NAEMT Advanced Medical Life Support (AMLS) Exam — Questions and Answers

Question 1: What is the first step in a patient assessment?

Obtaining a medical history
Performing a physical exam
Performing a scene size-up (Correct answer)
Administering treatment

Correct answer: Performing a scene size-up

In emergency medical care, the very first step in patient assessment is performing a scene size-up. This involves quickly assessing the safety of the scene for both the rescuer and the patient, identifying potential hazards, and determining the nature of the illness or mechanism of injury. Ensuring scene safety is paramount before approaching the patient and initiating direct care.

Question 2: What does the acronym "SAMPLE" stand for in patient history taking?

Signs, Assessment, Medications, Pulse, Last intake, Examination
Signs, Allergies, Medications, Past medical history, Last oral intake, Events (Correct answer)
Safety, Age, Medications, Plan, Examination
Symptoms, Age, Medical history, Physical exam, Last treatment, Examination

Correct answer: Signs, Allergies, Medications, Past medical history, Last oral intake, Events

The SAMPLE acronym is a mnemonic used in patient assessment to gather a comprehensive medical history quickly and systematically. It stands for Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events leading up to the present illness or injury. This structured approach helps ensure no critical information is missed during history taking.

Question 3: Pulsus paradoxus greater than 10 mmHg is a classic finding in which condition?

Tension pneumothorax
Hypertensive emergency
Aortic stenosis
Cardiac tamponade (Correct answer)

Correct answer: Cardiac tamponade

Pulsus paradoxus >10 mmHg, an exaggerated fall in BP during inspiration, is a classic sign of cardiac tamponade.

Question 4: Carbon monoxide poisoning should be treated with which intervention?

Supplemental oxygen via nasal cannula only
Bronchodilators and corticosteroids
Naloxone and sodium bicarbonate
100% oxygen via non-rebreather mask or hyperbaric oxygen (Correct answer)

Correct answer: 100% oxygen via non-rebreather mask or hyperbaric oxygen

High-flow 100% oxygen competes with CO for hemoglobin binding and reduces CO half-life from 5 hours to approximately 60–90 minutes.

Question 5: Which of the following signs suggests herniation in a deteriorating stroke patient?

Alternating pupil dilation
Bilateral miosis with normal consciousness
Bilateral mydriasis with normal motor function
Ipsilateral dilated and fixed pupil with contralateral hemiplegia (Correct answer)

Correct answer: Ipsilateral dilated and fixed pupil with contralateral hemiplegia

Uncal herniation causes compression of CN III, producing an ipsilateral fixed dilated pupil and contralateral hemiplegia.

Question 6: When managing DKA, insulin infusion is typically withheld until the serum potassium is at least what level?

4.0 mEq/L
2.5 mEq/L
3.5 mEq/L (Correct answer)
3.0 mEq/L

Correct answer: 3.5 mEq/L

Insulin drives potassium intracellularly, so insulin infusion should be withheld until serum potassium is at least 3.5 mEq/L to avoid life-threatening hypokalemia and cardiac dysrhythmias.

Question 7: Which medication is the first-line antiplatelet agent given to patients with suspected ACS?

Clopidogrel 300 mg
Ticagrelor 90 mg
Aspirin 324 mg chewed (Correct answer)
Warfarin 5 mg

Correct answer: Aspirin 324 mg chewed

Aspirin 324 mg chewed is the first-line antiplatelet agent in suspected ACS due to its rapid absorption and thromboxane inhibition.

Question 8: Which condition is an absolute contraindication to nasopharyngeal airway insertion?

Suspected basal skull fracture (Correct answer)
Recent nasal surgery
Intact gag reflex
Nasal congestion

Correct answer: Suspected basal skull fracture

Suspected basal skull fracture is an absolute contraindication to NPA insertion due to the risk of intracranial placement through the cribriform plate.

Question 9: Which of the following is a potential side effect of long-term oxygen therapy?

Muscle cramps
Weight gain
Hypercapnia (increased CO2 levels) (Correct answer)
Hypothermia

Correct answer: Hypercapnia (increased CO2 levels)

In patients with chronic obstructive pulmonary disease (COPD) who have chronic hypercapnia, long-term oxygen therapy can sometimes suppress the hypoxic drive to breathe. This can lead to decreased ventilation and an increase in carbon dioxide (CO2) levels in the blood, resulting in hypercapnia. Careful monitoring of blood gas levels is essential to prevent this complication.

Question 10: Which of the following is a vital sign that is typically measured during a patient assessment?

Pupil size
Blood pressure (Correct answer)
Weight
Skin color

Correct answer: Blood pressure

Vital signs are objective measurements of the body's most basic functions, indicating the state of a patient's health. Blood pressure is a key vital sign, along with heart rate, respiratory rate, and body temperature, providing crucial information about cardiovascular function. These measurements help healthcare providers monitor a patient's condition and detect changes.

Question 11: An AMLS provider identifies a patient with third-degree AV block and bradycardia with altered mental status. What is the immediate treatment?

Atropine 1 mg IV
Transcutaneous pacing (Correct answer)
Adenosine 6 mg IV
Amiodarone drip

Correct answer: Transcutaneous pacing

Complete heart block with hemodynamic compromise requires transcutaneous pacing as immediate stabilization while awaiting transvenous pacing.

Question 12: A patient with known epilepsy has a seizure that self-terminates in 2 minutes. They are postictal. Which assessment is still critical?

Stat brain CT only
Blood glucose to rule out hypoglycemia (Correct answer)
Immediate intubation
Repeat ECG

Correct answer: Blood glucose to rule out hypoglycemia

Hypoglycemia can trigger seizures and must be ruled out even in known epileptics, as it is a rapidly reversible cause.

Question 13: What is the initial priority in managing a patient in hyperosmolar hyperglycemic state (HHS) with a serum osmolality of 345 mOsm/kg and blood glucose of 820 mg/dL?

Immediate hemodialysis
Sodium bicarbonate infusion
Aggressive IV fluid resuscitation with isotonic saline (Correct answer)
Aggressive IV insulin bolus

Correct answer: Aggressive IV fluid resuscitation with isotonic saline

The cornerstone of HHS management is aggressive IV fluid resuscitation with isotonic saline to correct profound dehydration and hyperosmolality before insulin administration, which can precipitate cerebral edema if given first.

Question 14: In the AMLS approach, when is a nasopharyngeal airway (NPA) preferred over an oral airway (OPA)?

Only in pediatric patients
In a semi-conscious patient with an intact gag reflex (Correct answer)
In a patient with basal skull fracture
In an unconscious patient without a gag reflex

Correct answer: In a semi-conscious patient with an intact gag reflex

NPAs are better tolerated in conscious or semi-conscious patients with an intact gag reflex, avoiding the vomiting risk of OPAs.

Question 15: Which of the following medications is commonly prescribed for preventing blood clots in patients at risk of pulmonary embolism?

Anticoagulants (e.g., warfarin, heparin) (Correct answer)
Antibiotics
Beta-blockers
Statins

Correct answer: Anticoagulants (e.g., warfarin, heparin)

Anticoagulants, such as warfarin and heparin, are medications specifically designed to prevent the formation and growth of blood clots. By interfering with the body's clotting cascade, they reduce the risk of deep vein thrombosis (DVT) and subsequent pulmonary embolism in patients identified as being at risk. These medications are crucial for prophylaxis and treatment of thrombotic events.

Question 16: What is the pathophysiologic mechanism underlying cardiogenic shock?

Massive vasodilation lowers systemic vascular resistance
Obstruction impairs ventricular filling
Volume depletion reduces preload
Pump failure reduces cardiac output causing tissue hypoperfusion (Correct answer)

Correct answer: Pump failure reduces cardiac output causing tissue hypoperfusion

Cardiogenic shock results from the heart's inability to maintain adequate cardiac output, leading to tissue hypoperfusion despite normal or elevated filling pressures.

Question 17: A patient on long-term lithium therapy presents with hypothermia, altered mental status, macroglossia, periorbital edema, and bradycardia. What treatment should be initiated?

IV methimazole and propranolol
IV thyroid hormone (T4 or T3) replacement and supportive care (Correct answer)
Emergent cardioversion for bradycardia
High-dose corticosteroids only

Correct answer: IV thyroid hormone (T4 or T3) replacement and supportive care

Myxedema coma requires IV thyroid hormone replacement (T4 with or without T3) along with supportive care including passive rewarming, airway management, and corticosteroids to address possible concurrent adrenal insufficiency.

Question 18: What is the specific antidote for opioid overdose with respiratory depression?

Physostigmine
Naloxone (Narcan) (Correct answer)
Flumazenil
N-acetylcysteine

Correct answer: Naloxone (Narcan)

Naloxone competitively antagonizes opioid receptors and rapidly reverses respiratory depression, miosis, and altered consciousness in opioid overdose.

Question 19: A patient presents with hypotension, JVD, and absent breath sounds on the left. What is the most likely diagnosis?

Open pneumothorax
Cardiac tamponade
Massive hemothorax
Tension pneumothorax (Correct answer)

Correct answer: Tension pneumothorax

Tension pneumothorax presents with hypotension, JVD, tracheal deviation, and absent breath sounds on the affected side.

Question 20: What is the most common cause of pulmonary embolism (PE)?

Tumor embolism
Air embolism
Fat embolism
Blood clot (deep vein thrombosis) (Correct answer)

Correct answer: Blood clot (deep vein thrombosis)

The most common cause of a pulmonary embolism (PE) is a blood clot, specifically one that originates in the deep veins of the legs or pelvis, a condition known as deep vein thrombosis (DVT). This clot then breaks off, travels through the bloodstream, and lodges in the pulmonary arteries, blocking blood flow to the lungs. Other types of emboli are far less common.

Question 21: Which of the following respiratory conditions is characterized by a “barrel chest”?

Bronchitis
Emphysema (Correct answer)
Pneumonia
Asthma

Correct answer: Emphysema

A 'barrel chest' is a classic physical finding often associated with advanced emphysema. It occurs due to hyperinflation of the lungs, where air becomes trapped, causing the chest wall to expand and become more rounded. This change in chest shape reflects the chronic air trapping and loss of lung elasticity characteristic of the disease.

Question 22: What is the Cushing reflex and what does it indicate?

Bradycardia and hypoxia indicating pulmonary embolism
Hypertension, bradycardia, and irregular respirations indicating increased intracranial pressure (Correct answer)
Tachycardia and hypotension indicating spinal shock
Hypertension and tachycardia indicating stimulant overdose

Correct answer: Hypertension, bradycardia, and irregular respirations indicating increased intracranial pressure

The Cushing reflex (hypertension, bradycardia, irregular respirations) is a late sign of severely elevated ICP indicating impending herniation.

Question 23: A patient in decompensated shock has cold, mottled extremities and a capillary refill of 5 seconds. What organ is most immediately at risk?

Kidneys (acute tubular necrosis) (Correct answer)
Skin (pressure ulcers)
Brain (dementia)
Liver (fatty change)

Correct answer: Kidneys (acute tubular necrosis)

Prolonged hypoperfusion in shock preferentially damages the kidneys, causing acute tubular necrosis and acute kidney injury.

Question 24: Which is the most sensitive early indicator of hypovolemic shock in adults?

Decreased urine output
Altered mental status
Hypotension
Tachycardia (Correct answer)

Correct answer: Tachycardia

Tachycardia is the earliest compensatory response to hypovolemia, occurring before hypotension develops.

Question 25: Decerebrate posturing in a comatose patient indicates injury at which neurological level?

At or below the midbrain (diencephalon to brainstem) (Correct answer)
Peripheral nervous system
Spinal cord at C2
Cortical level only

Correct answer: At or below the midbrain (diencephalon to brainstem)

Decerebrate posturing (extension of all extremities) indicates injury at the midbrain or below, signaling severe brainstem dysfunction.

Question 26: Which complication is indicated by a sudden rise in peak airway pressure in a ventilated patient after ETT placement?

Pulmonary edema resolution
Tension pneumothorax, bronchospasm, or tube obstruction (Correct answer)
Esophageal intubation
Hypoventilation

Correct answer: Tension pneumothorax, bronchospasm, or tube obstruction

Sudden high peak airway pressures after intubation suggest tube obstruction, acute bronchospasm, right mainstem intubation, or tension pneumothorax.

Question 27: What is the significance of a right-sided ECG lead V4R showing ST elevation in the context of inferior STEMI?

Rules out posterior wall involvement
Confirms left anterior descending artery occlusion
Suggests pericarditis
Indicates concurrent right ventricular infarction (Correct answer)

Correct answer: Indicates concurrent right ventricular infarction

ST elevation in V4R indicates right ventricular infarction, which complicates inferior STEMI and changes management.

Question 28: What is the primary advantage of video laryngoscopy over direct laryngoscopy in difficult airways?

Faster intubation time in all patients
Eliminates need for NMBA during RSI
Improved glottic visualization without requiring direct line of sight (Correct answer)
Can be used without preoxygenation

Correct answer: Improved glottic visualization without requiring direct line of sight

Video laryngoscopy provides a magnified indirect view of the glottis via camera, improving visualization in difficult airways without requiring optimal neck positioning.

Question 29: Which neuromuscular blocking agent is contraindicated in burn patients, crush injury, or hyperkalemia due to risk of fatal hyperkalemia?

Cisatracurium
Vecuronium
Succinylcholine (Correct answer)
Rocuronium

Correct answer: Succinylcholine

Succinylcholine causes potassium release from acetylcholine receptors; in burns, crush injuries, or upregulated receptors, this can cause fatal hyperkalemia.

Question 30: Which factor increases the risk of developing a pulmonary embolism?

High protein diet
Sedentary lifestyle (Correct answer)
Dehydration
Insomnia

Correct answer: Sedentary lifestyle

A sedentary lifestyle significantly increases the risk of developing a pulmonary embolism because prolonged immobility leads to blood stasis, particularly in the deep veins of the legs. This lack of movement promotes the formation of deep vein thrombosis (DVT), which can then dislodge and travel to the lungs, causing a pulmonary embolism. Regular movement and activity help prevent blood clot formation.

Question 31: Beck's triad (hypotension, muffled heart sounds, and JVD) is associated with which cardiac emergency?

Acute MI
Cardiac tamponade (Correct answer)
Hypertensive emergency
Right-sided heart failure

Correct answer: Cardiac tamponade

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

Question 32: Which clinical finding indicates a positive response to a fluid challenge in a hypotensive patient?

Decrease in heart rate only
Rise in temperature
Normalization of respiratory rate alone
Increase in pulse pressure and improvement in mental status (Correct answer)

Correct answer: Increase in pulse pressure and improvement in mental status

A positive fluid response is indicated by improved perfusion markers such as increased pulse pressure, improved mentation, and decreased heart rate.

Question 33: Which AMLS assessment finding is most consistent with a lesion in the brainstem?

Aphasia without motor deficits
Cortical blindness only
Hemiplegia with preserved consciousness
Abnormal respiratory patterns and cranial nerve deficits (Correct answer)

Correct answer: Abnormal respiratory patterns and cranial nerve deficits

Brainstem lesions typically cause abnormal respiratory patterns, cranial nerve deficits, and altered consciousness due to the reticular activating system.

Question 34: Which class of hemorrhagic shock (using ATLS classification) first shows altered mental status?

Class III (30–40% blood loss) (Correct answer)
Class I (up to 15% blood loss)
Class II (15–30% blood loss)
Class IV (>40% blood loss)

Correct answer: Class III (30–40% blood loss)

Class III hemorrhage (30–40% blood volume loss) is the first class associated with altered mental status, anxiety, and confusion.

Question 35: Which of the following is part of the primary survey in patient assessment?

Blood pressure measurement
Detailed medical history
Checking airway, breathing, and circulation (ABC) (Correct answer)
X-ray examination

Correct answer: Checking airway, breathing, and circulation (ABC)

The primary survey in patient assessment focuses on identifying and immediately managing life-threatening conditions. Checking the patient's Airway, Breathing, and Circulation (ABC) is the cornerstone of this survey, as these are the most critical functions for survival. Addressing any issues with ABC takes precedence over other assessments to stabilize the patient.

Question 36: What is the primary goal of early reperfusion therapy in STEMI management?

Prevent ventricular hypertrophy
Decrease heart rate
Reduce systemic blood pressure
Restore coronary blood flow to salvage myocardium (Correct answer)

Correct answer: Restore coronary blood flow to salvage myocardium

Early reperfusion aims to restore coronary blood flow to limit infarct size and salvage viable myocardium.

Question 37: A patient presents with fever, tachycardia, hypertension, mydriasis, and dry flushed skin. Which toxidrome is most likely?

Anticholinergic toxidrome (Correct answer)
Cholinergic toxidrome
Sedative-hypnotic toxidrome
Opioid toxidrome

Correct answer: Anticholinergic toxidrome

The anticholinergic toxidrome is described as 'hot as a hare, dry as a bone, blind as a bat, red as a beet, mad as a hatter.'

Question 38: In anaphylactic shock, which is the first-line treatment?

Diphenhydramine 50 mg IV
Methylprednisolone 125 mg IV
Normal saline 2 L IV bolus
Epinephrine 0.3 mg IM in the anterolateral thigh (Correct answer)

Correct answer: Epinephrine 0.3 mg IM in the anterolateral thigh

Epinephrine IM is the cornerstone of anaphylaxis treatment, reversing bronchospasm and vasodilation while blocking mediator release.

Question 39: Which of the following is a common symptom of chronic obstructive pulmonary disease (COPD)?

Chest pain
Difficulty breathing (dyspnea) (Correct answer)
Sudden weight gain
Muscle weakness

Correct answer: Difficulty breathing (dyspnea)

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that makes breathing difficult. The most common and hallmark symptom of COPD is dyspnea, or shortness of breath, which often worsens with activity and over time. Other symptoms include chronic cough and wheezing, all stemming from airflow obstruction and lung damage.

Question 40: What does a Killip Class IV classification indicate in a myocardial infarction patient?

No heart failure signs
Cardiogenic shock with high mortality (Correct answer)
Moderate heart failure
Mild pulmonary congestion

Correct answer: Cardiogenic shock with high mortality

Killip Class IV indicates cardiogenic shock, associated with the highest mortality among MI patients.

Question 41: What does a GCS score of 8 or less indicate regarding airway management?

Perform jaw thrust without airway adjunct
The patient likely cannot protect their airway and may need intubation (Correct answer)
No intervention is needed if the patient is breathing
Apply nasal cannula oxygen only

Correct answer: The patient likely cannot protect their airway and may need intubation

A GCS of 8 or less is a widely used threshold indicating inability to protect the airway and is an indication for intubation.

Question 42: A patient presents with sudden-onset worst headache of their life. Which condition must be immediately suspected?

Tension headache
Migraine with aura
Cluster headache
Subarachnoid hemorrhage (Correct answer)

Correct answer: Subarachnoid hemorrhage

A thunderclap headache described as the worst of one's life is the hallmark of subarachnoid hemorrhage until proven otherwise.

Question 43: What is the main treatment option for patients with asthma?

Beta-blockers
Inhaled corticosteroids (Correct answer)
Antibiotics
Chemotherapy

Correct answer: Inhaled corticosteroids

Inhaled corticosteroids are the cornerstone of long-term control treatment for persistent asthma. They work by reducing inflammation in the airways, which is a key underlying factor in asthma, thereby preventing symptoms and exacerbations. While bronchodilators provide quick relief, corticosteroids are essential for managing the chronic inflammatory process.

Question 44: An ETCO2 reading of 0 mmHg immediately after intubation indicates what?

Correct tracheal placement
Esophageal intubation (Correct answer)
ETT cuff leak
Right mainstem intubation

Correct answer: Esophageal intubation

An ETCO2 of 0 or near-zero after intubation indicates esophageal placement, as no CO2 is exhaled from the stomach.

Question 45: What does OPQRST stand for when assessing a patient’s pain?

Observation, Provocation, Quantification, Radiation, Sensitivity, Time
Onset, Pulse, Quality, Reflex, Sensation, Temperature
Observation, Physical exam, Quantification, Severity, Treatment
Onset, Provocation, Quality, Radiation, Severity, Time (Correct answer)

Correct answer: Onset, Provocation, Quality, Radiation, Severity, Time

The OPQRST mnemonic is a standardized tool used by healthcare professionals to thoroughly assess a patient's pain. It guides the inquiry into the Onset of pain, what Provokes or palliates it, the Quality of the pain, if it Radiates, its Severity on a scale, and the Time or duration it has been present. This comprehensive approach helps in diagnosing and managing pain effectively.

Question 46: Which electrolyte abnormality is most commonly associated with DKA and requires careful monitoring during treatment?

Hypernatremia
Hypercalcemia
Hypermagnesemia
Hypokalemia (Correct answer)

Correct answer: Hypokalemia

Despite initially normal or elevated serum potassium in DKA (due to acidosis-driven extracellular shift), total body potassium is depleted, and treatment with insulin plus fluids causes rapid hypokalemia requiring aggressive potassium replacement.

Question 47: Which of the following conditions is caused by inflammation of the bronchi?

Bronchitis (Correct answer)
Pneumonia
Pleurisy
Tuberculosis

Correct answer: Bronchitis

Bronchitis is an inflammation of the lining of the bronchial tubes, which carry air to and from the lungs. This inflammation causes symptoms such as coughing, mucus production, and shortness of breath. It can be acute, often following a viral infection, or chronic, commonly linked to smoking and exposure to irritants.

Question 48: What is the antidote for benzodiazepine overdose?

Flumazenil (Correct answer)
Atropine
Physostigmine
Naloxone

Correct answer: Flumazenil

Flumazenil competitively antagonizes benzodiazepine binding at GABA receptors; use cautiously as it can precipitate seizures in chronic BZD users.

Question 49: What is the antidote for acetaminophen overdose?

Sodium bicarbonate
Activated charcoal alone
Atropine
N-acetylcysteine (NAC) (Correct answer)

Correct answer: N-acetylcysteine (NAC)

N-acetylcysteine replenishes glutathione stores, preventing toxic NAPQI accumulation and hepatic injury from acetaminophen overdose.

Question 50: Which intervention is contraindicated in a patient with ischemic stroke who is a tPA candidate?

Establishing IV access
Checking blood glucose
Administering anticoagulants prior to tPA (Correct answer)
Performing a 12-lead ECG

Correct answer: Administering anticoagulants prior to tPA

Anticoagulants should not be given before tPA in ischemic stroke as they increase bleeding risk and are part of exclusion criteria.

Question 51: What diagnostic test is most commonly used to confirm the presence of a pulmonary embolism?

Electrocardiogram (ECG)
MRI
Chest X-ray
CT pulmonary angiography (Correct answer)

Correct answer: CT pulmonary angiography

CT pulmonary angiography (CTPA) is considered the gold standard for diagnosing pulmonary embolism. This diagnostic test involves injecting a contrast dye into the bloodstream and using a CT scanner to visualize the pulmonary arteries. It allows for direct and accurate detection of blood clots within the lung vasculature, providing definitive confirmation of a PE.

NAEMT Advanced Medical Life Support (AMLS) Exam

The NAEMT AMLS exam evaluates an EMS practitioner's ability to assess and manage common medical emergencies using the AMLS Assessment Pathway, covering respiratory, cardiac, neurological, toxicological, and shock-related conditions.

Questions

60 min

Time Limit

80%

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