A-EMCA Theory Exam — Questions and Answers

Question 1: Which of the following best describes the Somogyi effect in diabetic patients?

Post-meal hyperglycemia despite adequate insulin dosing
Rebound hyperglycemia following nocturnal hypoglycemia (Correct answer)
Dawn phenomenon caused by growth hormone surge
Morning hyperglycemia due to insufficient evening insulin

Correct answer: Rebound hyperglycemia following nocturnal hypoglycemia

The Somogyi effect is rebound hyperglycemia that occurs after nocturnal hypoglycemia triggers counter-regulatory hormone release.

Question 2: A 2-year-old with known febrile seizures presents with a generalized tonic-clonic seizure lasting 8 minutes. The child remains postictal. What is the most appropriate prehospital intervention?

Apply ice packs to reduce fever immediately
Administer IM epinephrine for anaphylaxis
Provide supplemental oxygen, obtain IV access, and transport (Correct answer)
Administer oral diazepam and observe at home

Correct answer: Provide supplemental oxygen, obtain IV access, and transport

A febrile seizure lasting more than 5 minutes is considered prolonged and warrants oxygen, IV/IO access for potential benzodiazepine administration, and transport for evaluation.

Question 3: After inserting an oropharyngeal airway (OPA), the patient begins to gag and vomit. What should the AEMCA do immediately?

Push the OPA deeper to secure it
Remove the OPA and suction the airway (Correct answer)
Rotate the OPA to a different position
Apply chin-lift to keep the airway open with the OPA in place

Correct answer: Remove the OPA and suction the airway

If an OPA triggers gagging or vomiting, it must be removed immediately and the airway suctioned to prevent aspiration.

Question 4: 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?

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

Correct answer: 27%

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

Question 5: In mass casualty triage, a patient with a radial pulse, normal respirations, and who can follow commands should be tagged:

Immediate (Red)
Minor (Green)
Delayed (Yellow) (Correct answer)
Expectant (Black)

Correct answer: Delayed (Yellow)

A patient with a radial pulse present, normal respirations, and ability to follow commands in START triage is classified as Delayed (Yellow).

Question 6: An AEMCA is called to a scene where a patient's family member claims to hold power of attorney. In an emergency, the AEMCA should:

Treat the patient under implied consent while verifying the POA's scope with medical direction (Correct answer)
Refuse treatment until legal documentation is physically reviewed
Only follow instructions from the power of attorney holder
Always defer all decisions to the family member present

Correct answer: Treat the patient under implied consent while verifying the POA's scope with medical direction

In true emergencies, implied consent allows treatment while the validity and scope of a POA are clarified through medical direction.

Question 7: Which of the following is a sign of adequate ventilation during CPR without an advanced airway?

ETCO2 greater than 10 mmHg
No gastric distension after 10 ventilations
SpO2 reading of 95% or higher
Visible bilateral chest rise with each delivered breath (Correct answer)

Correct answer: Visible bilateral chest rise with each delivered breath

Visible bilateral chest rise with each ventilation is the primary clinical confirmation that ventilations are effective during CPR.

Question 8: 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 9: Which medication is the first-line treatment for a patient in symptomatic bradycardia with a pulse?

Amiodarone 300 mg IV
Atropine 0.5 mg IV (Correct answer)
Epinephrine 1 mg IV
Adenosine 6 mg IV

Correct answer: Atropine 0.5 mg IV

Atropine 0.5 mg IV is the first-line drug for symptomatic bradycardia, working by blocking vagal tone to increase heart rate.

Question 10: 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 LL and RL electrodes
Swapping LA and LL 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 11: During the START triage system, a patient who is breathing at a rate of 28 breaths per minute should be tagged:

Minor (Green)
Immediate (Red) (Correct answer)
Expectant (Black)
Delayed (Yellow)

Correct answer: Immediate (Red)

In START triage, a respiratory rate above 30 breaths per minute tags the patient as Immediate; 28 is borderline but combined with other findings often yields Immediate.

Question 12: A 3-year-old weighing approximately 15 kg requires epinephrine for anaphylaxis. What is the correct dose of 1:1,000 epinephrine administered IM?

0.1 mg/kg, maximum 1.0 mg (1.0 mL)
0.5 mg fixed dose regardless of weight
0.01 mg/kg, maximum 0.15 mg (0.15 mL)
0.01 mg/kg, maximum 0.5 mg (0.5 mL) (Correct answer)

Correct answer: 0.01 mg/kg, maximum 0.5 mg (0.5 mL)

Pediatric epinephrine for anaphylaxis is 0.01 mg/kg of 1:1,000 solution IM, with a maximum single dose of 0.5 mg.

Question 13: Epinephrine 1 mg IV/IO is administered during cardiac arrest. How frequently should this dose be repeated?

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

Correct answer: Every 3–5 minutes

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

Question 14: Which class of substances accounts for the greatest number of drug overdose deaths in the United States?

Methamphetamine
Benzodiazepines
Cocaine
Opioids (including synthetic opioids) (Correct answer)

Correct answer: Opioids (including synthetic opioids)

Opioids, particularly synthetic opioids such as illicitly manufactured fentanyl, account for the majority of drug overdose deaths in the US annually.

Question 15: When using a bag-valve mask with two rescuers, what is the recommended hand position for the person holding the mask?

C-clamp (EC technique) with both hands (Correct answer)
Thumb and index finger pinching the mask edges
One hand over the mask pressing down
Palm flat over the dome of the mask

Correct answer: C-clamp (EC technique) with both hands

The EC technique uses the third, fourth, and fifth fingers to lift the jaw (E) while the thumb and index finger form a C to hold the mask seal.

Question 16: Which of the following constellations of findings is most indicative of a patient meeting prehospital sepsis criteria, warranting a 'sepsis alert' notification to the receiving hospital?

Productive cough, heart rate of 95 bpm, and a blood pressure of 130/80 mmHg.
Localized cellulitis, normal mental status, and a heart rate of 88 bpm.
History of a UTI, respiratory rate of 18, and warm, dry skin.
Suspected infection, fever of 38.5°C, and a new onset of confusion. (Correct answer)

Correct answer: Suspected infection, fever of 38.5°C, and a new onset of confusion.

Prehospital sepsis screening tools (like qSOFA or SIRS) look for a suspected source of infection plus signs of systemic response or organ dysfunction. The combination of a suspected infection, fever (temperature >38°C), and altered mental status (new confusion) strongly suggests sepsis with organ dysfunction, meeting the criteria for a sepsis alert.

Question 17: A 5-year-old is found unresponsive with pinpoint pupils, bradycardia, and excessive secretions after playing in a shed containing pesticides. What antidote is indicated?

Flumazenil IV
Naloxone (Narcan) IV/IM
Activated charcoal only
Atropine IV/IM followed by pralidoxime (Correct answer)

Correct answer: Atropine IV/IM followed by pralidoxime

Organophosphate poisoning (SLUDGE/DUMBELS toxidrome) is treated with atropine to block muscarinic effects and pralidoxime (2-PAM) to reactivate acetylcholinesterase.

Question 18: A patient presents with severe hypotension, bradycardia, and bronchospasm after ingesting a large amount of eye drops. What toxidrome is most likely?

Anticholinergic toxidrome
Cholinergic toxidrome (Correct answer)
Sympathomimetic toxidrome
Opioid toxidrome

Correct answer: Cholinergic toxidrome

Tetrahydrozoline (found in eye drops) can cause a cholinergic-like toxidrome with bradycardia, hypotension, and bronchospasm in overdose, especially in children.

Question 19: Which sign indicates impending herniation in a head-injured patient and requires immediate intervention?

Unilateral fixed and dilated pupil with decreasing GCS (Correct answer)
Cheyne-Stokes respirations alone
Systolic hypertension without bradycardia
Bilateral pinpoint pupils with altered mental status

Correct answer: Unilateral fixed and dilated pupil with decreasing GCS

A blown pupil (fixed, dilated, unilateral) with declining GCS indicates uncal herniation from rising intracranial pressure requiring emergent action.

Question 20: Which of the following is considered the most reliable method for confirming initial and ongoing placement of an endotracheal tube in a patient with a perfusing rhythm?

Bilateral breath sounds on auscultation
Use of an esophageal detector device (EDD)
Condensation in the endotracheal tube
Continuous waveform capnography (Correct answer)

Correct answer: Continuous waveform capnography

Continuous waveform capnography is the gold standard for confirming and monitoring endotracheal tube placement. It provides real-time, breath-to-breath analysis of expired CO2, which is the most reliable indicator that the tube is in the trachea and not the esophagus. Other methods like auscultation, chest rise, and EDD are useful secondary confirmation techniques but are not as definitive.

Question 21: 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)
Move the power lines with a dry wooden pole before approaching
Approach if the lines appear not to be sparking
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 22: Which antidysrhythmic is the FIRST-LINE drug for ventricular fibrillation refractory to defibrillation?

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

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

Nerve conduction velocity study
CT chest for thymoma
Tensilon (edrophonium) test (Correct answer)
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 24: A 72-year-old is in cardiogenic shock after a large MI. Which hemodynamic pattern is expected?

Low BP, high CO, low SVR
Low BP, low CO, high SVR (Correct answer)
High BP, low CO, low SVR
High BP, high CO, low SVR

Correct answer: Low BP, low CO, high SVR

Cardiogenic shock is characterized by low cardiac output from pump failure and compensatory peripheral vasoconstriction (high SVR) causing low blood pressure.

Question 25: Which Glasgow Coma Scale (GCS) score indicates severe traumatic brain injury requiring aggressive airway management?

GCS 13–15
GCS 6–9
GCS 9–12
GCS ≤ 8 (Correct answer)

Correct answer: GCS ≤ 8

A GCS of 8 or less defines severe TBI; these patients cannot protect their airway and require definitive airway management.

Question 26: What is myasthenia gravis, and how does it come about?

It is an antihistamine and anticholinergic that works by inhibiting histamine H1 which reverses the effects of histamine release and pass the blood brain barrier causing sedative effects
An chronic autoimmune neuromuscular disorder that causes weakness in the skeletal muscles caused by a defect in nerve impulses at the neuromuscular junction; the body attacks the receptors for acetylcholine (Correct answer)
Can cause a brief loss of consciousness without losing postural tone with isolated motor tics such as lip smacking or eye blinking
a) there's a mandatory patch point <br> b) uncertainty about the appropriateness of a medical directive <br> c) when a RBH introduces another patch point <br> d) situations that fall outside the protocol but the paramedic believes the patient will benefit from medical direction within the paramedics scope of practice

Correct answer: An chronic autoimmune neuromuscular disorder that causes weakness in the skeletal muscles caused by a defect in nerve impulses at the neuromuscular junction; the body attacks the receptors for acetylcholine

Myasthenia gravis is a chronic autoimmune neuromuscular disorder causing skeletal muscle weakness because the body produces antibodies that attack acetylcholine receptors at the neuromuscular junction, impairing nerve-to-muscle signal transmission. This is why weakness worsens with activity. The other options describe patch-point situations, antihistamine action, and absence/focal seizures.

Question 27: 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)
Immobilize the extremity on a long backboard
Establish IV access for fluid resuscitation
Apply a pressure dressing and monitor

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 28: A woman at 39 weeks presents with contractions every 2 minutes lasting 90 seconds. She states she feels the urge to push. On visual inspection, you see the fetal head crowning. You should:

Prepare for immediate field delivery; do not attempt transport (Correct answer)
Apply gentle pressure to the head and attempt to delay delivery
Transport immediately in left lateral position
Tell the patient to resist the urge to push until you arrive at the hospital

Correct answer: Prepare for immediate field delivery; do not attempt transport

Crowning indicates imminent delivery; attempting transport at this stage risks delivery en route without proper preparation and is unsafe for mother and infant.

Question 29: 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?

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

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 30: A neonate delivered in the field has a heart rate of 80 bpm after 30 seconds of positive-pressure ventilation. What is your next step?

Continue PPV alone for another 30 seconds
Administer epinephrine IV
Begin chest compressions at a 3:1 ratio with ventilations (Correct answer)
Increase ventilation rate only

Correct answer: Begin chest compressions at a 3:1 ratio with ventilations

If neonatal HR remains below 100 bpm after 30 seconds of adequate PPV, chest compressions should be initiated at a 3:1 compression-to-ventilation ratio.

Question 31: A patient in 3rd-degree (complete) AV block is hemodynamically unstable with a rate of 30 bpm. What is the correct initial treatment?

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

Correct answer: Transcutaneous pacing

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

Question 32: Which ECG change is an early indicator of right ventricular strain in a patient with massive pulmonary embolism?

ST elevation in leads II, III, aVF
S1Q3T3 pattern (Correct answer)
Delta waves in precordial leads
Prominent U waves in V2-V4

Correct answer: S1Q3T3 pattern

The S1Q3T3 pattern (S wave in lead I, Q wave and T-wave inversion in lead III) is a classic, though non-specific, ECG sign of acute right heart strain from PE.

Question 33: During suction of an intubated patient, how long should each suction pass last?

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

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 34: 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?

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

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 35: The normal fetal heart rate range monitored during field assessment of a pregnant patient is:

60–80 beats per minute
160–200 beats per minute
80–110 beats per minute
110–160 beats per minute (Correct answer)

Correct answer: 110–160 beats per minute

A normal fetal heart rate is 110–160 bpm; rates outside this range may indicate fetal distress and require rapid transport.

Question 36: A rise in ETCO2 from 20 mmHg to 35 mmHg during CPR most likely indicates:

Worsening metabolic acidosis
The patient is being hyperventilated
Return of spontaneous circulation (ROSC) (Correct answer)
Esophageal intubation

Correct answer: Return of spontaneous circulation (ROSC)

A sudden sustained rise in ETCO2 toward normal levels (35–45 mmHg) during CPR is a strong indicator of ROSC as cardiac output resumes.

Question 37: What is the primary purpose of using a nasopharyngeal airway (NPA)?

To prevent aspiration of gastric contents
To bypass upper airway obstruction at the level of the tongue in a patient with a gag reflex (Correct answer)
To provide a definitive, long-term airway in an unresponsive patient
To isolate the trachea for endotracheal intubation

Correct answer: To bypass upper airway obstruction at the level of the tongue in a patient with a gag reflex

A nasopharyngeal airway is a basic airway adjunct used to bypass the tongue as a source of obstruction in the oropharynx. It is particularly useful in patients who are semiconscious and may still have an intact gag reflex, which would make an oropharyngeal airway (OPA) intolerable.

Question 38: A 58-year-old male with a history of type 1 diabetes is found confused and diaphoretic. His glucometer reads 2.1 mmol/L. He is able to follow simple commands but is too disoriented to swallow safely. An IV has been established. According to Ontario ALS PCS, what is the most appropriate initial treatment for this patient?

Administer 1 mg of Glucagon intramuscularly.
Administer 10 grams of Dextrose 10% (D10W) slow IV push, and reassess. (Correct answer)
Administer 25 grams of Dextrose 50% (D50W) slow IV push.
Encourage the patient to drink a glass of orange juice.

Correct answer: Administer 10 grams of Dextrose 10% (D10W) slow IV push, and reassess.

Current Ontario ALS PCS guidelines favor D10W over D50W for treating hypoglycemia due to a lower risk of extravasation injury and rebound hypoglycemia. D10W is administered in 10-gram aliquots, followed by a reassessment of the patient's blood glucose level and clinical status. Glucagon is an alternative if IV access cannot be obtained, and oral glucose is inappropriate as the patient cannot swallow safely.

Question 39: Which anatomical feature of a pediatric airway makes children more susceptible to airway obstruction compared to adults?

Larger glottic opening relative to body size
Proportionally larger tongue and more anterior, superior larynx (Correct answer)
Longer trachea with more cartilaginous support
Wider subglottic space

Correct answer: Proportionally larger tongue and more anterior, superior larynx

Children have a proportionally larger tongue and a more anterior and cephalad larynx, making visualization and management of the pediatric airway more challenging.

Question 40: A patient involved in a chemical spill is ambulatory and conscious. What is the FIRST step in managing this patient?

Load the patient into the ambulance for assessment
Decontaminate the patient before providing advanced care (Correct answer)
Apply a cervical collar and backboard
Administer oxygen and transport immediately

Correct answer: Decontaminate the patient before providing advanced care

Decontamination must occur before the patient enters the ambulance to prevent secondary contamination of crew and equipment.

Question 41: Which assessment finding best differentiates cardiogenic shock from hypovolemic shock in a trauma patient?

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

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

Hypertension, bradycardia, and irregular respirations.
Paradoxical chest movement, dyspnea, and localized pain.
Unilateral chest rise, tracheal deviation, and subcutaneous emphysema.
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 43: Which medication class is contraindicated in a patient with suspected hemorrhagic stroke?

Beta-blockers
Benzodiazepines
Antiemetics
Anticoagulants and thrombolytics (Correct answer)

Correct answer: Anticoagulants and thrombolytics

Anticoagulants and thrombolytics worsen hemorrhagic stroke by promoting further bleeding and are absolutely contraindicated.

Question 44: A 72-year-old female presents with a sudden onset of right-sided facial droop, slurred speech, and right arm weakness that began exactly 90 minutes ago. Her vital signs are stable. Which of the following is the most critical piece of information to relay to the receiving stroke center?

The patient's most recent blood pressure reading.
A detailed list of the patient's home medications.
The patient's score on the Cincinnati Prehospital Stroke Scale.
The exact time of symptom onset ('last known well'). (Correct answer)

Correct answer: The exact time of symptom onset ('last known well').

While all options are important pieces of information, the 'last known well' time is the most critical factor in determining the patient's eligibility for time-sensitive thrombolytic therapy (fibrinolysis) or endovascular treatment. The treatment window is strictly time-dependent, and this information is paramount for the stroke team's decision-making process.

Question 45: Which reversible cause of PEA is suggested by distended neck veins, absent breath sounds on the left, and tracheal deviation to the right?

Tension pneumothorax (Correct answer)
Hypovolemia
Cardiac tamponade
Pulmonary embolism

Correct answer: Tension pneumothorax

Tension pneumothorax causes JVD, absent breath sounds on the affected side, and tracheal deviation away from the affected side, and is a reversible cause of PEA.

Question 46: A 45-year-old with COPD presents in respiratory failure. Which inhaled medication is most appropriate as a first-line bronchodilator?

Salmeterol (long-acting beta-agonist)
Ipratropium bromide alone
Albuterol (salbutamol) (Correct answer)
Budesonide (inhaled corticosteroid)

Correct answer: Albuterol (salbutamol)

Albuterol is a short-acting beta-2 agonist and first-line bronchodilator for acute exacerbations of COPD and asthma.

Question 47: 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?

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

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

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

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 49: Which of the following is an absolute contraindication for administering oxytocin in the management of postpartum hemorrhage?

The placenta has not yet been delivered. (Correct answer)
The mother is breastfeeding.
The patient received an epidural during labor.
The patient has a history of Cesarean section.

Correct answer: The placenta has not yet been delivered.

Oxytocin is a uterotonic agent used to cause uterine contraction to control postpartum hemorrhage. It should only be administered AFTER the delivery of the placenta. Administering it before the placenta delivers can cause the cervix to contract and close, leading to a retained placenta, which can worsen bleeding and cause other complications. None of the other options are contraindications for the use of oxytocin in the management of PPH.

Question 50: When should CPR be withheld in a hypothermic cardiac arrest patient in the prehospital setting?

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

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 51: A 6-year-old is struck by a car. On assessment, you note absent breath sounds on the left, tracheal deviation to the right, distended neck veins, and hypotension. What intervention is immediately required?

Pericardiocentesis
Rapid sequence intubation and transport
Bilateral chest decompression
Needle thoracostomy on the left side at the second intercostal space, midclavicular line (Correct answer)

Correct answer: Needle thoracostomy on the left side at the second intercostal space, midclavicular line

These findings are classic for tension pneumothorax; immediate needle decompression on the affected (left) side relieves the life-threatening pressure.

Question 52: Which of the four elements of negligence addresses the requirement that the AEMCA's breach must have directly caused the patient's injury?

Damages
Duty to act
Proximate cause (Correct answer)
Breach of duty

Correct answer: Proximate cause

Proximate cause (causation) establishes a direct link between the provider's breach of duty and the harm suffered by the patient.

Question 53: What is the recommended target oxygen saturation for a patient with confirmed acute stroke in the prehospital setting?

SpO2 100% via NRB mask
SpO2 94–99% (Correct answer)
SpO2 90–92%
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 54: A patient with a known peanut allergy develops urticaria, angioedema, and stridor within minutes of eating. After administering IM epinephrine, the patient does not improve. What is the next action?

Perform immediate needle decompression
Administer IV corticosteroids and observe for 30 minutes
Switch to IV diphenhydramine as epinephrine failed
Administer a second dose of IM epinephrine and prepare for airway management (Correct answer)

Correct answer: Administer a second dose of IM epinephrine and prepare for airway management

A second dose of epinephrine can be given 5-15 minutes after the first if the patient does not respond; progressive stridor also demands preparation for surgical airway.

Question 55: In the prehospital setting, what is the primary goal of hyperventilation in a head-injured patient with signs of herniation?

Correct metabolic acidosis
Temporarily reduce intracranial pressure by inducing vasoconstriction (Correct answer)
Improve oxygenation
Increase cerebral blood flow

Correct answer: Temporarily reduce intracranial pressure by inducing vasoconstriction

Controlled mild hyperventilation lowers PaCO2, causing cerebral vasoconstriction and a temporary reduction in intracranial pressure.

Question 56: Which vasopressor works by releasing norepinephrine from sympathetic nerve terminals rather than directly stimulating adrenergic receptors?

Ephedrine (Correct answer)
Dopamine
Norepinephrine
Epinephrine

Correct answer: Ephedrine

Ephedrine is an indirect-acting sympathomimetic that displaces norepinephrine from vesicles at sympathetic nerve terminals.

Question 57: When using the Emergency Response Guidebook (ERG), the orange-bordered section provides:

Isolation and protective action distances (Correct answer)
Evacuation distances for hazmat incidents
Fire and explosion hazard data
UN identification numbers for hazardous materials

Correct answer: Isolation and protective action distances

The orange-bordered section of the ERG contains emergency response guides with isolation and protective action distances for specific chemicals.

Question 58: The term 'Beck's triad' is associated with which life-threatening emergency?

Pulmonary embolism
Cardiac tamponade (Correct answer)
Tension pneumothorax
Aortic dissection

Correct answer: Cardiac tamponade

Beck's triad — hypotension, muffled heart sounds, and jugular venous distension — classically indicates cardiac tamponade.

Question 59: 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?

Osborn (J) waves on ECG with risk of VF (Correct answer)
Ventricular fibrillation
Third-degree heart block
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 60: Which drug is the FIRST-LINE antiarrhythmic for stable wide-complex tachycardia of unknown origin?

Adenosine 6 mg IV
Lidocaine 1.5 mg/kg IV
Procainamide 20–50 mg/min IV
Amiodarone 150 mg IV over 10 minutes (Correct answer)

Correct answer: Amiodarone 150 mg IV over 10 minutes

Amiodarone 150 mg IV over 10 minutes is the preferred antiarrhythmic for stable wide-complex tachycardia of uncertain origin per ACLS guidelines.

Question 61: Which finding best differentiates a seizure from syncope in a prehospital patient?

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

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 62: What is the normal capillary refill time in a healthy adult?

Less than 2 seconds (Correct answer)
Less than 1 second
Less than 4 seconds
Less than 3 seconds

Correct answer: Less than 2 seconds

Normal capillary refill time is less than 2 seconds; prolonged refill suggests poor peripheral perfusion.

Question 63: The Health Insurance Portability and Accountability Act (HIPAA) primarily governs:

The protection and confidential handling of protected health information (Correct answer)
Credentialing standards for EMS providers
Mandatory reporting of communicable diseases
Insurance billing procedures for EMS agencies

Correct answer: The protection and confidential handling of protected health information

HIPAA establishes national standards for the protection of individuals' medical records and other personal health information.

Question 64: Which prehospital intervention is most important for a patient with a suspected large ischemic stroke and last known well time of 1 hour?

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

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 65: A patient presents with chest pain, diaphoresis, and nausea. The pain radiates to the jaw. Their ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely affected?

Right coronary artery (Correct answer)
Left main coronary artery
Left anterior descending artery
Left circumflex artery

Correct answer: Right coronary artery

ST elevation in leads II, III, and aVF indicates an inferior MI, most commonly caused by right coronary artery occlusion.

Question 66: A competent 55-year-old male is experiencing central chest pain radiating to his jaw. His vital signs are stable. After your assessment and strong recommendation for transport, he adamantly refuses to go to the hospital, stating he will see his family doctor tomorrow. Which of the following is the most critical action for the paramedic to take to mitigate legal risk?

Contact the patient's family doctor to inform them of the situation.
Thoroughly document the assessment findings, the risks of refusal that were explained to the patient, and the patient's demonstrated understanding of those risks. (Correct answer)
Have the patient sign the refusal of care section of the Ambulance Call Report without any further discussion.
Inform the patient that leaving him is considered abandonment and he must come to the hospital.

Correct answer: Thoroughly document the assessment findings, the risks of refusal that were explained to the patient, and the patient's demonstrated understanding of those risks.

When a competent patient refuses care against medical advice, the most crucial step for mitigating legal risk (such as claims of abandonment or negligence) is comprehensive and meticulous documentation. The paramedic's notes must clearly outline the patient's capacity, the information provided (including the risks of not going to the hospital, such as death or permanent disability), the patient's verbalized understanding of these risks, and the advice given. A signature is helpful, but the detailed narrative is the most important legal protection.

Question 67: 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 with the most burns
Patients in cardiopulmonary arrest (reverse triage) (Correct answer)
Oldest patients first
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 68: Which of the following is the correct landmark for adult IO (intraosseous) access using the tibial site?

Proximal tibia, 2 cm below the tibial tuberosity on the flat anteromedial surface (Correct answer)
The tibial tuberosity directly
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 69: 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?

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

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 70: A HAZMAT placard showing a skull and crossbones indicates:

Toxic or poisonous material (Correct answer)
Flammable material
Radioactive material
Oxidizing agent

Correct answer: Toxic or poisonous material

The skull and crossbones symbol (DOT Class 6) indicates toxic or poisonous materials that pose a serious health hazard.

Question 71: ST-segment elevation in leads II, III, and aVF with reciprocal changes in leads I and aVL indicates an MI in which cardiac territory?

Lateral wall
Posterior wall
Inferior wall (Correct answer)
Anterior wall

Correct answer: Inferior wall

Leads II, III, and aVF face the inferior wall of the left ventricle, so ST elevation in these leads with lateral reciprocal changes indicates an inferior MI.

Question 72: Which antidote is used to reverse benzodiazepine overdose?

Physostigmine
Naloxone
Flumazenil (Correct answer)
N-acetylcysteine

Correct answer: Flumazenil

Flumazenil is a competitive benzodiazepine receptor antagonist that reverses CNS and respiratory depression caused by benzodiazepine overdose.

Question 73: Nitroglycerin is CONTRAINDICATED in a patient with suspected MI if the patient has taken which medication within the past 24–48 hours?

Atorvastatin 40 mg
Sildenafil (Viagra) (Correct answer)
Aspirin 325 mg
Metoprolol 25 mg

Correct answer: Sildenafil (Viagra)

Phosphodiesterase-5 inhibitors like sildenafil potentiate nitrate-induced vasodilation, which can cause severe, refractory hypotension.

Question 74: 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:

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

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 75: A patient in compensated hemorrhagic shock will most likely demonstrate which early sign?

Hypotension with bradycardia
Tachycardia with normal blood pressure (Correct answer)
Widened pulse pressure
Decreased respiratory rate

Correct answer: Tachycardia with normal blood pressure

In compensated shock the body maintains blood pressure through tachycardia and vasoconstriction, so tachycardia is the earliest reliable indicator.

Question 76: A patient presents with confusion, ataxia, and nystagmus after ingesting from an unlabeled bottle, but has no severe acidosis. Which toxic alcohol is most likely?

Isopropanol (rubbing alcohol) (Correct answer)
Ethylene glycol (antifreeze)
Propylene glycol
Methanol

Correct answer: Isopropanol (rubbing alcohol)

Isopropanol causes CNS depression similar to ethanol (with ataxia and nystagmus) but is metabolized to acetone rather than an organic acid, so severe anion gap acidosis is absent.

Question 77: What is the most common shockable cardiac rhythm encountered in pediatric cardiac arrest?

Asystole (Correct answer)
Pulseless electrical activity (PEA)
Ventricular fibrillation (VF)
Pulseless ventricular tachycardia (VT)

Correct answer: Asystole

Unlike adults, pediatric cardiac arrest is most commonly caused by respiratory failure or shock, resulting in asystole or PEA as the predominant initial rhythms rather than shockable rhythms.

Question 78: Decerebrate posturing (extensor posturing) in a head-injured patient indicates injury at which level?

Cortex
Spinal cord
Brainstem (midbrain/pons) (Correct answer)
Cerebellum

Correct answer: Brainstem (midbrain/pons)

Decerebrate posturing reflects brainstem injury at the midbrain or pons level and indicates severe neurological compromise.

Question 79: Which bone is most commonly fractured in falls onto an outstretched hand (FOOSH) in elderly patients?

Ulna
Radius (Correct answer)
Scaphoid
Humerus

Correct answer: Radius

Colles' fracture of the distal radius is the most common wrist fracture in elderly patients from FOOSH mechanisms.

Question 80: During a field delivery, the baby's head delivers but the shoulders do not follow with the next contraction. Your first maneuver should be:

Apply fundal pressure
Attempt to rotate the infant 180 degrees
Apply suprapubic pressure while guiding the head downward (Correct answer)
Perform an episiotomy

Correct answer: Apply suprapubic pressure while guiding the head downward

Shoulder dystocia is managed first with suprapubic pressure (not fundal) combined with downward traction on the fetal head to dislodge the anterior shoulder.

Question 81: What is the appropriate tidal volume to deliver when ventilating an adult with a BVM?

250–300 mL
500–600 mL (Correct answer)
1200–1500 mL
800–1000 mL

Correct answer: 500–600 mL

Current guidelines recommend 500–600 mL tidal volume (visible chest rise) to avoid gastric inflation and barotrauma.

Question 82: A patient develops a wide-complex tachycardia at 220 bpm with a pulse and is becoming confused and hypotensive. What is the correct intervention?

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

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 83: 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?

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

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

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

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 85: When performing end-tidal CO2 (ETCO2) monitoring after intubation, a reading of 20 mmHg in a cardiac arrest patient with good CPR quality suggests:

Adequate perfusion and good prognosis
Esophageal intubation
Hyperventilation artifact only
Possible pulmonary embolism causing reduced pulmonary blood flow (Correct answer)

Correct answer: Possible pulmonary embolism causing reduced pulmonary blood flow

Low ETCO2 (≤20 mmHg) despite good CPR in arrest may indicate pulmonary embolism or severe circulatory failure reducing pulmonary perfusion.

Question 86: Which finding BEST differentiates placental abruption from placenta previa in a third-trimester patient?

Rupture of membranes before bleeding
Painful, dark red bleeding with a rigid abdomen (Correct answer)
Bleeding that worsens with digital examination
Painless bright red bleeding with a soft abdomen

Correct answer: Painful, dark red bleeding with a rigid abdomen

Placental abruption classically presents with painful vaginal bleeding and uterine rigidity due to retroplacental hemorrhage, distinguishing it from the painless bleeding of previa.

Question 87: Which fluid bolus volume is recommended for a pediatric patient in hemorrhagic shock?

10 mL/kg normal saline or lactated Ringer's
40 mL/kg normal saline
5 mL/kg normal saline
20 mL/kg normal saline or lactated Ringer's (Correct answer)

Correct answer: 20 mL/kg normal saline or lactated Ringer's

Initial fluid resuscitation for pediatric shock is 20 mL/kg of isotonic crystalloid (normal saline or lactated Ringer's), which may be repeated up to three times.

Question 88: A patient presents with pinpoint pupils, decreased respirations, and altered mental status. Which class of drugs is most likely responsible?

Opioids (Correct answer)
Benzodiazepines
Anticholinergics
Stimulants (cocaine/amphetamines)

Correct answer: Opioids

The classic opioid toxidrome includes miosis (pinpoint pupils), respiratory depression, and altered mental status — the life-threatening triad.

Question 89: 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's actions (or inactions) caused harm.
The paramedic acted with malicious intent. (Correct answer)
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 90: During rapid sequence intubation of a trauma patient with a suspected full stomach, which step prevents gastric content aspiration?

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

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 91: When selecting an OPA size, the correct method is to measure from the:

Incisors to the angle of the jaw
Tip of the nose to the earlobe
Corner of the mouth to the earlobe (Correct answer)
Center of the mouth to the earlobe

Correct answer: Corner of the mouth to the earlobe

OPA size is estimated by measuring from the corner of the mouth to the earlobe (or center of mouth to angle of jaw).

Question 92: Which of the following is a primary indication for the administration of dimenhydrinate according to Ontario paramedic standards?

Reversal of extrapyramidal symptoms caused by antipsychotics.
Management of acute anxiety or panic attacks.
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 93: A patient who was in a high-speed MVA is now hypotensive and tachycardic with abdominal rigidity and guarding. On the way to the trauma center, IV access cannot be established peripherally. What is the next best vascular access option?

External jugular vein catheterization
Delay fluids until arrival at the ED
Femoral vein cutdown
Intraosseous access at the proximal tibia or humeral head (Correct answer)

Correct answer: Intraosseous access at the proximal tibia or humeral head

Intraosseous access provides rapid, reliable vascular access equivalent to central IV access when peripheral access fails in a critical patient.

Question 94: A patient is in distributive (septic) shock 6 hours after a stab wound with bowel evisceration. Which clinical finding differentiates distributive from hypovolemic shock?

Cool, clammy skin with weak pulses
Oliguria with elevated hematocrit
Flat neck veins with tachycardia
Warm, flushed skin with bounding pulses (Correct answer)

Correct answer: Warm, flushed skin with bounding pulses

Distributive shock causes massive vasodilation, producing warm, flushed skin and bounding pulses due to inappropriately low vascular resistance.

Question 95: A 7-year-old with type 1 diabetes presents with confusion, diaphoresis, pallor, and a blood glucose of 38 mg/dL. The child is unable to swallow safely. What is the appropriate treatment?

Give oral glucose gel between the cheek and gum
Administer 2–4 mL/kg of D25W IV or IO (Correct answer)
Administer glucagon IM or intranasal dextrose gel rectally
Administer 25 mL of D50W IV

Correct answer: Administer 2–4 mL/kg of D25W IV or IO

For a pediatric patient unable to swallow, IV/IO dextrose is preferred; D25W at 2–4 mL/kg is the appropriate concentration for children to avoid hypertonicity.

Question 96: 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?

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

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 97: 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?

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

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 98: 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?

Administer epinephrine first, then defibrillate
Administer amiodarone 300 mg before shocking
Immediately deliver a defibrillation shock (Correct answer)
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 99: Which finding differentiates hypertensive emergency from hypertensive urgency?

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

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 100: A patient receives succinylcholine for RSI. Which condition is a relative contraindication due to risk of life-threatening hyperkalemia?

Acute closed-head injury
Burns more than 72 hours old (Correct answer)
Hypovolemic shock
Acute asthma exacerbation

Correct answer: Burns more than 72 hours old

Denervation injuries and burns older than 48-72 hours cause upregulation of nicotinic receptors, leading to massive potassium efflux with succinylcholine.

Question 101: Which type of shock is most commonly associated with a cervical spinal cord injury at C5?

Neurogenic shock (Correct answer)
Septic shock
Obstructive shock
Hypovolemic shock

Correct answer: Neurogenic shock

High cervical cord injuries disrupt sympathetic tone, causing vasodilation and bradycardia — the hallmarks of neurogenic shock.

Question 102: A patient is found unresponsive in a running vehicle inside a closed garage. After ensuring scene safety, the EMT's PRIMARY concern for self-protection is:

Bloodborne pathogen exposure
Electrical hazards
Communicable respiratory disease
Carbon monoxide inhalation (Correct answer)

Correct answer: Carbon monoxide inhalation

Carbon monoxide from a running vehicle in an enclosed space is immediately life-threatening to rescuers and is the primary hazard to manage.

Question 103: The OPQRST mnemonic is used during patient assessment primarily to:

Characterize a patient's chief complaint, especially pain (Correct answer)
Assess level of consciousness
Document vital signs in order
Evaluate respiratory status

Correct answer: Characterize a patient's chief complaint, especially pain

OPQRST (Onset, Provocation, Quality, Radiation, Severity, Time) is used to fully characterize the patient's pain or chief complaint.

Question 104: When using a manual defibrillator on an adult in ventricular fibrillation, what is the initial recommended energy setting for a biphasic device?

360 J
100–120 J
120–200 J (Correct answer)
300 J

Correct answer: 120–200 J

AHA guidelines recommend 120–200 J for the initial biphasic defibrillation shock, following the manufacturer's recommended dose.

Question 105: A patient has gurgling respirations after a seizure. What is the FIRST intervention?

Suction the airway (Correct answer)
Begin BVM ventilations
Insert an oropharyngeal airway
Perform a jaw-thrust

Correct answer: Suction the airway

Gurgling indicates secretions or fluid in the upper airway; suctioning must occur immediately to clear the obstruction before other interventions.

Question 106: Which finding on a 12-lead ECG is most consistent with a STEMI involving the right coronary artery (inferior MI)?

ST elevation in leads I and aVL
ST elevation in leads V5–V6 and I
ST elevation in leads V1–V4
ST elevation in leads II, III, and aVF (Correct answer)

Correct answer: ST elevation in leads II, III, and aVF

Inferior STEMI caused by right coronary artery occlusion produces ST elevation in the inferior leads: II, III, and aVF.

Question 107: When ventilating an apneic adult patient with an advanced airway in place, what is the correct ventilation rate according to current guidelines?

1 breath every 3-5 seconds (12-20 breaths/min)
1 breath every 2-3 seconds (20-30 breaths/min)
1 breath every 6 seconds (10 breaths/min) (Correct answer)
1 breath every 8-10 seconds (6-8 breaths/min)

Correct answer: 1 breath every 6 seconds (10 breaths/min)

According to the most recent CPR and ECC guidelines, when an advanced airway (such as an endotracheal tube or supraglottic airway) is in place, ventilations should be delivered at a rate of 1 breath every 6 seconds, which equates to 10 breaths per minute for an adult patient. This avoids the complications of hyperventilation.

Question 108: A patient in ventricular fibrillation receives a defibrillation shock. What is the IMMEDIATE next step after the shock is delivered?

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

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 109: The antidote for heparin overdose causing severe hemorrhage is:

Vitamin K
Fresh frozen plasma
Protamine sulfate (Correct answer)
Tranexamic acid

Correct answer: Protamine sulfate

Protamine sulfate binds and neutralizes heparin on a 1:1 basis, reversing its anticoagulant effect within minutes.

Question 110: Which medication is contraindicated in patients with suspected cocaine-induced chest pain and hypertension?

Propranolol (Correct answer)
Nitroglycerin
Lorazepam
Aspirin

Correct answer: Propranolol

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

Question 111: Which ECG finding is most characteristic of hyperkalemia-induced cardiac toxicity?

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

Correct answer: Peaked (tall, narrow) T waves

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

Question 112: Which vital sign finding in an adult trauma patient should most immediately concern the AEMCA regarding hemodynamic instability?

Respiratory rate of 18 with SpO2 of 98%
GCS of 15 with blood pressure of 120/80 mmHg
Temperature of 98.6°F with heart rate of 80 bpm
Heart rate of 120 bpm with systolic BP of 90 mmHg (Correct answer)

Correct answer: Heart rate of 120 bpm with systolic BP of 90 mmHg

Tachycardia combined with hypotension (systolic <90 mmHg) is a classic sign of decompensated shock requiring immediate intervention.

Question 113: 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
Vaso-occlusive pain crisis only
Splenic sequestration

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 114: A 68-year-old male with a history of COPD is found in respiratory distress. He is obtunded, has a respiratory rate of 8 breaths per minute, and his skin is cyanotic. Waveform capnography shows a 'shark fin' appearance. What is the most likely cause of this waveform?

Esophageal intubation
Bronchospasm (Correct answer)
Hyperventilation
Pulmonary embolism

Correct answer: Bronchospasm

The 'shark fin' capnography waveform is characteristic of bronchospasm. This shape is caused by uneven and prolonged alveolar emptying due to airway obstruction, which is common in patients with COPD or asthma exacerbations. The upstroke of the waveform has a sloped appearance rather than the normal steep, almost vertical angle.

Question 115: A patient in asystole undergoes CPR. Which medications are indicated per ACLS protocol? (Select the correct combination)

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

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 116: A patient presents with altered mental status, fever, headache, and a non-blanching petechial rash. What is the priority action?

Administer antibiotics immediately without delay (Correct answer)
Isolate the patient and wait for culture results
Obtain a lumbar puncture before any treatment
Order a CT head before any intervention

Correct answer: Administer antibiotics immediately without delay

Meningococcal meningitis with septicemia requires immediate antibiotics; delaying treatment for imaging or lumbar puncture significantly increases mortality.

Question 117: When using the Cincinnati Prehospital Stroke Scale, which THREE components are assessed?

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

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 118: Activated charcoal is MOST effective when given within which time frame after ingestion?

Within 1 hour (Correct answer)
Within 2 hours
Within 6 hours
Within 4 hours

Correct answer: Within 1 hour

Activated charcoal is most effective within 1 hour of ingestion before significant drug absorption has occurred.

Question 119: A 68-year-old on warfarin has a femur fracture with uncontrolled bleeding. Which agent is most appropriate to reverse anticoagulation in the field?

Vitamin K IV push
Fresh frozen plasma
Protamine sulfate
Tranexamic acid (Correct answer)

Correct answer: Tranexamic acid

Tranexamic acid inhibits fibrinolysis and is a prehospital option for major hemorrhage, while FFP and Vitamin K are hospital-based.

Question 120: According to the Ontario Advanced Life Support Patient Care Standards (ALS PCS), which of the following is a primary indication for administering Acetylsalicylic Acid (ASA) in the prehospital setting?

Confirmed diagnosis of pericarditis
Chest pain or discomfort suggestive of acute coronary syndrome (ACS) (Correct answer)
Hypertensive emergency with a systolic BP > 180 mmHg
Symptomatic bradycardia

Correct answer: Chest pain or discomfort suggestive of acute coronary syndrome (ACS)

ASA is an antiplatelet agent crucial in the early management of Acute Coronary Syndrome (ACS). Its primary role is to prevent the aggregation of platelets, which can worsen an occlusion in a coronary artery. Ontario guidelines specify its use for patients with chest pain or discomfort suggestive of ACS, unless contraindicated.

Question 121: Which ethical principle obligates the AEMCA to avoid causing harm to the patient?

Non-maleficence (Correct answer)
Beneficence
Justice
Autonomy

Correct answer: Non-maleficence

Non-maleficence is the duty to 'do no harm' and requires providers to avoid actions that could injure or worsen the patient's condition.

Question 122: A scuba diver surfaces rapidly and complains of joint pain, rash, and dyspnea. What condition should be suspected?

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

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

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

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 124: Which burn percentage is used as the threshold requiring transport to a burn center per ABA guidelines for a full-thickness burn?

Greater than 20% TBSA
Any full-thickness burn (Correct answer)
Greater than 5% TBSA in adults only
Greater than 10% TBSA

Correct answer: Any full-thickness burn

ABA guidelines recommend burn center referral for any full-thickness burn regardless of size due to complexity of care and risk of complications.

Question 125: Which fluid resuscitation strategy is currently recommended for hemorrhagic shock in penetrating trauma to prevent worsening coagulopathy?

No IV fluids until surgical hemorrhage control
Aggressive 2-liter crystalloid bolus
Colloid-only resuscitation
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 126: During a mass casualty incident using START triage, an adult patient is breathing at 24 breaths/minute, has a radial pulse, and can follow simple commands. This patient is tagged:

Black (expectant/deceased)
Green (minor)
Red (immediate)
Yellow (delayed) (Correct answer)

Correct answer: Yellow (delayed)

In START triage, a patient breathing >30 or <10 is red; this patient breathes at 24, has a pulse, and is responsive — meeting yellow (delayed) criteria.

Question 127: Which of the following is the most appropriate initial action for a patient with a suspected unstable pelvic fracture following a high-speed motor vehicle collision?

Log-rolling the patient onto a long spine board immediately.
Performing a 'pelvic rock' maneuver to confirm instability.
Applying a commercial pelvic binder or improvised sheet sling. (Correct answer)
Administering a 2-liter fluid bolus of normal saline.

Correct answer: Applying a commercial pelvic binder or improvised sheet sling.

The most appropriate and critical initial action for a suspected unstable pelvic fracture is to stabilize the pelvis with a commercial pelvic binder or an improvised sheet sling. This action helps to reduce the volume of the pelvic cavity, tamponade bleeding from venous plexuses and fractured bone ends, and prevent further injury. 'Rocking the pelvis' is an outdated and dangerous maneuver that can dislodge clots and worsen hemorrhage. While fluid resuscitation and spinal motion restriction are important, immediate mechanical stabilization of the fracture is the priority for hemorrhage control.

Question 128: A paramedic crew is called to a public park for an individual found unconscious. There are no bystanders, and no identification or medical information is found on the patient. The patient has slow, shallow respirations and a weak, rapid pulse. Which legal principle allows the paramedics to begin treatment, including IV access and airway management?

Implied Consent (Correct answer)
Expressed Consent
Informed Consent
Substituted Consent

Correct answer: Implied Consent

Implied consent is a legal principle that applies in emergency situations where a patient is unable to provide expressed or informed consent due to being unconscious, incapacitated, or otherwise unable to communicate. [3] The law assumes that a reasonable person would want emergency, life-saving treatment in such circumstances. Therefore, paramedics can and should proceed with necessary medical care in the patient's best interest. [9, 10]

Question 129: In a patient with suspected pulmonary embolism, which triad of findings is classically described?

Hemoptysis, pleuritic chest pain, dyspnea (Correct answer)
Fever, productive cough, decreased breath sounds
Chest pain, syncope, bradycardia
JVD, tracheal deviation, absent breath sounds

Correct answer: Hemoptysis, pleuritic chest pain, dyspnea

The classic PE triad includes hemoptysis, pleuritic chest pain, and dyspnea, though all three are present in only a minority of cases.

Question 130: Nitrogen narcosis: what is it?

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

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 131: You are treating a patient with blunt abdominal trauma who is hypotensive. Which organ is statistically most commonly injured in blunt abdominal trauma?

Spleen (Correct answer)
Small intestine
Kidney
Liver

Correct answer: Spleen

The spleen is the most commonly injured solid organ in blunt abdominal trauma due to its location, vascularity, and fragile capsule.

Question 132: 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
Ice-water facial immersion
Carotid sinus massage
Valsalva maneuver (Correct answer)

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 133: Which sign differentiates meningitis from a simple headache in a patient with fever and neck stiffness?

Both Kernig's and Brudzinski's signs (Correct answer)
Babinski's sign
Brudzinski's sign
Kernig's sign

Correct answer: Both Kernig's and Brudzinski's signs

Both Kernig's sign (resistance to knee extension with hip flexed) and Brudzinski's sign (involuntary hip flexion with neck flexion) indicate meningeal irritation.

Question 134: Which type of burn injury is associated with the highest risk of inhalation injury?

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

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

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

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 136: Which opioid analgesic has the longest duration of action and highest risk for prolonged respiratory depression?

Hydromorphone
Methadone (Correct answer)
Fentanyl
Morphine

Correct answer: Methadone

Methadone has an extremely long half-life (24-36+ hours), putting patients at risk for delayed respiratory depression after initial dosing.

Question 137: Which sign is most specific for right-sided heart failure in a medical emergency assessment?

Jugular venous distension (Correct answer)
Orthopnea
Pulmonary edema with crackles
Pink frothy sputum

Correct answer: Jugular venous distension

Jugular venous distension (JVD) reflects elevated central venous pressure and is most specific for right-sided heart failure.

Question 138: 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:

Ask bystanders to confirm the patient's wishes before acting
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

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 139: A patient has Beck's triad following blunt chest trauma. Which emergency procedure does this finding indicate?

Needle decompression for tension pneumothorax
Pericardiocentesis for cardiac tamponade (Correct answer)
Chest tube insertion for hemothorax
Endotracheal intubation for airway protection

Correct answer: Pericardiocentesis for cardiac tamponade

Beck's triad (hypotension, muffled heart sounds, JVD) indicates cardiac tamponade, which requires pericardiocentesis to relieve pericardial pressure.

Question 140: In pediatric patients, which of the following is the MOST reliable early indicator of shock?

Decreased respiratory rate
Tachycardia (Correct answer)
Bradycardia
Hypotension

Correct answer: Tachycardia

Children compensate well and maintain blood pressure until late in shock; tachycardia is the earliest and most reliable indicator of hypovolemia in pediatric patients.

Question 141: When involved in an ambulance collision while responding to an emergency, the EMT should FIRST:

Complete the Patient Care Report before assessing scene
Continue responding to the original call
Call the supervisor before checking for injuries
Ensure personal safety, then assess crew and patient for injuries (Correct answer)

Correct answer: Ensure personal safety, then assess crew and patient for injuries

Personal and crew safety is the first priority after a collision — assess for injuries before taking any other action.

Question 142: When administering dopamine at 10-20 mcg/kg/min, the predominant clinical effect is:

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

Correct answer: Alpha-adrenergic vasoconstriction

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

Question 143: During a difficult airway scenario, you have failed two intubation attempts. The patient's SpO2 is dropping to 85%. What is the next best intervention?

Continue BVM ventilation indefinitely
Attempt a third laryngoscopy with a different blade
Insert a supraglottic airway device (e.g., King LT or LMA) (Correct answer)
Perform a surgical cricothyrotomy

Correct answer: Insert a supraglottic airway device (e.g., King LT or LMA)

Following a failed intubation, the next step per failed airway algorithms is placement of a supraglottic airway device to restore oxygenation before considering surgical airway.

Question 144: The 'golden hour' concept in trauma care was popularized by which physician?

James Styner
R Adams Cowley (Correct answer)
Frank Pantridge
Peter Safar

Correct answer: R Adams Cowley

R Adams Cowley, founder of the first shock trauma unit, popularized the concept that critically injured patients must reach definitive care within the first hour.

Question 145: When documenting a patient's mental status using the AVPU scale in the field, 'V' indicates the patient:

Has a normal voice with clear speech
Responds only to verbal stimulation (Correct answer)
Requires verbal commands for all actions
Is fully verbal and oriented

Correct answer: Responds only to verbal stimulation

'V' on the AVPU scale means the patient responds to verbal stimulation but is not spontaneously alert.

Question 146: Which of the following is the MOST appropriate initial intervention for a patient in anaphylactic shock?

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

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 147: After delivery of the placenta, a patient has sustained heavy vaginal bleeding. The uterus feels soft and 'boggy.' Your priority intervention is:

Place patient in Trendelenburg position
Apply direct pressure to the vaginal opening
Uterine fundal massage and oxytocin if available (Correct answer)
Immediate IV fluid bolus only

Correct answer: Uterine fundal massage and oxytocin if available

A boggy, atonic uterus is the most common cause of postpartum hemorrhage; fundal massage stimulates contraction and oxytocin (if available) helps maintain tone.

Question 148: A neonate's APGAR score is assessed at 1 minute. Which component is NOT part of the APGAR scoring system?

Heart rate
Blood glucose level (Correct answer)
Muscle tone
Respiratory effort

Correct answer: Blood glucose level

APGAR scores assess Appearance (color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration — glucose is not included.

Question 149: 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 LMA cuff has been over-inflated
The patient needs a faster ventilation rate only
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 150: A patient with COPD is found with a decreased level of consciousness and a SpO2 of 72%. The AEMCA should:

Use a Venturi mask set at 24% FiO2 only
Withhold oxygen to avoid suppressing the hypoxic drive
Observe the patient without oxygen until SpO2 falls below 60%
Apply high-flow oxygen and be prepared to assist ventilations (Correct answer)

Correct answer: Apply high-flow oxygen and be prepared to assist ventilations

Severe hypoxia (SpO2 72%) is immediately life-threatening; high-flow oxygen and ventilatory support take priority over concern about hypoxic drive.

Question 151: Which oxygen delivery device provides the highest concentration of oxygen for a spontaneously breathing patient?

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

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.

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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