Pediatrics, Geriatrics, and Special Populations Practice Questions for Paramedics

600 free paramedic practice questions on pediatric emergencies, geriatric emergencies, and patients with special challenges. Every question has the answer and a short explanation.

24 sample questions

1. The pediatric (0.15-mg) epinephrine auto-injector is generally intended for children weighing about:

   1. A. 5 to 10 kg
   2. B. 30 to 45 kg
   3. C. 15 to 30 kg
   4. D. Over 45 kg
   Show answer

   Answer: C. 15 to 30 kg

   FDA labeling gives the 0.15-mg auto-injector for about 15 to 30 kg and the 0.3-mg device for 30 kg or more, with a 0.1-mg device for 7.5 to 15 kg in some brands; the AAP (2017) suggests moving to the 0.3-mg device at about 25 kg because 0.15 mg underdoses heavier children. 5 to 10 kg is the 0.1-mg range or below. 30 to 45 kg and over 45 kg call for the 0.3-mg device. (Sicherer SH, Simons FER, AAP. Epinephrine for First-aid Management of Anaphylaxis. Pediatrics 2017;139:e20164006.)

2. A man had a tracheostomy placed 4 days ago. At home the tube comes out, and he is in distress. His mouth and upper airway are clear. You should first:

   1. A. Force a new tube into the fresh stoma
   2. B. Pack the stoma and start chest compressions
   3. C. Cover the stoma and oxygenate from above
   4. D. Wait for the surgeon to replace the tube
   Show answer

   Answer: C. Cover the stoma and oxygenate from above

   A tracheostomy tract younger than about a week has not matured, and blind reinsertion can create a false passage into the neck tissues, with subcutaneous emphysema and failed ventilation. With a patent upper airway, cover the stoma and give oxygen or bag-mask ventilation through the face, with oral intubation as the backup; only experienced providers should attempt reinsertion, per protocol. Packing the stoma is reasonable only while ventilating from above, and compressions are not indicated in a patient with a pulse. Waiting for a surgeon delays oxygenation. (NTSP emergency algorithm.)

3. Older adults are at high risk in the weeks after hospital discharge mainly because of:

   1. A. Frequent home health nurse visits at home
   2. B. Physical therapy that is too intensive
   3. C. Medication changes and poor follow-up
   4. D. Discharge papers that are too detailed
   Show answer

   Answer: C. Medication changes and poor follow-up

   New or changed medications, confusion about instructions, and missed follow-up appointments drive readmissions after discharge. Home health visits and therapy reduce, not raise, that risk.

4. A 4-year-old has a minor forearm bruise, you suspect abuse, and the parent refuses transport. You should:

   1. A. Accept the refusal and leave
   2. B. Take the child without telling the parent
   3. C. Call police and medical control
   4. D. Confront the parent about the abuse
   Show answer

   Answer: C. Call police and medical control

   When abuse is suspected and a caregiver refuses care, law enforcement can take the child into protective custody, and medical control can guide you; document carefully and report as required. Leaving the child fails your duty to protect and report. Removing a child without authority can create legal and safety problems. Confronting the parent can escalate danger. (Caroline 9th ed.)

5. A 2-year-old is alert and interactive with normal skin color but has nasal flaring and intercostal retractions. The PAT indicates:

   1. A. Respiratory distress
   2. B. Respiratory failure
   3. C. Compensated shock
   4. D. Cardiopulmonary failure
   Show answer

   Answer: A. Respiratory distress

   An abnormal work of breathing with normal appearance and circulation means respiratory distress. Respiratory failure is suggested when appearance also becomes abnormal, as the child tires or becomes hypoxic.

6. A daughter reports that her 80-year-old father can no longer manage his pill box or pay his bills but still bathes and dresses himself. This describes a decline in his:

   1. A. Basic self-care activities of daily living
   2. B. Short-term memory recall
   3. C. Instrumental activities of daily living
   4. D. Decision-making capacity
   Show answer

   Answer: C. Instrumental activities of daily living

   Managing medications and finances are instrumental ADLs, which need planning and often decline first in early dementia. His basic self-care ADLs such as bathing and dressing are still intact.

7. A 79-year-old has had poor appetite, sleeplessness, and slowed thinking since her husband died 3 months ago. Her family worries she has dementia. Another condition to consider is:

   1. A. Depression
   2. B. Delirium tremens
   3. C. Normal pressure hydrocephalus
   4. D. Parkinson disease
   Show answer

   Answer: A. Depression

   Depression in older adults can cause memory and concentration problems (pseudodementia) and is often missed; the timing after bereavement is a strong clue. Normal pressure hydrocephalus causes gait disturbance, incontinence, and dementia, which this history lacks.

8. A woman in cardiac arrest wears a religious medallion on a chain over her chest. Her husband asks you not to take it off. The best approach is to:

   1. A. Cover the medallion with gauze, then shock
   2. B. Shift it aside for the pads, keep it on her
   3. C. Pause CPR while her husband takes the medallion off
   4. D. Place the pads directly over the medallion
   Show answer

   Answer: B. Shift it aside for the pads, keep it on her

   Move the medallion away from the pad sites (sliding it to the side or taping it) so the pads touch bare skin and no metal lies under them, and keep it with her or give it to her husband. Gauze over the metal does not insulate it and worsens pad contact. Pausing CPR while family removes it interrupts compressions and delays the shock when a simple move works. A pad over metal gives poor contact and can cause burns. (AHA 2025 adult life support.)

9. A frail nursing home resident with dementia is found with her head and neck wedged between the bed rail and the mattress. She is cyanotic but has a pulse. The main danger of this position is:

   1. A. A pressure injury that forms within minutes
   2. B. Aspiration of vomit from her trapped position
   3. C. Asphyxia from neck and chest compression
   4. D. A head injury from striking the rail
   Show answer

   Answer: C. Asphyxia from neck and chest compression

   Gaps between a bed rail and the mattress or headboard can trap the head, neck, or chest of a frail, confused person, compressing the airway and chest; the FDA has documented hundreds of entrapment deaths, mostly in older adults. Free her carefully, open the airway, ventilate as needed, assess for neck injury, and document the scene for reporting. Pressure injuries take hours, not minutes. Her cyanosis comes from compression of the neck and chest, not aspiration, and a blow against the rail does not explain cyanosis in a wedged neck.

10. An 18-month-old became angry, cried, held her breath, turned blue, and went limp for a few seconds, then woke fully. This is most consistent with:

    1. A. Status epilepticus
    2. B. Absence seizures
    3. C. A breath-holding spell
    4. D. A primary cardiac arrest
    Show answer

    Answer: C. A breath-holding spell

    Cyanotic breath-holding spells occur from about 6 months to 6 years, are triggered by anger, frustration or pain, and end with full recovery within a minute; a first episode still deserves evaluation. Status epilepticus means seizure activity for 5 minutes or more. Absence seizures are brief staring spells without a crying trigger or cyanosis. A cardiac arrest does not resolve on its own with full recovery. (Caroline 9th ed.)

11. A 26-year-old transgender man (assigned female at birth) has lower abdominal pain and vaginal bleeding. You should:

    1. A. Dismiss pregnancy because he takes testosterone
    2. B. Assume the bleeding is from a urinary infection
    3. C. Consider ectopic pregnancy in your assessment
    4. D. Avoid asking about anatomy to prevent offense
    Show answer

    Answer: C. Consider ectopic pregnancy in your assessment

    A transgender man with a uterus and ovaries can become pregnant, and testosterone is not reliable contraception, so pain with bleeding calls for considering ectopic pregnancy. Dismissing pregnancy because of testosterone is a dangerous error. A urinary infection does not explain vaginal bleeding. Asking respectfully about relevant anatomy is part of a proper assessment. (WPATH SOC8; Caroline, Emergency Care in the Streets, 9th ed., Patients With Special Challenges chapter.)

12. An 86-year-old with mild dementia fell yesterday and now refuses to stand. She points only to her knee, which looks normal. You should:

    1. A. Splint the knee and treat it as a knee sprain
    2. B. Reassure her since the knee shows no swelling
    3. C. Have her walk to test the knee's function
    4. D. Also examine her hip for a possible fracture
    Show answer

    Answer: D. Also examine her hip for a possible fracture

    Hip pain is often referred to the knee through the obturator and femoral nerves, and older adults, especially those with dementia, may localize pain poorly, so a patient who will not bear weight after a fall needs her hip examined (groin tenderness, pain with gentle rotation, shortening or rotation of the leg) and should be transported for imaging. Treating it as a knee sprain misses the likely hip fracture. A normal-looking knee does not explain her refusal to stand. Making her walk on a possible hip fracture can displace it.

13. A 76-year-old man with diabetes has fever and severe perineal pain. His scrotum is swollen, dusky, and crackles under your fingers. You should suspect:

    1. A. A simple scrotal skin abscess
    2. B. A tight but harmless inguinal hernia
    3. C. A necrotizing perineal infection
    4. D. A reaction to a new soap
    Show answer

    Answer: C. A necrotizing perineal infection

    Fournier gangrene is a necrotizing soft-tissue infection of the perineum and genitals, most common in older men with diabetes, obesity, or immunosuppression; pain out of proportion, dusky skin, and crepitus from gas in the tissues signal a surgical emergency with high mortality, so treat for sepsis and transport urgently. A simple abscess is localized and does not produce crepitus or spreading dusky skin. A hernia does not crackle or cause fever with skin necrosis. A soap reaction causes redness and itching, not crepitus and sepsis.

14. Long-acting benzodiazepines are a concern in older adults mainly because they:

    1. A. Cause severe hypertension
    2. B. Raise blood glucose levels
    3. C. Speed up renal clearance
    4. D. Raise the risk of falls
    Show answer

    Answer: D. Raise the risk of falls

    Benzodiazepines accumulate in older adults' larger fat stores and cause prolonged sedation, ataxia, and confusion, leading to falls and fractures. They lower, rather than raise, blood pressure when they affect it at all.

15. You need to remove the clothing of a woman who was sexually assaulted to assess an injury. To help preserve evidence, you should:

    1. A. Cut directly through the torn areas
    2. B. Shake the clothing out before bagging
    3. C. Rinse visible stains off the fabric
    4. D. Cut around holes, tears, or stains
    Show answer

    Answer: D. Cut around holes, tears, or stains

    Holes, tears, and stains can hold evidence such as fibers, fluids, or marks from a weapon, so cut around them, place each item in its own paper bag, and give the bags to police or the hospital. Cutting through torn areas destroys that evidence. Shaking clothing scatters hairs and fibers. Rinsing stains washes away biological evidence. Life-saving care always comes first. (DOJ National Protocol for Sexual Assault Medical Forensic Examinations.)

16. Which statement about intelligence in people with cerebral palsy is correct?

    1. A. Many have normal intelligence
    2. B. Most have a severe intellectual disability
    3. C. Intelligence declines over the years
    4. D. Intelligence cannot be tested in CP
    Show answer

    Answer: A. Many have normal intelligence

    Although some people with CP have intellectual disability, many have normal intelligence; difficulty speaking (dysarthria) is not a sign of poor understanding. Speak to the patient directly rather than over him.

17. A 3-month-old has a seizure and a low temperature. The parents have been mixing extra water into the formula to make it last longer. The most likely cause is:

    1. A. High blood sugar from too much formula intake
    2. B. A febrile seizure from a viral infection
    3. C. Dehydration from too little fluid intake overall
    4. D. Low blood sodium from overdiluted formula
    Show answer

    Answer: D. Low blood sodium from overdiluted formula

    Infants' kidneys cannot excrete large amounts of free water. Diluting formula or giving plain water can drop the serum sodium enough to cause swelling of the brain, seizures, and hypothermia. Check glucose, manage the seizure, and transport; tell the hospital about the formula preparation.

18. A 140-kg (309-lb) man with obstructive sleep apnea who uses CPAP at night has an open ankle fracture. After fentanyl, his greatest added risk is:

    1. A. Airway obstruction and slowed breathing
    2. B. A sharp rise in blood pressure from the opioid
    3. C. An allergic reaction to the fentanyl
    4. D. Delayed pain relief from fat storage
    Show answer

    Answer: A. Airway obstruction and slowed breathing

    Patients with OSA are especially prone to opioid-induced upper airway collapse and respiratory depression. Give small, titrated doses, keep him upright, monitor ETCO2 and SpO2, let him use his CPAP if available, and have naloxone and a BVM ready; consider nonopioid options per protocol. Fentanyl lowers or does not change blood pressure. True allergy to fentanyl is rare. Fat storage prolongs a lipophilic drug's effect; it does not delay the onset of IV fentanyl. (ASA OSA practice guidelines.)

19. The most effective way to prevent toddler drownings in home swimming pools is:

    1. A. Early swimming lessons
    2. B. Four-sided pool fencing
    3. C. Inflatable arm floats
    4. D. Floating pool alarms in use
    Show answer

    Answer: B. Four-sided pool fencing

    Isolation fencing on all four sides with a self-latching gate markedly reduces pool drownings, along with constant, attentive supervision. Swimming lessons help but do not make toddlers drown-proof. Arm floats are not safety devices. Floating alarms sound after a child is already in the water. (AAP Prevention of Drowning 2019.)

20. A 60-year-old man who is both deaf and blind communicates by touch. The most effective way to talk with him is usually to:

    1. A. Speak loudly and slowly right next to his ear
    2. B. Write large-print notes for him to read
    3. C. Sign or print letters into his open palm
    4. D. Direct every question to his caregiver
    Show answer

    Answer: C. Sign or print letters into his open palm

    Many DeafBlind people use tactile signing (hands over the signer's hands) or print-on-palm, in which letters are traced on the palm; ask his companion how he communicates, agree on a touch signal that identifies you, and request a tactile interpreter for complex discussions. Speaking loudly does not help profound deafness. Large print does not help blindness. Talking only to the caregiver leaves him out of his own care. (Helen Keller National Center; ADA effective communication.)

21. When documenting bruises on a suspected abuse victim, you should avoid:

    1. A. Describing the size, shape, and location of each bruise
    2. B. Estimating the age of each bruise from its color
    3. C. Noting whether bruises are on both sides
    4. D. Recording the patient's own explanation
    Show answer

    Answer: B. Estimating the age of each bruise from its color

    Bruise color is an unreliable guide to age, especially in older adults, so describe size, location, color, and pattern without dating them. Noting bilateral bruising is useful because it suggests a non-accidental pattern.

22. A 20-kg child remains in ventricular fibrillation after a 40-J shock and 2 minutes of CPR. The second shock should be dosed at:

    1. A. 1 J/kg
    2. B. 4 J/kg
    3. C. 2 J/kg
    4. D. 0.5 J/kg
    Show answer

    Answer: B. 4 J/kg

    The second shock is 4 J/kg, and later shocks are at least 4 J/kg, up to 10 J/kg or the adult dose. Repeating 2 J/kg does not follow the PALS escalation.

23. You are preparing to intubate a 14-year-old with Down syndrome. Compared with other children of the same age, you should anticipate that he may need:

    1. A. A larger tube because of a wide trachea
    2. B. A smaller endotracheal tube
    3. C. Routine nasal intubation
    4. D. A double dose of the paralytic
    Show answer

    Answer: B. A smaller endotracheal tube

    Children and adults with Down syndrome often have a narrower subglottis and trachea than age-based formulas predict, so have tubes one-half to one size smaller ready; also limit neck movement because of atlantoaxial instability. The trachea is not wider than usual. Nasal intubation is not routine and is harder with midface hypoplasia. Paralytic doses are standard. (Shott, Laryngoscope 2000; AAP 2022.)

24. A calm, afebrile 3-year-old has a resting heart rate of 165 beats/min. You should:

    1. A. Record it as a normal toddler rate
    2. B. Give adenosine for presumed SVT
    3. C. Ignore it unless BP is low
    4. D. Look for a cause such as shock
    Show answer

    Answer: D. Look for a cause such as shock

    An awake toddler normally runs about 98 to 140 beats/min, so 165 at rest without fever is tachycardia; look for hypovolemia, sepsis, hypoxia, pain or a toxin. It is not normal for age. SVT in a child is usually above about 220 beats/min with a fixed rate, so 165 does not fit. Blood pressure falls late in children, and waiting for hypotension means treating shock late. (AHA PALS provider manual vital-sign tables.)