Paramedics Exam Medical Emergencies 2 — Questions and Answers
Question 1: A 58-year-old male presents with crushing chest pain radiating to the jaw, diaphoresis, and nausea. His 12-lead ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Right coronary artery (Correct answer)
- Left circumflex artery
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior STEMI, most commonly caused by right coronary artery (RCA) occlusion.
Question 2: A patient with known COPD presents in severe respiratory distress. SpO2 is 84% on room air. What is the appropriate oxygen delivery target for this patient?
- 88-92% SpO2 (Correct answer)
- 98-100% SpO2
- 94-98% SpO2
- 100% SpO2 via NRB mask
Correct answer: 88-92% SpO2
COPD patients may rely on hypoxic drive, so target SpO2 of 88-92% to avoid suppressing respiratory effort while correcting dangerous hypoxia.
Question 3: A 70-year-old female presents with sudden onset of right-sided facial droop, right arm weakness, and aphasia. These symptoms began 45 minutes ago. Which intervention is the highest priority?
- Administer aspirin 325 mg
- Establish IV access and draw blood glucose (Correct answer)
- Provide high-flow oxygen via NRB
- Perform 12-lead ECG
Correct answer: Establish IV access and draw blood glucose
Checking blood glucose is critical because hypoglycemia can mimic stroke symptoms, and IV access is needed for potential thrombolytic therapy at the hospital.
Question 4: A 35-year-old patient presents with severe anxiety, carpopedal spasm, perioral tingling, and rapid deep breathing. Vital signs: RR 28, SpO2 99%, BP 130/80. What is the most likely diagnosis?
- Pulmonary embolism
- Hyperventilation syndrome (Correct answer)
- Hypovolemic shock
- Tension pneumothorax
Correct answer: Hyperventilation syndrome
Carpopedal spasm and perioral tingling with rapid breathing and normal SpO2 indicate hyperventilation syndrome causing hypocapnia and respiratory alkalosis.
Question 5: Which finding on a 12-lead ECG is most consistent with right ventricular infarction complicating an inferior STEMI?
- ST elevation in leads V4R and V5R (Correct answer)
- ST depression in leads V1-V4
- New left bundle branch block
- Prolonged QT interval
Correct answer: ST elevation in leads V4R and V5R
Right-sided precordial leads V4R and V5R showing ST elevation indicate right ventricular infarction, which commonly complicates inferior STEMI.
Question 6: A 50-year-old male with a history of hypertension presents with a sudden severe 'thunderclap' headache he describes as the worst of his life. He is alert and oriented. What condition must be suspected?
- Hypertensive urgency
- Subarachnoid hemorrhage (Correct answer)
- Migraine with aura
- Meningitis
Correct answer: Subarachnoid hemorrhage
A sudden-onset severe 'thunderclap' headache is the classic presentation of subarachnoid hemorrhage until proven otherwise, most often from a ruptured cerebral aneurysm.
Question 7: A dialysis patient presents with weakness, peaked T-waves on ECG, and a wide QRS complex. Which medication should be administered first?
- Sodium bicarbonate
- Calcium chloride or calcium gluconate (Correct answer)
- Albuterol nebulization
- Furosemide IV
Correct answer: Calcium chloride or calcium gluconate
Calcium chloride or gluconate is the first-line treatment for hyperkalemia with cardiac manifestations because it immediately stabilizes the myocardial membrane.
Paramedics Exam Medical Emergencies 2
A 58-year-old male presents with crushing chest pain radiating to the jaw, diaphoresis, and nausea.
His 12-lead ECG shows ST elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?