Working with Ambiguous and Critical Patients Practice Questions

57 multiple-choice questions on Working with ambiguous and critical patients 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. The most important early judgment about any patient is:

   1. A. Their most likely specific diagnosis
   2. B. Whether they are sick or not sick
   3. C. Their complete medication history
   4. D. The mechanism reported by dispatch
   Show answer

   Answer: B. Whether they are sick or not sick

   That single judgment drives urgency, treatment, and destination. A full medication history and the dispatch mechanism are useful, but they come after the immediate sick-or-not-sick judgment.

2. An undifferentiated patient is one who:

   1. A. Has a single, clearly identified diagnosis
   2. B. Has declined both assessment and transport
   3. C. Reports no chief complaint to the crew
   4. D. Has symptoms with several possible serious causes
   Show answer

   Answer: D. Has symptoms with several possible serious causes

   Weakness, dizziness, and altered mental status are common examples.

3. With an undifferentiated critical patient, the correct approach is to:

   1. A. Stay on scene until the diagnosis becomes clear
   2. B. Withhold treatment until hospital testing is done
   3. C. Treat threats, support ABCs, and keep assessing en route
   4. D. Transport rapidly without any field interventions
   Show answer

   Answer: C. Treat threats, support ABCs, and keep assessing en route

   Supportive care buys time for diagnosis.

4. Red flag findings that argue for urgent transport include:

   1. A. A normal exam in a patient who feels anxious
   2. B. A chronic complaint unchanged for several weeks
   3. C. Altered mentation, hypotension, or severe distress
   4. D. Mild localized pain with normal vital signs
   Show answer

   Answer: C. Altered mentation, hypotension, or severe distress

   These drive decisions even when the diagnosis is unclear. Abnormal skin signs are another red flag.

5. A patient who appears well but reports a frightening symptom, such as sudden severe headache, should be:

   1. A. Taken seriously despite a normal-appearing exam
   2. B. Reassured and released if vital signs are normal
   3. C. Given a brief assessment and a referral
   4. D. Transported nonemergently without further workup
   Show answer

   Answer: A. Taken seriously despite a normal-appearing exam

   Subarachnoid hemorrhage is the classic example. Some catastrophic conditions present with a normal exam.

6. Staying on scene longer is justified when:

   1. A. Scene interventions will improve the outcome
   2. B. IV access has not yet been obtained
   3. C. The family asks for more time before leaving
   4. D. Vital signs have not yet normalized
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   Answer: A. Scene interventions will improve the outcome

   Scene time should be spent on things that change the outcome. IV access can usually be gained en route, and waiting on scene for vital signs to normalize delays definitive care for patients who need the hospital.

7. Load-and-go decisions are appropriate when:

   1. A. The patient's main complaint is pain
   2. B. The patient is stable with no time pressures
   3. C. Definitive care is available only at the hospital
   4. D. A full secondary exam has already been completed on scene
   Show answer

   Answer: C. Definitive care is available only at the hospital

   Time-critical surgical problems belong in the operating room. Internal hemorrhage is a classic example. Pain alone does not make a call time-critical, and load-and-go means leaving before a full secondary exam, which is done en route.

8. When two problems compete for attention, the paramedic should address:

   1. A. The one that threatens life soonest
   2. B. The one the patient complains about most
   3. C. The one that is most visually obvious
   4. D. The one that is quickest to fix on scene
   Show answer

   Answer: A. The one that threatens life soonest

   A dramatic injury does not automatically outrank a quiet airway problem.

9. A patient who refuses transport but has concerning findings requires:

   1. A. A signed refusal form and prompt departure from scene
   2. B. A call to family to make the decision for the patient
   3. C. Capacity assessment, clear risk explanation, and persuasion
   4. D. Police involvement to compel transport in every case
   Show answer

   Answer: C. Capacity assessment, clear risk explanation, and persuasion

   Refusal calls carry high risk of both harm and liability. Involve medical control as needed.

10. The decision about destination should be based on:

    1. A. The hospital's diversion status considered alone
    2. B. The crew's preference and familiarity with the receiving staff
    3. C. The patient's needs and the facility's capabilities
    4. D. The closest emergency department in every case
    Show answer

    Answer: C. The patient's needs and the facility's capabilities

    Stroke, STEMI, trauma, and burns may require specific centers. Choose a facility that offers the needed capability within a reasonable time.

11. A patient whose condition improves after treatment:

    1. A. Should be released on scene with instructions to follow up
    2. B. Still needs evaluation because the cause remains
    3. C. Can be driven to the hospital by family later
    4. D. No longer needs transport to a hospital
    Show answer

    Answer: B. Still needs evaluation because the cause remains

    Improvement confirms your treatment, not the safety of the situation.

12. When the paramedic is uncertain whether a patient is critical, the safer assumption is:

    1. A. Assume the patient is stable until proven otherwise
    2. B. Treat the serious possibility as real until ruled out
    3. C. Defer to the patient's own sense of how sick they are
    4. D. Wait on scene and reassess before deciding
    Show answer

    Answer: B. Treat the serious possibility as real until ruled out

    Overtriage is cheaper than undertriage.

13. A 30-year-old fainted at work and now feels fine with normal vital signs. Which approach handles the ambiguity best?

    1. A. Release her, since she now feels completely fine
    2. B. Assume a simple faint from standing too long
    3. C. Screen for dangerous causes such as dysrhythmia
    4. D. Treat it as anxiety and advise rest at home
    Show answer

    Answer: C. Screen for dangerous causes such as dysrhythmia

    Syncope is ambiguous because benign and deadly causes look the same afterward. Get a 12-lead (for WPW, long QT, Brugada, or HCM), check glucose, ask about pregnancy, exertional onset, and family history of sudden death, and favor transport. Feeling fine now does not exclude a dangerous cause.

14. A 67-year-old has his first-ever sudden flank pain radiating to the groin, with blood in his urine. Which approach is safest?

    1. A. Kidney stone only, given the hematuria
    2. B. Musculoskeletal strain from lifting boxes
    3. C. Consider AAA as well as a kidney stone
    4. D. Urinary infection; advise fluids at home
    Show answer

    Answer: C. Consider AAA as well as a kidney stone

    A first episode of 'renal colic' in an older patient must prompt consideration of abdominal aortic aneurysm, which can mimic a stone and even cause hematuria. Check BP, distal pulses, and for a pulsatile mass, and treat the worst plausible cause until it is excluded.

15. A patient with vague weakness, nausea, and 'not feeling right' — especially an older woman or diabetic — should prompt consideration of:

    1. A. Viral gastroenteritis only
    2. B. Generalized anxiety disorder
    3. C. Dehydration from poor oral intake
    4. D. Atypical acute coronary syndrome
    Show answer

    Answer: D. Atypical acute coronary syndrome

    Atypical ACS presentations are common in these groups.

16. With two paramedics and an EMT caring for a critical patient, why should they work in parallel?

    1. A. It lets the crew skip the primary assessment
    2. B. Several life threats can be treated at once
    3. C. It removes the need for any team leader
    4. D. Protocols require every step to be done in order
    Show answer

    Answer: B. Several life threats can be treated at once

    With enough hands, the airway, hemorrhage control, monitoring, and access can be handled at the same time, which saves minutes. Parallel work still follows the primary assessment and needs a leader to coordinate. Protocols do not require one-at-a-time care.

17. A patient has a gunshot wound to the thigh with pulsatile bleeding. Which intervention is worth doing before you move him?

    1. A. Starting two large-bore IVs before moving
    2. B. A full secondary exam before loading
    3. C. Tourniquet application before moving
    4. D. A traction splint on the injured femur
    Show answer

    Answer: C. Tourniquet application before moving

    On scene, do only the interventions that cannot wait, and massive hemorrhage control is one of them. IV access and the secondary exam can be done en route. A traction splint is not the priority with uncontrolled arterial bleeding.

18. A critical patient's condition changes en route. The paramedic should:

    1. A. Continue the original plan without changes
    2. B. Document the change and address it at arrival
    3. C. Reassess, revise the plan, and update the hospital
    4. D. Pull over and wait for the patient to stabilize
    Show answer

    Answer: C. Reassess, revise the plan, and update the hospital

    Dynamic reassessment drives plan changes.

19. In an ambiguous presentation, a useful question is:

    1. A. What does dispatch say it is?
    2. B. What is easiest to treat?
    3. C. What is most common at this age?
    4. D. What would I regret missing?
    Show answer

    Answer: D. What would I regret missing?

    Regret-based framing surfaces the dangerous possibilities. The dispatch label and the most common cause for the age are starting points, but they can steer you away from the dangerous diagnosis you cannot afford to miss.

20. Which is a sign the paramedic is handling ambiguity well?

    1. A. Keeping several possibilities open and testing them
    2. B. Refusing to treat until the cause is certain
    3. C. Committing to one diagnosis early to save time
    4. D. Transporting without forming any impression
    Show answer

    Answer: A. Keeping several possibilities open and testing them

    Tolerating uncertainty while acting is a mark of mature reasoning.

21. A 40-year-old with a headache and neck stiffness and fever. The dangerous possibility to keep on the list is:

    1. A. Tension headache
    2. B. Caffeine withdrawal
    3. C. Sinusitis
    4. D. Meningitis
    Show answer

    Answer: D. Meningitis

    Fever plus meningismus requires meningitis consideration and rapid transport.

22. Critical patients benefit most from:

    1. A. Waiting on scene for a second opinion
    2. B. Focused life-saving care, then rapid transport
    3. C. Extensive on-scene history before treatment
    4. D. Prolonged scene times for complete stabilization
    Show answer

    Answer: B. Focused life-saving care, then rapid transport

    Minimize scene time; do what matters.

23. 'Treating the most dangerous possibility' may mean:

    1. A. Giving every available drug just in case
    2. B. Ignoring the complaint until a diagnosis is clear
    3. C. Routinely intubating every critically ill patient
    4. D. Giving aspirin and a 12-lead for possible cardiac pain
    Show answer

    Answer: D. Giving aspirin and a 12-lead for possible cardiac pain

    Low-risk, high-value interventions cover dangerous diagnoses while data accumulates. For example, epigastric pain that could be cardiac.

24. Which patient population most often presents ambiguously?

    1. A. Young healthy adults with no significant medical history
    2. B. Elderly, very young, immunocompromised, and diabetic
    3. C. Well-conditioned athletes in their twenties
    4. D. Patients with a single clearly stated complaint
    Show answer

    Answer: B. Elderly, very young, immunocompromised, and diabetic

    These groups blunt or alter classic signs.

25. When transport is long and the patient is ambiguous, the paramedic should:

    1. A. Focus on documentation and defer further history
    2. B. Use the time for serial assessments and trending
    3. C. Limit monitoring to avoid alarm fatigue
    4. D. Stop reassessing once a baseline has been set
    Show answer

    Answer: B. Use the time for serial assessments and trending

    Long transports allow deeper assessment and trending.

26. A critically ill child requires the paramedic to:

    1. A. Avoid interventions until reaching a pediatric center
    2. B. Treat the child as a small adult with scaled doses
    3. C. Use pediatric-specific assessment and weight-based dosing
    4. D. Obtain parental consent before any emergency care
    Show answer

    Answer: C. Use pediatric-specific assessment and weight-based dosing

    Children have distinct physiology and presentation. The pediatric assessment triangle is one such tool.

27. 'Uncertainty intolerance' in a provider can lead to:

    1. A. Calmer and more deliberate decisions
    2. B. Premature closure to escape discomfort
    3. C. Better outcomes through decisive action
    4. D. More thorough and repeated assessments
    Show answer

    Answer: B. Premature closure to escape discomfort

    The need for certainty pushes providers into early, possibly wrong, conclusions.

28. A critical patient refuses transport. The paramedic should:

    1. A. Physically force transport for the patient's own good
    2. B. Argue until the patient agrees to transport
    3. C. Assess capacity, explain risks, and involve medical control
    4. D. Obtain a signature on the refusal form and leave promptly
    Show answer

    Answer: C. Assess capacity, explain risks, and involve medical control

    Capacity, informed refusal, and medical control involvement are required. Document thoroughly.

29. Multiple simultaneous problems in one patient (e.g., COPD plus CHF plus sepsis) require the paramedic to:

    1. A. Treat only the condition the patient reports first
    2. B. Choose the condition easiest to correct
    3. C. Prioritize the most immediate threat to life
    4. D. Transport without treatment to avoid interactions
    Show answer

    Answer: C. Prioritize the most immediate threat to life

    Comorbid patients need prioritization and awareness of how treatments interact. Recognize interactions among the conditions.

30. When critical interventions compete (e.g., airway vs. hemorrhage), the paramedic prioritizes by:

    1. A. Whichever intervention is easier to perform
    2. B. Which threat will kill the patient fastest
    3. C. The threat the patient notices most
    4. D. The threat found first on exam
    Show answer

    Answer: B. Which threat will kill the patient fastest

    Priority follows the speed of lethality; MARCH/XABC reflect this. In trauma this often means massive hemorrhage before airway. The patient's most noticeable complaint and the first finding on exam are not reliable guides; the threat that will kill fastest comes first.

31. Which action best reduces ambiguity during a confusing call?

    1. A. Ending the assessment to speed transport
    2. B. Setting aside vital signs that don't fit
    3. C. Gathering more objective data, like a 12-lead
    4. D. Guessing the most likely cause and committing to it
    Show answer

    Answer: C. Gathering more objective data, like a 12-lead

    Objective diagnostics often clarify unclear presentations. Useful data include a 12-lead, glucose, SpO2, ETCO2, and temperature.

32. After stabilizing a critical patient, the paramedic should:

    1. A. Reduce monitoring now that vitals are stable
    2. B. Remove equipment to improve patient comfort
    3. C. Reassess and prepare for deterioration
    4. D. Shift attention fully to the documentation
    Show answer

    Answer: C. Reassess and prepare for deterioration

    Critical patients can decompensate again; vigilance continues. Stabilization may be temporary.

33. An 80-year-old woman 'just doesn't feel right.' Vital signs are normal, and she has no specific complaint. What is the most appropriate approach?

    1. A. Reassure her and recommend rest at home
    2. B. Assess thoroughly and favor transport
    3. C. Wait for a more specific complaint to develop
    4. D. Release her because vital signs are normal
    Show answer

    Answer: B. Assess thoroughly and favor transport

    Vague complaints in older adults may represent serious illness such as ACS, sepsis, or stroke. A thorough assessment should include a 12-lead ECG and glucose.

34. You are 30 minutes from the hospital with a patient whose cause of hypotension is unclear. Which is the best overall approach?

    1. A. Delay treatment until a diagnosis is established
    2. B. Focus on documentation until the cause is clear
    3. C. Withhold fluids and medications until arrival
    4. D. Support perfusion and reassess frequently en route
    Show answer

    Answer: D. Support perfusion and reassess frequently en route

    When the cause is unclear, supportive treatment and frequent reassessment protect the patient while information is gathered. Also treat the most dangerous likely causes.

35. A 25-year-old is agitated, hyperthermic, tachycardic, and fighting restraints after using methamphetamine. Which life-threat must be anticipated?

    1. A. Sudden cardiac arrest
    2. B. Simple dehydration
    3. C. Opioid withdrawal seizures
    4. D. Hypoglycemia alone
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    Answer: A. Sudden cardiac arrest

    Severe agitation with hyperthermia and sympathomimetic toxicity carries a high risk of sudden cardiac arrest; rapid sedation and cooling are often needed. This physiology is now termed hyperactive delirium with severe agitation (formerly 'excited delirium').

36. Your patient is unresponsive with no medical history available and no obvious cause. Which first steps address the most common reversible causes?

    1. A. Full family history, medications, and allergies
    2. B. Backboard, cervical collar, and rapid transport
    3. C. Airway, glucose, opioid toxicity, and temperature
    4. D. Defer workup to labs and imaging at the hospital
    Show answer

    Answer: C. Airway, glucose, opioid toxicity, and temperature

    Quick checks for hypoxia, hypoglycemia, opioid toxicity, and temperature address common reversible causes.

37. A trauma patient is alert but has a heart rate of 128 and a normal blood pressure. The mechanism was a rollover. What is the best interpretation?

    1. A. Possible early shock; treat as critical
    2. B. Pain response without clinical significance
    3. C. Normal stress response requiring no action
    4. D. Anxiety alone from the stress of the crash
    Show answer

    Answer: A. Possible early shock; treat as critical

    Tachycardia after significant trauma may be early shock; normal BP does not rule out serious bleeding. This may be compensated shock.

38. A 45-year-old with severe chest pain has a normal 12-lead and appears comfortable between episodes. How should ambiguity be handled?

    1. A. Give analgesia and leave the patient home
    2. B. Transport with serial ECGs and monitoring
    3. C. Release because the 12-lead is normal
    4. D. Treat as musculoskeletal pain and reassure
    Show answer

    Answer: B. Transport with serial ECGs and monitoring

    Serial ECGs may reveal evolving ischemia; a single normal ECG doesn't exclude ACS.

39. An elderly patient fell and has hip pain with no other complaints. Why should the paramedic still assess for causes of the fall?

    1. A. Falls in older adults rarely have medical causes
    2. B. Doing so is required only for documentation
    3. C. It determines whether the hip needs splinting
    4. D. The fall may have a medical cause such as syncope
    Show answer

    Answer: D. The fall may have a medical cause such as syncope

    Falls in older adults are often symptoms of an underlying medical problem. Possible causes include syncope, stroke, arrhythmia, or infection.

40. A patient with chest pain and dyspnea has both crackles and wheezing, and a history of COPD and CHF. When the cause is unclear, the best approach is to:

    1. A. Give a beta blocker to slow the heart rate
    2. B. Give large fluid boluses to support preload
    3. C. Withhold all treatment until the cause is known
    4. D. Favor treatments that help both, like CPAP
    Show answer

    Answer: D. Favor treatments that help both, like CPAP

    CPAP can benefit both COPD and pulmonary edema; cautious treatment reduces harm when the diagnosis is uncertain.

41. A 2-year-old has a fever and is sleepy but rousable. Parents are unsure how long he has been ill. The safest decision is to:

    1. A. Reassure the parents that fever is common
    2. B. Advise a pediatrician visit the next morning
    3. C. Assess with the pediatric triangle and transport
    4. D. Give acetaminophen and wait for the fever to break
    Show answer

    Answer: C. Assess with the pediatric triangle and transport

    Lethargy in a febrile child can indicate serious infection; the pediatric assessment triangle helps identify sick children.

42. A patient refuses transport but has slurred speech and an unsteady gait that may be from a stroke or intoxication. What is the most important consideration?

    1. A. Whether he is calm and cooperative
    2. B. Whether he can sign the refusal form
    3. C. Whether his family wants him transported
    4. D. Whether he has decision-making capacity
    Show answer

    Answer: D. Whether he has decision-making capacity

    A patient with possible stroke or intoxication may lack capacity; refusal is valid only if capacity is present.

43. A patient has a gunshot wound to the abdomen and a BP of 84/50. Which approach best reflects current trauma care?

    1. A. Delay transport until IV access is established
    2. B. Give large crystalloid volumes to normalize BP
    3. C. Control bleeding, permissive hypotension, rapid transport
    4. D. Complete a full secondary assessment before leaving
    Show answer

    Answer: C. Control bleeding, permissive hypotension, rapid transport

    Penetrating torso trauma benefits from rapid transport and permissive hypotension to avoid worsening bleeding.

44. Permissive hypotension is generally avoided in which trauma patient?

    1. A. A patient with a pelvic fracture and no head injury
    2. B. A young adult with a stab wound to the flank
    3. C. A patient with a traumatic brain injury
    4. D. A patient with an isolated penetrating abdominal wound
    Show answer

    Answer: C. A patient with a traumatic brain injury

    TBI patients need adequate perfusion pressure; hypotension worsens secondary brain injury.

45. A critical patient is deteriorating despite your interventions. What should the paramedic consider first?

    1. A. Continue the same treatment and transport faster
    2. B. Reassess the primary survey and verify interventions
    3. C. Add medications until the patient responds
    4. D. Assume the patient is beyond help and stop
    Show answer

    Answer: B. Reassess the primary survey and verify interventions

    Rechecking the ABCs and confirming equipment and interventions are effective is the first step when a patient worsens.

46. A patient intubated on scene suddenly desaturates. Which approach helps identify the cause systematically?

    1. A. DOPE mnemonic
    2. B. OPQRST mnemonic
    3. C. SAMPLE history
    4. D. AVPU scale
    Show answer

    Answer: A. DOPE mnemonic

    DOPE is a structured mnemonic for troubleshooting deterioration in intubated patients.

47. A patient with sepsis remains hypotensive after an appropriate crystalloid bolus. Which next step is generally indicated when available?

    1. A. Vasopressors per protocol and rapid transport
    2. B. Nitroglycerin to improve tissue perfusion
    3. C. Stop fluids and wait for spontaneous recovery
    4. D. A diuretic to correct third-spacing
    Show answer

    Answer: A. Vasopressors per protocol and rapid transport

    Fluid-refractory septic shock requires vasopressors, such as norepinephrine, when within protocol.

48. Which patient presentation is the most ambiguous and requires careful analysis?

    1. A. A patient with a clear anaphylactic reaction
    2. B. A patient with obvious arterial bleeding from the thigh
    3. C. A patient in witnessed ventricular fibrillation
    4. D. A diabetic with nausea, fatigue, and mild dyspnea
    Show answer

    Answer: D. A diabetic with nausea, fatigue, and mild dyspnea

    Vague symptoms in diabetics may represent silent MI, DKA, or infection, requiring careful evaluation.

49. When managing a critical patient with uncertain diagnosis, why is early notification of the receiving facility important?

    1. A. It hands field care decisions to the ED physician
    2. B. It lets the ED confirm the field diagnosis
    3. C. It lets the hospital prepare needed resources
    4. D. It replaces the need for a written report
    Show answer

    Answer: C. It lets the hospital prepare needed resources

    Early notification activates hospital resources and shortens time to definitive care. Examples include a trauma, stroke, or cath lab team. Notification does not transfer field decisions to the ED, and the hospital cannot confirm a diagnosis from a radio report; the point is to have the right team ready.

50. A patient in shock has a history of long-term prednisone use and does not respond to fluids. What should be considered?

    1. A. Adrenal insufficiency
    2. B. Allergic reaction to fluids
    3. C. Normal response to illness
    4. D. Simple dehydration
    Show answer

    Answer: A. Adrenal insufficiency

    Chronic steroid use suppresses the adrenal axis; refractory shock may reflect adrenal crisis. Adrenal crisis may respond to hydrocortisone if within protocol.

51. Which action best balances rapid transport with necessary treatment for a critical patient?

    1. A. Perform every possible intervention before leaving
    2. B. Do only life-saving interventions on scene
    3. C. Transport without any treatment at all
    4. D. Wait for medical control before moving
    Show answer

    Answer: B. Do only life-saving interventions on scene

    Limiting scene time to critical interventions shortens time to definitive care. Complete other interventions en route.

52. A 55-year-old with sudden severe chest pain radiating to his back has a BP of 190/110 in the right arm and 140/80 in the left. Which treatment should you avoid?

    1. A. Supplemental oxygen if the patient is hypoxic
    2. B. Pain management per local protocol
    3. C. Rapid transport to a facility with cardiac surgery
    4. D. Routine aspirin without physician consultation
    Show answer

    Answer: D. Routine aspirin without physician consultation

    Suspected aortic dissection is a reason to avoid reflexive aspirin, which may worsen bleeding; physician guidance is advised.

53. An elderly patient with dementia cannot describe symptoms but is grimacing and guarding her abdomen. How should this be interpreted?

    1. A. Attribute the behavior to her dementia
    2. B. Conclude pain cannot be assessed in dementia
    3. C. Assume discomfort from the stretcher
    4. D. Take her nonverbal pain signs seriously
    Show answer

    Answer: D. Take her nonverbal pain signs seriously

    Nonverbal pain indicators are valuable in patients who cannot communicate. These signs should be investigated.

54. A patient has a GCS of 8 after a head injury and snoring respirations. What is the immediate priority?

    1. A. Obtain a full medication list
    2. B. Open and protect the airway
    3. C. Perform a detailed neurologic exam
    4. D. Splint extremity injuries
    Show answer

    Answer: B. Open and protect the airway

    A GCS of 8 or less often indicates inability to protect the airway; airway management comes first. Maintain cervical spine precautions while managing the airway.

55. When dealing with an ambiguous presentation, which communication with the receiving hospital is most helpful?

    1. A. No report until arrival, then a verbal summary
    2. B. Findings, working impression, and differential concerns
    3. C. A single best-guess diagnosis with no supporting findings
    4. D. The patient's age and chief complaint only
    Show answer

    Answer: B. Findings, working impression, and differential concerns

    Sharing uncertainty and differential concerns helps the receiving team continue the diagnostic process.

56. A 35-year-old with a history of asthma is in severe distress, too tired to speak, with a silent chest. What does this indicate?

    1. A. Anxiety-related hyperventilation
    2. B. Impending respiratory failure
    3. C. Resolution of bronchospasm
    4. D. A mild, improving exacerbation
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    Answer: B. Impending respiratory failure

    A silent chest and fatigue signal minimal air movement and impending respiratory arrest. This requires aggressive treatment and possible ventilatory support.

57. A patient with suspected stroke has a last known well time 10 hours ago. What decision is most appropriate?

    1. A. Treat as a minor illness and arrange follow-up
    2. B. Do not transport because the window has closed
    3. C. Transport to a stroke-capable center per protocol
    4. D. Give aspirin and release with instructions
    Show answer

    Answer: C. Transport to a stroke-capable center per protocol

    Endovascular thrombectomy may be offered beyond traditional windows for selected patients, so stroke center destination still matters.