3: You are preparing to intubate a 72-year-old female in respiratory failure. Her SpO2 is 84%
on a non-rebreather mask. What is the most critical preoxygenation step before attempting
endotracheal intubation?
A. Administer 1 mg of atropine IV to prevent bradycardia
B. Provide 3 minutes of high-flow oxygen via BVM with a PEEP valve at 15 L/min
C. Apply CPAP at 10 cmH2O to recruit alveoli
D. Position the patient in left lateral recumbent to prevent aspiration
Correct Answer: B [CORRECT]
Rationale: Preoxygenation with high-flow oxygen via BVM for 3 minutes (or 8 vital capacity
breaths) denitrogenates the lungs and extends the safe apneic period during intubation
attempts. This is critical in respiratory failure patients who desaturate rapidly. Per Difficult
Airway Society and NAEMT guidelines, adequate preoxygenation reduces hypoxemia risk during
laryngoscopy.
Q4: After successful endotracheal intubation of a cardiac arrest patient, which method provides
the most reliable confirmation of correct tube placement in the trachea?
A. Auscultation of bilateral breath sounds and epigastrium
B. Continuous waveform capnography showing consistent EtCO2 readings
C. Visualization of the tube passing through the vocal cords
D. Chest rise observed during positive pressure ventilation
Correct Answer: B [CORRECT]
Rationale: While direct visualization and auscultation are important, continuous waveform
capnography is the gold standard for confirming tracheal placement and monitoring tube
dislodgement. The American Heart Association ACLS guidelines require waveform capnography
as the primary confirmation method. It also provides real-time feedback on CPR quality and
ROSC detection.
Q5: During CPR, your EtCO2 waveform suddenly rises from 15 mmHg to 45 mmHg with the
return of a palpable pulse. What does this indicate?
A. Worsening airway obstruction requiring immediate suctioning
B. Return of spontaneous circulation (ROSC) with improved perfusion
C. Esophageal intubation with gastric distension
D. Tension pneumothorax causing decreased cardiac output
,Correct Answer: B [CORRECT]
Rationale: A sudden sustained increase in EtCO2 during CPR is a highly sensitive indicator of
ROSC. During cardiac arrest, low cardiac output produces low EtCO2 (typically <20 mmHg). With
ROSC, pulmonary blood flow increases, delivering more CO2 to the lungs and raising EtCO2.
ACLS protocols use EtCO2 >40 mmHg as a strong predictor of ROSC.
Q6: A 6-year-old patient with status asthmaticus requires definitive airway management. You
attempt endotracheal intubation. What is the appropriate uncuffed endotracheal tube size?
A. 4.5 mm
B. 5.0 mm
C. 5.5 mm
D. 6.0 mm
Correct Answer: C [CORRECT]
Rationale: Using the pediatric formula (age/4) + 4: (6/4) + 4 = 1.5 + 4 = 5.5 mm. This is the
standard calculation for uncuffed endotracheal tubes in children. Always have one size larger
and one size smaller available. Cuffed tubes in children require a 0.5 mm reduction in size.
Q7: You are managing a 45-year-old male with a complete foreign body airway obstruction. He
is conscious but unable to speak or cough. What is your immediate intervention?
A. Deliver 5 back blows followed by 5 abdominal thrusts
B. Perform a blind finger sweep to remove the obstruction
C. Administer high-flow oxygen via non-rebreather mask
D. Encourage the patient to cough forcefully
Correct Answer: A [CORRECT]
Rationale: For a conscious adult with complete airway obstruction, the AHA BLS protocol
recommends alternating 5 back blows with 5 abdominal thrusts (Heimlich maneuver). Blind
finger sweeps are contraindicated as they may push the object deeper or cause airway trauma.
Coughing is ineffective in complete obstruction.
Q8: A patient with severe COPD presents with acute respiratory distress. Breath sounds are
diminished bilaterally, and the patient is using accessory muscles. SpO2 is 88% on 2 L/min nasal
cannula. What is the most appropriate oxygen delivery adjustment?
, A. Increase nasal cannula to 6 L/min to achieve SpO2 >94%
B. Apply a non-rebreather mask at 15 L/min
C. Apply CPAP at 5–10 cmH2O with supplemental O2
D. Withhold oxygen to maintain hypoxic drive
Correct Answer: C [CORRECT]
Rationale: CPAP is indicated for COPD exacerbations and pulmonary edema as it recruits alveoli,
reduces work of breathing, and improves oxygenation. The outdated "hypoxic drive" theory is
not a reason to withhold oxygen in acute respiratory distress. Target SpO2 of 88–92% in COPD
patients per GOLD guidelines, but CPAP addresses the underlying pathophysiology.
Q9: During intubation of a trauma patient, you visualize the vocal cords but cannot pass the
endotracheal tube. The patient is desaturating. What is your next best action?
A. Continue attempting to force the tube past the obstruction
B. Withdraw the laryngoscope and perform a surgical cricothyrotomy
C. Insert a bougie, railroad the endotracheal tube over it, and confirm placement
D. Remove the laryngoscope and ventilate with a BVM for 5 minutes
Correct Answer: C [CORRECT]
Rationale: A bougie (endotracheal tube introducer) is the standard rescue device when the
glottic opening is visualized but tube passage is difficult. It has a higher success rate than
repeated direct attempts and is recommended by the Difficult Airway Society. Surgical
cricothyrotomy is reserved for "can't intubate, can't ventilate" scenarios.
Q10: A 28-year-old male was struck in the face with a baseball bat. He has significant oral
bleeding, missing teeth, and a unstable midface. He is maintaining his airway but is drowsy.
What is your primary airway concern?
A. Laryngeal fracture requiring immediate surgical airway
B. Aspiration of blood, teeth, or bone fragments
C. Tension pneumothorax from associated chest trauma
D. Epiglottitis secondary to blunt trauma
Correct Answer: B [CORRECT]
Rationale: Facial trauma with oral bleeding and missing teeth creates a high aspiration risk.
Blood, teeth, and bone fragments can obstruct the airway or cause aspiration pneumonia. Early
