[ { "question": "A 36-year-old female presents with right-sided weakness, slurred speech, and facial droop that started 30 minutes ago. Her blood glucose is 98 mg/dL. What is the most appropriate next action?", "choices": [ "Transport to a stroke center immediately", "Administer oral glucose", "Give aspirin 324 mg", "Perform spinal immobilization" ], "answer": "Transport to a stroke center immediately", "reason": "The patient is within the window for stroke intervention and has a normal glucose. Rapid transport is key.", "subtopic": "Stroke", "topic": "Medical Emergencies" }, { "question": "A 50-year-old male has circumferential burns to his chest and is struggling to breathe. Breath sounds are decreased bilaterally. What is your most immediate concern?", "choices": [ "Impaired chest wall expansion", "Hypoglycemia from burn stress", "Cardiac tamponade", "Tension pneumothorax" ], "answer": "Impaired chest wall expansion", "reason": "Circumferential chest burns can restrict breathing due to tightening of skin and tissue.", "subtopic": "Burns", "topic": "Trauma" }, { "question": "A combative patient is threatening bystanders and screaming unintelligibly. Vitals are normal. What is the safest initial management?", "choices": [ "Ensure scene safety and wait for law enforcement", "Physically restrain the patient immediately", "Administer haloperidol without consent", "Attempt to reason with the patient alone" ], "answer": "Ensure scene safety and wait for law enforcement", "reason": "Scene safety is the top priority, especially with behavioral emergencies involving potential violence.", "subtopic": "Behavioral/Psychiatric", "topic": "Medical Emergencies" }, { "question": "A 26-year-old male has open femur fractures and is pulseless after a motorcycle crash. What should you do first?", "choices": [ "Start CPR and apply a tourniquet", "Apply splints before initiating CPR", "Perform a focused trauma assessment", "Transport without interventions" ], "answer": "Start CPR and apply a tourniquet", "reason": "Life-threatening bleeding and cardiac arrest require simultaneous resuscitative actions.", "subtopic": "Bleeding and Shock", "topic": "Trauma" }, { "question": "During hazmat response, you see a placard with skull and crossbones and the number 6. What does this indicate?", "choices": [ "Poisonous material", "Flammable gas", "Corrosive liquid", "Radioactive substance" ], "answer": "Poisonous material", "reason": "Class 6 placards with a skull and crossbones represent toxic substances.", "subtopic": "Hazmat Awareness", "topic": "EMS Operations" }, { "question": "A 22-year-old woman is in active labor with crowning visible. What is your next immediate action?", "choices": [ "Prepare for imminent delivery", "Insert a gloved hand for breech rotation", "Transport immediately with lights and sirens", "Administer oxygen and delay delivery" ], "answer": "Prepare for imminent delivery", "reason": "Visible crowning indicates that birth is imminent and should occur on scene with proper preparation.", "subtopic": "Obstetrics", "topic": "Special Populations" }, { "question": "A patient presents after diving into a shallow pool and complains of neck pain. Vitals are stable. What should you do first?", "choices": [ "Manually stabilize the spine", "Apply high-flow oxygen", "Log roll onto long spine board", "Ask the patient to walk to the stretcher" ], "answer": "Manually stabilize the spine", "reason": "Manual stabilization is the first step in suspected spinal injury, even before assessment or oxygen.", "subtopic": "Spinal Trauma", "topic": "Trauma" }, { "question": "You arrive to find an adult patient gasping and cyanotic with inspiratory stridor after a bee sting. What should you do first?", "choices": [ "Administer epinephrine IM", "Apply a non-rebreather mask", "Initiate chest compressions", "Place the patient in Trendelenburg" ], "answer": "Administer epinephrine IM", "reason": "This is anaphylaxis with airway involvement. Epinephrine is life-saving and must be given immediately.", "subtopic": "Respiratory Distress", "topic": "Airway Management, Respiration & Ventilation" }, { "question": "A trauma patient has a weak radial pulse, altered mental status, and pale, cool skin. What does this indicate?", "choices": [ "Compensated shock", "Normal perfusion", "Spinal cord injury", "Hypothermia" ], "answer": "Compensated shock", "reason": "These signs point to early hypoperfusion, when the body is still maintaining blood pressure.", "subtopic": "Bleeding and Shock", "topic": "Trauma" }, { "question": "A 54-year-old male is complaining of crushing substernal chest pain radiating to his left arm. He is diaphoretic and short of breath. What is the most appropriate initial treatment?", "choices": [ "Administer aspirin and provide oxygen", "Begin CPR immediately", "Apply a cervical collar", "Perform rapid extrication" ], "answer": "Administer aspirin and provide oxygen", "reason": "The presentation suggests an acute coronary syndrome. Aspirin reduces clot formation and oxygen addresses hypoxia, making this the correct initial treatment.", "subtopic": "Cardiac Emergencies", "topic": "Cardiovascular" }, { "question": "A 25-year-old male is found unconscious after a suspected opioid overdose. Respirations are 6/min and shallow. What is the most appropriate first action?", "choices": [ "Insert an OPA and ventilate with a BVM", "Administer naloxone IM", "Apply a non-rebreather mask", "Place the patient in the recovery position" ], "answer": "Insert an OPA and ventilate with a BVM", "reason": "The priority is airway and ventilation. Reversing the opioid is important, but airway support comes first when respirations are inadequate.", "subtopic": "Toxicology", "topic": "Medical Emergencies" }, { "question": "A 3-year-old child presents with inspiratory stridor, a barking cough, and mild fever. What condition is most likely?", "choices": [ "Croup", "Asthma", "Epiglottitis", "Foreign body aspiration" ], "answer": "Croup", "reason": "Croup presents with stridor, a seal-like cough, and is common in toddlers. Epiglottitis typically involves high fever and drooling.", "subtopic": "Pediatrics", "topic": "Special Populations" }, { "question": "A 70-year-old female complains of dizziness and has a heart rate of 38 bpm. Blood pressure is 84/60. What is the best next step?", "choices": [ "Begin transcutaneous pacing", "Administer nitroglycerin", "Have the patient walk to the stretcher", "Apply a cold pack to the neck" ], "answer": "Begin transcutaneous pacing", "reason": "Bradycardia with hypotension and symptoms indicates unstable bradycardia, for which pacing is the treatment of choice.", "subtopic": "Cardiac Emergencies", "topic": "Cardiovascular" }, { "question": "A 19-year-old female has been assaulted and complains of lower abdominal pain with vaginal bleeding. What is your priority?", "choices": [ "Treat for shock and transport", "Question her about the assailant", "Administer oxygen and notify police", "Apply a cervical collar and long board" ], "answer": "Treat for shock and transport", "reason": "Bleeding and trauma may indicate internal injury. Rapid transport and shock management take priority over legal aspects.", "subtopic": "Gynecological", "topic": "Medical Emergencies" }, { "question": "A 34-year-old diabetic patient is confused and combative. Blood glucose reads 35 mg/dL. What is the most appropriate action?", "choices": [ "Administer oral glucose if able", "Apply a cardiac monitor", "Begin cooling measures", "Transport without treatment" ], "answer": "Administer oral glucose if able", "reason": "A glucose of 35 indicates hypoglycemia. If the patient can protect their airway, oral glucose is appropriate.", "subtopic": "Endocrine", "topic": "Medical Emergencies" }, { "question": "You arrive on scene where multiple patients are involved in a building collapse. What is your first action?", "choices": [ "Ensure scene safety", "Start triaging patients", "Call for a second ambulance", "Begin CPR on a pulseless patient" ], "answer": "Ensure scene safety", "reason": "Scene safety always comes first. Entering an unsafe environment risks additional casualties.", "subtopic": "Scene Size-Up", "topic": "Patient Assessment" }, { "question": "A patient involved in a motorcycle crash presents with paradoxical chest wall movement. What is your most immediate concern?", "choices": [ "Flail chest and impaired ventilation", "Spinal cord injury", "Hypovolemia", "Airway obstruction from tongue" ], "answer": "Flail chest and impaired ventilation", "reason": "Paradoxical movement indicates flail chest, which compromises ventilation and requires stabilization and oxygen support.", "subtopic": "Chest Trauma", "topic": "Trauma" }, { "question": "A patient presents with pinpoint pupils, bradypnea, and hypotension. Which medication is most likely involved?", "choices": [ "Heroin", "Cocaine", "Atropine", "Aspirin" ], "answer": "Heroin", "reason": "Heroin and other opioids cause miosis (pinpoint pupils), respiratory depression, and hypotension.", "subtopic": "Toxicology", "topic": "Medical Emergencies" }, { "topic": "Cardiovascular", "question": "What is the primary purpose of administering aspirin to a patient experiencing chest pain?", "choices": [ "To relieve pain", "To reduce inflammation", "To inhibit platelet aggregation", "To dilate the coronary arteries" ], "answer": "To inhibit platelet aggregation", "explanation": "Aspirin inhibits platelet aggregation, which reduces the risk of clot formation in coronary arteries during an acute coronary syndrome." }, { "topic": "Cardiovascular", "question": "What is the contraindication for giving aspirin to a patient with chest pain?", "choices": [ "History of diabetes", "Recent surgery", "Active gastrointestinal bleeding", "Mild hypertension" ], "answer": "Active gastrointestinal bleeding", "explanation": "Aspirin can worsen bleeding, and is contraindicated in patients with active GI bleeding due to its antiplatelet effects." }, { "topic": "Cardiovascular", "question": "What is the typical dose of aspirin given to a patient with suspected acute coronary syndrome?", "choices": [ "81 mg", "324 mg", "500 mg", "650 mg" ], "answer": "324 mg", "explanation": "The usual field dose is 324 mg, administered as four 81 mg baby aspirin tablets chewed by the patient." }, { "topic": "Cardiovascular", "question": "Which of the following is a common side effect of aspirin administration?", "choices": [ "Shortness of breath", "Ringing in the ears", "Seizures", "Numbness" ], "answer": "Ringing in the ears", "explanation": "Tinnitus (ringing in the ears) is a known side effect of salicylates like aspirin, especially in higher doses." }, { "topic": "Cardiovascular", "question": "What is the proper route of administration for aspirin in the prehospital setting?", "choices": [ "Sublingual", "Intravenous", "Oral, chewed", "Intramuscular" ], "answer": "Oral, chewed", "explanation": "Aspirin should be given orally and chewed for faster absorption in the setting of suspected cardiac events." }, { "question": "What is the primary mechanism of action of adenosine in treating supraventricular tachycardia (SVT)?", "choices": [ "Beta-adrenergic blockade", "Inhibition of calcium channels", "Slowing conduction through the AV node", "Prolongation of QT interval" ], "answer": "Slowing conduction through the AV node", "reason": "Adenosine temporarily blocks AV node conduction, which often breaks reentrant tachycardias like SVT." }, { "question": "A 58-year-old with atrial fibrillation suddenly becomes hypotensive with altered mental status. What is the immediate intervention?", "choices": [ "Amiodarone 150 mg IV over 10 minutes", "Synchronized cardioversion", "Administer aspirin", "Defibrillation" ], "answer": "Synchronized cardioversion", "reason": "Unstable atrial fibrillation (hypotension, AMS) requires synchronized cardioversion per ACLS protocol." }, { "question": "Which of the following is a contraindication for nitroglycerin administration in chest pain?", "choices": [ "Tachycardia", "BP 110/70 mmHg", "Use of sildenafil within 24 hours", "History of diabetes" ], "answer": "Use of sildenafil within 24 hours", "reason": "Phosphodiesterase inhibitors combined with nitro can cause life-threatening hypotension." }, { "question": "What is the correct initial dose of ketamine for sedation in a violent patient (IM route)?", "choices": [ "0.1 mg/kg", "1 mg/kg", "4 mg/kg", "10 mg/kg" ], "answer": "4 mg/kg", "reason": "IM ketamine for sedation is commonly dosed at 4 mg/kg for rapid control of agitation." }, { "question": "A patient with CHF is given furosemide. What is the most concerning side effect to monitor for prehospital?", "choices": [ "Tinnitus", "Hypokalemia", "Seizures", "Hyperglycemia" ], "answer": "Hypokalemia", "reason": "Furosemide is a loop diuretic and can cause electrolyte imbalances, particularly hypokalemia." }, { "question": "Which medication is most appropriate to manage a stable patient with ventricular ectopy and a history of myocardial infarction?", "choices": [ "Epinephrine", "Amiodarone", "Atropine", "Lidocaine" ], "answer": "Amiodarone", "reason": "Amiodarone is preferred for ventricular arrhythmias, especially in post-MI patients." }, { "question": "Which of the following best explains the effect of glucagon in beta blocker overdose?", "choices": [ "Increases acetylcholine release", "Enhances insulin sensitivity", "Stimulates cAMP independently of beta receptors", "Blocks calcium influx" ], "answer": "Stimulates cAMP independently of beta receptors", "reason": "Glucagon activates cAMP without using beta-adrenergic receptors, restoring cardiac contractility." }, { "question": "What is the correct prehospital dose of magnesium sulfate for torsades de pointes in an adult patient?", "choices": [ "0.5 g IV over 10 min", "1 g IV push", "2 g IV diluted over 2\u20135 minutes", "4 g IM" ], "answer": "2 g IV diluted over 2\u20135 minutes", "reason": "Magnesium 2 g IV over 2\u20135 minutes is the ACLS-recommended dose for torsades." }, { "question": "Which of the following conditions is most associated with a pulsus paradoxus and muffled heart sounds?", "choices": [ "Tension pneumothorax", "Pulmonary embolism", "Cardiac tamponade", "Aortic dissection" ], "answer": "Cardiac tamponade", "reason": "Tamponade causes fluid compression around the heart, resulting in decreased stroke volume and pulsus paradoxus." }, { "question": "What ECG finding is most indicative of hyperkalemia?", "choices": [ "Peaked T waves", "Shortened PR interval", "U waves", "ST depression" ], "answer": "Peaked T waves", "reason": "Peaked T waves are the earliest and most classic ECG sign of elevated serum potassium." }, { "question": "What is the appropriate dose of epinephrine for adult anaphylaxis via IM route?", "choices": [ "0.3 mg of 1:1,000", "1 mg of 1:10,000", "0.1 mg of 1:1,000", "0.5 mg of 1:10,000" ], "answer": "0.3 mg of 1:1,000", "reason": "The standard adult dose is 0.3 mg IM using a 1:1,000 concentration." }, { "question": "A patient is postictal after a tonic-clonic seizure. What drug should be administered if seizures continue?", "choices": [ "Epinephrine", "Midazolam", "Naloxone", "Diazoxide" ], "answer": "Midazolam", "reason": "Benzodiazepines like midazolam are the treatment of choice for status epilepticus." }, { "question": "Which medication is used to reverse the effects of benzodiazepines?", "choices": [ "Naloxone", "Romazicon (Flumazenil)", "Atropine", "Fomepizole" ], "answer": "Romazicon (Flumazenil)", "reason": "Flumazenil is a benzodiazepine antagonist, used in very selective cases due to seizure risk." }, { "question": "A patient with COPD is given too much oxygen. What complication are you most concerned about?", "choices": [ "Cardiac ischemia", "Seizures", "Hypoventilation due to loss of hypoxic drive", "Hyperthermia" ], "answer": "Hypoventilation due to loss of hypoxic drive", "reason": "COPD patients rely partially on hypoxic respiratory drive; high-flow O\u2082 can reduce their respiratory effort." } ]