AQA AS PHYSICS PAPER 2 QP JUNE
PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS GRADED
A+
◍ You respond to a residence for a 68-year-old male with nausea, vomiting,
and blurred vision. As you are assessing him, he tells you that he has
congestive heart failure and atrial fibrillation, and takes numerous
medications. The cardiac monitor reveals atrial fibrillation with a ventricular
rate of 50 beats/min. Which of the following medications is MOST likely
responsible for this patient's clinical presentation?.
Answer: Digoxin.This patient has classic signs of digitalis toxicity. Digoxin
is commonly prescribed to patients with congestive heart failure and atrial
fibrillation (A-Fib) or atrial flutter (A-Flutter). Its positive inotropic effects
increase cardiac contractility and maintain cardiac output, while its negative
chronotropic effects control the ventricular rate of the A-Fib or A-Flutter.
Digitalis preparations (ie, Lanoxin, Digoxin) have a narrow therapeutic
index—that is, there is a fine line between a therapeutic and toxic dose. You
should suspect digitalis toxicity in any patient who takes Digoxin or
Lanoxin and presents with complaints such as nausea, vomiting, abdominal
pain, anorexia, or blurred/yellow vision. Additionally, virtually any cardiac
dysrhythmia can be caused by the toxic effects of digitalis. Treatment
involves the administration of Digibind, which is given at the hospital.
◍ What characteristic of chest pain is distinct to a myocardial infraction?.
Answer: Unrelieved with rest
◍ Which of the following is an absolute contraindication for fibrinolytic
therapy?.
, Answer: Subdural hematoma 3 years ago.According to current emergency
cardiac care (ECC) guidelines, absolute contraindications for fibrinolytic
therapy include ANY prior intracranial hemorrhage (ie, subdural, epidural,
intracerebral hematoma); known structural cerebrovascular lesion (ie,
arteriovenous malformation); known malignant intracranial tumor (primary
or metastatic); ischemic stroke within the past 3 months, EXCEPT for acute
ischemic stroke within the past 3 hours; suspected aortic dissection; active
bleeding or bleeding disorders (except menses); and significant closed head
trauma or facial trauma within the past 3 months. Relative contraindications
(eg, the physician may deem fibrinolytic therapy appropriate under certain
circumstances) include, a history of chronic, severe, poorly-controlled
hypertension; severe uncontrolled hypertension on presentation (SBP > 180
mm Hg or DBP > 110 mm Hg); ischemic stroke greater than 3 months ago;
dementia; traumatic or prolonged (> 10 minutes) CPR or major surgery
within the past 3 weeks; recent (within 2 to 4 weeks) internal bleeding;
noncompressible vascular punctures; pregnancy; prior exposure (> 5 days
ago) or prior allergic reaction to streptokinase or anistreplase; active peptic
ulcer; and current use of anticoagulants (ie, Coumadin).
◍ A 43 year old female complains of 8/10 chest pressure that started while
play tennis. The pressure is substernal, non-radiating, and decreases to 6/10
with rest. Vital signs are BP 150/88, P 96, R 18. She reluctant to go to the
hospital. What should you do?.
Answer: Convince her to accept transport and administer aspirin
◍ A middle-aged man presents with chest discomfort, shortness of breath, and
nausea. You give him supplemental oxygen and continue your assessment.
As your partner is attaching the ECG leads, you should:.
Answer: Administer up to 325 mg of aspirin. Since oxygen has already been
administered to this patient and your partner is attaching the ECG leads, you
should administer aspirin (160 to 325 mg, non-enteric-coated). Early
administration of aspirin has clearly been shown to reduce mortality and
morbidity in patients experiencing an acute coronary syndrome (ACS).
After establishing vascular access, you should assess his vital signs and then
, administer 0.4 mg of nitroglycerin (up to 3 doses, 5 minutes apart), provided
that his systolic BP is greater than 90 mm Hg. If 3 doses of nitroglycerin fail
to completely relieve his chest discomfort, consider administering 2 to 4 mg
of morphine IV, provided that his systolic BP remains above 90 mm Hg.
◍ Which of the following ECG lead configurations is correct?.
Answer: To assess lead II, place the negative lead on the right arm and the
positive lead on the left leg. According to the Einthoven triangle, lead I is
assessed by placing the negative (white) lead on the right arm and the
positive (red) lead on the left arm. Lead II is assessed by placing the
negative lead on the right arm and the positive lead on the left leg. Lead III
is assessed by placing the negative lead on the left arm and the positive lead
on the left leg.
◍ A 61-year-old male presents with chest pressure that woke him up from his
nap 30 minutes ago. He is diaphoretic, anxious, and rates his pain as an an 8
over 10. His past medical history is significant for hypertension, type II
diabetes, and coronary stent placement 2 months ago. He takes lisinopril,
Plavix, and Glucophage, and is wearing a medical alert bracelet stating
"allergic to salicylates." His blood pressure is 160/100 mm Hg, pulse is 110
beats/min, and respirations are 22 breaths/min. The 12-lead ECG shows
sinus tachycardia with 3-mm ST segment elevation in leads V1 through V5.
Which of the following treatment modalities is MOST appropriate for this
patient?.
Answer: Supplemental oxygen, vascular access, up to three 0.4 mg doses of
nitroglycerin, and 2 to 4 mg of morphine sulfate if his systolic BP is greater
than 90 mm Hg and he is still experiencing pain.The patient is experiencing
an acute coronary syndrome (ACS). His 12-lead ECG indicates anteroseptal
injury with lateral extension (ST elevation in leads V1 through V5).
Appropriate treatment includes oxygen (maintain an SpO2 of greater than
94%), vascular access, up to three 0.4 mg doses of nitroglycerin (NTG), and
2 to 4 mg of morphine if NTG fails to relieve his pain and his systolic BP is
above 90 mm Hg. Some EMS systems may use fentanyl (Sublimaze) for
analgesia. Aspirin, a salicylate, is also given to patients with ACS; however,
, this patient is allergic to salicylates. Obtain a right-sided 12-lead ECG in
patients with signs of inferior wall injury (ST elevation in leads II, III, aVF).
Inferior wall infarctions may involve the right ventricle; a right-sided
12-lead ECG will help confirm this. Apply the multi-pads to the patient, not
because he is at risk for bradycardia (more common with inferior
infarctions), but because he is at risk for cardiac arrest due to V-Fib or
pulseless V-Tach.
◍ You and your team are performing CPR on a 70-year-old male. The cardiac
monitor reveals a slow, organized rhythm. His wife tells you that he goes to
dialysis every day, but has missed his last three treatments. She also tells
you that he has high blood pressure, hyperthyroidism, and has had several
cardiac bypass surgeries. Based on the patient's medical history, which of
the following conditions is the MOST likely underlying cause of his
condition?.
Answer: Hyperkalemia.Although any of the listed conditions could be
causing this patient's condition, the fact that he missed his last three dialysis
treatments should make you most suspicious for hyperkalemia. Dialysis
filters metabolic waste products from the blood in patients with renal
insufficiency or failure. If the patient is not dialyzed, these waste products,
including potassium and other electrolytes, accumulate to toxic levels in the
blood. In addition to performing high-quality CPR, managing the airway,
and administering epinephrine, your protocols may call for the
administration of calcium chloride and sodium bicarbonate if hyperkalemia
is suspected. Albuterol also has been shown to be effective in treating
patients with hyperkalemia becauses it causes potassium to shift back into
the cells; it can be nebulized down the ET tube or administered
intravenously. Follow your local protocols regarding the treatment for
suspected hyperkalemia.
◍ An ECG shows a wide complex rhythm at a rate of 36 beats pre minute.
What part of the heart's conduction system is acting as the pacemaker for
this patient?.
Answer: Purkinje Fibers
PRACTICE EXAMINATION 2026
QUESTIONS WITH ANSWERS GRADED
A+
◍ You respond to a residence for a 68-year-old male with nausea, vomiting,
and blurred vision. As you are assessing him, he tells you that he has
congestive heart failure and atrial fibrillation, and takes numerous
medications. The cardiac monitor reveals atrial fibrillation with a ventricular
rate of 50 beats/min. Which of the following medications is MOST likely
responsible for this patient's clinical presentation?.
Answer: Digoxin.This patient has classic signs of digitalis toxicity. Digoxin
is commonly prescribed to patients with congestive heart failure and atrial
fibrillation (A-Fib) or atrial flutter (A-Flutter). Its positive inotropic effects
increase cardiac contractility and maintain cardiac output, while its negative
chronotropic effects control the ventricular rate of the A-Fib or A-Flutter.
Digitalis preparations (ie, Lanoxin, Digoxin) have a narrow therapeutic
index—that is, there is a fine line between a therapeutic and toxic dose. You
should suspect digitalis toxicity in any patient who takes Digoxin or
Lanoxin and presents with complaints such as nausea, vomiting, abdominal
pain, anorexia, or blurred/yellow vision. Additionally, virtually any cardiac
dysrhythmia can be caused by the toxic effects of digitalis. Treatment
involves the administration of Digibind, which is given at the hospital.
◍ What characteristic of chest pain is distinct to a myocardial infraction?.
Answer: Unrelieved with rest
◍ Which of the following is an absolute contraindication for fibrinolytic
therapy?.
, Answer: Subdural hematoma 3 years ago.According to current emergency
cardiac care (ECC) guidelines, absolute contraindications for fibrinolytic
therapy include ANY prior intracranial hemorrhage (ie, subdural, epidural,
intracerebral hematoma); known structural cerebrovascular lesion (ie,
arteriovenous malformation); known malignant intracranial tumor (primary
or metastatic); ischemic stroke within the past 3 months, EXCEPT for acute
ischemic stroke within the past 3 hours; suspected aortic dissection; active
bleeding or bleeding disorders (except menses); and significant closed head
trauma or facial trauma within the past 3 months. Relative contraindications
(eg, the physician may deem fibrinolytic therapy appropriate under certain
circumstances) include, a history of chronic, severe, poorly-controlled
hypertension; severe uncontrolled hypertension on presentation (SBP > 180
mm Hg or DBP > 110 mm Hg); ischemic stroke greater than 3 months ago;
dementia; traumatic or prolonged (> 10 minutes) CPR or major surgery
within the past 3 weeks; recent (within 2 to 4 weeks) internal bleeding;
noncompressible vascular punctures; pregnancy; prior exposure (> 5 days
ago) or prior allergic reaction to streptokinase or anistreplase; active peptic
ulcer; and current use of anticoagulants (ie, Coumadin).
◍ A 43 year old female complains of 8/10 chest pressure that started while
play tennis. The pressure is substernal, non-radiating, and decreases to 6/10
with rest. Vital signs are BP 150/88, P 96, R 18. She reluctant to go to the
hospital. What should you do?.
Answer: Convince her to accept transport and administer aspirin
◍ A middle-aged man presents with chest discomfort, shortness of breath, and
nausea. You give him supplemental oxygen and continue your assessment.
As your partner is attaching the ECG leads, you should:.
Answer: Administer up to 325 mg of aspirin. Since oxygen has already been
administered to this patient and your partner is attaching the ECG leads, you
should administer aspirin (160 to 325 mg, non-enteric-coated). Early
administration of aspirin has clearly been shown to reduce mortality and
morbidity in patients experiencing an acute coronary syndrome (ACS).
After establishing vascular access, you should assess his vital signs and then
, administer 0.4 mg of nitroglycerin (up to 3 doses, 5 minutes apart), provided
that his systolic BP is greater than 90 mm Hg. If 3 doses of nitroglycerin fail
to completely relieve his chest discomfort, consider administering 2 to 4 mg
of morphine IV, provided that his systolic BP remains above 90 mm Hg.
◍ Which of the following ECG lead configurations is correct?.
Answer: To assess lead II, place the negative lead on the right arm and the
positive lead on the left leg. According to the Einthoven triangle, lead I is
assessed by placing the negative (white) lead on the right arm and the
positive (red) lead on the left arm. Lead II is assessed by placing the
negative lead on the right arm and the positive lead on the left leg. Lead III
is assessed by placing the negative lead on the left arm and the positive lead
on the left leg.
◍ A 61-year-old male presents with chest pressure that woke him up from his
nap 30 minutes ago. He is diaphoretic, anxious, and rates his pain as an an 8
over 10. His past medical history is significant for hypertension, type II
diabetes, and coronary stent placement 2 months ago. He takes lisinopril,
Plavix, and Glucophage, and is wearing a medical alert bracelet stating
"allergic to salicylates." His blood pressure is 160/100 mm Hg, pulse is 110
beats/min, and respirations are 22 breaths/min. The 12-lead ECG shows
sinus tachycardia with 3-mm ST segment elevation in leads V1 through V5.
Which of the following treatment modalities is MOST appropriate for this
patient?.
Answer: Supplemental oxygen, vascular access, up to three 0.4 mg doses of
nitroglycerin, and 2 to 4 mg of morphine sulfate if his systolic BP is greater
than 90 mm Hg and he is still experiencing pain.The patient is experiencing
an acute coronary syndrome (ACS). His 12-lead ECG indicates anteroseptal
injury with lateral extension (ST elevation in leads V1 through V5).
Appropriate treatment includes oxygen (maintain an SpO2 of greater than
94%), vascular access, up to three 0.4 mg doses of nitroglycerin (NTG), and
2 to 4 mg of morphine if NTG fails to relieve his pain and his systolic BP is
above 90 mm Hg. Some EMS systems may use fentanyl (Sublimaze) for
analgesia. Aspirin, a salicylate, is also given to patients with ACS; however,
, this patient is allergic to salicylates. Obtain a right-sided 12-lead ECG in
patients with signs of inferior wall injury (ST elevation in leads II, III, aVF).
Inferior wall infarctions may involve the right ventricle; a right-sided
12-lead ECG will help confirm this. Apply the multi-pads to the patient, not
because he is at risk for bradycardia (more common with inferior
infarctions), but because he is at risk for cardiac arrest due to V-Fib or
pulseless V-Tach.
◍ You and your team are performing CPR on a 70-year-old male. The cardiac
monitor reveals a slow, organized rhythm. His wife tells you that he goes to
dialysis every day, but has missed his last three treatments. She also tells
you that he has high blood pressure, hyperthyroidism, and has had several
cardiac bypass surgeries. Based on the patient's medical history, which of
the following conditions is the MOST likely underlying cause of his
condition?.
Answer: Hyperkalemia.Although any of the listed conditions could be
causing this patient's condition, the fact that he missed his last three dialysis
treatments should make you most suspicious for hyperkalemia. Dialysis
filters metabolic waste products from the blood in patients with renal
insufficiency or failure. If the patient is not dialyzed, these waste products,
including potassium and other electrolytes, accumulate to toxic levels in the
blood. In addition to performing high-quality CPR, managing the airway,
and administering epinephrine, your protocols may call for the
administration of calcium chloride and sodium bicarbonate if hyperkalemia
is suspected. Albuterol also has been shown to be effective in treating
patients with hyperkalemia becauses it causes potassium to shift back into
the cells; it can be nebulized down the ET tube or administered
intravenously. Follow your local protocols regarding the treatment for
suspected hyperkalemia.
◍ An ECG shows a wide complex rhythm at a rate of 36 beats pre minute.
What part of the heart's conduction system is acting as the pacemaker for
this patient?.
Answer: Purkinje Fibers
