Medical Emergencies FISDAP Study Guide, Practice
Questions & Exam Prep Workbook for EMT and Paramedic
Students | Complete Emergency Care Scenarios, Critical
Thinking Review, and National Registry Success
Preparation
Question 1: A 68-year-old male presents with sudden onset of crushing substernal chest pain
radiating to his left jaw, diaphoresis, and nausea. His vital signs are BP 160/90, HR 110, RR 24,
SpO2 94% on room air. Which intervention should be performed FIRST?
A. Administer 324 mg aspirin chewed
B. Apply oxygen via non-rebreather mask
C. Obtain a 12-lead ECG
D. Administer sublingual nitroglycerin
CORRECT ANSWER: C. Obtain a 12-lead ECG
Rationale: In a patient with suspected acute coronary syndrome, obtaining a 12-lead ECG within
10 minutes of first medical contact is the priority intervention per AHA/ACC guidelines. This
allows for rapid identification of ST-elevation myocardial infarction (STEMI) and activation of
the catheterization lab. While aspirin, oxygen (if hypoxic), and nitroglycerin are important, they
should not delay ECG acquisition, which directly impacts time-sensitive reperfusion therapy
decisions.
Question 2: Which finding is MOST indicative of a hemorrhagic stroke versus an ischemic stroke
during prehospital assessment?
A. Sudden unilateral weakness
B. Slurred speech
C. Severe headache described as "worst headache of my life"
D. Facial droop
CORRECT ANSWER: C. Severe headache described as "worst headache of my life"
Rationale: A thunderclap headache, often described as the "worst headache of my life," is
highly suggestive of subarachnoid hemorrhage or other hemorrhagic stroke etiologies. While
unilateral weakness, slurred speech, and facial droop are common to both ischemic and
hemorrhagic strokes (and form the basis of stroke scales like FAST), the acute onset of an
extremely severe headache is a red flag for intracranial bleeding and warrants urgent
neurosurgical evaluation.
,Question 3: A patient with known type 1 diabetes is found confused, diaphoretic, and
tachycardic. Blood glucose is 48 mg/dL. After establishing IV access, what is the MOST
appropriate initial medication?
A. 50 mL of 50% dextrose (D50) IV push
B. 1 mg glucagon IM
C. 125 mL of 25% dextrose (D25) IV push
D. Oral glucose gel
CORRECT ANSWER: A. 50 mL of 50% dextrose (D50) IV push
Rationale: For a conscious or altered patient with severe hypoglycemia (glucose <70 mg/dL) and
established IV access, 25 grams of dextrose (typically 50 mL of D50W) IV push is the treatment
of choice per EMS protocols. It rapidly corrects hypoglycemia. Glucagon IM is reserved for
patients without IV access. D25 is sometimes used in pediatric patients to reduce osmolarity
risks. Oral glucose is inappropriate for an altered or confused patient due to aspiration risk.
Question 4: During assessment of a patient with suspected anaphylaxis, which sign represents
the MOST immediate life threat?
A. Urticaria and pruritus
B. Angioedema of the lips
C. Stridor and wheezing
D. Nausea and vomiting
CORRECT ANSWER: C. Stridor and wheezing
Rationale: Stridor indicates upper airway edema and potential complete airway obstruction,
while wheezing suggests lower airway bronchospasm—both are signs of respiratory
compromise, the leading cause of death in anaphylaxis. While urticaria, angioedema, and GI
symptoms are common, airway and breathing interventions take precedence. Immediate
epinephrine administration is critical to reverse these life-threatening effects.
Question 5: A 45-year-old female presents with acute onset of right lower quadrant abdominal
pain, fever, and rebound tenderness. Which condition should be HIGHEST on your differential?
A. Pyelonephritis
B. Appendicitis
C. Cholecystitis
D. Diverticulitis
,CORRECT ANSWER: B. Appendicitis
Rationale: Classic appendicitis presents with periumbilical pain migrating to the right lower
quadrant (McBurney's point), fever, anorexia, and rebound tenderness. While pyelonephritis
may cause flank pain and fever, cholecystitis typically causes right upper quadrant pain, and
diverticulitis usually affects the left lower quadrant in Western populations. Appendicitis
requires urgent surgical evaluation to prevent perforation.
Question 6: Which medication is CONTRAINDICATED in a patient with suspected right
ventricular myocardial infarction?
A. Aspirin
B. Nitroglycerin
C. Morphine
D. Oxygen
CORRECT ANSWER: B. Nitroglycerin
Rationale: Nitroglycerin is a venodilator that reduces preload. In right ventricular MI, the right
ventricle is dependent on adequate preload to maintain cardiac output. Administering
nitroglycerin can cause profound hypotension and cardiovascular collapse. Aspirin, morphine
(for pain), and oxygen (if hypoxic) remain appropriate. Fluid resuscitation is often needed to
support right ventricular function.
Question 7: A patient experiencing a generalized tonic-clonic seizure has been actively seizing
for 8 minutes. What is the PRIORITY intervention?
A. Place an oral airway
B. Administer lorazepam IV
C. Protect the patient from injury
D. Suction oral secretions
CORRECT ANSWER: B. Administer lorazepam IV
Rationale: A seizure lasting longer than 5 minutes is considered status epilepticus, a
neurological emergency requiring immediate benzodiazepine administration (e.g., lorazepam
IV, midazolam IM) to terminate seizure activity and prevent neuronal injury. While protecting
the patient from injury and managing the airway are important, pharmacological intervention is
time-critical. Oral airways are generally avoided during active seizures due to risk of dental
injury or airway obstruction.
Question 8: Which assessment finding is MOST consistent with diabetic ketoacidosis (DKA)?
, A. Blood glucose 600 mg/dL, Kussmaul respirations, fruity breath odor
B. Blood glucose 50 mg/dL, diaphoresis, confusion
C. Blood glucose 300 mg/dL, bradycardia, dry skin
D. Blood glucose 120 mg/dL, polyuria, weight gain
CORRECT ANSWER: A. Blood glucose 600 mg/dL, Kussmaul respirations, fruity breath odor
Rationale: DKA is characterized by hyperglycemia (typically >250 mg/dL), metabolic acidosis
leading to compensatory Kussmaul respirations (deep, rapid breathing), and acetone (fruity)
breath odor from ketone metabolism. Option B describes hypoglycemia. Option C lacks acidosis
signs. Option D describes controlled diabetes or other conditions. DKA requires fluid
resuscitation, insulin, and electrolyte management.
Question 9: A 70-year-old male with COPD presents with increased dyspnea, productive cough
with yellow sputum, and use of accessory muscles. SpO2 is 88% on room air. What is the MOST
appropriate initial oxygen therapy?
A. High-flow oxygen via non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min, titrating to SpO2 88-92%
C. Bag-valve-mask ventilation with 100% oxygen
D. Venturi mask at 24% FiO2
CORRECT ANSWER: B. Nasal cannula at 2 L/min, titrating to SpO2 88-92%
Rationale: Patients with severe COPD may rely on hypoxic drive for ventilation. High
concentrations of oxygen can suppress respiratory drive, leading to hypercapnia and respiratory
acidosis. Current guidelines recommend titrating oxygen to achieve SpO2 88-92% in known
COPD patients with acute exacerbation. Starting low (e.g., 2 L/min via nasal cannula) and
titrating based on saturation and clinical response is safest. Non-rebreather or BVM is reserved
for impending respiratory failure.
Question 10: Which sign is EARLIEST indicator of compensated shock in a pediatric patient?
A. Hypotension
B. Tachycardia
C. Altered mental status
D. Mottled skin
CORRECT ANSWER: B. Tachycardia
Questions & Exam Prep Workbook for EMT and Paramedic
Students | Complete Emergency Care Scenarios, Critical
Thinking Review, and National Registry Success
Preparation
Question 1: A 68-year-old male presents with sudden onset of crushing substernal chest pain
radiating to his left jaw, diaphoresis, and nausea. His vital signs are BP 160/90, HR 110, RR 24,
SpO2 94% on room air. Which intervention should be performed FIRST?
A. Administer 324 mg aspirin chewed
B. Apply oxygen via non-rebreather mask
C. Obtain a 12-lead ECG
D. Administer sublingual nitroglycerin
CORRECT ANSWER: C. Obtain a 12-lead ECG
Rationale: In a patient with suspected acute coronary syndrome, obtaining a 12-lead ECG within
10 minutes of first medical contact is the priority intervention per AHA/ACC guidelines. This
allows for rapid identification of ST-elevation myocardial infarction (STEMI) and activation of
the catheterization lab. While aspirin, oxygen (if hypoxic), and nitroglycerin are important, they
should not delay ECG acquisition, which directly impacts time-sensitive reperfusion therapy
decisions.
Question 2: Which finding is MOST indicative of a hemorrhagic stroke versus an ischemic stroke
during prehospital assessment?
A. Sudden unilateral weakness
B. Slurred speech
C. Severe headache described as "worst headache of my life"
D. Facial droop
CORRECT ANSWER: C. Severe headache described as "worst headache of my life"
Rationale: A thunderclap headache, often described as the "worst headache of my life," is
highly suggestive of subarachnoid hemorrhage or other hemorrhagic stroke etiologies. While
unilateral weakness, slurred speech, and facial droop are common to both ischemic and
hemorrhagic strokes (and form the basis of stroke scales like FAST), the acute onset of an
extremely severe headache is a red flag for intracranial bleeding and warrants urgent
neurosurgical evaluation.
,Question 3: A patient with known type 1 diabetes is found confused, diaphoretic, and
tachycardic. Blood glucose is 48 mg/dL. After establishing IV access, what is the MOST
appropriate initial medication?
A. 50 mL of 50% dextrose (D50) IV push
B. 1 mg glucagon IM
C. 125 mL of 25% dextrose (D25) IV push
D. Oral glucose gel
CORRECT ANSWER: A. 50 mL of 50% dextrose (D50) IV push
Rationale: For a conscious or altered patient with severe hypoglycemia (glucose <70 mg/dL) and
established IV access, 25 grams of dextrose (typically 50 mL of D50W) IV push is the treatment
of choice per EMS protocols. It rapidly corrects hypoglycemia. Glucagon IM is reserved for
patients without IV access. D25 is sometimes used in pediatric patients to reduce osmolarity
risks. Oral glucose is inappropriate for an altered or confused patient due to aspiration risk.
Question 4: During assessment of a patient with suspected anaphylaxis, which sign represents
the MOST immediate life threat?
A. Urticaria and pruritus
B. Angioedema of the lips
C. Stridor and wheezing
D. Nausea and vomiting
CORRECT ANSWER: C. Stridor and wheezing
Rationale: Stridor indicates upper airway edema and potential complete airway obstruction,
while wheezing suggests lower airway bronchospasm—both are signs of respiratory
compromise, the leading cause of death in anaphylaxis. While urticaria, angioedema, and GI
symptoms are common, airway and breathing interventions take precedence. Immediate
epinephrine administration is critical to reverse these life-threatening effects.
Question 5: A 45-year-old female presents with acute onset of right lower quadrant abdominal
pain, fever, and rebound tenderness. Which condition should be HIGHEST on your differential?
A. Pyelonephritis
B. Appendicitis
C. Cholecystitis
D. Diverticulitis
,CORRECT ANSWER: B. Appendicitis
Rationale: Classic appendicitis presents with periumbilical pain migrating to the right lower
quadrant (McBurney's point), fever, anorexia, and rebound tenderness. While pyelonephritis
may cause flank pain and fever, cholecystitis typically causes right upper quadrant pain, and
diverticulitis usually affects the left lower quadrant in Western populations. Appendicitis
requires urgent surgical evaluation to prevent perforation.
Question 6: Which medication is CONTRAINDICATED in a patient with suspected right
ventricular myocardial infarction?
A. Aspirin
B. Nitroglycerin
C. Morphine
D. Oxygen
CORRECT ANSWER: B. Nitroglycerin
Rationale: Nitroglycerin is a venodilator that reduces preload. In right ventricular MI, the right
ventricle is dependent on adequate preload to maintain cardiac output. Administering
nitroglycerin can cause profound hypotension and cardiovascular collapse. Aspirin, morphine
(for pain), and oxygen (if hypoxic) remain appropriate. Fluid resuscitation is often needed to
support right ventricular function.
Question 7: A patient experiencing a generalized tonic-clonic seizure has been actively seizing
for 8 minutes. What is the PRIORITY intervention?
A. Place an oral airway
B. Administer lorazepam IV
C. Protect the patient from injury
D. Suction oral secretions
CORRECT ANSWER: B. Administer lorazepam IV
Rationale: A seizure lasting longer than 5 minutes is considered status epilepticus, a
neurological emergency requiring immediate benzodiazepine administration (e.g., lorazepam
IV, midazolam IM) to terminate seizure activity and prevent neuronal injury. While protecting
the patient from injury and managing the airway are important, pharmacological intervention is
time-critical. Oral airways are generally avoided during active seizures due to risk of dental
injury or airway obstruction.
Question 8: Which assessment finding is MOST consistent with diabetic ketoacidosis (DKA)?
, A. Blood glucose 600 mg/dL, Kussmaul respirations, fruity breath odor
B. Blood glucose 50 mg/dL, diaphoresis, confusion
C. Blood glucose 300 mg/dL, bradycardia, dry skin
D. Blood glucose 120 mg/dL, polyuria, weight gain
CORRECT ANSWER: A. Blood glucose 600 mg/dL, Kussmaul respirations, fruity breath odor
Rationale: DKA is characterized by hyperglycemia (typically >250 mg/dL), metabolic acidosis
leading to compensatory Kussmaul respirations (deep, rapid breathing), and acetone (fruity)
breath odor from ketone metabolism. Option B describes hypoglycemia. Option C lacks acidosis
signs. Option D describes controlled diabetes or other conditions. DKA requires fluid
resuscitation, insulin, and electrolyte management.
Question 9: A 70-year-old male with COPD presents with increased dyspnea, productive cough
with yellow sputum, and use of accessory muscles. SpO2 is 88% on room air. What is the MOST
appropriate initial oxygen therapy?
A. High-flow oxygen via non-rebreather mask at 15 L/min
B. Nasal cannula at 2 L/min, titrating to SpO2 88-92%
C. Bag-valve-mask ventilation with 100% oxygen
D. Venturi mask at 24% FiO2
CORRECT ANSWER: B. Nasal cannula at 2 L/min, titrating to SpO2 88-92%
Rationale: Patients with severe COPD may rely on hypoxic drive for ventilation. High
concentrations of oxygen can suppress respiratory drive, leading to hypercapnia and respiratory
acidosis. Current guidelines recommend titrating oxygen to achieve SpO2 88-92% in known
COPD patients with acute exacerbation. Starting low (e.g., 2 L/min via nasal cannula) and
titrating based on saturation and clinical response is safest. Non-rebreather or BVM is reserved
for impending respiratory failure.
Question 10: Which sign is EARLIEST indicator of compensated shock in a pediatric patient?
A. Hypotension
B. Tachycardia
C. Altered mental status
D. Mottled skin
CORRECT ANSWER: B. Tachycardia
