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

Question 1: Which of the following is a primary symptom of pulmonary embolism?

Difficulty breathing (Correct answer)
Coughing up blood
High fever
Chest pain

Correct answer: Difficulty breathing

Difficulty breathing, or dyspnea, is a primary and often sudden symptom of pulmonary embolism (PE). This occurs because the blood clot blocks blood flow to a portion of the lung, impairing oxygen exchange and causing the body to feel starved for air. Other common symptoms include chest pain, rapid heart rate, and sometimes coughing up blood.

Question 2: What does OPQRST stand for when assessing a patient’s pain?

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

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

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

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 4: Which parameter is most useful for determining if a patient will respond to fluid resuscitation?

Heart rate alone
Passive leg raise test with cardiac output monitoring (Correct answer)
Central venous pressure alone
Blood pressure alone

Correct answer: Passive leg raise test with cardiac output monitoring

The passive leg raise (PLR) test predicts fluid responsiveness by temporarily increasing venous return; a rise in cardiac output confirms preload responsiveness.

Question 5: Which of the following respiratory conditions is characterized by a “barrel chest”?

Asthma
Pneumonia
Emphysema (Correct answer)
Bronchitis

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 6: 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 7: Which vasopressor is the recommended first-line agent for septic shock?

Epinephrine
Vasopressin
Dopamine
Norepinephrine (Correct answer)

Correct answer: Norepinephrine

Norepinephrine is the first-line vasopressor in septic shock due to its potent alpha effects with modest beta activity and favorable side-effect profile.

Question 8: Which substance causes profound metabolic acidosis with an elevated anion gap, optic nerve damage, and blindness?

Methanol (Correct answer)
Ethylene glycol
Ethanol
Isopropanol

Correct answer: Methanol

Methanol is metabolized to formaldehyde and formic acid, which damages the optic nerve and causes high anion gap metabolic acidosis.

Question 9: A patient with known epilepsy has a seizure that self-terminates in 2 minutes. They are postictal. Which assessment is still critical?

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

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 10: Which toxidrome is characterized by miosis, bradycardia, excessive secretions, and bronchospasm?

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

Correct answer: Cholinergic toxidrome (organophosphate poisoning)

The cholinergic toxidrome from organophosphate or nerve agent exposure presents with SLUDGE signs: salivation, lacrimation, urination, defecation, GI distress, emesis.

Question 11: What is the recommended time window for administering IV alteplase (tPA) in ischemic stroke from symptom onset?

Within 1 hour
Within 12 hours
Within 3 to 4.5 hours (Correct answer)
Within 6 hours

Correct answer: Within 3 to 4.5 hours

IV alteplase can be administered within 3 to 4.5 hours of symptom onset in eligible ischemic stroke patients.

Question 12: In a patient with suspected right ventricular infarction, which medication should be avoided?

Nitroglycerin (Correct answer)
Heparin
Oxygen
Aspirin

Correct answer: Nitroglycerin

Nitroglycerin causes venodilation and reduces preload, which is dangerous in RV infarction where preload dependence is critical.

Question 13: A diabetic patient presents with altered mental status, diaphoresis, and tachycardia. Blood glucose is 38 mg/dL. What is the priority treatment?

Normal saline 500 mL bolus
IV dextrose 50% (D50) 25 g (Correct answer)
Oral glucose gel
Glucagon 1 mg IM

Correct answer: IV dextrose 50% (D50) 25 g

IV D50 is the fastest and most effective treatment for symptomatic hypoglycemia in a patient with IV access.

Question 14: 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 15: Preoxygenation before RSI is performed to extend the apneic window. What SpO2 target indicates adequate preoxygenation?

Any SpO2 above 70%
SpO2 > 80% on room air
SpO2 ≥ 93–95% or higher before paralysis (Correct answer)
SpO2 > 88%

Correct answer: SpO2 ≥ 93–95% or higher before paralysis

Adequate preoxygenation aims for SpO2 ≥93–95% or higher, ideally 100%, to maximize oxygen reserves and extend the safe apneic period during RSI.

Question 16: Which class of hemorrhagic shock (using ATLS classification) first shows altered mental status?

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

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

In a patient with basal skull fracture
Only in pediatric patients
In a semi-conscious patient with an intact gag reflex (Correct answer)
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 18: Which of the following medications is commonly prescribed for preventing blood clots in patients at risk of pulmonary embolism?

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

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 19: What is the most common cause of nontraumatic intracerebral hemorrhage?

Arteriovenous malformation
Anticoagulation therapy
Hypertension (Correct answer)
Brain tumor

Correct answer: Hypertension

Chronic hypertension is the most common cause of spontaneous intracerebral hemorrhage, leading to rupture of small penetrating arteries.

Question 20: Which type of shock is characterized by decreased SVR (systemic vascular resistance) and increased cardiac output?

Obstructive shock
Hypovolemic shock
Cardiogenic shock
Distributive shock (Correct answer)

Correct answer: Distributive shock

Distributive shock (e.g., septic, anaphylactic, neurogenic) causes massive vasodilation, reducing SVR while initially increasing cardiac output.

Question 21: What is the target mean arterial pressure (MAP) in septic shock management per Surviving Sepsis guidelines?

80 mmHg or greater
90 mmHg or greater
65 mmHg or greater (Correct answer)
50 mmHg or greater

Correct answer: 65 mmHg or greater

The Surviving Sepsis Campaign recommends maintaining a MAP of 65 mmHg or greater in septic shock to ensure organ perfusion.

Question 22: Which factor increases the risk of developing a pulmonary embolism?

Dehydration
Insomnia
High protein diet
Sedentary lifestyle (Correct answer)

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 23: Carbon monoxide poisoning should be treated with which intervention?

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

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 24: 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 25: Beck's triad (hypotension, muffled heart sounds, and JVD) is associated with which cardiac emergency?

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

Correct answer: Cardiac tamponade

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

Question 26: A patient in decompensated shock has cold, mottled extremities and a capillary refill of 5 seconds. What organ is most immediately at risk?

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

Correct answer: Kidneys (acute tubular necrosis)

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

Question 27: A patient with altered mental status has a blood glucose of 38 mg/dL. IV access cannot be established. What is the most appropriate next intervention?

Oral glucose gel placed in the buccal mucosa
Intranasal dextrose spray
Intramuscular glucagon 1 mg (Correct answer)
Subcutaneous insulin to stabilize glucose

Correct answer: Intramuscular glucagon 1 mg

When IV access is unavailable in a hypoglycemic patient with altered mental status (making oral glucose unsafe), IM glucagon stimulates hepatic glycogenolysis to raise blood glucose.

Question 28: Which airway adjunct is preferred for an unconscious patient without a gag reflex who cannot be intubated immediately?

Nasopharyngeal airway (NPA)
Endotracheal tube
Oropharyngeal airway (OPA) (Correct answer)
Bag-valve-mask alone

Correct answer: Oropharyngeal airway (OPA)

An OPA is appropriate for unconscious patients without a gag reflex to maintain tongue displacement and allow effective BVM ventilation.

Question 29: A widened QRS complex and sodium channel blockade are hallmarks of toxicity from which drug class?

Selective serotonin reuptake inhibitors
Tricyclic antidepressants (TCAs) (Correct answer)
Beta-blockers
Opioids

Correct answer: Tricyclic antidepressants (TCAs)

TCA overdose blocks cardiac sodium channels causing QRS widening (>100 ms), dysrhythmias, hypotension, and seizures.

Question 30: Which of the following conditions is caused by inflammation of the bronchi?

Bronchitis (Correct answer)
Pneumonia
Tuberculosis
Pleurisy

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

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

Correct answer: Cardiac tamponade

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

Question 32: What diagnostic test is most commonly used to confirm the presence of a pulmonary embolism?

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

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.

Question 33: Which of the following is a common symptom of chronic obstructive pulmonary disease (COPD)?

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

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 34: A patient with wide-complex tachycardia and a pulse is hemodynamically unstable. What is the priority intervention?

Immediate CPR
Adenosine 6 mg rapid IV push
Amiodarone 150 mg IV
Synchronized cardioversion (Correct answer)

Correct answer: Synchronized cardioversion

Hemodynamically unstable tachycardia requires immediate synchronized cardioversion to restore organized rhythm.

Question 35: Which intervention is contraindicated in a patient with ischemic stroke who is a tPA candidate?

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

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 36: A patient presents with hyperthermia, muscle rigidity, and altered mental status after starting an antipsychotic. This is most consistent with:

Serotonin syndrome
Malignant hyperthermia
Anticholinergic toxidrome
Neuroleptic malignant syndrome (NMS) (Correct answer)

Correct answer: Neuroleptic malignant syndrome (NMS)

NMS is caused by dopamine blockade from antipsychotics, presenting with hyperthermia, lead-pipe rigidity, altered mentation, and autonomic instability.

Question 37: A patient on long-term lithium therapy presents with hypothermia, altered mental status, macroglossia, periorbital edema, and bradycardia. What treatment should be initiated?

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

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 38: Which vasopressor is preferred in cardiogenic shock when systolic BP is below 70 mmHg?

Phenylephrine
Dopamine
Norepinephrine (Correct answer)
Vasopressin

Correct answer: Norepinephrine

Norepinephrine is the preferred vasopressor in severe cardiogenic shock with profound hypotension due to its alpha and beta effects.

Question 39: Which medication is first-line for treatment of benzodiazepine-responsive seizures in the prehospital and emergency setting?

Lorazepam IV or midazolam IM (Correct answer)
Levetiracetam IV
Phenobarbital IV
Phenytoin IV

Correct answer: Lorazepam IV or midazolam IM

Benzodiazepines such as lorazepam IV or midazolam IM are first-line agents for acute seizure termination.

Question 40: Which of the following is a potential side effect of long-term oxygen therapy?

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

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

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

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 42: What is the significance of a serum lactate greater than 4 mmol/L in a shock patient?

Indicates severe tissue hypoperfusion and high mortality risk (Correct answer)
Indicates respiratory alkalosis
Confirms diabetic ketoacidosis
Is a normal finding in exercise-induced stress

Correct answer: Indicates severe tissue hypoperfusion and high mortality risk

A lactate >4 mmol/L reflects severe anaerobic metabolism from tissue hypoperfusion and is associated with significantly increased mortality.

Question 43: During BVM ventilation, what is the recommended ventilation rate for an adult patient in respiratory arrest?

20–24 breaths per minute
10–12 breaths per minute (one breath every 5–6 seconds) (Correct answer)
30 breaths per minute
6–8 breaths per minute

Correct answer: 10–12 breaths per minute (one breath every 5–6 seconds)

Adult BVM ventilation should deliver 10–12 breaths/minute to avoid hyperventilation, which reduces venous return and worsens outcomes.

Question 44: What is the primary goal of early reperfusion therapy in STEMI management?

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

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 45: A patient in respiratory failure cannot be intubated and cannot be mask-ventilated. What is the definitive emergency intervention?

Continue BVM indefinitely
Cricothyrotomy (surgical or needle) (Correct answer)
Repeat laryngoscopy attempts
Nasotracheal intubation only

Correct answer: Cricothyrotomy (surgical or needle)

In a 'can't intubate, can't oxygenate' (CICO) scenario, cricothyrotomy provides emergency surgical airway access.

Question 46: What is the most common cause of pulmonary embolism (PE)?

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

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

Skin color
Pupil size
Weight
Blood pressure (Correct answer)

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 48: A patient with chest pain has a 12-lead ECG showing new left bundle branch block. How should this be managed?

Perform immediate cardioversion
Treat as STEMI equivalent and activate cath lab (Correct answer)
Administer aspirin only and monitor
Discharge with cardiology follow-up

Correct answer: Treat as STEMI equivalent and activate cath lab

New LBBB with chest pain is treated as a STEMI equivalent, requiring emergent cardiac catheterization.

Question 49: Which of the following is part of the primary survey in patient assessment?

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

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 50: A patient with type 1 diabetes presents with diaphoresis, tachycardia, and anxiety. Blood glucose is 45 mg/dL. After giving 25 g of D50W IV, glucose rises to 120 mg/dL. What should be done next?

Start a regular insulin drip
Discharge the patient once glucose is above 100 mg/dL
Provide a complex carbohydrate snack and monitor for recurrence (Correct answer)
Administer a second D50W bolus immediately

Correct answer: Provide a complex carbohydrate snack and monitor for recurrence

After correcting acute hypoglycemia with D50W, a complex carbohydrate meal or snack is given to prevent rebound hypoglycemia, and the patient should be monitored because the original insulin or medication effect may outlast the glucose bolus.

Question 51: Which medication is most commonly used for sedation during RSI prior to neuromuscular blockade?

Midazolam alone
Fentanyl alone
Propofol in all patients
Ketamine or etomidate (Correct answer)

Correct answer: Ketamine or etomidate

Ketamine (maintains hemodynamics, bronchodilates) and etomidate (hemodynamically neutral) are the preferred induction agents for RSI in emergency settings.

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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