FISDAP Paramedic Final Exam
2026/2027 | 150 Questions with Correct Answers and Rationales
Already Graded A+ | 100% Verified
Advanced Airway Management
1. A 45-year-old male is unresponsive with no gag reflex. You are unable to intubate after two attempts.
Which device is the most appropriate next step?
A) Nasopharyngeal airway
B) Supraglottic airway (i-gel or King LT)
C) Simple face mask
D) Non-rebreather mask
Answer: B) Supraglottic airway (i-gel or King LT)
Rationale: When endotracheal intubation fails, a supraglottic airway is the primary backup per current AHA guidelines.
It provides a reliable airway without laryngoscopy. NPA/NRB do not protect the airway in an unresponsive patient
without a gag reflex.
2. During endotracheal intubation, which structure is the most reliable landmark for visual confirmation of
tube placement?
A) Uvula
B) Vocal cords
C) Epiglottis
D) Pyriform fossa
Answer: B) Vocal cords
Rationale: Direct visualization of the tube passing through the vocal cords is the gold standard for confirming
endotracheal placement. The epiglottis and uvula are anatomical landmarks used during laryngoscopy but do not
confirm tube position.
3. You are ventilating a patient with a bag-valve mask and notice decreased compliance and rising peak
airway pressures. What should you suspect?
A) Right mainstem intubation
B) Tension pneumothorax
C) Esophageal intubation
D) Equipment malfunction
Answer: A) Right mainstem intubation
Rationale: Right mainstem intubation reduces ventilated lung area, causing increased resistance and decreased
compliance. Esophageal intubation would show no chest rise or epigastric distension. While pneumothorax can cause
similar findings, the most common cause of sudden decreased compliance after intubation is tube malposition.
1
,4. Which of the following is the correct sequence for performing rapid sequence intubation (RSI)?
A) Sedation, paralysis, preoxygenation, intubation
B) Preoxygenation, sedation, paralysis, intubation
C) Preoxygenation, paralysis, sedation, intubation
D) Sedation, preoxygenation, intubation, paralysis
Answer: B) Preoxygenation, sedation, paralysis, intubation
Rationale: RSI follows the sequence: preoxygenation (denitrogenation for 3-5 minutes), sedation (induction agent),
paralysis (neuromuscular blocking agent), and then intubation. Preoxygenation must occur first to maximize apneic
oxygenation time.
5. A patient has a suspected cervical spine injury and requires intubation. Which technique should be used?
A) Awake fiberoptic intubation if available
B) Standard laryngoscopy without stabilization
C) Cricothyrotomy as the first-line approach
D) Nasotracheal intubation
Answer: A) Awake fiberoptic intubation if available
Rationale: Awake fiberoptic intubation maintains spontaneous breathing and cervical spine immobilization. If
unavailable, standard laryngoscopy with manual in-line stabilization (MILS) is performed. Cricothyrotomy is a surgical
airway reserved for "cannot intubate, cannot ventilate" scenarios.
6. After successfully intubating a patient, which method provides the most reliable confirmation of tube
placement in the field?
A) Observation of chest rise
B) End-tidal CO2 (capnography) waveform
C) Bilateral breath sounds
D) Fogging in the tube
Answer: B) End-tidal CO2 (capnography) waveform
Rationale: Continuous waveform capnography is the most reliable field confirmation of endotracheal tube placement.
A sustained capnography waveform with a quantitative ETCO2 of 35-45 mmHg confirms correct placement. Chest rise
and breath sounds are supplementary but not definitive.
7. Which size endotracheal tube is most appropriate for an average adult male?
A) 6.0-6.5 mm
B) 7.0-7.5 mm
C) 8.0-8.5 mm
D) 9.0-9.5 mm
Answer: C) 8.0-8.5 mm
Rationale: An 8.0-8.5 mm tube is typically used for adult males, while a 7.0-7.5 mm tube is used for adult females.
Tubes of 6.0-6.5 mm are used in pediatric patients. The size must be appropriate to allow adequate ventilation and
suctioning.
2
,8. A patient is in respiratory failure with copious secretions. Which airway management strategy is most
appropriate?
A) Intubation with a cuffed endotracheal tube
B) Nasopharyngeal airway and suctioning
C) Non-rebreather mask
D) Cricothyrotomy
Answer: A) Intubation with a cuffed endotracheal tube
Rationale: A cuffed endotracheal tube protects the airway from aspiration and provides access for suctioning copious
secretions. NPA alone is insufficient for respiratory failure. Cricothyrotomy is for complete airway obstruction, not
secretion management.
9. What is the primary advantage of using a video laryngoscope over direct laryngoscopy?
A) It requires less training
B) It provides improved glottic visualization
C) It eliminates the need for sedation
D) It does not require a cuff
Answer: B) It provides improved glottic visualization
Rationale: Video laryngoscopy provides a magnified view of the glottis around anatomical obstacles and is particularly
useful in patients with difficult airways. It still requires proper training and typically still requires sedation and a cuffed
tube.
10. When performing double lumen endotracheal tube placement, the primary indication is:
A) Routine airway management in cardiac arrest
B) Isolating lung ventilation in pulmonary hemorrhage or aspiration
C) Pediatric respiratory distress
D) Nasal intubation
Answer: B) Isolating lung ventilation in pulmonary hemorrhage or aspiration
Rationale: Double lumen tubes allow selective lung ventilation, most commonly indicated for massive pulmonary
hemorrhage or unilateral aspiration to protect the unaffected lung. This is an advanced technique not used in routine
airway management.
11. You are performing needle cricothyrotomy. What is the correct anatomical landmark?
A) Thyroid cartilage
B) Cricothyroid membrane
C) Tracheal rings
D) Hyoid bone
Answer: B) Cricothyroid membrane
Rationale: The cricothyroid membrane, located between the thyroid cartilage (Adam's apple) and the cricoid cartilage,
is the target for needle and surgical cricothyrotomy. It is the most accessible point for emergency surgical airway access
below the vocal cords.
3
, 12. A 30-year-old female with severe asthma has increasing dyspnea. Despite BVM ventilation, SpO2
continues to drop. What is the most likely cause?
A) Right mainstem intubation
B) Severe bronchospasm causing auto-PEEP
C) Esophageal intubation
D) Pneumothorax
Answer: B) Severe bronchospasm causing auto-PEEP
Rationale: In severe asthma exacerbation, bronchospasm and air trapping create auto-PEEP (intrinsic PEEP), which
increases intrathoracic pressure, decreases venous return, and makes ventilation progressively more difficult. This
requires careful ventilation strategies with longer expiratory times.
13. Which medication is used as an induction agent during RSI and has minimal cardiovascular depressant
effects?
A) Etomidate
B) Propofol
C) Ketamine
D) Midazolam
Answer: A) Etomidate
Rationale: Etomidate is the preferred induction agent for RSI in hemodynamically unstable patients because it has
minimal cardiovascular depressant effects. Ketamine is also hemodynamically stable but can increase secretions.
Propofol and midazolam cause significant hypotension.
14. You are managing the airway of a burn patient with suspected inhalation injury. Which finding most
strongly indicates the need for early intubation?
A) Singed nasal hairs
B) Hoarseness and stridor
C) Carbonaceous sputum
D) Facial burns
Answer: B) Hoarseness and stridor
Rationale: Hoarseness and stridor indicate upper airway edema, which can progress rapidly to complete obstruction in
burn patients with inhalation injury. While singed nasal hairs and carbonaceous sputum suggest inhalation injury, they
do not indicate immediate airway compromise. Early intubation is critical before edema makes it impossible.
15. The Sellick maneuver (cricoid pressure) during intubation is intended to:
A) Improve laryngoscopic view
B) Prevent passive regurgitation and aspiration
C) Open the vocal cords
D) Stabilize the cervical spine
Answer: B) Prevent passive regurgitation and aspiration
Rationale: The Sellick maneuver applies pressure to the cricoid cartilage to occlude the esophagus, preventing
regurgitation of gastric contents during intubation. Current evidence on its effectiveness is mixed, but it remains a
standard technique in many protocols. It is not a cervical stabilization technique.
4
2026/2027 | 150 Questions with Correct Answers and Rationales
Already Graded A+ | 100% Verified
Advanced Airway Management
1. A 45-year-old male is unresponsive with no gag reflex. You are unable to intubate after two attempts.
Which device is the most appropriate next step?
A) Nasopharyngeal airway
B) Supraglottic airway (i-gel or King LT)
C) Simple face mask
D) Non-rebreather mask
Answer: B) Supraglottic airway (i-gel or King LT)
Rationale: When endotracheal intubation fails, a supraglottic airway is the primary backup per current AHA guidelines.
It provides a reliable airway without laryngoscopy. NPA/NRB do not protect the airway in an unresponsive patient
without a gag reflex.
2. During endotracheal intubation, which structure is the most reliable landmark for visual confirmation of
tube placement?
A) Uvula
B) Vocal cords
C) Epiglottis
D) Pyriform fossa
Answer: B) Vocal cords
Rationale: Direct visualization of the tube passing through the vocal cords is the gold standard for confirming
endotracheal placement. The epiglottis and uvula are anatomical landmarks used during laryngoscopy but do not
confirm tube position.
3. You are ventilating a patient with a bag-valve mask and notice decreased compliance and rising peak
airway pressures. What should you suspect?
A) Right mainstem intubation
B) Tension pneumothorax
C) Esophageal intubation
D) Equipment malfunction
Answer: A) Right mainstem intubation
Rationale: Right mainstem intubation reduces ventilated lung area, causing increased resistance and decreased
compliance. Esophageal intubation would show no chest rise or epigastric distension. While pneumothorax can cause
similar findings, the most common cause of sudden decreased compliance after intubation is tube malposition.
1
,4. Which of the following is the correct sequence for performing rapid sequence intubation (RSI)?
A) Sedation, paralysis, preoxygenation, intubation
B) Preoxygenation, sedation, paralysis, intubation
C) Preoxygenation, paralysis, sedation, intubation
D) Sedation, preoxygenation, intubation, paralysis
Answer: B) Preoxygenation, sedation, paralysis, intubation
Rationale: RSI follows the sequence: preoxygenation (denitrogenation for 3-5 minutes), sedation (induction agent),
paralysis (neuromuscular blocking agent), and then intubation. Preoxygenation must occur first to maximize apneic
oxygenation time.
5. A patient has a suspected cervical spine injury and requires intubation. Which technique should be used?
A) Awake fiberoptic intubation if available
B) Standard laryngoscopy without stabilization
C) Cricothyrotomy as the first-line approach
D) Nasotracheal intubation
Answer: A) Awake fiberoptic intubation if available
Rationale: Awake fiberoptic intubation maintains spontaneous breathing and cervical spine immobilization. If
unavailable, standard laryngoscopy with manual in-line stabilization (MILS) is performed. Cricothyrotomy is a surgical
airway reserved for "cannot intubate, cannot ventilate" scenarios.
6. After successfully intubating a patient, which method provides the most reliable confirmation of tube
placement in the field?
A) Observation of chest rise
B) End-tidal CO2 (capnography) waveform
C) Bilateral breath sounds
D) Fogging in the tube
Answer: B) End-tidal CO2 (capnography) waveform
Rationale: Continuous waveform capnography is the most reliable field confirmation of endotracheal tube placement.
A sustained capnography waveform with a quantitative ETCO2 of 35-45 mmHg confirms correct placement. Chest rise
and breath sounds are supplementary but not definitive.
7. Which size endotracheal tube is most appropriate for an average adult male?
A) 6.0-6.5 mm
B) 7.0-7.5 mm
C) 8.0-8.5 mm
D) 9.0-9.5 mm
Answer: C) 8.0-8.5 mm
Rationale: An 8.0-8.5 mm tube is typically used for adult males, while a 7.0-7.5 mm tube is used for adult females.
Tubes of 6.0-6.5 mm are used in pediatric patients. The size must be appropriate to allow adequate ventilation and
suctioning.
2
,8. A patient is in respiratory failure with copious secretions. Which airway management strategy is most
appropriate?
A) Intubation with a cuffed endotracheal tube
B) Nasopharyngeal airway and suctioning
C) Non-rebreather mask
D) Cricothyrotomy
Answer: A) Intubation with a cuffed endotracheal tube
Rationale: A cuffed endotracheal tube protects the airway from aspiration and provides access for suctioning copious
secretions. NPA alone is insufficient for respiratory failure. Cricothyrotomy is for complete airway obstruction, not
secretion management.
9. What is the primary advantage of using a video laryngoscope over direct laryngoscopy?
A) It requires less training
B) It provides improved glottic visualization
C) It eliminates the need for sedation
D) It does not require a cuff
Answer: B) It provides improved glottic visualization
Rationale: Video laryngoscopy provides a magnified view of the glottis around anatomical obstacles and is particularly
useful in patients with difficult airways. It still requires proper training and typically still requires sedation and a cuffed
tube.
10. When performing double lumen endotracheal tube placement, the primary indication is:
A) Routine airway management in cardiac arrest
B) Isolating lung ventilation in pulmonary hemorrhage or aspiration
C) Pediatric respiratory distress
D) Nasal intubation
Answer: B) Isolating lung ventilation in pulmonary hemorrhage or aspiration
Rationale: Double lumen tubes allow selective lung ventilation, most commonly indicated for massive pulmonary
hemorrhage or unilateral aspiration to protect the unaffected lung. This is an advanced technique not used in routine
airway management.
11. You are performing needle cricothyrotomy. What is the correct anatomical landmark?
A) Thyroid cartilage
B) Cricothyroid membrane
C) Tracheal rings
D) Hyoid bone
Answer: B) Cricothyroid membrane
Rationale: The cricothyroid membrane, located between the thyroid cartilage (Adam's apple) and the cricoid cartilage,
is the target for needle and surgical cricothyrotomy. It is the most accessible point for emergency surgical airway access
below the vocal cords.
3
, 12. A 30-year-old female with severe asthma has increasing dyspnea. Despite BVM ventilation, SpO2
continues to drop. What is the most likely cause?
A) Right mainstem intubation
B) Severe bronchospasm causing auto-PEEP
C) Esophageal intubation
D) Pneumothorax
Answer: B) Severe bronchospasm causing auto-PEEP
Rationale: In severe asthma exacerbation, bronchospasm and air trapping create auto-PEEP (intrinsic PEEP), which
increases intrathoracic pressure, decreases venous return, and makes ventilation progressively more difficult. This
requires careful ventilation strategies with longer expiratory times.
13. Which medication is used as an induction agent during RSI and has minimal cardiovascular depressant
effects?
A) Etomidate
B) Propofol
C) Ketamine
D) Midazolam
Answer: A) Etomidate
Rationale: Etomidate is the preferred induction agent for RSI in hemodynamically unstable patients because it has
minimal cardiovascular depressant effects. Ketamine is also hemodynamically stable but can increase secretions.
Propofol and midazolam cause significant hypotension.
14. You are managing the airway of a burn patient with suspected inhalation injury. Which finding most
strongly indicates the need for early intubation?
A) Singed nasal hairs
B) Hoarseness and stridor
C) Carbonaceous sputum
D) Facial burns
Answer: B) Hoarseness and stridor
Rationale: Hoarseness and stridor indicate upper airway edema, which can progress rapidly to complete obstruction in
burn patients with inhalation injury. While singed nasal hairs and carbonaceous sputum suggest inhalation injury, they
do not indicate immediate airway compromise. Early intubation is critical before edema makes it impossible.
15. The Sellick maneuver (cricoid pressure) during intubation is intended to:
A) Improve laryngoscopic view
B) Prevent passive regurgitation and aspiration
C) Open the vocal cords
D) Stabilize the cervical spine
Answer: B) Prevent passive regurgitation and aspiration
Rationale: The Sellick maneuver applies pressure to the cricoid cartilage to occlude the esophagus, preventing
regurgitation of gastric contents during intubation. Current evidence on its effectiveness is mixed, but it remains a
standard technique in many protocols. It is not a cervical stabilization technique.
4
