EMT Practice Exam Medical and OBGYN

Question 1

While assessing a medical patient, what mnemonic will assist the EMT with finding out details of the chief complaint?

a. AVPU
b. OPQRST
c. SAMPLE
d. DCAP-BTLS

Answer 1

B. Rationale: The “OPQRT” mnemonic will assist the EMT with exploring the chief complaint. It consists of onset, provocation/palliation, quality, radiation, severity, and time. AVPU deals with ascertaining the mental status, SAMPLE deals more globally with the patient’s background (i.e., meds, history, allergies), and DCAP-BTLS is used when assessing for traumatic injuries or conditions.

Question 2

Which of the following is NOT considered to be one of the components of the secondary exam in a responsive patient with a medical emergency?

a. Baseline vital signs
b. Focused physical exam
c. History of the present illness
d. Determination of patient priority

Answer 2

D. Rationale: The determination of patient priority is actually more of a clinical outcome of completing the assessment of a patient and determining that the patient’s status is critical. Most commonly it is determined at the end of the primary survey, although it could be determined at any point in time. The other parameters mentioned—vitals, physical exam, and history—are all normal parts of the secondary assessment. The fourth component of the secondary exam is the history of the present illness.

Question 3

Upon initial questioning, a patient complains of multiple things: chest pain, dyspnea, and abdominal pain. What should be the next course of action for the EMT?

a. Ask the patient which thing bothered him first
b. Ask the patient which thing is bothering him the most
c. Treat the patient as if he has three chief complaints
d. Assume that the chest pain is the chief complaint due to its potential severity

Answer 3

B. Rationale: Asking the patient for clarity of the chief complaint (i.e., which thing is bothering him the most) will allow the EMT to focus care interventions on the thing that is troubling the patient the greatest. Although what was bothering him first is important, it will not necessarily direct patient care. Treating the patient for three chief complaints may lead to multiple interventions that may contradict each other, and assuming the chief complaint is chest pain will not be true in all instances.

Question 4

Which of the following medical patients will the EMT perform a rapid physical exam on?

a. An eighty-six-year-old unresponsive diabetic patient
b. A nine-year-old boy with asthma who is scared
c. A thirty-two-year-old male with respiratory distress
d. A sixty-year-old psych patient threatening to kill himself

Answer 4

A. Rationale: The rapid physical exam is performed on medical patients when they have an altered mental status and cannot provide reliable answers to the EMT’s questions. The focus of the exam is to find life-threatening conditions or evidence that can help the EMT determine what is wrong with the patient. The other patients listed were conscious and hence would probably not receive the rapid physical exam; rather, they would receive a focused physical exam.

Question 5

A patient with an injury or dysfunction to what region of the brain may have problems staying awake or paying attention?

a. Cerebellum
b. Hypothalamus
c. Foramen magnum
d. Reticular activating system

Answer 5

D. Rationale: The reticular activating system is a region of nerve fibers deep in the brain that controls consciousness by way of staying awake, paying attention, and indicating when sleeping should occur. Thus, an injury or dysfunction here can easily cause the patient to be unresponsive. The hypothalamus is part of the endocrine system, and the cerebellum is basically the involuntary control of voluntary muscles. The foramen magnum is actually a part of the skull.

Question 6

The patient with diabetes has a pathophysiologic problem with what hormone?

a. Insulin
b. Glucose
c. Dopamine
d. Norepinephrine

Answer 6

A. Rationale: A diabetic patient’s fundamental problem is that insulin is either not being produced or not working as efficiently as it was intended to (type 1 and type 2 diabetes, respectively). Glucose is not a hormone; actually, it is the dietary fuel used to create energy. Dopamine and norepinephrine are both hormones, but they operate within the sympathetic nervous system.

Question 7

A diabetic patient takes her insulin medication regularly and watches what she eats. However, one day she is not feeling well, and she vomits a few times after breakfast. What medical emergency related to diabetes could this cause?

a. Hypertension
b. Hypotension
c. Hypoglycemia
d. Hyperglycemia

Answer 7

C. Rationale: The diabetic’s regulation of sugar can become problematic if she is not stringently watching her diet and medication use. In this situation where the medications are taken to lower the sugar but the patient vomits the food up, there will be an inadequate amount of sugar in the blood for the insulin and the sugar will drop drastically and dangerously low (hypoglycemia). Hyperglycemia usually happens when the insulin levels are too low, and changes in blood pressure are really not part of the diabetic process.

Question 8

Within the body of the diabetic patient, what organ is most sensitive to lowered levels of glucose?

a. Liver
b. Brain
c. Heart
d. Pancreas

Answer 8

B. Rationale: Almost all tissues of the body can store a certain amount of glucose that can help temporarily buffers drop in glucose levels. The only organ that cannot do tis is the brain. As such, if sugar drops too low, the neurons of the brain start to malfunction, which essentially causes changes in the mental status. Hence, the brain is the most sensitive organ to decreasing glucose levels.

Question 9

A diabetic patient may be considered hypoglycemic if he has an altered mental status and a blood sugar level less than what value?

a. 80 mg/dL
b. 100 mg/dL
c. 120 mg/dL
d. 140 mg/dL

Answer 9

A. Rationale: When a diabetic patient starts to become hypoglycemic, there is usually a change in mental status, he becomes sweaty, and his heart rate increases. The blood sugar can complete this clinical picture as a value less than 80 mg/dL is considered to be hypoglycemic in the symptomatic patient. Naturally, levels lower than this further demonstrate hypoglycemia, but 80 mg/dL is when the suspicion becomes confirmed. Levels higher than 80 (up to 120 mg/dL) are consistent with normal glucose levels.

Question 10

You are caring for a diabetic patient with low blood sugar. The patient is unresponsive with sonorous airway sounds. He has a rapid pulse, and peripheral perfusion is intact. Which of the following interventions is of utmost concern for this patient?

a. Manual airway technique
b. Suctioning out the airway
c. Providing high-flow oxygen
d. Administration of oral glucose

Answer 10

A. Rationale: A hypoglycemic patient is in dire need of glucose to return normal brain activity. However, in this patient the glucose level has dropped so low that the patient is now unable to maintain his own airway. As such, the airway now becomes the immediate concern, and a manual technique is needed to open the airway. The use of oxygen is important, but that will come after the airway is open. The use of oral glucose is not warranted ow due to the patient’s inability to keep his airway open. There is no need to suction the airway as there is no evidence of obstruction.

Question 11

A patient with what type of seizure is most likely to present as unresponsive?

a. Partial
b. Generalized
c. Focal motor
d. Jacksonian seizures

Answer 11

B. Rationale: There are two types of seizures: partial seizures and generalized seizures. Partial seizures (also known as focal-motor seizures) occur when the seizure activity is occurring to one side of the brain and, hence, one side of the body. Generalized seizures affect both sides of the brain and cause the patient to be unresponsive. Jacksonian seizures are a type of partial seizure in which muscle tremors are progressive (i.e., fingers then hand then arm and so on).

Question 12

You are caring for a patient who is experiencing a generalized seizure. During the tonic-clonic phase, which of the following management strategies should you employ?

a. Apply high-flow oxygen via nonrebreather mask, and position the supine
b. Loosen restrictive clothing and protect the patient from injury
c. Apply oral glucose and place the patient in the recovery position
d. Restrain the patient physically to avoid harm and transport immediately

Answer 12

B. Rationale: A patient experiencing a generalized seizure will need multiple interventions employed quickly. This includes placing the patient on her side for drainage of fluids (if no c-spine injury is noted), loosening of restrictive clothing, removing objects from around the patient that she may fall upon or that might injure her, and protecting the patient from bodily injury without physically restraining her. The best answer described is loosening the clothing and protecting the patient from harm.

Question 13

You are assessing a patient who has confusion, has difficulty in speaking, and is unable to get out of bed due to left-sided weakness. The symptoms, the family states, occurred very suddenly. The blood pressure is 210/130, the pulse is 98, and respirations are 18. As an EMT, what should be your most likely field impression for the patient’s condition?

a. Stroke
b. Seizure
c. Hyperglycemia
d. Hypoperfusion

Answer 13

A. Rationale: A stroke occurs when a region of the brain is underperfused due to either an occluded blood vessel or a ruptured blood vessel. The brain tissue involved starts to malfunction, which causes changes in mental status and often weakness or paralysis on one-half of the body. Oftentimes, the blood pressure is high in these patients. Hyperglycemia does not have the unilateral findings and is usually a slow onset; in addition, hypoperfusion is unlikely given the blood pressure. Finally, seizures have a rapid onset, but their unilateral findings when present are muscular tremors or convulsions, not weakness.

Question 14

A patient who has recurrent episodes of unilateral weakness, headaches, vision disturbances, or confusion that resolves on its own in a short period of time is likely experiencing what emergency?

a. MI
b. CVA
c. HTN
d. TIA

Answer 14

D. Rationale: A transient ischemic attack (TIA) is a medical emergency in which there is a temporary diminishment or cessation of blood flow to an area of the brain, causing neurological impairment and possible headaches—much like a stroke. The small clot blocking the blood flow breaks up and normal blood flow returns, as does the neurological deficit. Often a TIA is considered an indication of an impending stroke. HTN refers to hypertension, which does not cause unilateral signs. The same is true for a heart attack (MI). A CVA is a cerebral vascular accident, which is an older name for a stroke.

Question 15

You are working with a new EMT on your squad. After a call for an MI patient who became unresponsive, the EMT asks you how a heart attack could cause such a thing. Which of the following most correctly answers this question?

a. “Increased blood flow due to tachycardia.”
b. “A drop in blood flow to the brain from a failing heart.”
c. “The heart was extracting too much oxygen from the bloodstream, leaving an insufficient amount for the brain to use.”
d. “The patient’s lungs were failing due to the drop in left ventricular contraction.”

Answer 15

B. Rationale: When a person is experiencing an MI, a portion of the heart is dying due to a lack of oxygen. That section will eventually stop contracting normally and will contribute to a drop in cardiac output to the brain and body. If this drop is too great, the patient’s mental status can deteriorate due to poor blood flow. Also, the heart does not extract so much oxygen that the other organs fail (it takes only what it needs), and the right ventricle (not left) pumps blood to the lungs.

Question 16

You are assessing a known seizure patient who “passed out” according to bystanders. During your assessment, which clinical clue would help you identify that the patient had a syncopal episode rather than a seizure?

a. The patient bit his tongue.
b. The patient was conscious upon your arrival.
c. The patient “woke up” seconds after going supine.
d. The patient took his antiseizure medications today.

Answer 16

C. Rationale: Both a seizure and syncopal episode can start while the patient is in a standing position. Since syncope commonly occurs from a temporary drop in cerebral blood flow for some reason, as soon as the patient goes supine, blood flow to the brain improves and the patient wakes back up. A seizure patient, however, will continue with the seizure activity when he goes supine, often biting his tongue, which is followed by a postictal period. Some patients may still experience a “breakthrough” seizure even though they are taking their meds regularly.

Question 17

You have a patient experiencing an anaphylactic reaction. Which chemical mediator function is responsible for the edema to the airway that can rapidly cause the patient’s death?

a. Dilation of blood vessels
b. Capillaries start to seep fluid
c. Bronchoconstriction to the lungs
d. Production of thick mucus in the airways

Answer 17

B. Rationale: During an anaphylactic reaction, capillaries start to leak out fluid (termed increased capillary permeability) that causes edema and swelling of surrounding tissues. This is critical in the airway structures where there is not much room for swelling. Bronchoconstriction and mucus production occur to the lungs, but neither causes the airway to occlude shut. Finally, the vascular dilation causes blood pressure to drop, leading to poor peripheral perfusion.

Question 18

You have a male patient who was stung by a bee 5 minutes ago. Of the various signs and symptoms consistent with an allergic reaction, which one would be the most suggestive of a severe allergic, which one would be the most suggestive of a severe allergic reaction (anaphylaxis)?

a. Tachycardia
b. Rapid onset
c. Bilateral wheezing
d. Stridorous breathing

Answer 18

D. Rationale: All of the above findings can be found in a severe allergic reaction. However, three of them (tachycardia, bilateral wheezing, and rapid onset) can also be seen in a mild or moderate reaction. In contrast, the stridorous breathing, a sign indicative of airway closure, is a critical finding as this implies the airway is nearing complete closure due to edema.

Question 19

The administration of epinephrine to an anaphylactic patient will not have any effect on which of the following clinical conditions?

a. Wheezing
b. Airway edema
c. Tachycardia
d. Low blood pressure

Answer 19

C. Rationale: Epinephrine is used in a severe allergic reaction to counter the easily fatal effects of the chemical mediators released during the syndrome. These include reversing airway edema as well as bronchiole constriction and vasoconstricting the blood vessels to raise the blood pressure. Epinephrine frequently causes tachycardia, but this is beneficial in a patient with shock because it will increase cardiac output.

Question 20

You are completing a PCR on an anaphylactic patient you just transported to the hospital. During transport, you had to assist the patient with the administration of her Epi-Pen. As you complete this task, what adult dose of drug would you document for the epinephrine?

a. 0.15 mg
b. 0.30 mg
c. 0.45 mg
d. 0.60 mg

Answer 20

B. Rationale: The correct adult dose of epinephrine contained within an epi auto-inject pen (Epi-Pen) is 0.30 mg. The pediatric dose is 0.15 mg. There is no correct dose of either 0.45 or 0.60 mg of drug for an Epi-Pen.

Question 21

Following the management of a patient with an acute allergic reaction, you have administered epinephrine, given oxygen, and placed him in a position of comfort. Which of the following findings is most consistent with marked patient improvement?

a. The blood pressure increased 10 mm Hg.
b. Bilateral wheezing has diminished greatly.
c. The patient is now able to speak in full sentences.
d. The heart rate decreased from 132 to 108/minute.

Answer 21

C. Rationale: Although the airway swelling, bronchiole constriction, or peripheral vasodilation could all be fatal, the fastest among them is the airway swelling and bronchiole constriction. As such, if the patient is now able to talk in full sentences, that means the airway is open and the patient is able to draw in a full breath. As an EMT, you should expect that the blood pressure will improve, the wheezing will improve, and the heart rate will drop. These are not as reliable for immediate patient improvement as simple speech patterns.

Question 22

Of the following mechanisms for a poison to enter the body, which is most likely to occur to the pediatric patient?

a. Injection
b. Ingestion
c. Inhalation
d. Absorption

Answer 22

B. Rationale: Infants and children have a tendency to place things into their mouths—whether it’s a food product or not. As such, this habit makes them more susceptible to poisoning from ingestion (i.e., swallowing). The poison is then absorbed across the GI tract and enters the bloodstream. Inhalation occurs when they inhale the poison, absorption occurs when it crosses the skin to get inside the body, and injection occurs when the poison is injected directly into the tissues or bloodstream.

Question 23

You are caring for a male patient who is complaining of severe global abdominal pain. The abdomen is also rigid to the touch. The patient has a history of blunt abdominal trauma from 5 days earlier during a sporting event that he did not seek medical treatment for. What condition is this presentation most consistent with?

a. Peritonitis
b. Pancreatitis
c. Appendicitis
d. Gastroenteritis

Answer 23

A. Rationale: Peritonitis is an inflammation of the peritoneal lining of the abdominal cavity. When this occurs, the abdomen becomes rigid and very painful. This condition can occur from irritation to the peritoneum from free blood in the abdomen following abdominal trauma. The other abdominal conditions (appendicitis, gastroenteritis, and pancreatitis) all typically result in localized pain during the syndrome development.

Question 24

Which of the following strategies would be MOST beneficial in establishing a rapport with a psychologically disturbed patient who is displaying a behavioral emergency?

a. Avoid eye contact
b. Speak slow and clear
c. Do not listen to her stories
d. Speak to her sternly for clarity

Answer 24

B. Rationale: There are general rules that should always apply when dealing with patients with behavioral emergencies. These include identifying yourself, speaking slowly and clearly, maintaining eye contact, always listening to the patient’s words, not being judgmental, using positive body language, acknowledging the patient’s feelings, and being alert for sudden changes in the patient’s emotional status.

Question 25

During the management of a patient known to have sickle cell anemia, the patient is complaining of shortness of breath. This could be due to what change in her red blood cells?

a. Inability to carry oxygen
b. Inability for the heart to pump the sickle-shaped cells
c. Inability for the lungs to take in oxygen and produce carbon dioxide
d. Inability of the red blood cells to use oxygen for energy production

Answer 25

A. Rationale: Sickle cell disease causes the red blood cells (which are normally doughnut shaped) to assume a sickle shape that has abnormal hemoglobin molecules that do not carry oxygen well, and the shape makes them difficult to pump through blood vessels. These patients often have episodes of hypoxia and chest pain termed “acute chest syndrome.” The heart can still pump the blood, and the lungs can still diffuse gas; the problem lies in the inability of the diseased red blood cells to carry oxygen (rather than an inability to properly use it).

Question 26

While assisting another ambulance with off-loading a patient at the hospital who is immobilized on a backboard, the EMT states that they can’t maintain the blood pressure in this thirty-year-old, near-term, pregnant female. As you quickly scan the patient, what would alert you to a cause for the hypotension?

a. The patient is immobilized supine.
b. The patient is on only low-flow oxygen.
c. The patient has a traction splint applied to the left leg.
d. The patient has backboard straps across the body tightly.

Answer 26

A. Rationale: In a pregnant female near term who is lying supine, the full weight of the gravid uterus will put pressure on the inferior vena cava and can pinch it nearly shut against the posterior pelvis. This reduces preload to the right side of the heart, ultimately leading to systolic hypotension. To prevent this, the EMT should position the supine pregnant female on one side, preferably on the left side or tilted to the left side. The fact the patient is or isn’t on oxygen, has a traction splint applied, or is secured by straps is irrelevant to the blood pressure.

Question 27

You arrive at the scene of a medical patient. You are shown to the patient’s bedroom where the patient is found lying on the bed. You immediately see the patient wearing a CPAP mask. Given this, what is one expected medical diagnosis you’ll probably see in the patient’s history?

a. Sleep apnea
b. Hypertension
c. Severe pneumonia
d. Neuromuscular disorder

Answer 27

A. Rationale: Sleep apnea is a condition in which, due to the patient’s weight and other pulmonary factors, the patient is unable to keep the small respiratory airways open during sleep. The use of CPAP (continuous positive airway pressure) helps the patient to breathe better while at sleep. Its use is warranted neither by hypertension nor by severe pneumonia. Finally, to use CPAP the patient must have competent breathing muscles; the patient with a neuromuscular disorder does not have this.

Question 28

You are assessing a patient who is on a home ventilator secondary to a traumatic brain injury years earlier. The family is afraid the ventilator is failing. What is the best assessment parameter to let the EMT know that the ventilator is still working properly?

a. The patient has no cyanosis.
b. The heart rate is >100/minute.
c. The patient’s pulse ox reading is <95 percent.
d. The patient still has bilateral breath sounds.

Answer 28

D. Rationale: Beyond a normal ventilatory rate, the EMT should gauge the quality of each ventilator breath by its ability to move the chest wall and create alveolar breath sounds. If the vent breath is too minimal to make breath sounds, the vent is simply working ineffectively. The heart rate, pulse ox reading, and skin color will all change if the vent fails—but not until after a period of poor ventilation. The breath sounds, however, change immediately if the vent fails and can serve as an early warning to the EMT.