2026 EMT FISDAP READINESS EXAM ACTUAL EXAM
ALL 200 QUESTIONS AND CORRECT DETAILED
ANSWERS .
B1 B2
Question 1
A 58-year-old male patient presents with a chief complaint of generalized
weakness. He reports experiencing severe chest pain and shortness of breath the
day prior to your arrival. Upon auscultation, you note the presence of crackles at
the bases of both lung fields. His skin is pale, cool, and diaphoretic to the touch.
His vital signs are as follows: blood pressure 70/40 mmHg, heart rate 110 beats
per minute and weak, respiratory rate 28 breaths per minute. Based on this
clinical presentation, which of the following conditions should you most suspect?
a. Cardiogenic shock
b. Hypovolemic shock
c. Angina pectoris
d. Pulmonary embolism
Correct Answer: A
Expert Rationale
Cardiogenic shock is a state of inadequate tissue perfusion resulting from the
heart's inability to pump sufficient blood to meet the body's metabolic demands.
It is most commonly caused by a severe myocardial infarction (heart attack) that
damages a significant portion of the left ventricular muscle. This patient's
presentation is a classic constellation of signs and symptoms indicative of
cardiogenic shock. The history of severe chest pain and shortness of breath the
previous day suggests an acute myocardial infarction (AMI). The presence of
crackles (rales) in the lung bases is a hallmark sign of pulmonary congestion and
edema, a direct consequence of left ventricular failure. His pale, cool, and clammy
skin indicates peripheral vasoconstriction and poor perfusion, a compensatory
response to the decreased cardiac output. Critically, his blood pressure of 70/40
mmHg is severely hypotensive (systolic < 90 mmHg), which is a key diagnostic
criterion for cardiogenic shock. The weak, tachycardic pulse (110 bpm) is a
,compensatory mechanism attempting to maintain cardiac output as stroke
volume falls.
Option B is incorrect because hypovolemic shock is caused by a significant loss of
intravascular volume (e.g., from hemorrhage, dehydration). While the patient
exhibits hypotension and tachycardia, hypovolemic shock would not typically
present with crackles in the lungs. Crackles suggest fluid overload, which is
paradoxical to hypovolemia. The presence of pulmonary edema points away from
hypovolemia and toward a pump failure (cardiogenic) or fluid overload (e.g., renal
failure) etiology.
Option C is incorrect because angina pectoris is chest pain caused by temporary
myocardial ischemia without permanent damage to the heart muscle. It does not
cause the severe pump failure and systemic hypotension seen in this patient.
While angina can be a precursor to an MI, it would not explain the hypotension,
crackles, or cool, clammy skin.
Option D is incorrect because a pulmonary embolism (PE) is a blockage in a
pulmonary artery, typically caused by a blood clot. While a massive PE can cause
obstructive shock and hypotension, the classic presentation includes acute, sharp
chest pain and sudden dyspnea. It may also cause tachypnea and tachycardia.
However, while a PE can cause hypoxia and occasionally crackles, it is less likely to
cause the widespread pulmonary edema seen as crackles at both lung bases,
which is more characteristic of left ventricular failure. Furthermore, the history of
chest pain the day before is more suggestive of an ischemic cardiac event than a
PE.
DIF: Cognitive Level: Analyze
TOP: Pathophysiology: Cardiovascular Emergencies
MSC: Shock and Resuscitation
Question 2
An unresponsive 52-year-old female is in respiratory failure after being struck in
the chest with a metal pipe. Upon assessment, you note that with each breath,
only one side of her chest rises. She has developed significant subcutaneous
emphysema and her radial pulses are absent. What is the most appropriate
immediate intervention?
,a. Begin chest compressions
b. Apply blow-by oxygen
c. Apply bulky dressings to the chest
d. Provide positive pressure ventilations
Correct Answer: D
Expert Rationale
This patient's presentation is indicative of a life-threatening tension
pneumothorax. The mechanism of injury (blunt trauma to the chest) can cause a
lung laceration that allows air to escape into the pleural space. This creates a one-
way valve effect, where air enters the pleural space with each inspiration but
cannot escape. The pressure builds up, causing the affected lung to collapse and
shifting the mediastinum (trachea, heart, great vessels) to the opposite side. This
is a medical emergency that rapidly compromises cardiac output and ventilation.
Subcutaneous emphysema (air under the skin) is a classic sign of a pneumothorax
or tracheal injury. The absence of radial pulses, despite likely a palpable carotid
pulse, indicates profound hypotension and impending cardiac arrest. The
immediate priority is to treat the tension pneumothorax. While definitive
treatment is needle decompression, providing positive pressure ventilation with a
bag-valve-mask (BVM) can temporarily help by increasing intrathoracic pressure,
which may worsen the situation. However, in this specific context, providing
positive pressure ventilations is the most immediate action to address the
patient's respiratory failure while preparing for decompression. The patient is
apneic and in respiratory failure; without ventilations, she will arrest.
Option A is incorrect because chest compressions are indicated for cardiac arrest
(pulselessness). While this patient may be close to cardiac arrest, the primary
problem is a tension pneumothorax causing obstructive shock. The priority is to
address the underlying cause of the shock and respiratory failure. Compressions
would not be effective without addressing the tension pneumothorax.
Option B is incorrect because blow-by oxygen is not sufficient for a patient in
respiratory failure with absent radial pulses. This patient requires ventilatory
support, not just supplemental oxygen.
Option C is incorrect because applying bulky dressings to the chest is an
intervention for an open (sucking) chest wound, not a tension pneumothorax.
, Bulky dressings would be used to create an occlusive seal to prevent air from
entering the chest through an open wound.
DIF: Cognitive Level: Analyze
TOP: Trauma: Chest Injury, Tension Pneumothorax
MSC: Airway Management and Ventilation
Question 3
A 48-year-old male who was involved in a high-speed motor vehicle collision is
found slumped over the steering wheel and is unresponsive to loud verbal stimuli.
You observe smoke emanating from inside the vehicle and note that the airbag
has been deployed. Given these circumstances, what is the most appropriate
initial action?
a. Perform an emergency extrication
b. Perform a primary survey
c. Administer high-flow oxygen by nonrebreather mask
d. Tell the fire department to stand by for extrication
Correct Answer: A
Expert Rationale
This scenario presents a classic "load and go" situation with a high priority for
rapid extrication. The presence of smoke inside the vehicle indicates an immediate
and significant fire hazard. The patient is unresponsive, which means he is unable
to self-extricate and is at high risk for inhalation injury. In any situation where the
patient's life is in immediate danger from environmental hazards (fire, explosion,
submersion, or hazardous materials), the priority is to perform an emergency
extrication. This means rapidly moving the patient from the vehicle to a safe
location, even if it means compromising full spinal immobilization. The risk of the
patient burning to death far outweighs the risk of spinal injury in this specific,
immediate life-threatening scenario.
Option B is incorrect because performing a primary survey should occur in a safe
environment. You cannot perform a thorough assessment while the patient is in a
vehicle that may catch fire. The immediate priority is to remove the patient from
the danger.
Option C is incorrect because administering high-flow oxygen is a later step that
should be performed after the patient has been safely extricated from the vehicle.
ALL 200 QUESTIONS AND CORRECT DETAILED
ANSWERS .
B1 B2
Question 1
A 58-year-old male patient presents with a chief complaint of generalized
weakness. He reports experiencing severe chest pain and shortness of breath the
day prior to your arrival. Upon auscultation, you note the presence of crackles at
the bases of both lung fields. His skin is pale, cool, and diaphoretic to the touch.
His vital signs are as follows: blood pressure 70/40 mmHg, heart rate 110 beats
per minute and weak, respiratory rate 28 breaths per minute. Based on this
clinical presentation, which of the following conditions should you most suspect?
a. Cardiogenic shock
b. Hypovolemic shock
c. Angina pectoris
d. Pulmonary embolism
Correct Answer: A
Expert Rationale
Cardiogenic shock is a state of inadequate tissue perfusion resulting from the
heart's inability to pump sufficient blood to meet the body's metabolic demands.
It is most commonly caused by a severe myocardial infarction (heart attack) that
damages a significant portion of the left ventricular muscle. This patient's
presentation is a classic constellation of signs and symptoms indicative of
cardiogenic shock. The history of severe chest pain and shortness of breath the
previous day suggests an acute myocardial infarction (AMI). The presence of
crackles (rales) in the lung bases is a hallmark sign of pulmonary congestion and
edema, a direct consequence of left ventricular failure. His pale, cool, and clammy
skin indicates peripheral vasoconstriction and poor perfusion, a compensatory
response to the decreased cardiac output. Critically, his blood pressure of 70/40
mmHg is severely hypotensive (systolic < 90 mmHg), which is a key diagnostic
criterion for cardiogenic shock. The weak, tachycardic pulse (110 bpm) is a
,compensatory mechanism attempting to maintain cardiac output as stroke
volume falls.
Option B is incorrect because hypovolemic shock is caused by a significant loss of
intravascular volume (e.g., from hemorrhage, dehydration). While the patient
exhibits hypotension and tachycardia, hypovolemic shock would not typically
present with crackles in the lungs. Crackles suggest fluid overload, which is
paradoxical to hypovolemia. The presence of pulmonary edema points away from
hypovolemia and toward a pump failure (cardiogenic) or fluid overload (e.g., renal
failure) etiology.
Option C is incorrect because angina pectoris is chest pain caused by temporary
myocardial ischemia without permanent damage to the heart muscle. It does not
cause the severe pump failure and systemic hypotension seen in this patient.
While angina can be a precursor to an MI, it would not explain the hypotension,
crackles, or cool, clammy skin.
Option D is incorrect because a pulmonary embolism (PE) is a blockage in a
pulmonary artery, typically caused by a blood clot. While a massive PE can cause
obstructive shock and hypotension, the classic presentation includes acute, sharp
chest pain and sudden dyspnea. It may also cause tachypnea and tachycardia.
However, while a PE can cause hypoxia and occasionally crackles, it is less likely to
cause the widespread pulmonary edema seen as crackles at both lung bases,
which is more characteristic of left ventricular failure. Furthermore, the history of
chest pain the day before is more suggestive of an ischemic cardiac event than a
PE.
DIF: Cognitive Level: Analyze
TOP: Pathophysiology: Cardiovascular Emergencies
MSC: Shock and Resuscitation
Question 2
An unresponsive 52-year-old female is in respiratory failure after being struck in
the chest with a metal pipe. Upon assessment, you note that with each breath,
only one side of her chest rises. She has developed significant subcutaneous
emphysema and her radial pulses are absent. What is the most appropriate
immediate intervention?
,a. Begin chest compressions
b. Apply blow-by oxygen
c. Apply bulky dressings to the chest
d. Provide positive pressure ventilations
Correct Answer: D
Expert Rationale
This patient's presentation is indicative of a life-threatening tension
pneumothorax. The mechanism of injury (blunt trauma to the chest) can cause a
lung laceration that allows air to escape into the pleural space. This creates a one-
way valve effect, where air enters the pleural space with each inspiration but
cannot escape. The pressure builds up, causing the affected lung to collapse and
shifting the mediastinum (trachea, heart, great vessels) to the opposite side. This
is a medical emergency that rapidly compromises cardiac output and ventilation.
Subcutaneous emphysema (air under the skin) is a classic sign of a pneumothorax
or tracheal injury. The absence of radial pulses, despite likely a palpable carotid
pulse, indicates profound hypotension and impending cardiac arrest. The
immediate priority is to treat the tension pneumothorax. While definitive
treatment is needle decompression, providing positive pressure ventilation with a
bag-valve-mask (BVM) can temporarily help by increasing intrathoracic pressure,
which may worsen the situation. However, in this specific context, providing
positive pressure ventilations is the most immediate action to address the
patient's respiratory failure while preparing for decompression. The patient is
apneic and in respiratory failure; without ventilations, she will arrest.
Option A is incorrect because chest compressions are indicated for cardiac arrest
(pulselessness). While this patient may be close to cardiac arrest, the primary
problem is a tension pneumothorax causing obstructive shock. The priority is to
address the underlying cause of the shock and respiratory failure. Compressions
would not be effective without addressing the tension pneumothorax.
Option B is incorrect because blow-by oxygen is not sufficient for a patient in
respiratory failure with absent radial pulses. This patient requires ventilatory
support, not just supplemental oxygen.
Option C is incorrect because applying bulky dressings to the chest is an
intervention for an open (sucking) chest wound, not a tension pneumothorax.
, Bulky dressings would be used to create an occlusive seal to prevent air from
entering the chest through an open wound.
DIF: Cognitive Level: Analyze
TOP: Trauma: Chest Injury, Tension Pneumothorax
MSC: Airway Management and Ventilation
Question 3
A 48-year-old male who was involved in a high-speed motor vehicle collision is
found slumped over the steering wheel and is unresponsive to loud verbal stimuli.
You observe smoke emanating from inside the vehicle and note that the airbag
has been deployed. Given these circumstances, what is the most appropriate
initial action?
a. Perform an emergency extrication
b. Perform a primary survey
c. Administer high-flow oxygen by nonrebreather mask
d. Tell the fire department to stand by for extrication
Correct Answer: A
Expert Rationale
This scenario presents a classic "load and go" situation with a high priority for
rapid extrication. The presence of smoke inside the vehicle indicates an immediate
and significant fire hazard. The patient is unresponsive, which means he is unable
to self-extricate and is at high risk for inhalation injury. In any situation where the
patient's life is in immediate danger from environmental hazards (fire, explosion,
submersion, or hazardous materials), the priority is to perform an emergency
extrication. This means rapidly moving the patient from the vehicle to a safe
location, even if it means compromising full spinal immobilization. The risk of the
patient burning to death far outweighs the risk of spinal injury in this specific,
immediate life-threatening scenario.
Option B is incorrect because performing a primary survey should occur in a safe
environment. You cannot perform a thorough assessment while the patient is in a
vehicle that may catch fire. The immediate priority is to remove the patient from
the danger.
Option C is incorrect because administering high-flow oxygen is a later step that
should be performed after the patient has been safely extricated from the vehicle.
