FISDAP EMS Readiness Exam — Questions and Answers

Question 1: Sodium bicarbonate is indicated in the prehospital setting for which condition?

Respiratory acidosis from COPD
Diabetic ketoacidosis
Hypernatremia
Tricyclic antidepressant overdose with widened QRS (Correct answer)

Correct answer: Tricyclic antidepressant overdose with widened QRS

Sodium bicarbonate alkalinizes the serum, which reduces sodium channel blockade from TCAs and narrows the QRS complex.

Question 2: A 12-lead ECG shows diffuse ST elevation in most leads with PR segment depression. These findings are most consistent with which condition?

STEMI involving the left anterior descending artery
Acute pericarditis (Correct answer)
Hyperkalemia
Brugada syndrome

Correct answer: Acute pericarditis

Diffuse ST elevation with PR segment depression across multiple leads (not in a coronary distribution) is the classic ECG pattern of acute pericarditis.

Question 3: Which FISDAP data point is most relevant for evaluating a student's ability to communicate with dispatch during an active call?

Transport distance
Patient contact time
On-scene time
Radio communication skills (Correct answer)

Correct answer: Radio communication skills

FISDAP logs radio and communication skills to evaluate how effectively students interact with dispatch and medical control.

Question 4: What is the primary indication for magnesium sulfate administration in the prehospital setting?

Stable angina
First-degree AV block
Torsades de pointes and eclampsia (Correct answer)
Stable atrial flutter

Correct answer: Torsades de pointes and eclampsia

Magnesium sulfate is first-line treatment for torsades de pointes and is used to prevent eclamptic seizures in preeclampsia.

Question 5: A 45-year-old male sustains blunt chest trauma and presents with paradoxical chest wall movement. Which condition does this indicate?

Flail chest (Correct answer)
Open pneumothorax
Tension pneumothorax
Cardiac tamponade

Correct answer: Flail chest

Flail chest occurs when three or more consecutive ribs are fractured in two or more places, causing a free-floating segment that moves paradoxically (inward on inspiration, outward on expiration).

Question 6: A program director reviews FISDAP data and notices a student has high skill attempt counts but low preceptor evaluation scores. This discrepancy most likely suggests:

The student should be advanced immediately
The student is performing well but is underrated by preceptors
The data entry system has an error
High quantity of attempts is not translating to quality performance as observed by preceptors (Correct answer)

Correct answer: High quantity of attempts is not translating to quality performance as observed by preceptors

Quantity of attempts without corresponding quality scores signals a student who may need targeted remediation to improve competency, not just exposure.

Question 7: A patient has a laryngeal mask airway (LMA) in place. Which of the following is a known limitation of the LMA?

It cannot deliver positive pressure ventilation
It requires visualization of the vocal cords
It cannot be used in cardiac arrest
It does not protect against aspiration (Correct answer)

Correct answer: It does not protect against aspiration

The LMA sits above the glottis and does not create a tracheal seal, so it does not reliably prevent aspiration.

Question 8: How does documentation support quality in OB/GYN Emergencies?

It creates records, ensures consistency, and enables improvement (Correct answer)
It is only for billing
It only serves administrative purposes
Documentation is unnecessary overhead

Correct answer: It creates records, ensures consistency, and enables improvement

Proper documentation creates accountability, ensures consistency, supports quality improvement, and provides legal protection.

Question 9: When using the Cincinnati Prehospital Stroke Scale, which of the following is NOT one of the three assessed components?

Arm drift
Abnormal speech
Pupil reactivity (Correct answer)
Facial droop

Correct answer: Pupil reactivity

The Cincinnati Stroke Scale assesses facial droop, arm drift, and speech abnormalities; pupil reactivity is not part of this tool.

Question 10: Which drug, when used by the mother shortly before delivery, is MOST likely to cause neonatal respiratory depression requiring positive-pressure ventilation?

Magnesium sulfate
Opioid analgesics (e.g., fentanyl, morphine) (Correct answer)
Terbutaline
Oxytocin (Pitocin)

Correct answer: Opioid analgesics (e.g., fentanyl, morphine)

Opioids cross the placenta and cause neonatal central nervous system and respiratory depression; naloxone may be indicated per protocol if maternal opioid use is confirmed.

Question 11: A patient in respiratory failure has a SpO2 of 78% despite BVM ventilation. After intubation, you confirm tube placement with capnography showing a flat waveform. What is the most likely cause?

Laryngospasm
Esophageal intubation (Correct answer)
Right mainstem intubation
Bronchospasm

Correct answer: Esophageal intubation

A flat or absent capnography waveform after intubation is the most reliable indicator of esophageal intubation.

Question 12: After delivery of the placenta, the EMT notes the patient has saturated two pads in 10 minutes. The uterus is soft and boggy. The FIRST intervention is:

Clamp the cervix with a ring forcep
Administer IV epinephrine
Apply a pressure dressing to the perineum
Perform bimanual fundal massage (Correct answer)

Correct answer: Perform bimanual fundal massage

A boggy (atonic) uterus causing hemorrhage is treated with fundal massage to stimulate uterine contraction and reduce blood loss.

Question 13: Which finding during abdominal assessment BEST indicates aortic aneurysm?

Positive Murphy's sign
Rigid, board-like abdomen
Pulsating abdominal mass (Correct answer)
Rebound tenderness in the right lower quadrant

Correct answer: Pulsating abdominal mass

A pulsating abdominal mass is the classic prehospital finding of an abdominal aortic aneurysm.

Question 14: How should you manage time during a timed test?

Rush through the entire test
Only work on hard questions
Spend equal time on every question
Divide total time by questions and pace yourself, spending less on easy ones (Correct answer)

Correct answer: Divide total time by questions and pace yourself, spending less on easy ones

Calculate time per question, spend less on easy questions to bank time for harder ones, and check your pace periodically.

Question 15: Which FISDAP feature allows programs to compare their students' skill attainment rates against national averages?

National benchmarking reports (Correct answer)
The shift scheduling calendar
The individual student portfolio
The preceptor feedback form

Correct answer: National benchmarking reports

FISDAP's national benchmarking reports aggregate data across programs so directors can see how their students compare nationally.

Question 16: Dopamine is ordered for a patient in cardiogenic shock. At which dose range does dopamine primarily exert beta-1 adrenergic effects to increase cardiac output?

Greater than 20 mcg/kg/min
5-10 mcg/kg/min (Correct answer)
10-20 mcg/kg/min
1-3 mcg/kg/min

Correct answer: 5-10 mcg/kg/min

At 5-10 mcg/kg/min, dopamine primarily stimulates beta-1 receptors, increasing heart rate and myocardial contractility to improve cardiac output.

Question 17: A patient is intubated and being transported. ETCO2 suddenly drops from 38 mmHg to near zero. What should you assess first?

Check for pneumothorax
Assess for tube dislodgement or obstruction (Correct answer)
Recheck IV access
Increase ventilation rate

Correct answer: Assess for tube dislodgement or obstruction

A sudden drop in ETCO2 to near zero during transport most likely indicates tube dislodgement or complete obstruction.

Question 18: What is the relationship between theory and practice in OB/GYN Emergencies?

Theory is unnecessary
Theory provides the foundation; practice applies it to real situations (Correct answer)
Practice is unnecessary if you know theory
They are completely separate

Correct answer: Theory provides the foundation; practice applies it to real situations

Theory provides the conceptual foundation and principles, while practice involves applying those concepts to real-world situations. Both are essential for competence.

Question 19: When a student administers oxygen to a patient during a field internship, which FISDAP section should this be documented under?

Interventions / treatments (Correct answer)
Transport narrative
Scene safety notes
Patient history

Correct answer: Interventions / treatments

All treatments and interventions, including oxygen administration, are documented in the interventions/treatments section of the patient encounter record.

Question 20: A patient presents with sudden onset of severe, tearing chest pain radiating to the back. BP is 190/110 in the right arm and 140/90 in the left arm. What is the most likely diagnosis?

Hypertensive crisis with pulmonary edema
Tension pneumothorax
Acute anterior STEMI
Aortic dissection (Correct answer)

Correct answer: Aortic dissection

Tearing chest pain radiating to the back with blood pressure differential between arms is the classic presentation of aortic dissection, a life-threatening emergency.

Question 21: A conscious adult patient refuses treatment after a thorough assessment. Which action is MOST appropriate?

Restrain the patient and transport
Call medical direction and then leave without documentation
Document the refusal and have the patient sign an AMA form (Correct answer)
Administer treatment without consent

Correct answer: Document the refusal and have the patient sign an AMA form

A competent adult has the right to refuse care; EMTs must document the refusal thoroughly and obtain a signed against medical advice (AMA) form.

Question 22: When operating at a highway incident scene, EMS personnel should park their unit at a minimum of how far from the wreckage on a high-speed roadway?

50 feet uphill and upwind
At least 100 feet back with apparatus angled to create a buffer (Correct answer)
100 feet past the scene
Directly adjacent to the vehicles involved

Correct answer: At least 100 feet back with apparatus angled to create a buffer

EMS units should be positioned at least 100 feet from the wreckage with the unit angled to deflect oncoming traffic and protect the work zone.

Question 23: A patient in SVT receives adenosine 6 mg IV push without effect. What is the next appropriate dose?

12 mg IV push (Correct answer)
6 mg repeated
18 mg IV push
Amiodarone 150 mg

Correct answer: 12 mg IV push

If the initial 6 mg adenosine dose fails, the next dose is 12 mg rapid IV push, which may be repeated once more if needed.

Question 24: At a structure fire scene, EMS staging areas should be located:

Immediately adjacent to the fire suppression vehicles
Upwind and uphill from the incident, outside the hot zone (Correct answer)
Inside the perimeter to allow rapid patient access
Downwind to avoid blocking the command post

Correct answer: Upwind and uphill from the incident, outside the hot zone

EMS staging upwind and uphill keeps providers and equipment away from smoke, hazardous gases, and structural collapse zones.

Question 25: What is the primary concern when administering calcium channel blockers to a patient already on beta-blockers?

Additive hypotension and AV block (Correct answer)
Paradoxical tachycardia
Increased risk of bronchospasm
Hyperkalemia

Correct answer: Additive hypotension and AV block

Both drug classes depress cardiac conduction and contractility; combining them greatly increases the risk of severe hypotension and complete AV block.

Question 26: Which study approach is most effective for Medical Emergencies material?

Studying for very long sessions without breaks
Passive re-reading of notes
Active recall with practice questions (Correct answer)
Highlighting all text

Correct answer: Active recall with practice questions

Active recall through practice questions is the most effective study method, as it strengthens memory retrieval pathways.

Question 27: A FISDAP program report shows a student has a high number of shift hours but a low skill attempt count. This pattern MOST likely indicates:

The student's account has a data entry error only
The student is performing above average
The student may be observing rather than actively participating in patient care (Correct answer)
The preceptor has not logged any evaluations

Correct answer: The student may be observing rather than actively participating in patient care

High hours with low skill counts often signals a passive observer role, prompting program directors to investigate student engagement.

Question 28: In FISDAP EMS operations, which skill is measured when a student correctly decontaminates equipment after a patient contact?

Scene safety entry
PPE donning
Post-call infection control (Correct answer)
Biohazard documentation

Correct answer: Post-call infection control

Post-call infection control is a tracked FISDAP operations skill ensuring students follow decontamination protocols after patient care.

Question 29: During a breech delivery in the field, the baby's body delivers to the level of the umbilicus but the head is retained. The EMT should:

Clamp and cut the cord immediately to reduce tension
Pull firmly on the legs to complete delivery
Support the body, allow the head to deliver by gravity, and create an airway with two fingers if needed (Correct answer)
Apply suprapubic pressure to deliver the head rapidly

Correct answer: Support the body, allow the head to deliver by gravity, and create an airway with two fingers if needed

In a retained aftercoming head, the EMT supports the body weight, allows gravity to assist, and if needed, inserts two fingers along the baby's face to maintain an airway while awaiting delivery.

Question 30: How does documentation support quality in Trauma Management?

It only serves administrative purposes
It creates records, ensures consistency, and enables improvement (Correct answer)
It is only for billing
Documentation is unnecessary overhead

Correct answer: It creates records, ensures consistency, and enables improvement

Proper documentation creates accountability, ensures consistency, supports quality improvement, and provides legal protection.

Question 31: A patient with a GCS of 8 after blunt head trauma begins vomiting. What is the immediate priority?

Apply a non-rebreather mask at 15 LPM and monitor
Place the patient supine and elevate legs
Protect the airway with suction and consider early intubation (Correct answer)
Administer ondansetron IV

Correct answer: Protect the airway with suction and consider early intubation

A GCS of 8 or less indicates inability to protect the airway; vomiting in this setting dramatically increases aspiration risk, making airway management the immediate priority.

Question 32: How does documentation support quality in Cardiac Emergencies?

It only serves administrative purposes
Documentation is unnecessary overhead
It creates records, ensures consistency, and enables improvement (Correct answer)
It is only for billing

Correct answer: It creates records, ensures consistency, and enables improvement

Proper documentation creates accountability, ensures consistency, supports quality improvement, and provides legal protection.

Question 33: What is a side effect?

An expired medication
A dosing error
The intended therapeutic effect
An unintended effect of a medication beyond its intended action (Correct answer)

Correct answer: An unintended effect of a medication beyond its intended action

Side effects are unintended responses to a medication that occur alongside the desired therapeutic effect.

Question 34: When calculating CPP (coronary perfusion pressure) during CPR, which values are used?

Diastolic aortic pressure minus right atrial pressure (Correct answer)
Mean arterial pressure minus central venous pressure
Systolic BP minus heart rate
Systolic aortic pressure minus pulmonary wedge pressure

Correct answer: Diastolic aortic pressure minus right atrial pressure

CPP = diastolic aortic pressure minus right atrial pressure; a CPP above 15 mmHg is associated with better ROSC outcomes during resuscitation.

Question 35: Which FISDAP feature automatically flags a student when their cumulative required skill attempts fall below the program-defined minimum threshold?

Skills tracker alert (Correct answer)
Preceptor dashboard
Competency verification form
Shift audit log

Correct answer: Skills tracker alert

The skills tracker alert system monitors running totals and highlights deficiencies relative to the program's minimum attempt requirements.

Question 36: When arriving at a scene with multiple casualties, which FISDAP-tracked skill involves establishing command and organizing resources?

Mass casualty documentation
Incident Command System (ICS) (Correct answer)
Triage START protocol
Scene size-up

Correct answer: Incident Command System (ICS)

FISDAP tracks Incident Command System use as a key EMS operations skill during multi-casualty events.

Question 37: Why is continuing education important in Trauma Management?

It is not important after certification
To stay current with evolving standards and practices (Correct answer)
Only for re-certification requirements
To network only

Correct answer: To stay current with evolving standards and practices

Continuing education keeps professionals updated with the latest developments, standards, and best practices in their field.

Question 38: A 28-year-old male sustains a stab wound to the right upper quadrant. Which organ is MOST likely injured?

Liver (Correct answer)
Descending colon
Spleen
Stomach

Correct answer: Liver

The liver occupies most of the right upper quadrant and is the most commonly injured solid organ in penetrating abdominal trauma to that region.

Question 39: When managing a patient with placenta previa in the field, the EMT should:

Apply direct pressure inside the vagina to slow bleeding
Perform a vaginal exam to estimate dilation
Apply a sterile pad, do NOT perform a vaginal exam, and transport rapidly (Correct answer)
Attempt gentle manual removal of the placenta if visible

Correct answer: Apply a sterile pad, do NOT perform a vaginal exam, and transport rapidly

Vaginal examination in suspected placenta previa can cause catastrophic hemorrhage; the EMT should apply an external pad and transport immediately.

Question 40: The AVPU scale is used during a pediatric assessment. What does the 'V' represent?

Vocalizing but not oriented
Verbally distressed
Verbalizing spontaneously
Responds to verbal stimuli (Correct answer)

Correct answer: Responds to verbal stimuli

In the AVPU scale, 'V' means the patient responds to verbal stimuli but is not fully alert.

Question 41: How does FISDAP's field internship tracking help programs comply with the requirement for supervised field experience?

It assigns field internship sites automatically based on zip code
It documents the number of shifts, patient contacts, and preceptor-verified skills completed in the field setting (Correct answer)
It replaces the need for students to complete actual field internships
It tracks only classroom hours, not field time

Correct answer: It documents the number of shifts, patient contacts, and preceptor-verified skills completed in the field setting

FISDAP's field internship module captures shift hours, patient contacts, and preceptor-verified skills, providing auditable evidence of required supervised field experience.

Question 42: A patient presents with altered mental status and a blood glucose reading of 38 mg/dL. After administering oral glucose, reassessment reveals no improvement. What is the NEXT appropriate intervention?

Establish IV access and administer dextrose 50% (Correct answer)
Administer a second dose of oral glucose
Recheck blood glucose in 15 minutes
Perform a 12-lead ECG

Correct answer: Establish IV access and administer dextrose 50%

When oral glucose fails in a hypoglycemic patient, IV dextrose (D50) is the next step to rapidly correct glucose levels.

Question 43: In what way does FISDAP streamline the documentation process for accreditation?

By assisting with the financial documentation required for accreditation
By automatically submitting student reports to accreditation agencies
By generating mock accreditation tests for students
By organizing and storing data on student performance and clinical hours for easy access during audits (Correct answer)

Correct answer: By organizing and storing data on student performance and clinical hours for easy access during audits

FISDAP streamlines the documentation process for accreditation by centralizing and systematically organizing all relevant student data. This makes it incredibly efficient for programs to retrieve and present comprehensive records of student performance, clinical hours, and skill attainment during accreditation audits, saving significant time and effort for administrators.

Question 44: When performing synchronized cardioversion on a patient with unstable atrial flutter, where should the sync marker ideally fall on the ECG waveform?

On the U wave
On the T wave
On the P wave
On the R wave (QRS complex) (Correct answer)

Correct answer: On the R wave (QRS complex)

Synchronized cardioversion delivers the shock on the R wave of the QRS complex to avoid the vulnerable T-wave period, which could precipitate ventricular fibrillation.

Question 45: What role does ethics play in Trauma Management practice?

It only applies to managers
It only matters for legal compliance
It guides professional conduct and protects stakeholders (Correct answer)
Ethics is optional in professional settings

Correct answer: It guides professional conduct and protects stakeholders

Professional ethics provide frameworks for responsible decision-making, ensuring practitioners act in the best interest of those they serve.

Question 46: During the primary assessment of an unconscious patient, you determine breathing is adequate. The NEXT step is to:

Apply a pulse oximeter
Perform a head-to-toe physical exam
Assess circulation and control major bleeding (Correct answer)
Obtain a SAMPLE history from bystanders

Correct answer: Assess circulation and control major bleeding

After confirming adequate airway and breathing, the primary assessment proceeds to circulation — assessing pulse quality and controlling life-threatening hemorrhage.

Question 47: A patient with chest pain and diaphoresis has ST depression in V1-V3 with dominant R waves. Which condition does this pattern suggest?

Anterior STEMI
Posterior STEMI (posterior wall MI) (Correct answer)
Digitalis toxicity
Benign early repolarization

Correct answer: Posterior STEMI (posterior wall MI)

ST depression with tall R waves in V1-V3 represents the reciprocal mirror image of a posterior STEMI and should prompt acquisition of posterior leads V7-V9.

Question 48: A 45-year-old female presents with tearing chest pain radiating to her back, unequal blood pressures in both arms, and a BP of 190/110 mmHg. What is the most likely diagnosis?

Aortic dissection (Correct answer)
Spontaneous pneumothorax
Acute MI with posterior wall involvement
Pulmonary embolism

Correct answer: Aortic dissection

Tearing back pain, hypertension, and unequal bilateral arm blood pressures are classic features of aortic dissection due to compromise of arterial branch origins.

Question 49: Which of the following ETCO2 values during CPR is associated with a higher likelihood of return of spontaneous circulation (ROSC)?

10–20 mmHg
< 10 mmHg
> 20 mmHg (Correct answer)
ETCO2 is not predictive of ROSC

Correct answer: > 20 mmHg

An ETCO2 greater than 20 mmHg during CPR indicates better cardiac output and is associated with improved likelihood of ROSC.

Question 50: In FISDAP, documenting 'refusal of care' for a patient encounter requires the student to record which key data element?

Reason the crew did not want to transport
That the patient was informed of risks and signed a refusal (Correct answer)
Patient's insurance information
Hospital destination even if patient refused

Correct answer: That the patient was informed of risks and signed a refusal

A valid refusal of care requires documentation that the patient was informed of potential consequences and voluntarily declined treatment or transport.

Question 51: A patient with a history of COPD presents with increased work of breathing, pursed-lip breathing, and barrel chest. These findings are associated with which underlying condition?

Emphysema (Correct answer)
Pulmonary edema
Pneumonia
Asthma

Correct answer: Emphysema

Barrel chest and pursed-lip breathing are classic chronic physical findings of emphysema, a component of COPD caused by air trapping.

Question 52: Which sign is MOST associated with a basilar skull fracture?

Battle's sign and raccoon eyes (Correct answer)
Cheyne-Stokes respirations and pupil dilation
Bradycardia and diaphoresis
Kussmaul respirations and hypertension

Correct answer: Battle's sign and raccoon eyes

Battle's sign (bruising behind the ear over the mastoid) and raccoon eyes (periorbital bruising) are classic delayed signs of basilar skull fracture.

Question 53: A patient on warfarin presents with a major GI bleed. Which reversal agent is most appropriate?

Vitamin K and/or fresh frozen plasma (Correct answer)
Protamine sulfate
Naloxone
Flumazenil

Correct answer: Vitamin K and/or fresh frozen plasma

Warfarin antagonizes vitamin K-dependent clotting factors; reversal is achieved with vitamin K and/or FFP to restore clotting factor activity rapidly.

Question 54: During a field delivery, the placenta has not delivered 30 minutes after the baby. The EMT should:

Monitor for hemorrhage, keep the cord clamped, and transport for hospital management (Correct answer)
Manually explore the uterine cavity to remove the placenta
Administer oxytocin IM per local protocol and then massage the fundus forcefully
Clamp the cord tightly and apply steady traction to deliver the placenta

Correct answer: Monitor for hemorrhage, keep the cord clamped, and transport for hospital management

Retained placenta beyond 30 minutes requires hospital management; the EMT should monitor for hemorrhage and transport without attempting manual removal.

Question 55: A 22-year-old restrained driver involved in a frontal collision complains of sternal pain and irregular heartbeats. Which injury should you suspect?

Myocardial contusion (Correct answer)
Spontaneous pneumothorax
Pulmonary embolism
Aortic dissection

Correct answer: Myocardial contusion

Blunt cardiac injury (myocardial contusion) results from direct chest wall compression against the steering wheel, causing dysrhythmias and chest pain.

Question 56: During a vehicle rescue, a patient has a positive Seat Belt Sign (bruising across the abdomen). This finding is associated with which injury pattern?

Femoral artery laceration
Isolated rib fractures
Hollow organ injury, lumbar spine fracture (Chance fracture) (Correct answer)
Cardiac contusion and sternal fracture

Correct answer: Hollow organ injury, lumbar spine fracture (Chance fracture)

The Seat Belt Sign indicates significant deceleration force transmitted through the lap belt, commonly causing hollow organ rupture and Chance fractures of the lumbar spine.

Question 57: A patient sustains a traumatic amputation of the right hand. A bystander has already applied a tourniquet. It is now bleeding through. What is your action?

Remove the tourniquet and apply direct pressure
Reapply the tourniquet 2 inches distal to the first
Apply a second tourniquet proximal to the first (Correct answer)
Loosen the tourniquet 10 minutes to allow circulation

Correct answer: Apply a second tourniquet proximal to the first

If a tourniquet is not controlling hemorrhage, apply a second tourniquet immediately proximal to the first to achieve complete arterial occlusion.

Question 58: You are managing a patient with suspected tension pneumothorax. After needle decompression in the 2nd intercostal space, midclavicular line, there is no improvement. What is your next action?

Immediately perform a surgical cricothyrotomy
Perform needle decompression at the 4th or 5th ICS, anterior axillary line (Correct answer)
Administer IV fluid bolus and reassess
Repeat the needle decompression at the same site

Correct answer: Perform needle decompression at the 4th or 5th ICS, anterior axillary line

If the first decompression fails, the second attempt should be performed at the 4th–5th intercostal space at the anterior axillary line, which may be more effective in obese or muscular patients.

Question 59: Why is continuing education important in Airway Management?

To stay current with evolving standards and practices (Correct answer)
To network only
It is not important after certification
Only for re-certification requirements

Correct answer: To stay current with evolving standards and practices

Continuing education keeps professionals updated with the latest developments, standards, and best practices in their field.

Question 60: In FISDAP, which data field is used to document the primary impression of a patient during a clinical shift?

Chief complaint
Nature of illness or mechanism of injury (Correct answer)
Patient acuity level
Primary assessment finding

Correct answer: Nature of illness or mechanism of injury

Nature of illness (NOI) or mechanism of injury (MOI) captures the primary impression that guides the EMS assessment.

Question 61: When succinylcholine is used for RSI, which electrolyte abnormality is its use most dangerous in?

Hyponatremia
Hypomagnesemia
Hypocalcemia
Hyperkalemia (Correct answer)

Correct answer: Hyperkalemia

Succinylcholine causes transient potassium efflux; in patients with pre-existing hyperkalemia, this can trigger fatal ventricular dysrhythmias.

Question 62: A patient with a suspected foreign body upper airway obstruction is coughing forcefully. The correct immediate action is to:

Encourage continued coughing and monitor closely (Correct answer)
Perform abdominal thrusts immediately
Attempt laryngoscopy
Perform a blind finger sweep

Correct answer: Encourage continued coughing and monitor closely

A patient with a forceful cough still has adequate airflow; allow them to continue coughing as it is the most effective way to clear the obstruction.

Question 63: A 16-year-old athlete collapses during football practice on a hot day. He is conscious, sweating profusely, and has muscle cramps. Vital signs are BP 100/60, HR 120, core temp 38.2°C. What is the most likely condition?

Exertional rhabdomyolysis
Heat stroke
Exercise-associated hyponatremia
Heat exhaustion (Correct answer)

Correct answer: Heat exhaustion

Heat exhaustion is characterized by heavy sweating, weakness, mild hypotension, tachycardia, and core temperature below 40°C, distinguishing it from the neurological dysfunction of heat stroke.

Question 64: What is the relationship between theory and practice in Cardiac Emergencies?

They are completely separate
Practice is unnecessary if you know theory
Theory provides the foundation; practice applies it to real situations (Correct answer)
Theory is unnecessary

Correct answer: Theory provides the foundation; practice applies it to real situations

Theory provides the conceptual foundation and principles, while practice involves applying those concepts to real-world situations. Both are essential for competence.

Question 65: A patient presents with signs of cardiac tamponade including hypotension, distended jugular veins, and muffled heart sounds. What is this classic triad called?

Murphy's triad
Virchow's triad
Beck's triad (Correct answer)
Cushing's triad

Correct answer: Beck's triad

Beck's triad — hypotension, jugular venous distension, and muffled heart sounds — is the classic presentation of cardiac tamponade.

Question 66: Which medication is contraindicated in a patient taking MAO inhibitors who presents with hypertensive crisis?

Nitroglycerin
Aspirin
Epinephrine (Correct answer)
Morphine

Correct answer: Epinephrine

Epinephrine combined with MAO inhibitors can cause a severe, potentially fatal hypertensive crisis due to catecholamine potentiation.

Question 67: A patient presents with chest pain and his ECG shows a new right bundle branch block (RBBB) with ST elevation in V1-V4. This pattern suggests occlusion of which vessel?

Left circumflex artery
Proximal left anterior descending artery (Correct answer)
Posterior descending artery
Right coronary artery proximal segment

Correct answer: Proximal left anterior descending artery

New RBBB with anterior ST elevation strongly suggests a proximal LAD occlusion, which can interrupt blood flow to the right bundle branch and the anterior wall.

Question 68: A student documents assisting with a mutual aid response to a neighboring county. Which FISDAP category best captures this experience?

Disaster response
Community paramedicine
Mass casualty incident
Inter-agency operations (Correct answer)

Correct answer: Inter-agency operations

Inter-agency operations are tracked in FISDAP to document experiences involving cooperation between different EMS agencies or jurisdictions.

Question 69: Which finding during auscultation of a pediatric patient's chest is MOST consistent with foreign body aspiration?

High-pitched inspiratory stridor
Diffuse crackles bilaterally
Unilateral decreased breath sounds (Correct answer)
Bilateral expiratory wheezing

Correct answer: Unilateral decreased breath sounds

Unilateral decreased breath sounds suggest a foreign body lodged in one mainstem bronchus, causing air trapping on that side.

Question 70: A 70 kg adult patient requires dopamine at 5 mcg/kg/min. The solution is 400 mg in 250 mL. What is the correct infusion rate in mL/hr?

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

Correct answer: 13.1 mL/hr

Concentration = 1600 mcg/mL; dose = 5 × 70 = 350 mcg/min; rate = 350/1600 × 60 = 13.125 mL/hr.

Question 71: Which breath sound, heard on auscultation, is described as a high-pitched, monophonic wheeze heard primarily on expiration and indicates upper airway obstruction?

Crackles
Rhonchi
Wheezing
Stridor (Correct answer)

Correct answer: Stridor

Stridor is a high-pitched sound caused by turbulent airflow through a partially obstructed upper airway.

Question 72: During assessment of a patient in respiratory distress, you note tracheal deviation to the right. This MOST likely indicates:

Left-sided tension pneumothorax (Correct answer)
Right-sided pleural effusion
Bilateral pneumonia
Right-sided atelectasis

Correct answer: Left-sided tension pneumothorax

A left-sided tension pneumothorax creates pressure that pushes the trachea and mediastinum toward the right.

Question 73: Which type of hemorrhage is characterized by dark red blood that flows steadily and does not pulsate?

Venous hemorrhage (Correct answer)
Occult hemorrhage
Capillary hemorrhage
Arterial hemorrhage

Correct answer: Venous hemorrhage

Venous blood is dark red and flows steadily due to lower pressure in veins, unlike arterial hemorrhage which is bright red and pulsatile.

Question 74: Atropine is indicated for symptomatic bradycardia. What is the initial adult dose?

0.5 mg IV (Correct answer)
2.0 mg IV
1.0 mg IV
0.1 mg IV

Correct answer: 0.5 mg IV

The initial dose of atropine for symptomatic bradycardia is 0.5 mg IV, which may be repeated every 3-5 minutes to a maximum of 3 mg.

Question 75: A patient in ventricular fibrillation receives a defibrillation shock. What is the FIRST action after shock delivery?

Recheck the rhythm on the monitor
Check for a pulse immediately
Administer epinephrine 1 mg IV
Resume CPR immediately (Correct answer)

Correct answer: Resume CPR immediately

After defibrillation, CPR should be resumed immediately for 2 minutes before pausing to recheck rhythm, as perfusion may not be restored instantly.

Question 76: When assessing a patient using the AVPU scale, a patient who only responds to a sternal rub would be classified as:

Verbal
Unresponsive
Pain (Correct answer)
Alert

Correct answer: Pain

AVPU 'P' indicates the patient responds only to painful stimuli, such as a sternal rub or pinch.

Question 77: In FISDAP analytics, 'item analysis' on a readiness exam refers to reviewing which of the following?

Preceptor response times to evaluations
Student attendance patterns across shifts
How individual exam questions performed in terms of discrimination and difficulty (Correct answer)
Equipment checklist completion rates

Correct answer: How individual exam questions performed in terms of discrimination and difficulty

Item analysis evaluates each exam question's difficulty index and discrimination power, helping educators identify poorly performing questions.

Question 78: A student notices that a previously submitted patient care report in FISDAP contains an error in the vitals section. What is the appropriate action?

Leave it as-is since submissions cannot be changed
Delete the entry and resubmit from scratch
Contact the program coordinator to correct the record through proper channels (Correct answer)
Edit the record directly without notifying anyone

Correct answer: Contact the program coordinator to correct the record through proper channels

Corrections to submitted records should follow program protocols and involve program coordinators to maintain data integrity and audit trails.

Question 79: Which of the following best describes the role of the precordial thump in cardiac arrest management?

Routinely used for all shockable rhythms
Contraindicated in all prehospital settings
Used after every failed defibrillation attempt
Only considered for witnessed monitored pulseless VT when a defibrillator is not immediately available (Correct answer)

Correct answer: Only considered for witnessed monitored pulseless VT when a defibrillator is not immediately available

The precordial thump may be considered only for witnessed, monitored pulseless VT when defibrillation is not immediately available, as its benefit is uncertain.

Question 80: During assessment, a patient rates abdominal pain as 9/10. You note guarding and rigidity. These findings together MOST suggest which priority level?

Moderate priority — treat and monitor on scene
Low priority — reassess in 15 minutes
High priority — expedite transport (Correct answer)
Undetermined — gather more history first

Correct answer: High priority — expedite transport

Severe pain with peritoneal signs (guarding and rigidity) indicates a high-priority patient requiring rapid transport to a definitive care facility.

Question 81: Which of the following is the MOST reliable early indicator of shock in a pediatric patient?

Hypotension
Absent peripheral pulses
Altered mental status
Tachycardia (Correct answer)

Correct answer: Tachycardia

Tachycardia is the earliest and most reliable compensatory sign of shock in pediatric patients, as hypotension is a late and ominous sign.

Question 82: In permissive hypotension strategy for penetrating trauma patients without TBI, what is the target systolic BP during transport?

120 mmHg
70–90 mmHg (Correct answer)
100–110 mmHg
60 mmHg or less

Correct answer: 70–90 mmHg

Permissive hypotension targets a systolic BP of 70–90 mmHg to maintain minimal organ perfusion while avoiding aggressive fluid resuscitation that can worsen coagulopathy and clot disruption.

Question 83: A FISDAP program coordinator wants to identify which clinical sites yield the highest student skill diversity. Which report would be MOST helpful?

Student demographic report
Individual student attendance log
National benchmarking summary
Site-level skill distribution report (Correct answer)

Correct answer: Site-level skill distribution report

A site-level skill distribution report shows which patient contact types and skills are being practiced at each clinical location.

Question 84: A pediatric patient requires intubation. Using the length-based tape (Broselow tape) estimate, which parameter does the tape directly estimate?

Ideal body weight and appropriate equipment sizes (Correct answer)
Exact drug doses based on renal function
Chest compression depth and rate
SpO2 and ETCO2 targets

Correct answer: Ideal body weight and appropriate equipment sizes

The Broselow tape uses the child's length as a proxy for weight to estimate appropriate equipment sizes and drug doses.

Question 85: During assessment of a burn patient, which finding would MOST indicate airway involvement from inhalation injury?

Blistering on the forearms
Singed nasal hairs and carbonaceous sputum (Correct answer)
Circumferential burns to the extremities
Burns below the waist

Correct answer: Singed nasal hairs and carbonaceous sputum

Singed nasal hairs, burned facial hair, and carbonaceous (sooty) sputum are key indicators of upper airway inhalation injury.

Question 86: What role does ethics play in Airway Management practice?

Ethics is optional in professional settings
It only matters for legal compliance
It only applies to managers
It guides professional conduct and protects stakeholders (Correct answer)

Correct answer: It guides professional conduct and protects stakeholders

Professional ethics provide frameworks for responsible decision-making, ensuring practitioners act in the best interest of those they serve.

Question 87: Which study approach is most effective for Trauma Management material?

Studying for very long sessions without breaks
Highlighting all text
Active recall with practice questions (Correct answer)
Passive re-reading of notes

Correct answer: Active recall with practice questions

Active recall through practice questions is the most effective study method, as it strengthens memory retrieval pathways.

Question 88: During a mass casualty incident, a patient with a femur fracture, open airway, and weak radial pulse is classified as which triage category using START?

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

Correct answer: Yellow (delayed)

In START triage, a patient who is walking or has a patent airway, adequate respirations, and a radial pulse with only a long-bone fracture is classified Yellow (delayed).

Question 89: A patient is found apneic with dentures present. What is the best action regarding the dentures during BVM ventilation?

Leave well-fitting dentures in place to maintain mask seal (Correct answer)
Remove only the upper denture
Remove only the lower denture
Always remove them immediately

Correct answer: Leave well-fitting dentures in place to maintain mask seal

Well-fitting dentures help maintain facial contour and improve mask seal during BVM ventilation; remove them only if they become dislodged.

Question 90: Which electrolyte abnormality is most commonly associated with the development of Torsades de Pointes?

Hyperkalemia
Hypomagnesemia (Correct answer)
Hypocalcemia
Hypernatremia

Correct answer: Hypomagnesemia

Hypomagnesemia is the electrolyte abnormality most strongly associated with Torsades de Pointes and is also the treatment of choice (magnesium sulfate 2g IV).

Question 91: Which of the following ECG findings is MOST specific for right ventricular (RV) infarction in a patient with an inferior STEMI?

ST elevation in leads V1-V4
ST elevation in lead V4R (right-sided lead) (Correct answer)
ST depression in leads I and aVL
New LBBB on the standard 12-lead

Correct answer: ST elevation in lead V4R (right-sided lead)

ST elevation in lead V4R (right-sided lead) is the most sensitive and specific finding for right ventricular infarction in the setting of an inferior STEMI.

Question 92: During a hazardous materials incident, which zone is EMS treatment typically conducted in?

Command zone
Warm zone (contamination reduction zone)
Hot zone (exclusion zone)
Cold zone (support zone) (Correct answer)

Correct answer: Cold zone (support zone)

EMS treatment occurs in the cold zone after patients have been decontaminated in the warm zone, ensuring providers are not exposed to the hazardous material.

Question 93: What is the maximum number of seconds an intubation attempt should last before pausing to re-oxygenate the patient?

45 seconds
10 seconds
30 seconds (Correct answer)
20 seconds

Correct answer: 30 seconds

Intubation attempts should be limited to 30 seconds, after which the patient must be re-oxygenated with BVM ventilation.

Question 94: When should you change an answer on a test?

Never change answers
Only when you have a clear reason the new answer is better (Correct answer)
Change every answer you doubt
Always change your first answer

Correct answer: Only when you have a clear reason the new answer is better

Research shows changing answers is beneficial only when you have a specific reason, such as recalling new information or catching a misread question.

Question 95: A hiker is rescued from a remote mountain trail with a core temperature of 28°C, absent pulse, and fixed dilated pupils. What is the most appropriate action?

Rewarm passively in the field until pulse returns before initiating CPR
Perform one defibrillation attempt then cease resuscitation
Begin CPR and transport to a hospital with rewarming and ECMO capability (Correct answer)
Declare death in the field based on pupillary findings

Correct answer: Begin CPR and transport to a hospital with rewarming and ECMO capability

Severe hypothermia can mimic death; the principle 'not dead until warm and dead' applies, and patients at 28°C with cardiac arrest may survive with CPR, active rewarming, and ECMO-assisted rewarming at a hospital.

Question 96: A FISDAP program coordinator wants to produce an end-of-year report demonstrating program effectiveness to hospital administrators. Which combination of data best supports this goal?

Individual preceptor compensation records and site mileage
Student absentee records and equipment maintenance logs
Student financial aid status and tuition payment history
Cohort NREMT pass rates, average skill completion percentages, and patient contact totals (Correct answer)

Correct answer: Cohort NREMT pass rates, average skill completion percentages, and patient contact totals

NREMT pass rates, skill completion, and patient contact volume are the key outcome metrics that demonstrate clinical training effectiveness to external stakeholders.

Question 97: When administering activated charcoal, which patient presentation is an absolute contraindication?

Ingestion of aspirin 30 minutes ago
Pediatric patient under 12
Ingestion of a tricyclic antidepressant
Unprotected airway with altered mental status (Correct answer)

Correct answer: Unprotected airway with altered mental status

Activated charcoal should never be given to a patient with an unprotected airway because aspiration can cause severe airway compromise.

Question 98: Which of the following findings would indicate a NORMAL newborn assessment at 5 minutes of life?

HR 120, acrocyanosis only, strong cry, active movement (Correct answer)
HR 80, central cyanosis, no respiratory effort
HR 55, generalized cyanosis, limp, grimace only
HR 100, gasping, trunk cyanosis, absent tone

Correct answer: HR 120, acrocyanosis only, strong cry, active movement

A 5-minute APGAR of approximately 8–10 is normal: HR ≥100, peripheral cyanosis (acrocyanosis) only, vigorous cry, and active muscle tone are all reassuring signs.

Question 99: A 45-year-old male presents with sudden onset of tearing chest pain radiating to his back. Blood pressure is 190/110 in the right arm and 150/90 in the left arm. You MOST suspect:

Aortic dissection (Correct answer)
Pneumothorax
Pulmonary embolism
Myocardial infarction

Correct answer: Aortic dissection

Tearing chest pain radiating to the back with unequal bilateral blood pressures is the hallmark presentation of aortic dissection.

Question 100: Which FISDAP-tracked skill is being evaluated when a student performs a full-body assessment on a homeless patient with suspected frostbite?

Trauma head-to-toe assessment
Skin condition documentation
Environmental injury recognition (Correct answer)
Wound care protocol

Correct answer: Environmental injury recognition

Environmental injury recognition is tracked in FISDAP to ensure students can identify cold-related injuries like frostbite during patient assessment.

FISDAP EMS Readiness Exam

The FISDAP (Field Internship Student Data Acquisition Project) EMS Readiness Exam assesses EMT and paramedic student competency in patient assessment, airway management, cardiac emergencies, trauma management, medical emergencies, OB/GYN emergencies, pediatric assessment, pharmacology, EMS operations, and special populations.

100

Questions

120 min

Time Limit

70%

To Pass

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