Forming a Field Impression Practice Questions

57 multiple-choice questions on Forming a field impression for paramedic and EMT students, from Chapter 12 (Critical Thinking and Clinical Decision Making). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

57 practice questions

1. A field impression is:

   1. A. The complaint given by dispatch
   2. B. A provisional working conclusion
   3. C. A confirmed diagnosis of the problem
   4. D. The diagnosis made at the hospital
   Show answer

   Answer: B. A provisional working conclusion

   It should change if the evidence changes. It is based on the available findings.

2. A differential diagnosis in EMS serves to:

   1. A. Replace the need for further assessment
   2. B. Justify the decision to transport
   3. C. Keep dangerous possibilities in play
   4. D. Pinpoint the exact underlying condition
   Show answer

   Answer: C. Keep dangerous possibilities in play

   Narrow it as evidence accumulates. Keeping several plausible explanations in play prevents missing the dangerous ones.

3. When building a differential, the paramedic should first consider:

   1. A. The least likely possible cause
   2. B. The patient's own theory of the cause
   3. C. The most dangerous possible causes
   4. D. The most statistically common cause
   Show answer

   Answer: C. The most dangerous possible causes

   Rule out what can kill before settling on what is likely.

4. A patient with vague weakness and no obvious cause should prompt consideration of:

   1. A. One likely diagnosis to focus on
   2. B. Anxiety as the leading cause
   3. C. Dehydration as the only cause
   4. D. A broad, multisystem differential
   Show answer

   Answer: D. A broad, multisystem differential

   Vague complaints in older adults often signal serious disease. Include cardiac, metabolic, infectious, neurologic, and hemorrhagic causes.

5. Field impressions are limited compared with hospital diagnoses because:

   1. A. Field impressions are seldom necessary
   2. B. Paramedics lack adequate diagnostic training
   3. C. Protocols forbid paramedic diagnoses
   4. D. There are no imaging or lab results
   Show answer

   Answer: D. There are no imaging or lab results

   This is why treatment targets syndromes and threats rather than exact diagnoses.

6. A patient may have more than one problem, which means:

   1. A. The first finding explains everything
   2. B. Documentation can focus on one problem
   3. C. Finding one cause does not end the search
   4. D. Only the most serious problem matters
   Show answer

   Answer: C. Finding one cause does not end the search

   Trauma and a medical cause frequently coexist.

7. The three broad categories used to prioritize patients are:

   1. A. Stable, potentially unstable, and critically unstable patients
   2. B. Emergent, urgent, and routine transport priority
   3. C. Life-threatening, potentially life-threatening, non-life-threatening
   4. D. Traumatic, medical, and psychiatric or behavioral emergencies
   Show answer

   Answer: C. Life-threatening, potentially life-threatening, non-life-threatening

   The category drives urgency more than the diagnosis does.

8. When the field impression is uncertain but the patient looks sick, the paramedic should:

   1. A. Treat threats, transport, and keep assessing
   2. B. Stay on scene until the diagnosis is clear
   3. C. Assume a benign cause until proven otherwise
   4. D. Wait for medical control to direct care
   Show answer

   Answer: A. Treat threats, transport, and keep assessing

   You do not need a diagnosis to recognize a critical patient.

9. A working impression should be communicated to the hospital as:

   1. A. Only the raw findings, without impression
   2. B. Only the original dispatch complaint
   3. C. Your impression plus supporting findings
   4. D. A definitive, confirmed diagnosis
   Show answer

   Answer: C. Your impression plus supporting findings

   Giving your reasoning lets the receiving team evaluate it.

10. Which is the strongest reason to revise a field impression?

    1. A. Your partner disagrees with your reasoning
    2. B. Findings or responses that contradict it
    3. C. The patient prefers another explanation
    4. D. A long transport time to the hospital
    Show answer

    Answer: B. Findings or responses that contradict it

    A patient who does not respond as expected is telling you something.

11. Treating the patient rather than the monitor means:

    1. A. Skipping the ECG when vitals are normal
    2. B. Ignoring technology in favor of instinct
    3. C. Interpreting devices in clinical context
    4. D. Avoiding pulse oximetry on stable patients
    Show answer

    Answer: C. Interpreting devices in clinical context

    A normal number in a sick-looking patient deserves scrutiny. Read devices against the patient's appearance and findings.

12. A patient who says "this feels like the last time I had a heart attack" should be:

    1. A. Told to wait for hospital testing
    2. B. Documented as an anxious patient
    3. C. Taken seriously as a valid clue
    4. D. Reassured that it is probably anxiety
    Show answer

    Answer: C. Taken seriously as a valid clue

    Patients often recognize their own patterns accurately. A patient's own recognition of a prior event carries weight.

13. A 70-year-old has right-sided weakness and slurred speech. The glucose is 36 mg/dL. What should your field impression be?

    1. A. Acute stroke; withhold the dextrose to avoid any harm
    2. B. Hypoglycemia mimicking stroke; treat and reassess
    3. C. Stroke only, since the deficits are one-sided
    4. D. Bell palsy with an incidental low glucose
    Show answer

    Answer: B. Hypoglycemia mimicking stroke; treat and reassess

    Hypoglycemia can cause focal deficits that mimic stroke. Correct the glucose first, then reassess. If the deficits persist, treat as a stroke and note the last known well time. Withholding dextrose is harmful, one-sided deficits do not exclude a metabolic cause, and Bell palsy affects only the face.

14. The field impression should be based on:

    1. A. The paramedic's gut feeling alone
    2. B. The dispatch information on its own
    3. C. The first complaint the patient voices
    4. D. All history, exam, and diagnostic data
    Show answer

    Answer: D. All history, exam, and diagnostic data

    A sound impression integrates all available data rather than any single element. This includes vital signs.

15. When several diagnoses are possible, the paramedic should treat for:

    1. A. The most common cause alone
    2. B. Nothing until the cause is certain
    3. C. The most likely and most dangerous
    4. D. Whichever fits the dispatch complaint
    Show answer

    Answer: C. The most likely and most dangerous

    Field care addresses the probable cause while protecting against the life-threatening ones still on the differential. Treat for possibilities that fit the findings. Treating the most common cause alone leaves a dangerous alternative untreated, and the dispatch complaint is a starting point rather than a basis for treatment.

16. A patient with dyspnea, wheezing, and a history of CHF and COPD presents a challenge because:

    1. A. Protocols forbid treating both conditions
    2. B. Wheezing points to COPD rather than heart failure
    3. C. Crackles would rule out a COPD flare
    4. D. Wheezing occurs in both; look for differences
    Show answer

    Answer: D. Wheezing occurs in both; look for differences

    'Cardiac asthma' mimics bronchospasm; JVD, edema, and orthopnea help separate the two. Wheezing does not settle the question because heart failure can cause it, and crackles do not exclude COPD, since pneumonia or coexisting fluid can produce them.

17. The process of narrowing a broad differential to a working impression is called:

    1. A. Secondary triage
    2. B. Diagnostic refinement
    3. C. Anchoring on the impression
    4. D. Premature closure
    Show answer

    Answer: B. Diagnostic refinement

    Refinement uses new findings to rule possibilities in or out.

18. En route with a patient you assessed as having gastroenteritis, she becomes hypotensive and her abdomen becomes rigid. What should you do?

    1. A. Keep the gastroenteritis impression, since it fit at first
    2. B. Give an antiemetic and continue as planned
    3. C. Wait for the ED to decide what has changed
    4. D. Revise the impression toward a surgical cause
    Show answer

    Answer: D. Revise the impression toward a surgical cause

    New findings that contradict an impression require revising it. Rigidity with hypotension suggests peritonitis, perforation, or intra-abdominal bleeding (for example, a ruptured ectopic or AAA). Treat the shock, update the hospital, and expedite. Holding on to the first impression is anchoring.

19. A 60-year-old with epigastric pain, diaphoresis, and nausea. The safest field impression approach is to:

    1. A. Assume indigestion given the epigastric site
    2. B. Treat only the nausea and monitor
    3. C. Consider ACS until ruled out
    4. D. Decline transport if pain resolves
    Show answer

    Answer: C. Consider ACS until ruled out

    Atypical ACS presentations are common; the dangerous diagnosis must stay on the list.

20. For a 45-year-old with a sudden severe headache, which differential keeps the dangerous causes in play?

    1. A. Tension headache and migraine, with nothing else
    2. B. Sinusitis and dehydration from a long workday
    3. C. Caffeine withdrawal and poor posture only
    4. D. SAH, meningitis, hypertensive crisis, migraine
    Show answer

    Answer: D. SAH, meningitis, hypertensive crisis, migraine

    A differential keeps dangerous possibilities in play while benign ones are considered. A sudden severe headache calls for considering subarachnoid hemorrhage, meningitis, and hypertensive emergency (and dissection or venous thrombosis) before migraine. The other lists contain only benign causes.

21. A patient has pleuritic chest pain, and you cannot obtain a D-dimer or CT in the field. How should your impression handle pulmonary embolism?

    1. A. Rule out PE, since both her lungs sound clear on exam
    2. B. Rule out PE, since her SpO2 is 97 percent
    3. C. Keep PE on the list and transport with monitoring
    4. D. Diagnose PE definitively from the history alone
    Show answer

    Answer: C. Keep PE on the list and transport with monitoring

    Field impressions are provisional because they are made without labs or imaging. Clear lungs and a normal SpO2 do not exclude PE, but the history cannot confirm it either. Keep it on the differential, monitor, and communicate it to the hospital.

22. Which finding would most strongly shift a field impression from 'syncope' toward 'seizure'?

    1. A. A recent history of dehydration
    2. B. Brief loss of consciousness with quick recovery
    3. C. Pale, sweaty skin just before the event
    4. D. Tongue biting and prolonged postictal confusion
    Show answer

    Answer: D. Tongue biting and prolonged postictal confusion

    Tongue laceration, incontinence, and postictal state point toward seizure rather than simple syncope. Incontinence also favors seizure.

23. The monitor shows asystole, but your patient is talking to you. What should you do?

    1. A. Begin CPR right away for the asystole
    2. B. Check the leads; he is not in arrest
    3. C. Defibrillate at the highest available energy
    4. D. Give 1 mg of epinephrine IV now
    Show answer

    Answer: B. Check the leads; he is not in arrest

    Treat the patient, not the monitor. A talking patient has a perfusing rhythm, so a flat line means a lead or electrode has come off, the gain is low, or there is artifact. CPR or epinephrine would harm him, and asystole is not a shockable rhythm in any case.

24. When forming a field impression for an altered patient, the paramedic should first consider:

    1. A. Rapidly reversible life threats
    2. B. Underlying psychiatric illness
    3. C. Nothing until hospital workup
    4. D. Progression of dementia
    Show answer

    Answer: A. Rapidly reversible life threats

    Rapidly reversible causes are prioritized because treatment can be immediate and life-saving. Examples include hypoglycemia, hypoxia, and opioid overdose.

25. A field impression should be communicated to the receiving facility because:

    1. A. It helps the hospital prepare resources
    2. B. It replaces the hospital's own assessment
    3. C. It is required by federal law
    4. D. It prevents the ED from re-examining
    Show answer

    Answer: A. It helps the hospital prepare resources

    Sharing the impression and its basis supports continuity of care. It also lets the hospital continue the thought process.

26. Which best describes an 'index of suspicion'?

    1. A. Certainty that a specific diagnosis is present
    2. B. A ranked list of hospital capabilities
    3. C. Awareness of possible serious conditions
    4. D. A scoring tool that confirms a diagnosis
    Show answer

    Answer: C. Awareness of possible serious conditions

    A high index of suspicion keeps serious injuries or illnesses in mind even when initial findings seem minor. It is based on mechanism or presentation. It is not certainty about a diagnosis and not a scoring tool; it is an alertness that prompts you to look harder and keep possibilities open.

27. A trauma patient appears stable but had a high-speed mechanism. The field impression should:

    1. A. Keep a high suspicion for hidden injury
    2. B. Downgrade the transport priority
    3. C. Rule out injury because the patient looks fine
    4. D. Omit spinal motion restriction
    Show answer

    Answer: A. Keep a high suspicion for hidden injury

    Mechanism alone warrants suspicion; compensated shock can hide serious injury. Reassess frequently.

28. The paramedic forms the impression 'anaphylaxis' based on hives, wheezing, and hypotension after a bee sting. This impression is:

    1. A. Unsupported unless the airway is swelling
    2. B. Premature without more data
    3. C. Unsupported without a known sting allergy
    4. D. Appropriate; multisystem findings fit
    Show answer

    Answer: D. Appropriate; multisystem findings fit

    Classic multisystem findings after an allergen exposure support an actionable field impression. Airway swelling is not required, because skin findings with wheezing or hypotension already meet anaphylaxis criteria, and a first reaction can occur without any known prior allergy.

29. Your impression is 'anxiety' for a woman with palpitations, but the monitor shows a regular narrow-complex rhythm at 190. What should you do?

    1. A. Keep anxiety; coach her slow breathing
    2. B. Ignore the monitor, since she is anxious
    3. C. Revise to SVT and treat the rhythm
    4. D. Give a sedative for the anxiety alone
    Show answer

    Answer: C. Revise to SVT and treat the rhythm

    An objective finding that contradicts the impression is the strongest reason to revise it. A regular narrow-complex tachycardia at 190 is SVT until proven otherwise, and it is treated with vagal maneuvers and then adenosine if stable. Keeping 'anxiety,' ignoring the monitor, or sedating her leaves the dysrhythmia untreated.

30. Which is an example of a field impression that is too vague to guide treatment?

    1. A. 'Sick'
    2. B. Anaphylaxis
    3. C. Acute asthma exacerbation
    4. D. Hypoglycemia
    Show answer

    Answer: A. 'Sick'

    A useful impression is specific enough to direct interventions.

31. What is the primary purpose of forming a field impression?

    1. A. To guide treatment and transport
    2. B. To complete the documentation
    3. C. To reach a definitive diagnosis
    4. D. To replace the hospital's workup
    Show answer

    Answer: A. To guide treatment and transport

    The impression exists to drive action; it is the bridge between assessment and treatment. A field impression is provisional, so it neither delivers a definitive diagnosis nor replaces hospital testing.

32. A patient's presentation matches a textbook pattern perfectly. The paramedic should:

    1. A. Proceed but stay alert for contradictions
    2. B. Decline to consider any differential
    3. C. Stop assessing since the diagnosis is clear
    4. D. Skip reassessment because it is classic
    Show answer

    Answer: A. Proceed but stay alert for contradictions

    Even classic presentations deserve ongoing scrutiny; mimics exist.

33. A 68-year-old man has sudden severe abdominal pain radiating to his back, a pulsatile abdominal mass, and BP 88/50. Your field impression should be:

    1. A. Kidney stone with renal colic
    2. B. Ruptured or leaking AAA
    3. C. Acute lumbar strain
    4. D. Acute gastroenteritis
    Show answer

    Answer: B. Ruptured or leaking AAA

    Sudden abdominal or back pain with a pulsatile mass and hypotension in an older man is classic for AAA rupture.

34. A 22-year-old with type 1 diabetes has abdominal pain, vomiting, deep rapid respirations, and a fruity breath odor. Glucose reads 'HI.' The most likely field impression is:

    1. A. Severe hypoglycemia
    2. B. Acute appendicitis
    3. C. Alcoholic ketoacidosis
    4. D. Diabetic ketoacidosis
    Show answer

    Answer: D. Diabetic ketoacidosis

    Kussmaul respirations, fruity breath, vomiting, and marked hyperglycemia point to DKA.

35. A 34-year-old had a 12-hour flight yesterday and now has sudden pleuritic chest pain, HR 118, and SpO2 89%. Lung sounds are clear. Which field impression fits best?

    1. A. Anxiety attack
    2. B. Pulmonary embolism
    3. C. Pneumonia
    4. D. Asthma exacerbation
    Show answer

    Answer: B. Pulmonary embolism

    Recent prolonged travel, sudden pleuritic pain, tachycardia, and hypoxia with clear lungs suggest PE.

36. A 58-year-old woman complains of fatigue and 'indigestion' for two hours. She is diaphoretic. The 12-lead shows ST elevation in II, III, and aVF. Your field impression is:

    1. A. Anxiety
    2. B. Inferior STEMI
    3. C. Gastroesophageal reflux
    4. D. Pericarditis
    Show answer

    Answer: B. Inferior STEMI

    ST elevation in the inferior leads with diaphoresis indicates an inferior STEMI despite atypical symptoms.

37. In the patient with an inferior STEMI, which additional step helps refine the impression before giving nitroglycerin?

    1. A. Check pupil size and reactivity
    2. B. Obtain a posterior chest x-ray
    3. C. Obtain right-sided leads
    4. D. Perform a straight leg raise
    Show answer

    Answer: C. Obtain right-sided leads

    Right ventricular infarction is preload dependent; right-sided leads such as V4R help identify it before giving nitrates.

38. A 19-year-old is found confused at a summer music festival, hot to the touch with a temperature of 41°C (105.8°F). What is the best field impression to prioritize?

    1. A. Febrile viral illness
    2. B. Heat stroke, possibly stimulant-related
    3. C. Alcohol intoxication with dehydration
    4. D. Heat exhaustion from fluid loss
    Show answer

    Answer: B. Heat stroke, possibly stimulant-related

    Hyperthermia above 40°C with altered mental status is heat stroke until proven otherwise; stimulant drugs can contribute.

39. A patient has a headache, vomiting, and a blown right pupil after a fall. BP is 190/100 with HR 52. The field impression is:

    1. A. Classic migraine with vomiting
    2. B. Simple concussion
    3. C. Rising intracranial pressure
    4. D. Hypertensive urgency
    Show answer

    Answer: C. Rising intracranial pressure

    Hypertension, bradycardia, and a unilateral dilated pupil after trauma indicate rising ICP and possible herniation.

40. A 75-year-old has a fever, new confusion, HR 120, BP 84/50, and RR 28. Which field impression best guides care?

    1. A. Adverse medication side effect
    2. B. Sepsis with septic shock
    3. C. Dehydration only
    4. D. Dementia progression
    Show answer

    Answer: B. Sepsis with septic shock

    Fever with hypotension, tachycardia, tachypnea, and altered mentation is concerning for septic shock.

41. A 6-year-old has a barking cough, low-grade fever, and inspiratory stridor that worsens at night. The most likely field impression is:

    1. A. Epiglottitis
    2. B. Asthma
    3. C. Croup
    4. D. Foreign body aspiration
    Show answer

    Answer: C. Croup

    A barking seal-like cough with stridor and low-grade fever in a young child is classic croup.

42. A 30-year-old was stung by a wasp and has generalized hives and mild itching. Vital signs and breathing are normal. How should the field impression be stated?

    1. A. No medical problem; release on scene
    2. B. Mild allergic reaction, monitored
    3. C. Septic shock from an infected sting site
    4. D. Anaphylaxis requiring immediate intubation
    Show answer

    Answer: B. Mild allergic reaction, monitored

    Generalized hives and itching with normal vital signs and breathing, and no respiratory, circulatory, or GI involvement, is a mild skin-only allergic reaction; it may still progress, so monitor closely for anaphylaxis. A systemic skin reaction after a sting is a real medical problem rather than one to release on scene, septic shock does not develop minutes after a sting and needs abnormal vital signs, and anaphylaxis needs involvement beyond the skin, with intubation reserved for airway compromise.

43. A patient has crushing chest pain, but her 12-lead ECG is normal. What is the correct conclusion?

    1. A. She no longer needs transport
    2. B. The pain must be musculoskeletal
    3. C. ACS has been ruled out
    4. D. A normal ECG does not exclude ACS
    Show answer

    Answer: D. A normal ECG does not exclude ACS

    A single normal 12-lead cannot exclude ACS; serial ECGs and hospital evaluation are required.

44. A 45-year-old alcoholic presents with confusion, ataxia, and abnormal eye movements. Which field impression should be considered?

    1. A. Wernicke encephalopathy
    2. B. Bell's palsy
    3. C. Hyperthyroidism
    4. D. Simple alcohol intoxication
    Show answer

    Answer: A. Wernicke encephalopathy

    Confusion, ataxia, and ophthalmoplegia in a patient with chronic alcohol use suggest Wernicke encephalopathy from thiamine deficiency.

45. A 28-year-old woman at 34 weeks' gestation has a severe headache, visual disturbances, and BP 172/110. Your field impression is:

    1. A. Migraine
    2. B. Normal pregnancy changes
    3. C. Tension headache
    4. D. Severe preeclampsia
    Show answer

    Answer: D. Severe preeclampsia

    Severe hypertension with headache and visual changes in late pregnancy indicates severe preeclampsia and seizure risk.

46. A 50-year-old has sudden 'worst headache of my life' while lifting weights, followed by vomiting. Neuro exam is normal. The impression to prioritize is:

    1. A. Subarachnoid hemorrhage
    2. B. Tension-type headache
    3. C. Exertional neck strain
    4. D. Acute bacterial sinusitis
    Show answer

    Answer: A. Subarachnoid hemorrhage

    Thunderclap headache with exertional onset suggests subarachnoid hemorrhage even with a normal neuro exam.

47. Your differential for a patient with altered mental status includes hypoglycemia, stroke, overdose, and sepsis. Which approach best narrows it?

    1. A. Treat every cause empirically at once
    2. B. Do targeted checks for each possibility
    3. C. Wait for hospital labs before acting
    4. D. Treat only the most common cause
    Show answer

    Answer: B. Do targeted checks for each possibility

    Targeted, quick assessments for each item allow the paramedic to rule causes in or out efficiently. Check glucose, perform a stroke scale, look for toxidromes, and check temperature.

48. A trauma patient is hypotensive with flat neck veins and no external bleeding after a fall from a ladder. Which field impression should be prioritized?

    1. A. Internal hemorrhage
    2. B. Neurogenic shock only
    3. C. Tension pneumothorax
    4. D. Cardiac tamponade
    Show answer

    Answer: A. Internal hemorrhage

    Hypotension with flat neck veins suggests hypovolemia; internal bleeding must be assumed when external bleeding is absent. Internal hemorrhage causes hypovolemic shock.

49. A patient with a spinal cord injury at C5 has BP 78/40, HR 54, and warm, dry skin below the injury. The best field impression is:

    1. A. Neurogenic shock
    2. B. Hypovolemic shock
    3. C. Cardiogenic shock
    4. D. Septic shock
    Show answer

    Answer: A. Neurogenic shock

    Hypotension with relative bradycardia and warm skin after cervical cord injury is characteristic of neurogenic shock.

50. Why is it important to keep hemorrhagic shock on the differential for the patient with suspected neurogenic shock?

    1. A. Hemorrhagic shock causes warm skin
    2. B. Both may coexist; bleeding is more common
    3. C. Neurogenic shock always masks any bleeding
    4. D. Neurogenic shock never occurs with trauma
    Show answer

    Answer: B. Both may coexist; bleeding is more common

    Neurogenic shock is a diagnosis of exclusion in trauma; hemorrhage must be ruled out first. Hypovolemia is also more treatable.

51. A 3-month-old has a temperature of 38.4°C (101.1°F) and is feeding poorly. How should the field impression be framed?

    1. A. Teething causing a low fever
    2. B. Possible serious bacterial infection
    3. C. Viral illness safe to manage at home
    4. D. Normal behavior for a young infant
    Show answer

    Answer: B. Possible serious bacterial infection

    Fever in a young infant carries a significant risk of serious bacterial infection and warrants evaluation. Hospital evaluation is required.

52. A patient with COPD has increased dyspnea, a productive cough with green sputum, and a fever. Which field impression best fits?

    1. A. Spontaneous pneumothorax
    2. B. Anaphylactic reaction
    3. C. Pulmonary edema from heart failure
    4. D. COPD exacerbation from infection
    Show answer

    Answer: D. COPD exacerbation from infection

    Fever and purulent sputum suggest an infectious trigger of a COPD exacerbation.

53. While forming a field impression for a COPD patient with sudden dyspnea and unilateral absent breath sounds, you should strongly consider:

    1. A. Spontaneous pneumothorax
    2. B. Lobar pneumonia
    3. C. Simple COPD exacerbation
    4. D. Acute panic attack
    Show answer

    Answer: A. Spontaneous pneumothorax

    COPD patients with bullae are at risk of spontaneous pneumothorax, suggested by sudden onset and unilateral absent breath sounds.

54. A 40-year-old with a history of depression is found drowsy with HR 132, a wide QRS on the monitor, and dilated pupils. Which field impression is most likely?

    1. A. Opioid overdose
    2. B. Severe hypoglycemia
    3. C. Benzodiazepine overdose
    4. D. Tricyclic overdose
    Show answer

    Answer: D. Tricyclic overdose

    Tachycardia, QRS widening, anticholinergic signs, and altered mentation suggest TCA toxicity.

55. A patient has pinpoint pupils, RR 6, and is unresponsive. Which field impression is most likely and what does it suggest?

    1. A. Benzodiazepine overdose; give flumazenil
    2. B. Hypoglycemia; give oral glucose now
    3. C. Alcohol intoxication; observe in recovery position
    4. D. Opioid toxicity; ventilate, consider naloxone
    Show answer

    Answer: D. Opioid toxicity; ventilate, consider naloxone

    Miosis, respiratory depression, and decreased LOC are the opioid toxidrome; ventilatory support and naloxone are indicated. Benzodiazepines do not typically cause pinpoint pupils, and flumazenil can trigger seizures. Oral glucose is unsafe in an unresponsive patient, although glucose should still be checked. A respiratory rate of 6 needs ventilation, not observation in the recovery position.

56. Which statement best describes how a field impression should be documented when the cause is unclear?

    1. A. List only the patient's chief complaint
    2. B. Leave the impression field blank for now
    3. C. Note likely and serious possibilities
    4. D. Write 'unknown' and nothing more
    Show answer

    Answer: C. Note likely and serious possibilities

    Documenting a working impression and differential shows reasoning and alerts receiving staff to possibilities. Describe the most likely problem and note other serious possibilities considered.

57. A 66-year-old has acute dyspnea, crackles to the apices, BP 210/120, and pink frothy sputum. Your field impression is:

    1. A. Hypertensive pulmonary edema
    2. B. Severe asthma exacerbation
    3. C. Massive pulmonary embolism
    4. D. Bilateral pneumonia with sepsis
    Show answer

    Answer: A. Hypertensive pulmonary edema

    Severe hypertension with diffuse crackles and frothy sputum indicates acute cardiogenic pulmonary edema. This is acute pulmonary edema from hypertensive heart failure.