UCLA PARAMEDIC FINAL EXAM ACTUAL EXAM 2026 | ALL QUESTIONS AND
CORRECT ANSWERS | VERIFIED ANSWERS | JUST RELEASED
Question 1
A 65-year-old male presents with acute respiratory distress. You observe an EtCO2 waveform
with a "shark fin" appearance and a reading of 52 mmHg. The patient has a history of smoking
and is currently using accessory muscles to breathe. What is the most likely underlying
pathophysiology?
A) Pulmonary edema leading to impaired diffusion
B) Bronchoconstriction causing an obstructive outflow delay
C) Pulmonary embolism causing a dead-space ventilation issue
D) High-altitude pulmonary edema
E) Hypoventilation due to central nervous system depression
Correct Answer: B) Bronchoconstriction causing an obstructive outflow delay
Rationale: The "shark fin" morphology on a capnography waveform is pathognomonic for
an obstructive process, such as Asthma or COPD. This shape represents a slowed and
uneven emptying of the alveoli during the expiratory phase (Phase II and III). As the
patient struggles to push air out through constricted bronchioles, the slope of the alveolar
plateau increases. Pulmonary edema (A) usually presents with a normal waveform shape
but decreased height if gas exchange is severely impaired, or increased height if the patient
is hypoventilating. Pulmonary embolism (C) typically shows a sudden drop in EtCO2
values due to lack of perfusion to ventilated alveoli, but the waveform shape remains
relatively square.
Question 2
You are performing RSI on a 30-year-old trauma patient. After administering Succinylcholine,
you observe fine muscle twitching across the chest and face. What is this phenomenon called,
and what is its physiological cause?
A) Fasciculation; caused by the depolarization of the motor endplate
B) Tetanus; caused by excessive calcium release in the sarcoplasmic reticulum
C) Myoclonus; caused by cerebral hypoxia
D) Convulsion; caused by an idiosyncratic reaction to induction agents
E) Defasciculation; caused by the competitive inhibition of nicotinic receptors
, 2
Correct Answer: A) Fasciculation; caused by the depolarization of the motor endplate
Rationale: Succinylcholine is a depolarizing neuromuscular blocking agent. It works by
mimicking acetylcholine and binding to nicotinic receptors at the neuromuscular junction.
Unlike acetylcholine, it is not broken down immediately by acetylcholinesterase, leading to
a persistent depolarization. The initial binding causes the muscle fibers to contract once,
which is visible as fasciculations. This is a sign that the medication is working and that total
paralysis is imminent. Non-depolarizing agents (like Rocuronium) do not cause
fasciculations because they act as competitive antagonists and do not trigger an initial
contraction.
Question 3
Which of the following patients is the most appropriate candidate for Continuous Positive
Airway Pressure (CPAP)?
A) A 19-year-old female with a suspected pneumothorax after a motor vehicle collision
B) A 72-year-old male with rales, peripheral edema, and a blood pressure of 88/50 mmHg
C) A 60-year-old female with acute pulmonary edema, alert and oriented, BP 160/90 mmHg
D) A 45-year-old male who is unconscious and has a diminished gag reflex
E) A 25-year-old male with massive facial trauma and active airway bleeding
Correct Answer: C) A 60-year-old female with acute pulmonary edema, alert and oriented,
BP 160/90 mmHg
Rationale: CPAP is highly effective for patients with congestive heart failure (CHF) and
pulmonary edema because the positive pressure increases the surface area of the alveoli
and pushes interstitial fluid back into the pulmonary vasculature. However, CPAP
increases intrathoracic pressure, which can decrease venous return to the heart and lower
blood pressure; therefore, it is contraindicated in hypotensive patients (B). It is also
contraindicated in patients who cannot protect their own airway (D), those with suspected
pneumothorax (A) as it may convert it into a tension pneumothorax, and those with facial
trauma (E) where a mask seal is impossible.
Question 4
While monitoring a patient with a suspected myocardial infarction, you see a rhythm with a rate
, 3
of 42 bpm, a constant PR interval of 0.16 seconds, and a narrow QRS complex. Every third P-
wave is followed by a QRS. What is this rhythm?
A) First-degree AV block
B) Second-degree AV block, Type I (Wenckebach)
C) Second-degree AV block, Type II
D) Third-degree AV block
E) Sinus bradycardia with PACs
Correct Answer: C) Second-degree AV block, Type II
Rationale: In Second-degree AV block Type II (Classical), the conduction through the AV
node is "all or nothing." The PR intervals of the conducted beats remain constant and
fixed, but some P-waves are not conducted to the ventricles at all. This rhythm is often
associated with a bundle branch block and has a high risk of progressing to complete heart
block. Type I (Wenckebach) (B) is distinguished by a progressively lengthening PR interval
before a dropped beat. Third-degree block (D) is distinguished by a total lack of correlation
between P-waves and QRS complexes (AV dissociation).
Question 5
A 55-year-old female is in ventricular fibrillation. You have delivered one shock and resumed
CPR. What is the priority medication and dose for the first pharmacological intervention?
A) Amiodarone 300 mg IV/IO
B) Lidocaine 1.5 mg/kg IV/IO
C) Epinephrine 1 mg 1:10,000 IV/IO
D) Vasopressin 40 Units IV/IO
E) Magnesium Sulfate 2 g IV/IO
Correct Answer: C) Epinephrine 1 mg 1:10,000 IV/IO
Rationale: According to current AHA ACLS guidelines, Epinephrine should be
administered as soon as possible in non-shockable rhythms (Asystole/PEA) and after the
second shock in shockable rhythms (V-Fib/Pulseless V-Tach). Epinephrine’s alpha-1 effects
produce vasoconstriction, which increases coronary and cerebral perfusion pressure during
CPR. Antiarrhythmics like Amiodarone (A) or Lidocaine (B) are typically administered
, 4
after the third shock. Vasopressin (D) has been removed from the standard ACLS cardiac
arrest algorithm.
Question 6
A patient presents with a regular, wide-complex tachycardia at a rate of 170 bpm. The patient is
pale, diaphoretic, and has a blood pressure of 74/40 mmHg. What is the immediate treatment of
choice?
A) Vagal maneuvers followed by Adenosine 6 mg
B) Amiodarone 150 mg infusion over 10 minutes
C) Procainamide 20 mg/min until the rhythm converts
D) Synchronized cardioversion at 100 Joules
E) Defibrillation at 200 Joules (Biphasic)
Correct Answer: D) Synchronized cardioversion at 100 Joules
Rationale: This patient is "unstable" as evidenced by the hypotension and signs of poor
perfusion (diaphoresis/pallor). ACLS guidelines mandate immediate synchronized
cardioversion for unstable tachycardias. Synchronization is necessary to avoid the "R-on-
T" phenomenon, which could induce ventricular fibrillation. Defibrillation (E) is reserved
for pulseless patients. Pharmacological interventions (A, B, C) are only considered for
stable patients or after electricity has failed.
Question 7
Which of the following conditions is most likely to cause a "Low-Voltage" EKG across all leads?
A) Left ventricular hypertrophy
B) Pulmonary embolism
C) Pericardial effusion/Tamponade
D) Hyperkalemia
E) Acute anterior wall MI
Correct Answer: C) Pericardial effusion/Tamponade
Rationale: Pericardial effusion involves fluid accumulation within the pericardial sac. This
fluid acts as an insulator, dampening the electrical signal as it travels from the myocardium
to the skin electrodes, resulting in low-voltage QRS complexes. If the fluid volume is high
CORRECT ANSWERS | VERIFIED ANSWERS | JUST RELEASED
Question 1
A 65-year-old male presents with acute respiratory distress. You observe an EtCO2 waveform
with a "shark fin" appearance and a reading of 52 mmHg. The patient has a history of smoking
and is currently using accessory muscles to breathe. What is the most likely underlying
pathophysiology?
A) Pulmonary edema leading to impaired diffusion
B) Bronchoconstriction causing an obstructive outflow delay
C) Pulmonary embolism causing a dead-space ventilation issue
D) High-altitude pulmonary edema
E) Hypoventilation due to central nervous system depression
Correct Answer: B) Bronchoconstriction causing an obstructive outflow delay
Rationale: The "shark fin" morphology on a capnography waveform is pathognomonic for
an obstructive process, such as Asthma or COPD. This shape represents a slowed and
uneven emptying of the alveoli during the expiratory phase (Phase II and III). As the
patient struggles to push air out through constricted bronchioles, the slope of the alveolar
plateau increases. Pulmonary edema (A) usually presents with a normal waveform shape
but decreased height if gas exchange is severely impaired, or increased height if the patient
is hypoventilating. Pulmonary embolism (C) typically shows a sudden drop in EtCO2
values due to lack of perfusion to ventilated alveoli, but the waveform shape remains
relatively square.
Question 2
You are performing RSI on a 30-year-old trauma patient. After administering Succinylcholine,
you observe fine muscle twitching across the chest and face. What is this phenomenon called,
and what is its physiological cause?
A) Fasciculation; caused by the depolarization of the motor endplate
B) Tetanus; caused by excessive calcium release in the sarcoplasmic reticulum
C) Myoclonus; caused by cerebral hypoxia
D) Convulsion; caused by an idiosyncratic reaction to induction agents
E) Defasciculation; caused by the competitive inhibition of nicotinic receptors
, 2
Correct Answer: A) Fasciculation; caused by the depolarization of the motor endplate
Rationale: Succinylcholine is a depolarizing neuromuscular blocking agent. It works by
mimicking acetylcholine and binding to nicotinic receptors at the neuromuscular junction.
Unlike acetylcholine, it is not broken down immediately by acetylcholinesterase, leading to
a persistent depolarization. The initial binding causes the muscle fibers to contract once,
which is visible as fasciculations. This is a sign that the medication is working and that total
paralysis is imminent. Non-depolarizing agents (like Rocuronium) do not cause
fasciculations because they act as competitive antagonists and do not trigger an initial
contraction.
Question 3
Which of the following patients is the most appropriate candidate for Continuous Positive
Airway Pressure (CPAP)?
A) A 19-year-old female with a suspected pneumothorax after a motor vehicle collision
B) A 72-year-old male with rales, peripheral edema, and a blood pressure of 88/50 mmHg
C) A 60-year-old female with acute pulmonary edema, alert and oriented, BP 160/90 mmHg
D) A 45-year-old male who is unconscious and has a diminished gag reflex
E) A 25-year-old male with massive facial trauma and active airway bleeding
Correct Answer: C) A 60-year-old female with acute pulmonary edema, alert and oriented,
BP 160/90 mmHg
Rationale: CPAP is highly effective for patients with congestive heart failure (CHF) and
pulmonary edema because the positive pressure increases the surface area of the alveoli
and pushes interstitial fluid back into the pulmonary vasculature. However, CPAP
increases intrathoracic pressure, which can decrease venous return to the heart and lower
blood pressure; therefore, it is contraindicated in hypotensive patients (B). It is also
contraindicated in patients who cannot protect their own airway (D), those with suspected
pneumothorax (A) as it may convert it into a tension pneumothorax, and those with facial
trauma (E) where a mask seal is impossible.
Question 4
While monitoring a patient with a suspected myocardial infarction, you see a rhythm with a rate
, 3
of 42 bpm, a constant PR interval of 0.16 seconds, and a narrow QRS complex. Every third P-
wave is followed by a QRS. What is this rhythm?
A) First-degree AV block
B) Second-degree AV block, Type I (Wenckebach)
C) Second-degree AV block, Type II
D) Third-degree AV block
E) Sinus bradycardia with PACs
Correct Answer: C) Second-degree AV block, Type II
Rationale: In Second-degree AV block Type II (Classical), the conduction through the AV
node is "all or nothing." The PR intervals of the conducted beats remain constant and
fixed, but some P-waves are not conducted to the ventricles at all. This rhythm is often
associated with a bundle branch block and has a high risk of progressing to complete heart
block. Type I (Wenckebach) (B) is distinguished by a progressively lengthening PR interval
before a dropped beat. Third-degree block (D) is distinguished by a total lack of correlation
between P-waves and QRS complexes (AV dissociation).
Question 5
A 55-year-old female is in ventricular fibrillation. You have delivered one shock and resumed
CPR. What is the priority medication and dose for the first pharmacological intervention?
A) Amiodarone 300 mg IV/IO
B) Lidocaine 1.5 mg/kg IV/IO
C) Epinephrine 1 mg 1:10,000 IV/IO
D) Vasopressin 40 Units IV/IO
E) Magnesium Sulfate 2 g IV/IO
Correct Answer: C) Epinephrine 1 mg 1:10,000 IV/IO
Rationale: According to current AHA ACLS guidelines, Epinephrine should be
administered as soon as possible in non-shockable rhythms (Asystole/PEA) and after the
second shock in shockable rhythms (V-Fib/Pulseless V-Tach). Epinephrine’s alpha-1 effects
produce vasoconstriction, which increases coronary and cerebral perfusion pressure during
CPR. Antiarrhythmics like Amiodarone (A) or Lidocaine (B) are typically administered
, 4
after the third shock. Vasopressin (D) has been removed from the standard ACLS cardiac
arrest algorithm.
Question 6
A patient presents with a regular, wide-complex tachycardia at a rate of 170 bpm. The patient is
pale, diaphoretic, and has a blood pressure of 74/40 mmHg. What is the immediate treatment of
choice?
A) Vagal maneuvers followed by Adenosine 6 mg
B) Amiodarone 150 mg infusion over 10 minutes
C) Procainamide 20 mg/min until the rhythm converts
D) Synchronized cardioversion at 100 Joules
E) Defibrillation at 200 Joules (Biphasic)
Correct Answer: D) Synchronized cardioversion at 100 Joules
Rationale: This patient is "unstable" as evidenced by the hypotension and signs of poor
perfusion (diaphoresis/pallor). ACLS guidelines mandate immediate synchronized
cardioversion for unstable tachycardias. Synchronization is necessary to avoid the "R-on-
T" phenomenon, which could induce ventricular fibrillation. Defibrillation (E) is reserved
for pulseless patients. Pharmacological interventions (A, B, C) are only considered for
stable patients or after electricity has failed.
Question 7
Which of the following conditions is most likely to cause a "Low-Voltage" EKG across all leads?
A) Left ventricular hypertrophy
B) Pulmonary embolism
C) Pericardial effusion/Tamponade
D) Hyperkalemia
E) Acute anterior wall MI
Correct Answer: C) Pericardial effusion/Tamponade
Rationale: Pericardial effusion involves fluid accumulation within the pericardial sac. This
fluid acts as an insulator, dampening the electrical signal as it travels from the myocardium
to the skin electrodes, resulting in low-voltage QRS complexes. If the fluid volume is high
