MEDICAL PARAMEDIC FISDAP
ACTUAL EXAM 2026/2027 |
Comprehensive Practice Test | Verified
Q&A | Pass Guaranteed - A+ Graded
SECTION 1: Advanced Airway Management & Respiratory
Emergencies (25 Questions)
Q1: A 34-year-old male presents with severe facial trauma following an MVC. He is conscious
but has significant oral bleeding, a missing upper incisor, and is gurgling. SpO₂ is 88% on
room air. His GCS is 13 (E3, V4, M6). Which intervention is MOST appropriate?
A. Immediate oral intubation with rapid sequence induction
B. Nasotracheal intubation with sedation only
C. Surgical cricothyrotomy under local anesthesia [CORRECT]
D. Placement of a King LT airway with high-flow oxygen
Rationale: This patient has a predicted difficult airway due to facial trauma, active bleeding
obscuring visualization, and potential airway obstruction. The altered anatomy and bleeding
make oral intubation high-risk. Surgical cricothyrotomy is indicated in "can't intubate, can't
ventilate" scenarios or when anatomy is severely distorted. The patient is conscious, so local
anesthesia is required.
Q2: During RSI for a 28-year-old trauma patient, you administer etomidate 0.3 mg/kg IV
followed by succinylcholine 1.5 mg/kg IV. Forty-five seconds later, the patient develops
masseter muscle rigidity and their temperature rises to 39.2°C (102.6°F). What is the MOST
likely diagnosis?
A. Anaphylactic reaction to etomidate
B. Malignant hyperthermia [CORRECT]
C. Neuroleptic malignant syndrome
D. Serotonin syndrome
Rationale: Succinylcholine is a known trigger for malignant hyperthermia (MH), an autosomal
dominant disorder of skeletal muscle calcium regulation. Classic presentation includes
,masseter rigidity ("jaws of steel"), hyperthermia, tachycardia, and hypercapnia. Immediate
treatment requires discontinuation of triggering agents, hyperventilation with 100% oxygen,
and dantrolene 2.5 mg/kg IV.
Q3: A 45-year-old female with status asthmaticus has been intubated. Initial ventilator
settings are: AC/VC, Vt 500 mL, RR 14, FiO₂ 40%, PEEP 5 cm H₂O. Five minutes
post-intubation, peak airway pressures are 55 cm H₂O with plateau pressures of 35 cm H₂O.
Which adjustment is MOST appropriate?
A. Increase respiratory rate to 20 breaths/min
B. Decrease tidal volume to 6 mL/kg and increase expiratory time [CORRECT]
C. Increase PEEP to 10 cm H₂O
D. Switch to pressure control ventilation with higher pressures
Rationale: Status asthmaticus causes severe bronchospasm and air trapping (auto-PEEP).
The high peak-to-plateau pressure gradient (20 cm H₂O) indicates increased airway
resistance. Lung-protective strategy requires lower tidal volumes (6 mL/kg ideal body weight)
and prolonged expiratory time (I:E ratio 1:3 or 1:4) to allow complete exhalation and prevent
barotrauma.
Q4: Which of the following is an ABSOLUTE contraindication to succinylcholine
administration?
A. History of stroke 6 months ago
B. Hyperkalemia with K⁺ of 5.2 mEq/L
C. Known pseudocholinesterase deficiency [CORRECT]
D. History of malignant hyperthermia in a sibling
Rationale: Pseudocholinesterase deficiency results in prolonged paralysis (hours to days)
due to inability to metabolize succinylcholine. While hyperkalemia >5.5 mEq/L and recent
stroke (72 hours to 6 months) are relative contraindications, inherited enzyme deficiency is
absolute. Malignant hyperthermia susceptibility requires avoidance, but the question asks
about succinylcholine specifically—MH is a contraindication to succinylcholine as well, but
pseudocholinesterase deficiency causes direct harm through prolonged apnea.
Q5: Capnography waveform analysis reveals an abrupt loss of EtCO₂ from 38 mmHg to 3
mmHg during mechanical ventilation. The patient is unconscious with bilateral breath sounds
present. What is the MOST likely cause?
A. Bronchospasm
B. Esophageal intubation
, C. Cardiac arrest or pulmonary embolism [CORRECT]
D. Hypoventilation
Rationale: An abrupt drop to near-zero EtCO₂ indicates either complete airway disconnection,
esophageal intubation (though this typically shows some CO₂ initially), or catastrophic loss
of pulmonary blood flow. Given bilateral breath sounds, cardiac arrest or massive pulmonary
embolism (eliminating CO₂ transport) is most likely. Bronchospasm causes a "shark fin"
waveform; hypoventilation causes elevated EtCO₂.
Q6: A 62-year-old male with COPD presents with respiratory distress. He is alert, speaking in
short phrases, and using accessory muscles. Vital signs: HR 118, BP 148/92, RR 28, SpO₂ 84%
on 2L NC (home oxygen). Which statement regarding his ventilatory support is MOST
accurate?
A. CPAP is contraindicated due to risk of pneumothorax
B. BiPAP with IPAP 10, EPAP 5 is appropriate initial settings [CORRECT]
C. Immediate intubation is required given his SpO₂
D. High-flow nasal cannula at 60 L/min is contraindicated in COPD
Rationale: This patient has COPD exacerbation with respiratory failure. Non-invasive positive
pressure ventilation (NIPPV) is first-line for hypercapnic respiratory failure. Initial BiPAP
settings typically start with IPAP 10-12 cm H₂O and EPAP 4-5 cm H₂O, titrating to reduce work
of breathing and improve ventilation. CPAP alone doesn't assist ventilation; intubation is
reserved for NIPPV failure.
Q7: During rapid sequence intubation, you plan to use rocuronium 1.2 mg/kg IV instead of
succinylcholine. Which statement is TRUE regarding this approach?
A. Rocuronium provides faster onset than succinylcholine at this dose
B. Sugammadex 16 mg/kg can reverse this dose if needed [CORRECT]
C. Rocuronium causes less histamine release than succinylcholine
D. This dose provides shorter duration than succinylcholine
Rationale: Rocuronium 1.2 mg/kg (3x ED95) provides intubating conditions in 60-90 seconds
(similar to succinylcholine). Sugammadex is a selective relaxant binding agent that reverses
rocuronium at 16 mg/kg for immediate reversal (3 minutes) or 2-4 mg/kg for routine reversal.
Rocuronium actually has longer duration (45-70 minutes) compared to succinylcholine (5-10
minutes).
ACTUAL EXAM 2026/2027 |
Comprehensive Practice Test | Verified
Q&A | Pass Guaranteed - A+ Graded
SECTION 1: Advanced Airway Management & Respiratory
Emergencies (25 Questions)
Q1: A 34-year-old male presents with severe facial trauma following an MVC. He is conscious
but has significant oral bleeding, a missing upper incisor, and is gurgling. SpO₂ is 88% on
room air. His GCS is 13 (E3, V4, M6). Which intervention is MOST appropriate?
A. Immediate oral intubation with rapid sequence induction
B. Nasotracheal intubation with sedation only
C. Surgical cricothyrotomy under local anesthesia [CORRECT]
D. Placement of a King LT airway with high-flow oxygen
Rationale: This patient has a predicted difficult airway due to facial trauma, active bleeding
obscuring visualization, and potential airway obstruction. The altered anatomy and bleeding
make oral intubation high-risk. Surgical cricothyrotomy is indicated in "can't intubate, can't
ventilate" scenarios or when anatomy is severely distorted. The patient is conscious, so local
anesthesia is required.
Q2: During RSI for a 28-year-old trauma patient, you administer etomidate 0.3 mg/kg IV
followed by succinylcholine 1.5 mg/kg IV. Forty-five seconds later, the patient develops
masseter muscle rigidity and their temperature rises to 39.2°C (102.6°F). What is the MOST
likely diagnosis?
A. Anaphylactic reaction to etomidate
B. Malignant hyperthermia [CORRECT]
C. Neuroleptic malignant syndrome
D. Serotonin syndrome
Rationale: Succinylcholine is a known trigger for malignant hyperthermia (MH), an autosomal
dominant disorder of skeletal muscle calcium regulation. Classic presentation includes
,masseter rigidity ("jaws of steel"), hyperthermia, tachycardia, and hypercapnia. Immediate
treatment requires discontinuation of triggering agents, hyperventilation with 100% oxygen,
and dantrolene 2.5 mg/kg IV.
Q3: A 45-year-old female with status asthmaticus has been intubated. Initial ventilator
settings are: AC/VC, Vt 500 mL, RR 14, FiO₂ 40%, PEEP 5 cm H₂O. Five minutes
post-intubation, peak airway pressures are 55 cm H₂O with plateau pressures of 35 cm H₂O.
Which adjustment is MOST appropriate?
A. Increase respiratory rate to 20 breaths/min
B. Decrease tidal volume to 6 mL/kg and increase expiratory time [CORRECT]
C. Increase PEEP to 10 cm H₂O
D. Switch to pressure control ventilation with higher pressures
Rationale: Status asthmaticus causes severe bronchospasm and air trapping (auto-PEEP).
The high peak-to-plateau pressure gradient (20 cm H₂O) indicates increased airway
resistance. Lung-protective strategy requires lower tidal volumes (6 mL/kg ideal body weight)
and prolonged expiratory time (I:E ratio 1:3 or 1:4) to allow complete exhalation and prevent
barotrauma.
Q4: Which of the following is an ABSOLUTE contraindication to succinylcholine
administration?
A. History of stroke 6 months ago
B. Hyperkalemia with K⁺ of 5.2 mEq/L
C. Known pseudocholinesterase deficiency [CORRECT]
D. History of malignant hyperthermia in a sibling
Rationale: Pseudocholinesterase deficiency results in prolonged paralysis (hours to days)
due to inability to metabolize succinylcholine. While hyperkalemia >5.5 mEq/L and recent
stroke (72 hours to 6 months) are relative contraindications, inherited enzyme deficiency is
absolute. Malignant hyperthermia susceptibility requires avoidance, but the question asks
about succinylcholine specifically—MH is a contraindication to succinylcholine as well, but
pseudocholinesterase deficiency causes direct harm through prolonged apnea.
Q5: Capnography waveform analysis reveals an abrupt loss of EtCO₂ from 38 mmHg to 3
mmHg during mechanical ventilation. The patient is unconscious with bilateral breath sounds
present. What is the MOST likely cause?
A. Bronchospasm
B. Esophageal intubation
, C. Cardiac arrest or pulmonary embolism [CORRECT]
D. Hypoventilation
Rationale: An abrupt drop to near-zero EtCO₂ indicates either complete airway disconnection,
esophageal intubation (though this typically shows some CO₂ initially), or catastrophic loss
of pulmonary blood flow. Given bilateral breath sounds, cardiac arrest or massive pulmonary
embolism (eliminating CO₂ transport) is most likely. Bronchospasm causes a "shark fin"
waveform; hypoventilation causes elevated EtCO₂.
Q6: A 62-year-old male with COPD presents with respiratory distress. He is alert, speaking in
short phrases, and using accessory muscles. Vital signs: HR 118, BP 148/92, RR 28, SpO₂ 84%
on 2L NC (home oxygen). Which statement regarding his ventilatory support is MOST
accurate?
A. CPAP is contraindicated due to risk of pneumothorax
B. BiPAP with IPAP 10, EPAP 5 is appropriate initial settings [CORRECT]
C. Immediate intubation is required given his SpO₂
D. High-flow nasal cannula at 60 L/min is contraindicated in COPD
Rationale: This patient has COPD exacerbation with respiratory failure. Non-invasive positive
pressure ventilation (NIPPV) is first-line for hypercapnic respiratory failure. Initial BiPAP
settings typically start with IPAP 10-12 cm H₂O and EPAP 4-5 cm H₂O, titrating to reduce work
of breathing and improve ventilation. CPAP alone doesn't assist ventilation; intubation is
reserved for NIPPV failure.
Q7: During rapid sequence intubation, you plan to use rocuronium 1.2 mg/kg IV instead of
succinylcholine. Which statement is TRUE regarding this approach?
A. Rocuronium provides faster onset than succinylcholine at this dose
B. Sugammadex 16 mg/kg can reverse this dose if needed [CORRECT]
C. Rocuronium causes less histamine release than succinylcholine
D. This dose provides shorter duration than succinylcholine
Rationale: Rocuronium 1.2 mg/kg (3x ED95) provides intubating conditions in 60-90 seconds
(similar to succinylcholine). Sugammadex is a selective relaxant binding agent that reverses
rocuronium at 16 mg/kg for immediate reversal (3 minutes) or 2-4 mg/kg for routine reversal.
Rocuronium actually has longer duration (45-70 minutes) compared to succinylcholine (5-10
minutes).
