Medical Emergencies Practice Questions for Paramedics

3,146 free paramedic practice questions on neurologic emergencies, diseases of the eyes, ears, nose, and throat, abdominal and gastrointestinal emergencies, genitourinary and renal emergencies, gynecologic emergencies, endocrine emergencies, hematologic emergencies, immunologic emergencies, infectious diseases, toxicology, psychiatric emergencies, obstetrics, and neonatal care, plus the pathophysiology and medications behind them. Every question has the answer and a short explanation.

25 sample questions

1. A newborn's blood glucose falls in the first hours of life mainly because:

   1. A. Insulin from the placenta keeps acting
   2. B. The maternal glucose supply has stopped
   3. C. The liver cannot store any glycogen
   4. D. Breast milk lowers the glucose level
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   Answer: B. The maternal glucose supply has stopped

   Once the cord is cut, the infant must rely on limited glycogen stores and feeding to maintain glucose, so stress, cold, or prematurity can rapidly cause hypoglycemia. Maternal insulin does not cross the placenta; fetal hyperinsulinism in diabetic pregnancies is the infant's own insulin.

2. A paramedic gets her flu vaccine the day before a large influenza outbreak at a nursing home she covers. She should assume that she is:

   1. A. Fully protected starting the next morning
   2. B. Not yet protected for about 2 weeks
   3. C. Contagious with flu from the vaccine
   4. D. Protected after 12 hours of rest
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   Answer: B. Not yet protected for about 2 weeks

   After vaccination the body needs about 2 weeks to make protective antibodies, so she should keep using PPE and hand hygiene in the meantime. Injected flu vaccines are inactivated and cannot give her influenza.

3. Coma results from dysfunction of the reticular activating system or of:

   1. A. One frontal lobe
   2. B. Both hemispheres
   3. C. The cerebellum alone
   4. D. One occipital lobe
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   Answer: B. Both hemispheres

   Unconsciousness requires either brainstem RAS dysfunction or diffuse bilateral hemispheric dysfunction; a small unilateral lesion usually does not cause coma.

4. Which fetal presentation found during a field delivery cannot be delivered vaginally and needs rapid transport for cesarean delivery?

   1. A. Frank breech with the buttocks first
   2. B. Transverse lie, shoulder first
   3. C. Vertex with the occiput anterior
   4. D. Vertex with the occiput posterior
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   Answer: B. Transverse lie, shoulder first

   When the fetus lies across the uterus, a shoulder or arm presents and the body cannot pass through the pelvis, so the mother needs a cesarean; position her to reduce pressure and transport rapidly. A frank breech can deliver vaginally if you support the body and let it deliver itself. Occiput anterior is the normal vertex position. Occiput posterior causes back pain and slower labor, but most such infants still deliver vaginally. (Caroline, abnormal presentations.)

5. A blood sample drawn with hard suction through a small catheter hemolyzes in the tube. Which lab result is most likely to be falsely high?

   1. A. Potassium
   2. B. Sodium
   3. C. Glucose
   4. D. Bicarbonate
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   Answer: A. Potassium

   Red cells hold far more potassium than plasma, so cells bursting in the tube release it and the lab reports a falsely high level. Draw gently through an adequate catheter. Sodium, glucose, and bicarbonate are not raised by hemolysis to any important degree.

6. A 2-year-old ate several of his mother's prenatal vitamins with iron and has vomiting and bloody diarrhea. Iron toxicity is dangerous because:

   1. A. Iron is very well bound by activated charcoal
   2. B. A quiet phase can precede shock and liver failure
   3. C. Symptoms always resolve within about 6 hours
   4. D. It causes only mild stomach upset in small children
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   Answer: B. A quiet phase can precede shock and liver failure

   Iron poisoning has GI, latent, and shock phases, so a quiet period does not mean recovery. Charcoal does not bind iron; deferoxamine is the antidote.

7. Why is the uninjured eye often covered when treating a penetrating eye injury?

   1. A. To reduce intraocular pressure directly
   2. B. To prevent spread of infection
   3. C. To limit sympathetic eye movement
   4. D. To allow testing of consensual reflex
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   Answer: C. To limit sympathetic eye movement

   The eyes move together, so movement of the uninjured eye moves the injured one. Covering both reduces movement and further injury. Explain this to the patient, who will be unable to see.

8. A patient with pancreatitis is most comfortable:

   1. A. Supine with legs straight
   2. B. Prone on the stretcher
   3. C. Sitting, leaning forward
   4. D. In Trendelenburg position
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   Answer: C. Sitting, leaning forward

   Leaning forward takes pressure off the inflamed retroperitoneal pancreas. Lying flat usually worsens the pain.

9. When securing soft limb restraints on an ambulance stretcher, the straps should be attached to:

   1. A. The stretcher side rails
   2. B. The patient's belt
   3. C. Each other, wrist to ankle
   4. D. The stretcher frame
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   Answer: D. The stretcher frame

   Restraints should be tied to a fixed part of the stretcher frame so they stay secure and can be released quickly. Side rails can be lowered or moved, which can loosen the restraint or injure the limb. A belt gives no secure anchor. Tying wrists to ankles is hog-tying, which impairs breathing and is prohibited.

10. Angioedema of the uvula is sometimes called:

    1. A. Quincke's uvula
    2. B. Ludwig angina
    3. C. Bell palsy variant
    4. D. Acute epiglottitis
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    Answer: A. Quincke's uvula

    Isolated angioedema of the uvula is called Quincke's uvula, after Heinrich Quincke, who described angioedema (also called Quincke's edema); the swollen uvula can cause gagging, a muffled voice, and airway compromise. Ludwig angina is a spreading infection of the floor of the mouth and submandibular spaces. Bell palsy is a facial nerve weakness and does not swell the uvula. Acute epiglottitis is infectious swelling of the epiglottis, not the uvula.

11. Untreated PID can lead to chronic:

    1. A. Hot flashes
    2. B. Urinary incontinence
    3. C. Vaginal yeast infections
    4. D. Pelvic pain
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    Answer: D. Pelvic pain

    Scarring and adhesions can cause long-term pelvic pain. PID does not cause hot flashes, lasting incontinence, or yeast infections.

12. Systemic lupus erythematosus (SLE) commonly causes:

    1. A. Joint pain, malar rash
    2. B. Bulging eyes and tremor
    3. C. Painless jaundice
    4. D. Spoon-shaped nails
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    Answer: A. Joint pain, malar rash

    Lupus can affect skin, joints, kidneys, heart, lungs, and brain.

13. In an acute abdomen with hypotension, fluid resuscitation should generally aim for:

    1. A. Perfusion, avoiding large volumes
    2. B. A normal BP regardless of volume
    3. C. Withholding all fluids until arrival
    4. D. Oral fluids until IV access is made
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    Answer: A. Perfusion, avoiding large volumes

    In hemorrhage, aggressive fluids can raise pressure, dilute clotting factors, and worsen bleeding. Titrate small boluses to mental status and a radial pulse per protocol.

14. Children with intussusception may appear:

    1. A. Lethargic between episodes
    2. B. Constantly hyperactive
    3. C. Pain-free with a high fever
    4. D. Calm with normal stools
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    Answer: A. Lethargic between episodes

    Episodic crying with legs drawn up, followed by lethargy, is a classic pattern.

15. Brief jerking movements of the limbs lasting a few seconds during a faint most likely represent:

    1. A. A generalized seizure
    2. B. Convulsive syncope
    3. C. Status epilepticus
    4. D. Psychogenic seizure
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    Answer: B. Convulsive syncope

    Brief myoclonic jerks commonly occur from cerebral hypoperfusion during syncope. Unlike seizures, recovery is quick with little or no confusion.

16. Bleeding after intercourse in a 45-year-old woman should prompt evaluation for:

    1. A. Normal ovulation
    2. B. Kidney stones
    3. C. Appendicitis
    4. D. Cervical lesions
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    Answer: D. Cervical lesions

    Postcoital bleeding can come from infection, polyps, or cervical cancer. It always needs follow-up.

17. An older patient found on the floor in HHS should also be assessed for:

    1. A. Seasonal allergies
    2. B. A recent tooth infection
    3. C. Pressure injury and muscle damage
    4. D. Hearing loss from loud noise exposure
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    Answer: C. Pressure injury and muscle damage

    Patients with HHS often lie on the floor for hours, risking pressure injury and rhabdomyolysis, which worsens kidney injury. Check skin, extremities, and urine color.

18. Tumor lysis syndrome is most likely to develop:

    1. A. Several years into remission
    2. B. Within days of starting chemotherapy
    3. C. After a routine blood transfusion
    4. D. As a slow-growing cancer first appears
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    Answer: B. Within days of starting chemotherapy

    It usually appears 1 to 3 days after treatment starts for bulky, fast-growing cancers such as some leukemias and lymphomas, when many cells die at once. Slow-growing cancers rarely cause it.

19. A patient with TTP has a platelet count of 9,000/µL. Platelet transfusions are generally avoided because they:

    1. A. Will be quickly destroyed by the spleen
    2. B. Cannot be given through an IV
    3. C. Raise the hemoglobin too far
    4. D. May fuel more small-vessel clots
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    Answer: D. May fuel more small-vessel clots

    TTP is driven by platelet clumping in small vessels. Extra platelets may feed new clots in the brain and kidneys, so treatment is plasma exchange unless bleeding is life-threatening.

20. The vaginal canal is lined with:

    1. A. Mucous membrane
    2. B. Serous membrane
    3. C. Keratinized skin
    4. D. Skeletal muscle
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    Answer: A. Mucous membrane

    The vagina is a muscular canal lined with mucous membrane, which can tear and bleed. Serous membranes line closed body cavities, the vaginal surface is not keratinized like skin, and its wall muscle is smooth, not skeletal.

21. A transplanted kidney is usually placed in the:

    1. A. Flank, just beside the old kidney
    2. B. Lower abdomen near the pelvis
    3. C. Chest, behind the heart
    4. D. Upper back near the spine
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    Answer: B. Lower abdomen near the pelvis

    Transplant kidneys are usually placed in the iliac fossa, where they connect to the iliac vessels and bladder. Pain, tenderness, or trauma over the lower abdomen in a transplant patient may involve the graft.

22. Withdrawal symptoms in a newborn exposed to methadone in utero may not appear until:

    1. A. Several days to 2 weeks after birth
    2. B. The first 2 hours after the birth
    3. C. The first feeding after the birth
    4. D. Six months after the infant's birth
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    Answer: A. Several days to 2 weeks after birth

    Methadone and buprenorphine have long half-lives, so withdrawal may begin later and last longer than with heroin, which typically causes signs within 24 to 48 hours. Expecting signs within hours would miss most cases.

23. Signs of acute hemolysis include:

    1. A. Black, tarry stools
    2. B. Bright red bloody vomit
    3. C. Clear, dilute urine
    4. D. Jaundice, dark urine
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    Answer: D. Jaundice, dark urine

    Released hemoglobin colors the urine dark, and bilirubin causes jaundice.

24. Hypomania differs from mania in that hypomania:

    1. A. Must last at least 2 weeks to be diagnosed
    2. B. Does not cause marked impairment or psychosis
    3. C. Involves a depressed rather than elevated mood
    4. D. Usually requires admission to a hospital
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    Answer: B. Does not cause marked impairment or psychosis

    Hypomania is a milder elevation that does not severely impair functioning. If psychosis or hospitalization occurs, the episode is mania by definition.

25. Patients with sickle cell disease dehydrate easily because their kidneys:

    1. A. Cannot concentrate urine well
    2. B. Make too much erythropoietin
    3. C. Retain extra sodium and water
    4. D. Stop making urine during a crisis
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    Answer: A. Cannot concentrate urine well

    Sickling in the kidney's medulla damages the concentrating mechanism, so patients keep passing dilute urine even when dry. Dehydration then promotes more sickling.