NREMT - National Registry of Emergency Medical Technicians Medical 2 — Questions and Answers
Question 1: A 68-year-old male presents with sudden facial droop, slurred speech, and right arm weakness. His wife states symptoms began about 45 minutes ago. What is your primary field diagnosis?
- Hypoglycemia
- Stroke (Correct answer)
- Hypertensive emergency
- Transient ischemic attack
Correct answer: Stroke
Sudden onset facial droop, slurred speech, and unilateral arm weakness are the hallmark signs of stroke. Time of onset is critical information for the receiving hospital's stroke team. Rapid transport to a stroke center is your priority.
Question 2: You respond to a 24-year-old female stung by a bee. She now has hives, severe throat tightness, labored breathing, and her BP is 80/50. What is your immediate treatment priority?
- Administer diphenhydramine IM and monitor
- Apply ice to the sting site and reassess
- Administer epinephrine and prepare for rapid transport (Correct answer)
- Give oral antihistamines and call ALS
Correct answer: Administer epinephrine and prepare for rapid transport
This patient is in anaphylactic shock — a life-threatening systemic allergic reaction with hypotension and airway compromise. Epinephrine is the only first-line treatment for anaphylaxis. Antihistamines act too slowly and will not reverse cardiovascular collapse or airway swelling.
Question 3: A 55-year-old male has crushing chest pain radiating to his left jaw and arm, diaphoresis, and nausea. BP is 140/90, HR 88, RR 16. He has no known drug allergies. What is the most appropriate field treatment?
- High-flow oxygen, aspirin 324 mg, and rapid transport (Correct answer)
- Nitroglycerin only and await ALS backup
- Reassurance and transport in a position of comfort
- Oxygen only and continuous cardiac monitoring
Correct answer: High-flow oxygen, aspirin 324 mg, and rapid transport
Classic AMI presentation calls for oxygen to support myocardial demand, aspirin for its antiplatelet effect to limit clot propagation, and rapid transport to a PCI-capable facility. Aspirin should be given as soon as AMI is suspected unless contraindicated.
Question 4: You find a 32-year-old male unresponsive on the floor. Bystanders say he had a seizure lasting about two minutes. He is now breathing adequately but remains unresponsive. What phase is this patient most likely in?
- Active tonic-clonic phase
- Absence seizure phase
- Post-ictal phase (Correct answer)
- Pre-ictal aura phase
Correct answer: Post-ictal phase
The post-ictal phase follows the active seizure and is characterized by decreased responsiveness or unconsciousness as the brain recovers from the abnormal electrical activity. This phase can last from minutes to hours. Airway management and monitoring for additional seizures are the priorities.
Question 5: A 70-year-old male with a documented history of COPD presents with severe dyspnea, audible wheezing on exhalation, and use of accessory muscles. His SpO2 is 88% on room air. What is the most appropriate oxygen delivery?
- Non-rebreather mask at 15 L/min
- Nasal cannula at 2 L/min (Correct answer)
- Immediate bag-valve mask ventilation
- Simple face mask at 8 L/min
Correct answer: Nasal cannula at 2 L/min
Patients with severe COPD may rely on hypoxic drive to breathe rather than elevated CO2 levels. High-flow oxygen can suppress this drive and cause respiratory depression. Low-flow oxygen via nasal cannula targets an SpO2 of 88–92% in known COPD patients to avoid oxygen-induced hypoventilation.
Question 6: A 45-year-old female reports a sudden 'thunderclap' headache she describes as the worst of her life. She also has neck stiffness and sensitivity to light. Vital signs are stable. What is your highest priority concern?
- Severe migraine headache
- Subarachnoid hemorrhage (Correct answer)
- Tension headache
- Hypertensive headache
Correct answer: Subarachnoid hemorrhage
A sudden-onset 'worst headache of my life' combined with nuchal rigidity (neck stiffness) and photophobia is the classic presentation of subarachnoid hemorrhage until proven otherwise. This is a true neurological emergency and warrants immediate transport even with stable vitals.
NREMT - National Registry of Emergency Medical Technicians Medical 2
A 68-year-old male presents with sudden facial droop, slurred speech, and right arm weakness.
His wife states symptoms began about 45 minutes ago.
What is your primary field diagnosis?