A-EMCA Theory Exam — Questions and Answers

Question 1: Which nerve, when compressed during a diabetic emergency, can cause the patient to present with foot drop?

Common peroneal nerve (Correct answer)
Sciatic nerve
Tibial nerve
Femoral nerve

Correct answer: Common peroneal nerve

The common peroneal nerve wraps around the fibular head and is vulnerable to compression, causing foot drop.

Question 2: A 30-year-old hiker presents with confusion, ataxia, and slurred speech after several days in the cold. Core temperature is 30°C (86°F). What dysrhythmia is classically associated with this temperature?

Ventricular fibrillation
Third-degree heart block
Osborn (J) waves on ECG with risk of VF (Correct answer)
Atrial flutter

Correct answer: Osborn (J) waves on ECG with risk of VF

Hypothermia at this level produces Osborn (J) waves on ECG and significantly increases the risk of ventricular fibrillation.

Question 3: What is decompression sickness type 1?

First starts with fever, dry coughing, sneezing, red watery eyes then within a 2 week period dry cough becomes wet and brings up thick stringy mucus
Starts with a fever and then progresses to conjunctivitis , coryza, cough, and koplik spots on the buccal musosa
Obese trunk, Muscle wasting, Moon shaped face, Purple striations on the trunk, Hyperglycemia, skin is thin and Bruises easy
Caused by nitrogen bubbles collecting in the tissues and Causing puritis, Molting skin, and Skeletal muscle or Joint pain (Correct answer)

Correct answer: Caused by nitrogen bubbles collecting in the tissues and Causing puritis, Molting skin, and Skeletal muscle or Joint pain

Type 1 decompression sickness is the milder form, caused by nitrogen bubbles collecting in the skin, lymphatics, and musculoskeletal tissues, producing pruritus (itching), skin mottling/marbling, and joint or muscle pain ('the bends'). It spares vital organs, unlike Type 2 which affects the CNS, lungs, or heart. The wrong options describe Cushing's syndrome, pertussis, and measles.

Question 4: Which maternal position is MOST appropriate during transport of a 36-week patient in preterm labor who is hemodynamically stable?

Left lateral recumbent to relieve aortocaval compression (Correct answer)
Supine with legs elevated to improve cardiac output
Fowler's position at 45 degrees to ease breathing
Right lateral recumbent to facilitate venous return

Correct answer: Left lateral recumbent to relieve aortocaval compression

The left lateral recumbent position prevents the gravid uterus from compressing the inferior vena cava and aorta, optimizing maternal cardiac output and fetal perfusion.

Question 5: How many lumbar vertebrae are there in a human?

brandykinesia, trembling, impaired balance, stiffness in the limbs
glucagon
5ml
5 (Correct answer)

Correct answer: 5

The human lumbar spine has 5 vertebrae (L1-L5), located in the lower back. The other options are a hormone (glucagon), Parkinson's symptoms, and a volume measurement, none of which answer an anatomical count.

Question 6: Which ECG finding is most characteristic of hyperkalemia-induced cardiac toxicity?

Prominent U waves
ST-segment depression in V4-V6
Peaked (tall, narrow) T waves (Correct answer)
Prolonged QT interval

Correct answer: Peaked (tall, narrow) T waves

Hyperkalemia classically causes tall, peaked, narrow T waves as an early sign of cardiac toxicity.

Question 7: A patient in cardiac arrest is wearing a clearly visible medical alert bracelet indicating 'NO CPR.' With no written DNR on scene, the AEMCA should:

Immediately initiate CPR and ignore the bracelet
Contact medical direction while assessing the scene for any written directive (Correct answer)
Honor the bracelet and withhold CPR without any further steps
Ask bystanders to confirm the patient's wishes before acting

Correct answer: Contact medical direction while assessing the scene for any written directive

A medical alert bracelet alone may not constitute a legally valid DNR, so contacting medical direction while searching for written documentation is the safest approach.

Question 8: A patient has ingested an unknown organophosphate pesticide. Which cluster of symptoms is most consistent with organophosphate toxidrome?

Fever, rigidity, altered mental status, and hypertension
Diaphoresis, miosis, bronchospasm, salivation, and bradycardia (Correct answer)
Dry skin, dilated pupils, tachycardia, and urinary retention
Euphoria, miosis, respiratory depression, and bradycardia

Correct answer: Diaphoresis, miosis, bronchospasm, salivation, and bradycardia

Organophosphates cause cholinergic toxidrome (SLUDGE/DUMBELS): salivation, lacrimation, urination, defecation, GI distress, emesis, miosis, bradycardia, and bronchospasm.

Question 9: When performing a jaw-thrust maneuver, what is the primary advantage over the head-tilt chin-lift in trauma patients?

It minimizes cervical spine movement (Correct answer)
It can be performed with one hand
It opens the airway more effectively
It prevents aspiration better

Correct answer: It minimizes cervical spine movement

The jaw-thrust maneuver is preferred in trauma because it opens the airway while minimizing movement of the cervical spine.

Question 10: You are treating a patient involved in a minor motor vehicle collision. A police officer at the scene asks you for the patient's name and a summary of their injuries for the police report. According to the Personal Health Information Protection Act (PHIPA), what is the paramedic's correct course of action?

Ask the officer to wait and obtain the information from the hospital staff later.
Provide the patient's name but withhold any clinical information.
Provide the requested information, as police are partners in emergency services.
Refuse to provide any information unless the patient gives explicit consent or the officer presents a warrant. (Correct answer)

Correct answer: Refuse to provide any information unless the patient gives explicit consent or the officer presents a warrant.

The Personal Health Information Protection Act (PHIPA) in Ontario governs the confidentiality of patient information. [16, 24] Paramedics are health information custodians and cannot disclose personal health information to third parties, including police, without the patient's consent, unless specific legal exceptions are met (such as a warrant or a subpoena). The most appropriate and legally sound action is to protect the patient's privacy by declining to share the information without proper authorization. [10]

Question 11: When staging at a hazmat scene, EMS should position upwind and uphill because:

It ensures faster access to the hot zone
It allows the crew to hear radio communications more clearly
It minimizes exposure to chemical vapors and runoff (Correct answer)
It provides the best view for documentation

Correct answer: It minimizes exposure to chemical vapors and runoff

Positioning upwind and uphill prevents chemical vapors and contaminated runoff from reaching EMS personnel and equipment.

Question 12: After a large-scale disaster, the primary role of the EMS Medical Branch Director within ICS is to:

Personally treat the most critically injured patients
Drive the command vehicle and relay radio traffic
Oversee all medical operations, resources, and personnel coordination within the incident (Correct answer)
Administer medications independently without physician oversight

Correct answer: Oversee all medical operations, resources, and personnel coordination within the incident

The Medical Branch Director coordinates all medical resources and operations within the ICS structure, ensuring organized and effective patient care.

Question 13: A patient with known heart failure presents with severe dyspnea, pink frothy sputum, and SpO2 of 84%. After high-flow oxygen, what is the priority pharmacological intervention?

Metoprolol 5 mg IV
Furosemide IV 40–80 mg (Correct answer)
Amiodarone 150 mg IV over 10 minutes
Adenosine 6 mg rapid IV push

Correct answer: Furosemide IV 40–80 mg

IV furosemide reduces preload by promoting diuresis and venodilation, directly addressing pulmonary edema in acute decompensated heart failure.

Question 14: What is the correct intraosseous (IO) needle placement site for a 2-year-old in cardiac arrest when IV access cannot be obtained?

Distal femur, 3 cm above the lateral condyle
Humeral head, greater tubercle
Iliac crest, posterior superior spine
Proximal tibia, 1–2 cm below the tibial tuberosity on the anteromedial surface (Correct answer)

Correct answer: Proximal tibia, 1–2 cm below the tibial tuberosity on the anteromedial surface

The proximal tibia (1–2 cm below the tibial tuberosity on the anteromedial flat surface) is the preferred first-line IO site in pediatric patients.

Question 15: A patient with sickle cell disease presents with chest pain, fever, and progressive hypoxia. What is the most likely life-threatening complication?

Acute chest syndrome (Correct answer)
Aplastic crisis
Splenic sequestration
Vaso-occlusive pain crisis only

Correct answer: Acute chest syndrome

Acute chest syndrome is a leading cause of death in sickle cell disease, characterized by new pulmonary infiltrates with fever, chest pain, and hypoxia.

Question 16: During assessment of a pulseless patient, the monitor shows organized electrical activity at 80 bpm. What condition must be considered first?

Pulseless electrical activity (PEA) (Correct answer)
Ventricular tachycardia
Asystole
Atrial fibrillation with block

Correct answer: Pulseless electrical activity (PEA)

Organized electrical activity without a palpable pulse defines pulseless electrical activity (PEA), requiring CPR and identification of reversible causes.

Question 17: During a focused assessment of a patient complaining of chest pain, the AEMCA should evaluate for paradoxical chest wall movement, which indicates:

Normal diaphragmatic breathing
Flail chest from multiple rib fractures (Correct answer)
Effective positive pressure ventilation
Mild musculoskeletal chest wall strain

Correct answer: Flail chest from multiple rib fractures

Paradoxical movement (inward motion during inhalation) of a chest wall segment indicates a flail chest caused by multiple consecutive rib fractures.

Question 18: During a scene size-up of an industrial accident, you note a worker with a large open wound to the thigh with arterial spurting. After BSI, what is your immediate priority?

Apply a tourniquet proximal to the wound (Correct answer)
Apply a pressure dressing and monitor
Establish IV access for fluid resuscitation
Immobilize the extremity on a long backboard

Correct answer: Apply a tourniquet proximal to the wound

Arterial hemorrhage from an extremity requires immediate tourniquet application to control life-threatening bleeding before any other intervention.

Question 19: A postictal patient becomes increasingly unresponsive 20 minutes after a witnessed tonic-clonic seizure. What is the most concerning possibility?

Status epilepticus (Correct answer)
Vagal syncope
Normal postictal state
Todd's paralysis

Correct answer: Status epilepticus

Failure to regain consciousness after a seizure raises concern for status epilepticus, which requires immediate intervention.

Question 20: Which electrolyte abnormality is most associated with peaked T-waves and widened QRS complex on ECG?

Hypercalcemia
Hyponatremia
Hyperkalemia (Correct answer)
Hypomagnesemia

Correct answer: Hyperkalemia

Hyperkalemia causes progressive ECG changes including peaked T-waves, prolonged PR interval, widened QRS, and ultimately a sine-wave pattern.

Question 21: Which of the following is the MOST reliable indicator that BVM ventilations are effective?

SpO2 immediately rises to 100%
Chest rise is visible with each breath (Correct answer)
Epigastric sounds are absent
Heart rate improves

Correct answer: Chest rise is visible with each breath

Visible chest rise with each ventilation is the most direct indicator that air is entering the lungs effectively.

Question 22: When assessing a pediatric burn patient, which rule is used to more accurately estimate total body surface area (TBSA) burned in children compared to the Rule of Nines?

Modified Glasgow scale
Lund and Browder chart (Correct answer)
Wallace Rule of Sevens
Parkland formula

Correct answer: Lund and Browder chart

The Lund and Browder chart accounts for age-related differences in body proportions (larger head, smaller legs in children) and is more accurate than the Rule of Nines for estimating pediatric burns.

Question 23: Which mechanism of injury is most associated with aortic transection (traumatic aortic rupture)?

Crush injury to the thorax
Blast overpressure from an explosion
Penetrating trauma directly over the sternum
High-speed deceleration, such as a head-on MVA or fall from height (Correct answer)

Correct answer: High-speed deceleration, such as a head-on MVA or fall from height

Sudden deceleration creates shear forces at the aortic isthmus where the mobile aorta meets the fixed ligamentum arteriosum, causing transection.

Question 24: What is the appropriate initial dose of naloxone for an adult with suspected opioid overdose?

0.4–2 mg IV/IM/IN titrated to effect (Correct answer)
0.01 mg/kg IV push
0.1 mg IV only
5–10 mg IV bolus

Correct answer: 0.4–2 mg IV/IM/IN titrated to effect

Naloxone is given at 0.4–2 mg via IV, IM, or intranasal routes and titrated to restore adequate ventilation without precipitating withdrawal.

Question 25: A 9-month-old is brought in with sudden onset inconsolable crying, drawing up of the legs, and 'currant jelly' stools. What condition is most likely?

Intussusception (Correct answer)
Pyloric stenosis
Hirschsprung's disease
Mesenteric adenitis

Correct answer: Intussusception

Intussusception classically presents in infants with colicky abdominal pain, legs drawn to chest, and late-stage 'currant jelly' stools (blood mixed with mucus).

Question 26: Which fluid resuscitation strategy is currently recommended for hemorrhagic shock in penetrating trauma to prevent worsening coagulopathy?

Colloid-only resuscitation
Aggressive 2-liter crystalloid bolus
No IV fluids until surgical hemorrhage control
Permissive hypotension with limited crystalloid (Correct answer)

Correct answer: Permissive hypotension with limited crystalloid

Permissive hypotension (targeting SBP ~80–90 mmHg) with limited crystalloid minimizes dilutional coagulopathy and clot disruption until surgical control.

Question 27: When must an AEMCA complete a patient care report (PCR) for a call where a patient refused transport?

For every patient contact, regardless of transport outcome (Correct answer)
Only if the patient shows signs of a serious condition
Only when the patient signs a refusal form
Only if law enforcement was present on scene

Correct answer: For every patient contact, regardless of transport outcome

A PCR must be completed for every patient contact, including refusals, as it provides a legal record of assessment, interventions, and the informed refusal process.

Question 28: A patient in 3rd-degree (complete) AV block is hemodynamically unstable with a rate of 30 bpm. What is the correct initial treatment?

Adenosine 6 mg rapid IV push
Synchronized cardioversion at 50 J
Amiodarone 300 mg IV bolus
Transcutaneous pacing (Correct answer)

Correct answer: Transcutaneous pacing

Transcutaneous pacing is the immediate treatment for hemodynamically unstable symptomatic bradycardia including complete heart block.

Question 29: During a mass casualty incident, which triage tag color indicates a patient who is deceased or has injuries incompatible with survival?

Red
Green
Yellow
Black (Correct answer)

Correct answer: Black

Black tags are assigned to patients who are deceased or have injuries so severe that survival is not expected even with medical intervention.

Question 30: A patient is found in cardiac arrest. The first responder has been performing CPR for 8 minutes. The monitor shows fine ventricular fibrillation. What is the MOST appropriate action?

Immediately deliver a defibrillation shock (Correct answer)
Administer epinephrine first, then defibrillate
Administer amiodarone 300 mg before shocking
Continue CPR for 2 more minutes, then defibrillate

Correct answer: Immediately deliver a defibrillation shock

Fine VF is still a shockable rhythm and should be defibrillated immediately; CPR has already been ongoing and a perfusing rhythm may be restored with defibrillation.

Question 31: A 55-year-old female presents with sudden-onset tearing chest pain radiating to the back, unequal blood pressures in both arms, and no ST changes on ECG. What is the most likely diagnosis?

Esophageal rupture (Boerhaave syndrome)
Acute anterior STEMI
Massive pulmonary embolism
Aortic dissection (Correct answer)

Correct answer: Aortic dissection

Tearing chest/back pain with unequal arm blood pressures and a normal ECG is the classic presentation of aortic dissection requiring emergent surgical evaluation.

Question 32: During a field delivery, the amniotic sac has not ruptured and the infant delivers inside the intact membranes ('en caul'). You should:

Puncture and peel away the membranes from the infant's face immediately (Correct answer)
Administer oxygen to the mother to improve fetal oxygenation through the intact sac
Leave the membranes intact and transport to allow hospital delivery
Clamp and cut the membranes as you would the umbilical cord

Correct answer: Puncture and peel away the membranes from the infant's face immediately

An en caul delivery requires the provider to immediately puncture and remove the membranes from the infant's face to allow breathing.

Question 33: Which of the following medications is a known cause of medication-induced hypoglycemia?

DPP-4 inhibitors as monotherapy
SGLT2 inhibitors as monotherapy
Metformin alone at therapeutic doses
Sulfonylureas such as glipizide (Correct answer)

Correct answer: Sulfonylureas such as glipizide

Sulfonylureas stimulate insulin secretion regardless of blood glucose level, making hypoglycemia a significant risk even without excess dosing.

Question 34: You are triaging patients at a mass casualty incident. You encounter an adult victim who is not breathing. After manually opening the patient's airway, they remain apneic. According to the Simple Triage and Rapid Treatment (START) system, what is the correct action?

Re-attempt to open the airway a second time before making a triage decision.
Tag the patient as RED (Immediate), and begin bag-valve-mask ventilations.
Tag the patient as BLACK (Deceased/Expectant) and move to the next patient. (Correct answer)
Tag the patient as YELLOW (Delayed) and place them in the recovery position.

Correct answer: Tag the patient as BLACK (Deceased/Expectant) and move to the next patient.

In the START triage system, an adult patient who does not begin breathing after a single attempt to open their airway is categorized as BLACK (Deceased/Expectant). The goal of MCI triage is to do the most good for the greatest number of people, and resources are not allocated to patients who are apneic after basic airway maneuvers.

Question 35: The pediatric assessment triangle (PAT) evaluates a child's condition using which three components?

Airway, Breathing, Circulation
Appearance, Work of breathing, Circulation to skin (Correct answer)
Alertness, Pulse, Temperature
Activity, Perfusion, Temperature

Correct answer: Appearance, Work of breathing, Circulation to skin

The PAT rapidly evaluates a child by observing Appearance (tone, interactivity, consolability, gaze, speech), Work of Breathing, and Circulation to skin before physical contact.

Question 36: A patient with a crush injury to the lower extremities is extricated after 4 hours. You should be most concerned about which life-threatening complication upon release?

Disseminated intravascular coagulation immediately
Pulmonary embolism from fat emboli
Tension pneumothorax from chest compression
Hyperkalemia and acute renal failure from rhabdomyolysis (Correct answer)

Correct answer: Hyperkalemia and acute renal failure from rhabdomyolysis

Crush syndrome releases myoglobin and potassium from damaged muscle into circulation, causing hyperkalemia and tubular obstruction leading to renal failure.

Question 37: Which of the following is the correct landmark for adult IO (intraosseous) access using the tibial site?

The tibial tuberosity directly
Proximal tibia, 2 cm below the tibial tuberosity on the flat anteromedial surface (Correct answer)
Posterior aspect of the proximal tibia
Lateral aspect of the distal tibia, 2 cm above the medial malleolus

Correct answer: Proximal tibia, 2 cm below the tibial tuberosity on the flat anteromedial surface

The proximal tibia IO site is 2 cm below the tibial tuberosity on the flat anteromedial surface, away from the growth plate.

Question 38: Which type of burn injury is associated with the highest risk of inhalation injury?

Chemical burns from acids
Burns from boiling water
Burns sustained in an enclosed space fire (Correct answer)
Electrical burns from high voltage

Correct answer: Burns sustained in an enclosed space fire

Enclosed space fires concentrate toxic gases and superheated air, dramatically increasing the risk of inhalation injury and carbon monoxide poisoning.

Question 39: A scuba diver surfaces rapidly and complains of joint pain, rash, and dyspnea. What condition should be suspected?

Nitrogen narcosis
Decompression sickness (the bends) (Correct answer)
Pulmonary barotrauma
Arterial gas embolism

Correct answer: Decompression sickness (the bends)

Decompression sickness results from dissolved nitrogen forming bubbles in tissues and blood during rapid ascent, causing joint pain, rash, and respiratory symptoms.

Question 40: During rapid sequence intubation of a trauma patient with a suspected full stomach, which step prevents gastric content aspiration?

Positioning the patient in Trendelenburg before intubation
Sellick's maneuver (cricoid pressure) during induction (Correct answer)
Using a King airway as a first-line device
Administering metoclopramide to speed gastric emptying

Correct answer: Sellick's maneuver (cricoid pressure) during induction

Cricoid pressure compresses the esophagus against the vertebral body to reduce passive regurgitation during RSI in patients at aspiration risk.

Question 41: You are treating a patient found unconscious at an outdoor event on a very hot day. The patient has hot, dry skin, a core temperature of 41°C, and altered mental status. Which of the following actions is the most critical and immediate prehospital treatment for classic heat stroke?

Initiating rapid active cooling measures. (Correct answer)
Administering antipyretics like Acetaminophen.
Placing the patient in the recovery position to protect the airway.
Administering a 500 mL IV fluid bolus of normal saline.

Correct answer: Initiating rapid active cooling measures.

In classic heat stroke, the body's thermoregulatory system has failed, and the core temperature is dangerously high. The single most important intervention is to begin rapid and aggressive cooling immediately to prevent further organ damage. This takes priority over all other interventions, although they may be performed simultaneously. Antipyretics are ineffective as the mechanism of hyperthermia is different from that of a fever.

Question 42: Which oxygen delivery device provides the highest concentration of oxygen for a spontaneously breathing patient?

Simple face mask
Nasal cannula
Venturi mask
Non-rebreather mask (Correct answer)

Correct answer: Non-rebreather mask

A non-rebreather mask with a reservoir bag can deliver 90–95% oxygen when properly fitted and flow rate is adequate.

Question 43: A patient with stable angina reports chest pain that begins with exercise and resolves with rest within 5 minutes. This is BEST described as which type of angina?

Classic (stable) angina (Correct answer)
Microvascular angina
Unstable angina
Prinzmetal's (variant) angina

Correct answer: Classic (stable) angina

Classic stable angina is predictably triggered by exertion or stress and consistently relieved by rest or nitrates within a few minutes.

Question 44: Using the Rule of Nines, what percentage of body surface area (BSA) is affected when an adult has burns to both anterior arms and the entire anterior trunk?

18%
36%
22%
27% (Correct answer)

Correct answer: 27%

Each anterior arm is 4.5%, totaling 9% for both; the anterior trunk is 18%; combined BSA is 27%.

Question 45: A patient with known epilepsy has been seizing continuously for 8 minutes. This condition is classified as:

Absence seizure
Simple partial seizure
Status epilepticus (Correct answer)
Postictal state

Correct answer: Status epilepticus

Status epilepticus is defined as a seizure lasting more than 5 minutes or two or more seizures without regaining consciousness between them.

Question 46: Which presentation is MOST consistent with a patient experiencing neurogenic shock?

Hypotension, bradycardia, warm dry skin (Correct answer)
Hypertension, tachycardia, cold clammy skin
Hypertension, bradycardia, diaphoresis
Hypotension, tachycardia, poor skin turgor

Correct answer: Hypotension, bradycardia, warm dry skin

Neurogenic shock from spinal cord injury presents with hypotension and paradoxical bradycardia with warm, dry skin due to loss of sympathetic tone below the injury.

Question 47: A postpartum patient delivered 20 minutes ago and now has BP of 84/60, HR of 128, and ongoing vaginal bleeding. After uterine massage and oxytocin, bleeding continues. This is BEST described as:

Refractory postpartum hemorrhage requiring ALS-level intervention and rapid transport (Correct answer)
Hypovolemic shock from placenta previa
Secondary postpartum hemorrhage unrelated to uterine atony
Normal lochia rubra within the first hour

Correct answer: Refractory postpartum hemorrhage requiring ALS-level intervention and rapid transport

Persistent hemorrhage with hemodynamic instability despite uterotonic therapy constitutes refractory PPH requiring advanced interventions and immediate transport.

Question 48: Which of the following is a contraindication to the use of succinylcholine during RSI?

Increased intracranial pressure
Burns more than 48–72 hours old or crush injuries with suspected hyperkalemia (Correct answer)
Systolic blood pressure below 90 mmHg
Rapid sequence intubation in less than 8 hours post-injury

Correct answer: Burns more than 48–72 hours old or crush injuries with suspected hyperkalemia

Succinylcholine is contraindicated in burns >48–72 hours old, crush injuries, and denervation injuries because up-regulated acetylcholine receptors can cause fatal hyperkalemia.

Question 49: A 45-year-old diabetic patient is found unresponsive. Blood glucose reads 32 mg/dL. After administering dextrose, the patient does not improve. What should you consider?

Insulin overdose requiring glucagon
Administer more dextrose immediately
The glucometer is inaccurate
Concurrent neurological emergency such as stroke (Correct answer)

Correct answer: Concurrent neurological emergency such as stroke

When hypoglycemia correction does not restore consciousness, a simultaneous neurological emergency such as stroke or head injury must be considered.

Question 50: A competent adult patient with chest pain is refusing transport to the hospital after your assessment and explanation of the risks. Which action is most crucial for the paramedic to complete to mitigate legal and professional risk?

Requesting police assistance to forcibly transport the patient for their own safety.
Thoroughly documenting the patient's capacity, the risks explained, the advice given, and obtaining the patient's signature on a refusal form. (Correct answer)
Contacting a family member to convince the patient to go to the hospital.
Informing the patient that they must find their own way to the hospital.

Correct answer: Thoroughly documenting the patient's capacity, the risks explained, the advice given, and obtaining the patient's signature on a refusal form.

When a competent patient refuses care, comprehensive documentation is the paramedic's most critical responsibility. This documentation serves as a legal record that the paramedic acted appropriately. It must include evidence of the patient's decision-making capacity, a detailed list of the risks of refusal that were explained to the patient, the alternative plans discussed, and the patient's signature acknowledging their decision against medical advice.

Question 51: Which of the following BEST describes the purpose of the initial 'golden minute' in neonatal resuscitation?

Allow the neonate time to transition without intervention before assessing
Perform APGAR scoring and make transport decisions within the first minute
Administer epinephrine and establish IV access within 60 seconds of delivery
Complete initial steps and begin PPV if the neonate is not breathing or HR is below 100 bpm within 60 seconds (Correct answer)

Correct answer: Complete initial steps and begin PPV if the neonate is not breathing or HR is below 100 bpm within 60 seconds

The golden minute emphasizes rapid completion of warming, drying, stimulation, and airway positioning, then beginning PPV promptly if needed.

Question 52: A patient with known alcohol use disorder presents with tremors, diaphoresis, hypertension, and visual hallucinations 48 hours after last drink. What is the priority treatment?

Naltrexone to reduce alcohol cravings
IV thiamine only, no sedatives needed
Haloperidol for hallucinations
Benzodiazepines to prevent seizures and delirium tremens (Correct answer)

Correct answer: Benzodiazepines to prevent seizures and delirium tremens

Benzodiazepines are the cornerstone of alcohol withdrawal management, preventing progression to life-threatening delirium tremens and seizures.

Question 53: You are treating a patient in anaphylactic shock with severe bronchospasm and hypotension. After epinephrine 0.3 mg IM, the patient remains hemodynamically unstable. What is the next appropriate intervention?

Apply CPAP for respiratory support only
Repeat epinephrine IM and establish IV access for fluid bolus (Correct answer)
Administer diphenhydramine IV as first-line rescue
Administer albuterol nebulizer and observe

Correct answer: Repeat epinephrine IM and establish IV access for fluid bolus

If initial epinephrine IM fails, a repeat dose should be given while establishing IV access for fluid resuscitation to counter vasodilation.

Question 54: For a lawsuit alleging negligence against a paramedic to be successful in court, four specific elements must be proven by the plaintiff. Which of the following is NOT one of those four required elements?

There was a breach of the standard of care.
The paramedic acted with malicious intent. (Correct answer)
The paramedic's actions (or inactions) caused harm.
A duty of care existed between the paramedic and the patient.

Correct answer: The paramedic acted with malicious intent.

The four essential elements required to prove negligence in Canadian law are: 1) A duty of care was owed to the patient; 2) There was a breach of that duty (the paramedic failed to act as a reasonable, prudent paramedic would in similar circumstances); 3) Causation (the breach of duty directly caused the harm); and 4) Damages (the patient suffered a recognizable injury or loss). [19, 23] Proving malicious intent is not required for a finding of negligence; an unintentional error that breaches the standard of care and causes harm is sufficient. [23]

Question 55: When performing needle decompression for suspected tension pneumothorax, which landmark is the preferred insertion site?

4th intercostal space, midaxillary line
5th intercostal space, anterior axillary line
2nd intercostal space, midclavicular line (Correct answer)
3rd intercostal space, midsternal line

Correct answer: 2nd intercostal space, midclavicular line

The 2nd intercostal space at the midclavicular line is the standard landmark for needle decompression to avoid neurovascular bundles and major vessels.

Question 56: An AEMCA discovers that a colleague falsified documentation in a patient care report. The AEMCA's ethical and professional obligation is to:

Confront the colleague privately and take no further action
Report the falsification through proper agency channels (Correct answer)
Correct the record personally without reporting the incident
Ignore it to avoid conflict with a coworker

Correct answer: Report the falsification through proper agency channels

Falsified documentation constitutes fraud and endangers patient safety; AEMCAs have a professional and ethical duty to report misconduct through established channels.

Question 57: When administering dopamine at 10-20 mcg/kg/min, the predominant clinical effect is:

Beta-1 stimulation increasing cardiac output
Alpha-adrenergic vasoconstriction (Correct answer)
Dopaminergic receptor stimulation only
Renal vasodilation and diuresis

Correct answer: Alpha-adrenergic vasoconstriction

At high doses (10-20 mcg/kg/min), dopamine predominantly stimulates alpha-1 receptors, causing significant vasoconstriction.

Question 58: Which route of administration provides the most rapid onset of medication action in a prehospital emergency?

Sublingual
Intranasal
Intramuscular
Intravenous (Correct answer)

Correct answer: Intravenous

IV administration delivers medication directly into systemic circulation, providing the fastest onset compared to all other routes.

Question 59: A patient sustained a gunshot wound to the right upper quadrant. On assessment, right shoulder pain is noted without direct shoulder injury. This referred pain is most likely due to:

Diaphragmatic irritation from hepatic bleeding (Correct answer)
Brachial plexus injury from projectile path
Aortic injury causing referred pain
Pneumothorax on the right side

Correct answer: Diaphragmatic irritation from hepatic bleeding

Blood or injury beneath the diaphragm irritates the phrenic nerve (C3-C5), causing referred pain to the ipsilateral shoulder — known as Kehr's sign.

Question 60: Which medication is considered the first-line reversal agent for benzodiazepine overdose?

Flumazenil (Correct answer)
Naloxone
N-acetylcysteine
Physostigmine

Correct answer: Flumazenil

Flumazenil competitively antagonizes GABA-A receptors to reverse benzodiazepine sedation, though it must be used cautiously due to seizure risk.

Question 61: When a patient has ingested a caustic substance (strong acid or base), which prehospital intervention is contraindicated?

Supportive airway management
High-flow supplemental oxygen
Inducing vomiting or gastric lavage (Correct answer)
IV fluid administration for hemodynamic support

Correct answer: Inducing vomiting or gastric lavage

Inducing vomiting after caustic ingestion is contraindicated because it re-exposes the esophagus, oropharynx, and airway to the caustic substance, worsening mucosal injury.

Question 62: What is the recommended target oxygen saturation for a patient with confirmed acute stroke in the prehospital setting?

SpO2 90–92%
SpO2 100% via NRB mask
SpO2 94–99% (Correct answer)
SpO2 > 88%

Correct answer: SpO2 94–99%

Current guidelines recommend maintaining SpO2 at 94–99% in stroke patients to avoid both hypoxia and hyperoxia-related harm.

Question 63: A nasopharyngeal airway (NPA) is contraindicated in which of the following situations?

Patient who is combative
Patient with nasal polyps
Unconscious patient with intact gag reflex
Patient with suspected basal skull fracture (Correct answer)

Correct answer: Patient with suspected basal skull fracture

A suspected basal skull fracture is a contraindication for NPA insertion because it may enter the cranial vault through the fracture.

Question 64: Which anatomical landmark is used to identify the cricothyroid membrane for emergency surgical airway access?

Space between first and second tracheal rings
Space between thyroid and cricoid cartilages (Correct answer)
Space between cricoid and first tracheal ring
Space between thyroid and hyoid cartilages

Correct answer: Space between thyroid and cricoid cartilages

The cricothyroid membrane lies between the thyroid cartilage superiorly and the cricoid cartilage inferiorly.

Question 65: How does cor pulmonale develop in a patient with chronic bronchitis?

The disease leads to chronic high CO2 levels in the blood which trigger pulmonary vasoconstriction which puts extra pressure on the right side of the heart to work (Correct answer)
a) under police authority b) under Dr. authority c) pt in ambulance becomes violent en route
Low V/Q mismatch - decrease in ventilation compared to profusion due to the body trying to compensate by increasing the heart rate and decreasing ventilation
The peritubular capillaries reabsorb minerals from the renal tubule such as glucose, ions, water, amino acids

Correct answer: The disease leads to chronic high CO2 levels in the blood which trigger pulmonary vasoconstriction which puts extra pressure on the right side of the heart to work

In chronic bronchitis, impaired gas exchange causes chronic hypercapnia (high CO2) and hypoxia, which trigger pulmonary vasoconstriction. This raises pulmonary arterial pressure, forcing the right ventricle to work harder and eventually leading to right-sided heart failure (cor pulmonale). The other options describe tubular reabsorption, V/Q mismatch, and exemptions from medical directives.

Question 66: Which of the following is the MOST appropriate initial intervention for a patient in anaphylactic shock?

Albuterol nebulization
IV methylprednisolone 125mg
IV diphenhydramine 50mg
IM epinephrine 0.3mg (1:1,000) (Correct answer)

Correct answer: IM epinephrine 0.3mg (1:1,000)

Intramuscular epinephrine (1:1,000) into the lateral thigh is the first-line treatment for anaphylaxis due to its rapid onset and life-saving effects.

Question 67: In a patient with suspected myasthenic crisis, which test can help differentiate it from cholinergic crisis?

Tensilon (edrophonium) test (Correct answer)
CT chest for thymoma
Nerve conduction velocity study
Serum acetylcholine receptor antibody level

Correct answer: Tensilon (edrophonium) test

The Tensilon test uses edrophonium (an anticholinesterase) — if symptoms improve, it confirms myasthenic crisis; if they worsen, it suggests cholinergic crisis.

Question 68: Which of the following is the MOST common cause of neonatal resuscitation being required at delivery?

Meconium aspiration syndrome
Neonatal sepsis from maternal infection
Failure to breathe adequately at birth requiring ventilatory support (Correct answer)
Congenital cardiac defects

Correct answer: Failure to breathe adequately at birth requiring ventilatory support

The vast majority of neonates requiring resuscitation need only stimulation and/or positive-pressure ventilation to establish effective breathing.

Question 69: A patient at 31 weeks has a gush of clear fluid from the vagina without contractions. Your HIGHEST priority assessment concern is:

Inspect for cord prolapse before providing any treatment (Correct answer)
Check fundal height to estimate gestational age
Administer oxygen and obtain IV access
Determine whether she had intercourse in the last 24 hours

Correct answer: Inspect for cord prolapse before providing any treatment

Premature rupture of membranes with fluid gush requires immediate inspection for umbilical cord prolapse, which is a life-threatening emergency.

Question 70: You are assessing a patient with suspected Acute Coronary Syndrome. Which of the following 12-lead ECG findings is most indicative of a STEMI (ST-Segment Elevation Myocardial Infarction) requiring immediate reperfusion therapy?

ST-segment elevation of 2 mm or more in two contiguous leads (Correct answer)
ST-segment depression in leads V1-V4
Presence of a pathological Q-wave
Peaked T-waves in precordial leads

Correct answer: ST-segment elevation of 2 mm or more in two contiguous leads

The diagnostic criteria for a STEMI on a 12-lead ECG is significant ST-segment elevation in two or more anatomically contiguous leads. This finding indicates a full-thickness myocardial injury and is a critical indicator for activating cardiac catheterization lab protocols for reperfusion.

Question 71: You are managing a 30-year-old patient who is experiencing a prolonged generalized tonic-clonic seizure lasting more than 5 minutes. Which of the following is the first-line medication and preferred route of administration for status epilepticus according to AEMCA protocols, especially when IV access is delayed?

Lorazepam, IV
Phenytoin, IV infusion
Midazolam, IM (Correct answer)
Diazepam, Rectal

Correct answer: Midazolam, IM

For status epilepticus in the prehospital setting, especially when IV access is not yet established or is difficult to obtain during a seizure, Midazolam administered intramuscularly (IM) is the preferred first-line benzodiazepine due to its rapid absorption and ease of administration.

Question 72: The reassessment interval for an unstable critical patient during transport should be performed every:

10 minutes
5 minutes (Correct answer)
15 minutes
30 minutes

Correct answer: 5 minutes

Unstable or critical patients should be reassessed every 5 minutes to detect changes in condition during transport.

Question 73: A neonate is apneic and limp at birth. After drying, warming, and stimulation for 30 seconds, there is still no respiratory effort. What is your next action?

Insert an oropharyngeal airway and provide blow-by oxygen
Administer epinephrine and transport
Begin chest compressions immediately
Begin positive-pressure ventilation with room air (or blended oxygen) (Correct answer)

Correct answer: Begin positive-pressure ventilation with room air (or blended oxygen)

Per NRP guidelines, apnea after initial steps requires immediate positive-pressure ventilation, ideally starting with 21% oxygen (room air) for term neonates.

Question 74: When applying a 12-lead ECG, which limb lead placement error will invert Lead I and reverse aVR and aVL?

Swapping RA and LA electrodes (Correct answer)
Swapping LA and LL electrodes
Swapping LL and RL electrodes
Swapping RA and RL electrodes

Correct answer: Swapping RA and LA electrodes

Swapping the right arm (RA) and left arm (LA) electrodes inverts Lead I and reverses the augmented limb leads aVR and aVL.

Question 75: The AEMCA is ventilating a pediatric patient. How should BVM ventilation differ from adult technique?

Use the same technique but with a smaller mask
Use age-appropriate mask size, lower tidal volumes, and faster rates (Correct answer)
Use faster rates and larger tidal volumes
Squeeze the bag harder to overcome pediatric airway resistance

Correct answer: Use age-appropriate mask size, lower tidal volumes, and faster rates

Pediatric patients require age-appropriate equipment, smaller tidal volumes (visible chest rise), and faster ventilation rates than adults.

Question 76: When operating at a scene involving downed power lines, EMS should:

Stage at a safe distance and wait for the utility company to de-energize the lines (Correct answer)
Approach if the lines appear not to be sparking
Move the power lines with a dry wooden pole before approaching
Drive the ambulance over the lines if they appear slack

Correct answer: Stage at a safe distance and wait for the utility company to de-energize the lines

Only qualified utility personnel can safely de-energize power lines — EMS must stage at a distance and wait for clearance.

Question 77: A 70-year-old male presents with tearing chest pain radiating to the back, unequal blood pressures in both arms, and a widened mediastinum on CXR. The most likely diagnosis is:

Aortic dissection (Correct answer)
STEMI with posterior extension
Cardiac tamponade
Tension pneumothorax

Correct answer: Aortic dissection

Tearing back pain, blood pressure differential between arms, and widened mediastinum are hallmarks of aortic dissection.

Question 78: A patient with a spinal cord injury at C4 requires which immediate intervention?

IV corticosteroids
Spinal immobilization only
Airway management and ventilatory support (Correct answer)
Dopamine infusion for neurogenic shock

Correct answer: Airway management and ventilatory support

C4 injuries can paralyze the diaphragm (phrenic nerve roots C3–C5), making airway and ventilatory support immediately critical.

Question 79: A patient on chronic lithium therapy presents with nausea, tremor, and altered mental status. This presentation is most consistent with:

Neuroleptic malignant syndrome
Lithium toxicity (Correct answer)
Serotonin syndrome
Lithium therapeutic level

Correct answer: Lithium toxicity

Tremor, nausea, and AMS are classic signs of lithium toxicity, which has a narrow therapeutic index and is worsened by dehydration.

Question 80: A 32-year-old woman in status epilepticus has no IV access. The most appropriate route for midazolam administration is:

Rectal diazepam
Intramuscular midazolam (Correct answer)
Sublingual clonazepam
Intranasal lorazepam

Correct answer: Intramuscular midazolam

IM midazolam is the preferred route when IV access is unavailable and has been shown to be as effective as IV lorazepam for status epilepticus.

Question 81: A 55-year-old male is found to be in a perfusing, wide-complex bradycardia with a heart rate of 38 bpm. He is pale, diaphoretic, and has a blood pressure of 80/50 mmHg. According to AEMCA-level protocols, which intervention should be prioritized after establishing IV access and administering oxygen?

Immediate application and initiation of transcutaneous pacing (TCP) (Correct answer)
Administering a 1 mg dose of epinephrine
Preparing for synchronized cardioversion
Administering Atropine 0.5 mg IV

Correct answer: Immediate application and initiation of transcutaneous pacing (TCP)

In a patient with symptomatic, unstable bradycardia, particularly with a wide QRS complex or high-degree AV block, transcutaneous pacing (TCP) is the treatment of choice and should not be delayed. While Atropine may be considered, it is often ineffective in wide-complex bradycardias or high-degree blocks, making TCP the more definitive and immediate treatment.

Question 82: A 3-year-old presents with inspiratory stridor, a barking cough, and low-grade fever. What is the most likely diagnosis?

Bronchiolitis
Croup (laryngotracheobronchitis) (Correct answer)
Epiglottitis
Foreign body aspiration

Correct answer: Croup (laryngotracheobronchitis)

Croup classically presents with a barking seal-like cough, inspiratory stridor, and low-grade fever in children aged 6 months to 3 years.

Question 83: When is a nasal cannula at 6 L/min appropriate?

For a patient requiring controlled low-concentration oxygen
For a patient with mild hypoxia who is breathing adequately (Correct answer)
For any patient requiring supplemental oxygen
For a patient in severe respiratory distress needing maximum FiO2

Correct answer: For a patient with mild hypoxia who is breathing adequately

Nasal cannula at 2–6 L/min is appropriate for patients with mild to moderate hypoxia who are breathing adequately on their own.

Question 84: You are managing a 5-year-old, 18 kg patient in ventricular fibrillation. According to PALS guidelines, what is the appropriate initial energy dose for defibrillation?

72 Joules
18 Joules
100 Joules
36 Joules (Correct answer)

Correct answer: 36 Joules

The current Pediatric Advanced Life Support (PALS) guidelines recommend an initial energy dose for defibrillation of 2 to 4 Joules per kilogram (J/kg). For an 18 kg child, the initial shock should be calculated at 2 J/kg, which equals 36 Joules (18 kg * 2 J/kg). Subsequent shocks can be increased, typically to 4 J/kg or higher.

Question 85: A construction worker fell 30 feet and has paradoxical chest wall movement over the right lateral chest. This finding is consistent with:

Rib contusion
Tension pneumothorax
Open pneumothorax
Flail chest (Correct answer)

Correct answer: Flail chest

Flail chest occurs when three or more adjacent ribs are fractured in two or more places, causing a segment to move paradoxically inward with inhalation.

Question 86: A patient in SVT fails vagal maneuvers. The first-line pharmacological intervention is:

Metoprolol 5 mg IV
Verapamil 5 mg IV slow push
Adenosine 6 mg rapid IV push (Correct answer)
Amiodarone 300 mg IV

Correct answer: Adenosine 6 mg rapid IV push

Adenosine 6 mg given as a rapid IV push is first-line for stable SVT due to its ultra-short half-life and AV node blocking effect.

Question 87: Which of the following is a primary indication for the administration of dimenhydrinate according to Ontario paramedic standards?

Management of acute anxiety or panic attacks.
Reversal of extrapyramidal symptoms caused by antipsychotics.
Prophylaxis against motion sickness during air transport.
Treatment of nausea and vomiting associated with vertigo. (Correct answer)

Correct answer: Treatment of nausea and vomiting associated with vertigo.

In the prehospital setting under Ontario's ALS PCS, a primary indication for administering dimenhydrinate is for the management of nausea and vomiting, particularly when associated with vertigo or vestibular disturbances. While it can be used for other causes of nausea, its anticholinergic and antihistamine properties are especially effective for these conditions. The other options describe indications for different medications (benzodiazepines or diphenhydramine).

Question 88: A patient develops a wide-complex tachycardia at 220 bpm with a pulse and is becoming confused and hypotensive. What is the correct intervention?

Synchronized cardioversion starting at 100 J (Correct answer)
Adenosine 12 mg rapid IV push
Amiodarone 150 mg IV over 10 minutes
Unsynchronized defibrillation at 200 J

Correct answer: Synchronized cardioversion starting at 100 J

Unstable wide-complex tachycardia with a pulse requires immediate synchronized cardioversion; the synchronized mode prevents shock delivery during the vulnerable T-wave period.

Question 89: You are called to a 24-year-old found unresponsive in a public washroom. The patient has a respiratory rate of 4 breaths per minute, pinpoint pupils, and central cyanosis. What is the most important initial intervention after ensuring the airway is open?

Perform a 12-lead ECG to rule out a cardiac cause.
Administer Naloxone via the intranasal or intramuscular route. (Correct answer)
Establish IV access for fluid resuscitation.
Apply high-flow oxygen via a non-rebreather mask.

Correct answer: Administer Naloxone via the intranasal or intramuscular route.

The clinical presentation is classic for an opioid overdose causing severe respiratory depression. The most critical and definitive initial intervention is to reverse the effects of the opioids by administering Naloxone. While airway and ventilation support are crucial and should be done concurrently, Naloxone is the specific antidote that addresses the root cause of respiratory failure.

Question 90: Which medication is contraindicated in patients with suspected cocaine-induced chest pain and hypertension?

Propranolol (Correct answer)
Lorazepam
Aspirin
Nitroglycerin

Correct answer: Propranolol

Non-selective beta-blockers like propranolol cause unopposed alpha-adrenergic stimulation, worsening coronary vasospasm in cocaine toxicity.

Question 91: When should CPR be withheld in a hypothermic cardiac arrest patient in the prehospital setting?

Patient appears frozen with no signs of life
Asystole on the monitor
Core temperature below 30°C
Obvious lethal injury or the chest wall is non-compressible (frozen solid) (Correct answer)

Correct answer: Obvious lethal injury or the chest wall is non-compressible (frozen solid)

CPR should be withheld only when an obvious lethal injury is present or the chest wall cannot be compressed due to freezing.

Question 92: During transcutaneous pacing for symptomatic bradycardia, how do you confirm mechanical capture?

Palpate a pulse corresponding to the paced rate (Correct answer)
Observe a pacer spike on the ECG for each impulse
Note an increase in the patient's heart rate on the monitor
Confirm that the patient reports chest discomfort

Correct answer: Palpate a pulse corresponding to the paced rate

Mechanical capture is confirmed by palpating a pulse that corresponds to the set pacing rate, distinguishing true capture from electrical artifact.

Question 93: When assessing a patient's pupils during the neurological examination, anisocoria refers to:

Unequal pupil sizes (Correct answer)
Both pupils fixed and dilated
Pupils that are reactive but sluggish
Both pupils constricted to pinpoints

Correct answer: Unequal pupil sizes

Anisocoria is the term for unequal pupil sizes, which may indicate a unilateral intracranial lesion or herniation in a trauma patient.

Question 94: A patient with penetrating chest trauma has a sucking chest wound. After sealing it with a vented chest seal, the patient deteriorates with worsening hypotension and absent breath sounds on the same side. What should you do next?

Add a second vented seal over the first
Perform immediate needle decompression on the opposite side
Increase IV fluid rate and transport rapidly
Burp or remove the seal to release trapped air (Correct answer)

Correct answer: Burp or remove the seal to release trapped air

Deterioration after sealing a sucking chest wound suggests developing tension pneumothorax; burping or removing the seal allows trapped air to escape.

Question 95: Beck's triad, a collection of signs associated with acute cardiac tamponade, consists of which of the following?

Hypertension, bradycardia, and irregular respirations.
Unilateral chest rise, tracheal deviation, and subcutaneous emphysema.
Paradoxical chest movement, dyspnea, and localized pain.
Hypotension, jugular venous distention, and muffled heart sounds. (Correct answer)

Correct answer: Hypotension, jugular venous distention, and muffled heart sounds.

Beck's triad is the classic set of signs for cardiac tamponade. It includes: 1) Hypotension due to decreased cardiac output from the compressed heart, 2) Jugular venous distention (JVD) from blood backing up into the venous system, and 3) Muffled heart sounds due to the insulating effect of the fluid in the pericardial sac. The other answer choices describe Cushing's triad (head injury), signs of a tension pneumothorax, and signs of a flail chest, respectively.

Question 96: A patient on a beta-blocker overdose is in cardiogenic shock. After atropine fails, which medication is most appropriate?

Glucagon IV bolus (Correct answer)
Epinephrine 1:1000 IM
Dopamine 2 mcg/kg/min
Adenosine 6 mg IV push

Correct answer: Glucagon IV bolus

Glucagon bypasses beta receptors and directly stimulates adenylyl cyclase, increasing heart rate and contractility independent of adrenergic pathways.

Question 97: A patient presents with sudden severe headache described as 'the worst of my life,' neck stiffness, and photophobia. What should the AEMCA suspect?

Tension headache
Hypertensive urgency
Migraine with aura
Subarachnoid hemorrhage (Correct answer)

Correct answer: Subarachnoid hemorrhage

A sudden 'thunderclap' headache with meningeal signs strongly suggests subarachnoid hemorrhage, a life-threatening emergency.

Question 98: Which of the following best describes the purpose of the scene size-up in patient assessment?

Obtain the patient's medical history
Identify hazards, determine mechanism of injury, and estimate number of patients (Correct answer)
Administer initial treatment for life threats
Perform a head-to-toe physical examination

Correct answer: Identify hazards, determine mechanism of injury, and estimate number of patients

The scene size-up establishes scene safety, identifies the mechanism of injury or nature of illness, and determines how many patients require care.

Question 99: Which finding on pupil assessment is most consistent with herniation syndrome in a head-injured patient?

Unilateral dilated and fixed pupil (Correct answer)
Bilateral pinpoint pupils
Bilateral dilated reactive pupils
Anisocoria with equal reactivity

Correct answer: Unilateral dilated and fixed pupil

A unilateral dilated and fixed (blown) pupil indicates uncal herniation compressing cranial nerve III and is a neurosurgical emergency.

Question 100: The therapeutic effect of morphine sulfate in acute pulmonary edema is primarily due to:

Venodilation reducing preload and anxiolysis (Correct answer)
Diuresis through renal prostaglandin release
Bronchodilation and airway clearance
Positive inotropic effect on the heart

Correct answer: Venodilation reducing preload and anxiolysis

Morphine reduces venous return (preload) through venodilation and decreases the patient's anxiety-driven sympathetic drive.

Question 101: You are treating a 25-year-old who fell from a significant height and is complaining of paralysis below the waist. His blood pressure is 80/50 mmHg, heart rate is 58 bpm, and his skin below the chest is warm and dry. Which type of shock is most consistent with this presentation?

Cardiogenic Shock
Septic Shock
Neurogenic Shock (Correct answer)
Hypovolemic Shock

Correct answer: Neurogenic Shock

This patient's presentation is classic for neurogenic shock, a form of distributive shock. The spinal cord injury disrupts sympathetic nervous system signals, leading to widespread vasodilation and a loss of sympathetic tone to the heart. This results in hypotension combined with a normal or slow heart rate (bradycardia) and warm, dry skin below the level of the injury, contrasting with the cool, clammy skin seen in hypovolemic shock.

Question 102: In thyroid storm, which of the following is the CORRECT order of medication administration?

Iodine → PTU → beta-blocker → steroids
Beta-blocker → steroids → PTU → iodine
PTU → beta-blocker → iodine → steroids (Correct answer)
Steroids → iodine → beta-blocker → PTU

Correct answer: PTU → beta-blocker → iodine → steroids

PTU must be given before iodine to block new thyroid hormone synthesis before iodine is administered, which would otherwise fuel more hormone production.

Question 103: A patient has frostbite to all toes. The toes are white, waxy, and insensate. What is the correct prehospital management?

Rub the toes vigorously to restore circulation
Rewarm immediately in warm water in the field
Protect from further freezing and do not rewarm if risk of refreezing exists (Correct answer)
Apply ice to reduce swelling

Correct answer: Protect from further freezing and do not rewarm if risk of refreezing exists

Refreezing after thawing causes severe additional injury; prehospital providers should protect frostbitten areas and delay rewarming until a controlled environment is available.

Question 104: A trauma patient has a SpO2 of 88% on 15 L/min non-rebreather mask. Breath sounds are absent on the left. The MOST likely diagnosis is:

Hemothorax requiring fluid resuscitation
Pulmonary contusion requiring CPAP
Left tension pneumothorax (Correct answer)
Left mainstem bronchus intubation

Correct answer: Left tension pneumothorax

Absent unilateral breath sounds with hypoxia despite high-flow oxygen in a trauma patient strongly suggests tension pneumothorax requiring needle decompression.

Question 105: When applying a windlass tourniquet to a bleeding extremity, how should you document the application?

Write the time of application directly on the tourniquet and on the patient's forehead in marker (Correct answer)
Apply a second tourniquet as a timer reference
Record only in the patient care report at the hospital
Note the time in a verbal report to receiving staff only

Correct answer: Write the time of application directly on the tourniquet and on the patient's forehead in marker

Tourniquet time must be written on the device and visible on the patient so all providers, including surgeons, can calculate total ischemia time.

Question 106: When using the Cincinnati Prehospital Stroke Scale, which THREE components are assessed?

Blood pressure, heart rate, and GCS
Pupil response, grip strength, and gait
Facial droop, arm drift, and speech (Correct answer)
Visual fields, reflexes, and coordination

Correct answer: Facial droop, arm drift, and speech

The Cincinnati Prehospital Stroke Scale evaluates facial droop, arm drift, and abnormal speech to rapidly identify stroke in the field.

Question 107: A patient in a lightning strike has cardiopulmonary arrest. In a mass casualty scenario involving multiple lightning strike victims, who is prioritized for CPR?

Patients in cardiopulmonary arrest (reverse triage) (Correct answer)
Oldest patients first
Patients with the most burns
Patients who are breathing and conscious

Correct answer: Patients in cardiopulmonary arrest (reverse triage)

Lightning strike victims in cardiac arrest have a high survival rate with CPR; reverse triage prioritizes the apparently dead because they are salvageable.

Question 108: A patient is breathing at a rate of 6 breaths per minute with shallow tidal volume. How should the AEMCA manage this?

Place the patient in recovery position
Apply high-flow oxygen via non-rebreather mask
Begin positive pressure ventilation with BVM (Correct answer)
Administer a bronchodilator

Correct answer: Begin positive pressure ventilation with BVM

A respiratory rate of 6 breaths per minute with inadequate tidal volume constitutes respiratory failure requiring assisted ventilation with a BVM.

Question 109: What is the correct ventilation rate for an adult patient who has a pulse but is apneic?

16–20 breaths per minute
20–24 breaths per minute
10–12 breaths per minute (Correct answer)
8–10 breaths per minute

Correct answer: 10–12 breaths per minute

Current guidelines recommend 10–12 breaths per minute (one breath every 5–6 seconds) for an adult with a pulse but no respirations.

Question 110: Which prehospital intervention is most important for a patient with a suspected large ischemic stroke and last known well time of 1 hour?

Administer aspirin 324 mg PO
Rapid transport to a stroke center with pre-notification (Correct answer)
Establish two large-bore IVs and bolus 1 L NS
Apply supplemental oxygen regardless of SpO2

Correct answer: Rapid transport to a stroke center with pre-notification

Rapid transport with advance notification to a stroke center minimizes door-to-needle time for tPA or endovascular intervention.

Question 111: A patient's blood pressure is 220/120 mmHg after an ischemic stroke. In the prehospital setting, what is the correct approach?

Administer labetalol 20 mg IV immediately
Give sublingual nitroglycerin
Aggressively lower BP to below 140 systolic
Do not treat unless BP exceeds 220/120 or patient is symptomatic beyond stroke (Correct answer)

Correct answer: Do not treat unless BP exceeds 220/120 or patient is symptomatic beyond stroke

In ischemic stroke, permissive hypertension maintains cerebral perfusion; prehospital providers should generally avoid lowering BP unless directed by medical control.

Question 112: Epinephrine 1 mg IV/IO is administered during cardiac arrest. How frequently should this dose be repeated?

Every 5–10 minutes
Every 2 minutes
Every 3–5 minutes (Correct answer)
Only once during the arrest

Correct answer: Every 3–5 minutes

AHA ACLS guidelines recommend 1 mg epinephrine IV/IO every 3–5 minutes during cardiac arrest.

Question 113: A patient on dialysis presents with peaked T-waves on ECG and blood pressure of 80/50. Which intervention should be considered FIRST?

Furosemide IV bolus
Calcium gluconate IV (Correct answer)
Sodium bicarbonate IV push
Potassium-binding resin (Kayexalate)

Correct answer: Calcium gluconate IV

Calcium gluconate IV is the first intervention in severe hyperkalemia as it immediately stabilizes the cardiac membrane, buying time for potassium-lowering measures.

Question 114: A patient presents with one-sided weakness, facial droop, and slurred speech that resolved completely within 30 minutes. What is this event called?

Transient ischemic attack (TIA) (Correct answer)
Hemiplegic migraine
Todd's paralysis
Completed stroke

Correct answer: Transient ischemic attack (TIA)

A TIA involves focal neurological deficits that resolve within 24 hours (often minutes) and is a major warning sign of imminent stroke.

Question 115: A patient with an acute MI develops new-onset atrial fibrillation with rapid ventricular response at 140 bpm and is hemodynamically stable. Which is the BEST initial management?

Rate control with a beta-blocker or calcium channel blocker IV (Correct answer)
Adenosine 6 mg rapid IV push
Immediate unsynchronized defibrillation at 200 J
Synchronized cardioversion at 200 J

Correct answer: Rate control with a beta-blocker or calcium channel blocker IV

In stable AF with rapid ventricular response, the priority is rate control using IV beta-blockers (metoprolol) or non-dihydropyridine calcium channel blockers (diltiazem).

Question 116: An AEMCA documents in the patient care report that a patient was 'intoxicated and uncooperative' without objective clinical findings. This documentation could create liability for:

Defamation (Correct answer)
False imprisonment
Negligence
Battery

Correct answer: Defamation

Documenting subjective characterizations without clinical basis can constitute defamation if the statements damage the patient's reputation.

Question 117: A 58-year-old presents with intermittent palpitations. The rhythm strip shows a regular narrow-complex tachycardia at 160 bpm with no visible P waves. Which vagal maneuver should be attempted first?

Eyeball pressure
Carotid sinus massage
Valsalva maneuver (Correct answer)
Ice-water facial immersion

Correct answer: Valsalva maneuver

The Valsalva maneuver is the first-line vagal technique for stable SVT; it is safe, non-invasive, and has a reasonable conversion rate.

Question 118: A patient in asystole undergoes CPR. Which medications are indicated per ACLS protocol? (Select the correct combination)

Amiodarone 300 mg + epinephrine 1 mg
Vasopressin 40 units + lidocaine 1.5 mg/kg
Atropine 1 mg + epinephrine 1 mg
Epinephrine 1 mg only (Correct answer)

Correct answer: Epinephrine 1 mg only

Current ACLS guidelines removed atropine from the asystole/PEA algorithm; only epinephrine 1 mg IV every 3–5 minutes is recommended.

Question 119: A patient is having an acute asthma attack unresponsive to two albuterol treatments. Which additional medication is most appropriate for the AEMCA to administer?

Magnesium sulfate 2 g IV over 20 minutes (Correct answer)
Furosemide 40 mg IV
Diphenhydramine 50 mg IV
Calcium gluconate 1 g IV

Correct answer: Magnesium sulfate 2 g IV over 20 minutes

Magnesium sulfate acts as a bronchodilator by blocking calcium in smooth muscle and is indicated for severe asthma refractory to bronchodilator therapy.

Question 120: Which cranial nerve is responsible for the gag reflex's afferent limb?

CN VII (Facial)
CN XII (Hypoglossal)
CN X (Vagus)
CN IX (Glossopharyngeal) (Correct answer)

Correct answer: CN IX (Glossopharyngeal)

CN IX (glossopharyngeal) carries the afferent signals from the posterior pharynx that trigger the gag reflex.

Question 121: You are treating a 75-year-old female with a history of congestive heart failure (CHF) who presents with severe dyspnea, crackles in all lung fields, and pitting edema in her lower extremities. Which of the following prehospital interventions is most appropriate for managing her acute pulmonary edema?

Administering nitroglycerin and applying Continuous Positive Airway Pressure (CPAP) (Correct answer)
Preparing for immediate defibrillation
Administering a 500 mL normal saline fluid bolus
Placing the patient in a supine position

Correct answer: Administering nitroglycerin and applying Continuous Positive Airway Pressure (CPAP)

For a patient with acute cardiogenic pulmonary edema secondary to CHF, the treatment goals are to reduce preload and afterload and improve oxygenation. Nitroglycerin is a vasodilator that reduces preload, and CPAP provides continuous pressure to keep alveoli open, improving gas exchange by pushing fluid out of the alveolar space.

Question 122: Which antidysrhythmic is the FIRST-LINE drug for ventricular fibrillation refractory to defibrillation?

Amiodarone 300 mg IV bolus (Correct answer)
Magnesium sulfate 2 g IV
Procainamide 20 mg/min IV
Lidocaine 1.5 mg/kg IV

Correct answer: Amiodarone 300 mg IV bolus

Current AHA guidelines recommend amiodarone 300 mg IV as first-line antidysrhythmic for shock-refractory VF/pulseless VT.

Question 123: Nitrogen narcosis: what is it?

It is a short term beta 2 receptor agonist bronchi to expand in diameter thereby increasing lumen size
Used to treat hypertension, arrhythmia's, angina, CHF, glaucoma
Occurs when new bone replaces old bone and with the use of gravity and deposits of calcium salts
Caused by breathing in compressed nitrogen which is toxic to the CNS and causes confusion, slow motor, response, and euphoria (Correct answer)

Correct answer: Caused by breathing in compressed nitrogen which is toxic to the CNS and causes confusion, slow motor, response, and euphoria

Nitrogen narcosis is caused by breathing compressed nitrogen at depth, where the raised partial pressure has a toxic, anaesthetic effect on the central nervous system, producing confusion, slowed motor response, and euphoria. The other options describe drug uses, bone remodelling, and a beta-2 bronchodilator — none of which relate to the effect of compressed nitrogen on the CNS.

Question 124: A 30-year-old male has a gunshot wound to the thigh with significant hemorrhage. He is anxious and confused, with a heart rate of 135 bpm, a respiratory rate of 34, and a blood pressure of 88/60 mmHg. Based on these findings, which class of hemorrhagic shock is he most likely in?

Class III (Correct answer)
Class I
Class II
Class IV

Correct answer: Class III

Class III hemorrhagic shock is characterized by a blood volume loss of 30-40% (1500-2000 mL). This stage marks the transition to decompensated shock, where the body's compensatory mechanisms fail. Key signs include a heart rate over 120 bpm, respiratory rate of 30-40, a significant drop in systolic blood pressure, and altered mental status such as confusion or anxiety. The patient's vitals and presentation align perfectly with this classification.

Question 125: Which three stages make up trauma care?

Package the proteins up and sends them to the correct locations in the cell
Throbbing headache with N/V, sensitivity to light or sound, the headache is usually worse on one side
Heart rate, Blood pressure. Breathing and controls vomiting's
1. Per incident <br> 2. Incident <br> 3. Post Incident (Correct answer)

Correct answer: 1. Per incident <br> 2. Incident <br> 3. Post Incident

Trauma care is organized around the timing of the event: pre-incident (preparation and prevention), incident (the actual response and care delivered), and post-incident (recovery, transport, and follow-up). This logical before/during/after progression structures the entire care continuum. The other options describe cellular processes, brainstem functions, and migraine symptoms.

Question 126: You are managing a patient following a traumatic injury and suspect a cervical spine injury. The patient is unconscious and requires airway management. Which manual maneuver is most appropriate for opening the airway in this patient?

Flexion of the neck
Head-tilt, chin-lift
Jaw-thrust maneuver (Correct answer)
Head-tilt, neck-lift

Correct answer: Jaw-thrust maneuver

In a patient with a suspected cervical spine injury, the jaw-thrust maneuver is the recommended technique for opening the airway. This method avoids extending or flexing the neck, minimizing the risk of exacerbating a potential spinal cord injury. The head-tilt, chin-lift is contraindicated in this scenario.

Question 127: A patient is found unresponsive after a high-speed MVA. During your rapid trauma assessment you note distended neck veins, absent breath sounds on the left, and hypotension. Which condition does this triad most suggest?

Cardiac tamponade
Pulmonary contusion
Tension pneumothorax (Correct answer)
Massive hemothorax

Correct answer: Tension pneumothorax

Tension pneumothorax classically presents with absent breath sounds on the affected side, jugular venous distension, hypotension, and tracheal deviation.

Question 128: START triage designates a patient as 'immediate' (red) if:

Respirations are absent after repositioning the airway
The patient can walk to a designated area
The patient is unconscious and unresponsive
Respirations are present but greater than 30/min, or capillary refill is greater than 2 seconds, or unable to follow commands (Correct answer)

Correct answer: Respirations are present but greater than 30/min, or capillary refill is greater than 2 seconds, or unable to follow commands

START triage uses respirations >30/min, capillary refill >2 seconds, or inability to follow simple commands to classify patients as immediate (red).

Question 129: Which finding best differentiates a seizure from syncope in a prehospital patient?

Postictal confusion lasting several minutes (Correct answer)
Pallor and diaphoresis
Brief clonic jerking at syncopal onset
Loss of consciousness

Correct answer: Postictal confusion lasting several minutes

A postictal state with prolonged confusion is characteristic of seizure and does not occur after a simple syncopal episode.

Question 130: A patient presents with a suspected opioid overdose: unresponsive, pinpoint pupils, respiratory rate of 4/min. What is the correct naloxone dose for an adult?

2 mg IV once only
0.4–2 mg IV/IM/IN, titrated to restore adequate breathing (Correct answer)
0.1 mg/kg IV every 5 minutes
10 mg IV push

Correct answer: 0.4–2 mg IV/IM/IN, titrated to restore adequate breathing

Naloxone is titrated at 0.4–2 mg IV/IM/IN to restore spontaneous respirations without precipitating acute withdrawal; repeat as needed based on response.

Question 131: A patient's skin color, mental status, and SpO2 are all worsening despite BVM ventilations through an LMA. What should the AEMCA suspect?

Oxygen tank is nearly empty
The patient needs a faster ventilation rate only
The LMA cuff has been over-inflated
Improper LMA placement or inadequate seal (Correct answer)

Correct answer: Improper LMA placement or inadequate seal

Worsening despite LMA ventilation most commonly results from malposition or inadequate seal, requiring repositioning or a more definitive airway.

Question 132: A patient stung by multiple bees rapidly develops urticaria, stridor, and hypotension. After administering epinephrine IM, what additional treatment is indicated?

Oral diphenhydramine only
Nebulized albuterol only
IV fluid bolus, antihistamines, and corticosteroids (Correct answer)
Observation without further treatment

Correct answer: IV fluid bolus, antihistamines, and corticosteroids

Anaphylaxis management after epinephrine includes IV fluids for shock, diphenhydramine for urticaria, and corticosteroids to prevent biphasic reactions.

Question 133: A neonate delivered at term has central cyanosis but is vigorous with a strong cry and HR of 130 bpm at 3 minutes of life. Your BEST action is:

No intervention; central cyanosis is normal at 3 minutes
Provide supplemental oxygen and reassess; SpO2 targets guide oxygen titration (Correct answer)
Begin chest compressions due to cyanosis
Begin positive-pressure ventilation immediately

Correct answer: Provide supplemental oxygen and reassess; SpO2 targets guide oxygen titration

Central cyanosis persisting beyond the first minutes with a vigorous neonate warrants supplemental oxygen titrated to NRP SpO2 targets (60–65% at 1 min, rising to 85–95% by 10 min).

Question 134: Which landmark is used to confirm proper endotracheal tube depth in an average adult male?

22 cm mark at the lip for males (Correct answer)
25 cm mark at the lips for all adults
Cuff should be at vocal cord level
Tube tip at 18 cm at the teeth

Correct answer: 22 cm mark at the lip for males

For average adult males, the ETT is positioned at approximately 22–23 cm at the lip to place the tube tip mid-trachea.

Question 135: Which of the following is the hallmark of distributive shock that distinguishes it from other shock types?

Normal or elevated cardiac output with decreased SVR (Correct answer)
Decreased preload with elevated heart rate
Elevated CVP with pulmonary congestion
Decreased cardiac output with elevated SVR

Correct answer: Normal or elevated cardiac output with decreased SVR

Distributive shock (septic, anaphylactic, neurogenic) is characterized by profound vasodilation with decreased SVR and typically a compensatory elevated cardiac output.

Question 136: You are caring for a neonate born with meconium-stained amniotic fluid who is vigorous, crying, and has good muscle tone. Your management should be:

Administer blow-by oxygen and transport without further intervention
Routine care; do not routinely suction the airway (Correct answer)
Bulb suction the oropharynx before delivering the shoulders
Immediate endotracheal intubation for tracheal suctioning

Correct answer: Routine care; do not routinely suction the airway

Current NRP guidelines state that routine intubation for tracheal suctioning is NOT recommended for vigorous meconium-stained neonates; provide routine care.

Question 137: During suction of an intubated patient, how long should each suction pass last?

5 seconds maximum
No more than 10–15 seconds (Correct answer)
As long as needed to clear secretions
Up to 30 seconds

Correct answer: No more than 10–15 seconds

Suction passes should be limited to 10–15 seconds to prevent hypoxia and atelectasis from removing oxygen along with secretions.

Question 138: Which assessment finding best differentiates cardiogenic shock from hypovolemic shock in a trauma patient?

Altered mental status with hypotension
Jugular venous distension with pulmonary edema (Correct answer)
Tachycardia with narrow pulse pressure
Flat neck veins with cool, clammy skin

Correct answer: Jugular venous distension with pulmonary edema

Cardiogenic shock causes fluid backup, presenting with JVD and pulmonary edema, while hypovolemic shock presents with flat neck veins and no pulmonary edema.

Question 139: Which finding differentiates hypertensive emergency from hypertensive urgency?

Symptomatic complaints such as headache
Patient's age and comorbidities
Presence of end-organ damage (Correct answer)
Blood pressure greater than 180/120 mmHg

Correct answer: Presence of end-organ damage

Hypertensive emergency is defined by evidence of acute end-organ damage (stroke, MI, renal failure, retinopathy) regardless of the exact blood pressure value.

Question 140: In the context of trauma, what does the 'lethal triad' refer to?

Hypovolemia, hypoxia, and hypoglycemia
Hypothermia, acidosis, and coagulopathy (Correct answer)
Hemorrhage, airway obstruction, and tension pneumothorax
Hypotension, tachycardia, and altered mental status

Correct answer: Hypothermia, acidosis, and coagulopathy

The lethal triad of hypothermia, acidosis, and coagulopathy is a self-reinforcing cycle that dramatically increases mortality in trauma patients.

Question 141: A 10-month-old presents with a 3-day history of vomiting and diarrhea. Signs include sunken fontanelle, dry mucous membranes, absent tears, and capillary refill of 4 seconds. What level of dehydration does this represent?

Mild (5% body weight loss)
Severe (>10% body weight loss) (Correct answer)
Moderate (5–10% body weight loss)
No significant dehydration

Correct answer: Severe (>10% body weight loss)

Severe dehydration (>10% body weight loss) presents with multiple systemic signs including prolonged capillary refill, sunken fontanelle, and hemodynamic compromise.

Question 142: Which benzodiazepine reversal agent should be used cautiously in patients with a history of seizure disorders?

N-acetylcysteine
Physostigmine
Flumazenil (Correct answer)
Naloxone

Correct answer: Flumazenil

Flumazenil can precipitate seizures in benzodiazepine-dependent patients by rapidly reversing CNS depression.

Question 143: A cyclist struck by a car has a closed femur fracture. Approximately how much blood can be lost into the thigh from this injury?

Up to 1,500 mL (Correct answer)
Up to 3,000 mL
Up to 300 mL
Up to 500 mL

Correct answer: Up to 1,500 mL

A closed femur fracture can conceal up to 1,000–1,500 mL of blood within the thigh compartment, contributing significantly to hypovolemic shock.

Question 144: A 70 kg patient in cardiogenic shock requires a dopamine infusion at 5 mcg/kg/min. You have dopamine 400 mg in 250 mL NS. What is the infusion rate in mL/hr?

26.3 mL/hr
10.5 mL/hr
21.0 mL/hr
13.1 mL/hr (Correct answer)

Correct answer: 13.1 mL/hr

Concentration = 400 mg/250 mL = 1600 mcg/mL; dose = 5 mcg/kg/min × 70 kg = 350 mcg/min = 21,000 mcg/hr; rate = 21,000/1600 ≈ 13.1 mL/hr.

Question 145: A patient rescued from a house fire presents with hot, dry skin; temperature 41°C (106°F); altered mental status; and no sweating. What condition is this?

Classic heat stroke (Correct answer)
Heat cramps
Exertional heat stroke
Heat exhaustion

Correct answer: Classic heat stroke

Classic heat stroke is characterized by hyperthermia >40°C, anhidrosis, and CNS dysfunction, typically in elderly or sedentary individuals.

Question 146: Which condition causes pulsus paradoxus — an exaggerated drop in systolic BP >10 mmHg during inspiration?

Mitral valve prolapse
Cardiac tamponade (Correct answer)
Hypertrophic cardiomyopathy
Aortic stenosis

Correct answer: Cardiac tamponade

Cardiac tamponade causes pulsus paradoxus because pericardial fluid restricts ventricular filling, and inspiration-related changes in intrathoracic pressure exaggerate this effect.

Question 147: A 3-year-old child presents in respiratory arrest. Which BVM mask size and ventilation rate are most appropriate?

Infant mask, 10–12 breaths per minute
Adult mask, 12–15 breaths per minute
Infant mask, 30–40 breaths per minute
Pediatric mask, 20–30 breaths per minute (Correct answer)

Correct answer: Pediatric mask, 20–30 breaths per minute

A pediatric mask sized to fit the child's face is used, and the recommended ventilation rate for children in arrest is 20–30 breaths per minute.

Question 148: A patient is alert and oriented to person, place, and time but not to event. Using the AVPU scale, this patient would be classified as:

Verbal (V)
Painful (P)
Unresponsive (U)
Alert (A) (Correct answer)

Correct answer: Alert (A)

A patient who is alert and oriented, even partially, is classified as 'A' (Alert) on the AVPU scale.

Question 149: A patient in ventricular fibrillation receives a defibrillation shock. What is the IMMEDIATE next step after the shock is delivered?

Administer 1 mg epinephrine IV
Deliver a second shock at higher energy
Resume CPR for 2 minutes (Correct answer)
Check the pulse

Correct answer: Resume CPR for 2 minutes

Current AHA guidelines require immediate resumption of CPR for 2 minutes after a defibrillation shock before rhythm and pulse checks.

Question 150: You are assessing a 2-year-old child from across the room using the Pediatric Assessment Triangle (PAT). You note the child is crying, has audible stridor, and visible intercostal retractions. Their skin appears pink. Based on the PAT, which category best describes the child's physiological state?

Decompensated shock
Respiratory distress (Correct answer)
Cardiopulmonary failure
Central nervous system dysfunction

Correct answer: Respiratory distress

The Pediatric Assessment Triangle (PAT) evaluates Appearance, Work of Breathing, and Circulation to the skin. In this scenario, the child's Appearance is acceptable (crying is an appropriate response). The Circulation is also normal (pink skin). However, there are clear signs of increased Work of Breathing (stridor, retractions). An abnormality in only the Work of Breathing component of the PAT indicates respiratory distress.

Question 151: Which ICS position is responsible for the overall management of an incident and all incident objectives?

Logistics Section Chief
Safety Officer
Incident Commander (Correct answer)
Operations Section Chief

Correct answer: Incident Commander

The Incident Commander holds overall responsibility for managing the incident and setting all strategic objectives.

A-EMCA Theory Exam

The Advanced Emergency Medical Care Assistant (A-EMCA) Theory Examination is administered by the Ontario Ministry of Health and Long-Term Care. Passing this exam is required for certification as a Primary Care Paramedic in Ontario.

150

Questions

180 min

Time Limit

70%

To Pass

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