FREC 4 ACTUAL EXAM 2026/2027
QUESTIONS AND ANSWERS
1. Which of the following signs specifically defines Cushing’s Triad, indicating a significant
increase in intracranial pressure?
A. Bradycardia, hypertension, and irregular respirations
B. Tachycardia, hypertension, and tachypnea
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
D. Tachycardia, hypotension, and narrowed pulse pressure
Answer: A
Conceptual Explanation: Cushing’s Triad consists of bradycardia, hypertension (often
with a widening pulse pressure), and irregular respirations, signaling impending brain
herniation due to high ICP.
2. In adult advanced life support, when should the first dose of 300mg Amiodarone be
administered for a patient in Ventricular Fibrillation?
A. After the third shock
B. After the second shock
,C. Immediately after the first shock
D. After the fifth shock
Answer: A
Conceptual Explanation: According to standard ALS guidelines (and JRCALC),
Amiodarone 300mg is administered intravenously or intraosseously after the third shock
in refractory VF or pulseless VT.
3. Which of the following is an absolute contraindication for the administration of Tranexamic
Acid (TXA) in a trauma patient?
A. The patient is over 65 years old
B. The patient is taking anticoagulant medication
C. The injury occurred more than 3 hours ago
D. The patient has a history of deep vein thrombosis
Answer: C
Conceptual Explanation: TXA must be administered within 3 hours of the injury; evidence
suggests it may increase the risk of death due to thrombotic events if given after this
window.
4. In the context of the oxyhemoglobin dissociation curve, a ‘shift to the right’ is caused by
which of the following?
A. Decreased temperature
, B. Decreased 2,3-DPG
C. Increased PCO2 (Hypercapnia)
D. Increased pH (Alkalosis)
Answer: C
Conceptual Explanation: A right shift (Bohr effect) decreases hemoglobin’s affinity for
oxygen, facilitating its release to tissues. This is caused by increased PCO2, increased
temperature, increased 2,3-DPG, and decreased pH.
5. What is the characteristic ECG finding associated with a Mobitz Type I (Wenckebach)
second-degree heart block?
A. No relationship between P waves and QRS complexes
B. A constant PR interval with randomly dropped QRS complexes
C. A PR interval greater than 0.20 seconds with no dropped beats
D. Progressive lengthening of the PR interval until a QRS complex is dropped
Answer: D
Conceptual Explanation: Mobitz Type I is defined by the progressive prolongation of the
PR interval culminating in a non-conducted P wave (dropped QRS).
6. What is the recommended fluid bolus volume for a pediatric patient in compensated
hypovolemic shock according to JRCALC?
A. 10ml/kg
QUESTIONS AND ANSWERS
1. Which of the following signs specifically defines Cushing’s Triad, indicating a significant
increase in intracranial pressure?
A. Bradycardia, hypertension, and irregular respirations
B. Tachycardia, hypertension, and tachypnea
C. Bradycardia, hypotension, and Cheyne-Stokes respirations
D. Tachycardia, hypotension, and narrowed pulse pressure
Answer: A
Conceptual Explanation: Cushing’s Triad consists of bradycardia, hypertension (often
with a widening pulse pressure), and irregular respirations, signaling impending brain
herniation due to high ICP.
2. In adult advanced life support, when should the first dose of 300mg Amiodarone be
administered for a patient in Ventricular Fibrillation?
A. After the third shock
B. After the second shock
,C. Immediately after the first shock
D. After the fifth shock
Answer: A
Conceptual Explanation: According to standard ALS guidelines (and JRCALC),
Amiodarone 300mg is administered intravenously or intraosseously after the third shock
in refractory VF or pulseless VT.
3. Which of the following is an absolute contraindication for the administration of Tranexamic
Acid (TXA) in a trauma patient?
A. The patient is over 65 years old
B. The patient is taking anticoagulant medication
C. The injury occurred more than 3 hours ago
D. The patient has a history of deep vein thrombosis
Answer: C
Conceptual Explanation: TXA must be administered within 3 hours of the injury; evidence
suggests it may increase the risk of death due to thrombotic events if given after this
window.
4. In the context of the oxyhemoglobin dissociation curve, a ‘shift to the right’ is caused by
which of the following?
A. Decreased temperature
, B. Decreased 2,3-DPG
C. Increased PCO2 (Hypercapnia)
D. Increased pH (Alkalosis)
Answer: C
Conceptual Explanation: A right shift (Bohr effect) decreases hemoglobin’s affinity for
oxygen, facilitating its release to tissues. This is caused by increased PCO2, increased
temperature, increased 2,3-DPG, and decreased pH.
5. What is the characteristic ECG finding associated with a Mobitz Type I (Wenckebach)
second-degree heart block?
A. No relationship between P waves and QRS complexes
B. A constant PR interval with randomly dropped QRS complexes
C. A PR interval greater than 0.20 seconds with no dropped beats
D. Progressive lengthening of the PR interval until a QRS complex is dropped
Answer: D
Conceptual Explanation: Mobitz Type I is defined by the progressive prolongation of the
PR interval culminating in a non-conducted P wave (dropped QRS).
6. What is the recommended fluid bolus volume for a pediatric patient in compensated
hypovolemic shock according to JRCALC?
A. 10ml/kg
