NAEMT Advanced Medical Life Support (AMLS) Exam — Questions and Answers

Question 1: Which clinical finding indicates a positive response to a fluid challenge in a hypotensive patient?

Normalization of respiratory rate alone
Increase in pulse pressure and improvement in mental status (Correct answer)
Decrease in heart rate only
Rise in temperature

Correct answer: Increase in pulse pressure and improvement in mental status

A positive fluid response is indicated by improved perfusion markers such as increased pulse pressure, improved mentation, and decreased heart rate.

Question 2: Which of the following is a common symptom of chronic obstructive pulmonary disease (COPD)?

Difficulty breathing (dyspnea) (Correct answer)
Chest pain
Sudden weight gain
Muscle weakness

Correct answer: Difficulty breathing (dyspnea)

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that makes breathing difficult. The most common and hallmark symptom of COPD is dyspnea, or shortness of breath, which often worsens with activity and over time. Other symptoms include chronic cough and wheezing, all stemming from airflow obstruction and lung damage.

Question 3: A patient on long-term lithium therapy presents with hypothermia, altered mental status, macroglossia, periorbital edema, and bradycardia. What treatment should be initiated?

IV thyroid hormone (T4 or T3) replacement and supportive care (Correct answer)
High-dose corticosteroids only
Emergent cardioversion for bradycardia
IV methimazole and propranolol

Correct answer: IV thyroid hormone (T4 or T3) replacement and supportive care

Myxedema coma requires IV thyroid hormone replacement (T4 with or without T3) along with supportive care including passive rewarming, airway management, and corticosteroids to address possible concurrent adrenal insufficiency.

Question 4: In the AMLS approach, when is a nasopharyngeal airway (NPA) preferred over an oral airway (OPA)?

In a patient with basal skull fracture
In a semi-conscious patient with an intact gag reflex (Correct answer)
Only in pediatric patients
In an unconscious patient without a gag reflex

Correct answer: In a semi-conscious patient with an intact gag reflex

NPAs are better tolerated in conscious or semi-conscious patients with an intact gag reflex, avoiding the vomiting risk of OPAs.

Question 5: Which medication is the first-line antiplatelet agent given to patients with suspected ACS?

Ticagrelor 90 mg
Aspirin 324 mg chewed (Correct answer)
Clopidogrel 300 mg
Warfarin 5 mg

Correct answer: Aspirin 324 mg chewed

Aspirin 324 mg chewed is the first-line antiplatelet agent in suspected ACS due to its rapid absorption and thromboxane inhibition.

Question 6: What is the treatment for organophosphate poisoning causing SLUDGE symptoms?

Physostigmine and benzodiazepines
Atropine and pralidoxime (2-PAM) (Correct answer)
Flumazenil and oxygen
Naloxone and activated charcoal

Correct answer: Atropine and pralidoxime (2-PAM)

Atropine blocks muscarinic effects and is given in large doses, while pralidoxime (2-PAM) reactivates acetylcholinesterase before aging occurs.

Question 7: What does the acronym "SAMPLE" stand for in patient history taking?

Signs, Allergies, Medications, Past medical history, Last oral intake, Events (Correct answer)
Safety, Age, Medications, Plan, Examination
Signs, Assessment, Medications, Pulse, Last intake, Examination
Symptoms, Age, Medical history, Physical exam, Last treatment, Examination

Correct answer: Signs, Allergies, Medications, Past medical history, Last oral intake, Events

The SAMPLE acronym is a mnemonic used in patient assessment to gather a comprehensive medical history quickly and systematically. It stands for Signs/Symptoms, Allergies, Medications, Past medical history, Last oral intake, and Events leading up to the present illness or injury. This structured approach helps ensure no critical information is missed during history taking.

Question 8: A patient in decompensated shock has cold, mottled extremities and a capillary refill of 5 seconds. What organ is most immediately at risk?

Skin (pressure ulcers)
Liver (fatty change)
Kidneys (acute tubular necrosis) (Correct answer)
Brain (dementia)

Correct answer: Kidneys (acute tubular necrosis)

Prolonged hypoperfusion in shock preferentially damages the kidneys, causing acute tubular necrosis and acute kidney injury.

Question 9: What is the recommended time window for administering IV alteplase (tPA) in ischemic stroke from symptom onset?

Within 6 hours
Within 1 hour
Within 3 to 4.5 hours (Correct answer)
Within 12 hours

Correct answer: Within 3 to 4.5 hours

IV alteplase can be administered within 3 to 4.5 hours of symptom onset in eligible ischemic stroke patients.

Question 10: Which of the following is a primary symptom of pulmonary embolism?

Coughing up blood
Chest pain
High fever
Difficulty breathing (Correct answer)

Correct answer: Difficulty breathing

Difficulty breathing, or dyspnea, is a primary and often sudden symptom of pulmonary embolism (PE). This occurs because the blood clot blocks blood flow to a portion of the lung, impairing oxygen exchange and causing the body to feel starved for air. Other common symptoms include chest pain, rapid heart rate, and sometimes coughing up blood.

Question 11: A conscious diabetic patient is found with a blood glucose of 52 mg/dL and mild confusion. Which is the most appropriate initial treatment?

IM glucagon 1 mg
15-20 grams of fast-acting oral carbohydrates (Correct answer)
IV dextrose 50% (D50W) 25 g
IV normal saline 500 mL bolus

Correct answer: 15-20 grams of fast-acting oral carbohydrates

In a conscious patient able to protect their airway, the preferred initial treatment for mild hypoglycemia is 15-20 g of fast-acting oral carbohydrates (the '15-15 rule'), which is safe and effective.

Question 12: Which toxin causes a 'sympathomimetic toxidrome' with hyperthermia, tachycardia, hypertension, and agitation?

Benzodiazepines
Opioids
Beta-blockers
Cocaine or amphetamines (Correct answer)

Correct answer: Cocaine or amphetamines

Cocaine and amphetamines cause the sympathomimetic toxidrome by blocking catecholamine reuptake or increasing release, producing excess adrenergic stimulation.

Question 13: What is the target mean arterial pressure (MAP) in septic shock management per Surviving Sepsis guidelines?

65 mmHg or greater (Correct answer)
90 mmHg or greater
80 mmHg or greater
50 mmHg or greater

Correct answer: 65 mmHg or greater

The Surviving Sepsis Campaign recommends maintaining a MAP of 65 mmHg or greater in septic shock to ensure organ perfusion.

Question 14: Which of the following medications is commonly prescribed for preventing blood clots in patients at risk of pulmonary embolism?

Beta-blockers
Antibiotics
Anticoagulants (e.g., warfarin, heparin) (Correct answer)
Statins

Correct answer: Anticoagulants (e.g., warfarin, heparin)

Anticoagulants, such as warfarin and heparin, are medications specifically designed to prevent the formation and growth of blood clots. By interfering with the body's clotting cascade, they reduce the risk of deep vein thrombosis (DVT) and subsequent pulmonary embolism in patients identified as being at risk. These medications are crucial for prophylaxis and treatment of thrombotic events.

Question 15: A patient with known epilepsy has a seizure that self-terminates in 2 minutes. They are postictal. Which assessment is still critical?

Blood glucose to rule out hypoglycemia (Correct answer)
Repeat ECG
Immediate intubation
Stat brain CT only

Correct answer: Blood glucose to rule out hypoglycemia

Hypoglycemia can trigger seizures and must be ruled out even in known epileptics, as it is a rapidly reversible cause.

Question 16: What is the LEMON law mnemonic used for in airway management?

Choosing the correct ET tube size
Assessing adequacy of mask ventilation
Determining need for surgical airway
Predicting difficult laryngoscopy and intubation (Correct answer)

Correct answer: Predicting difficult laryngoscopy and intubation

LEMON (Look externally, Evaluate 3-3-2, Mallampati, Obstruction, Neck mobility) is used to predict difficult laryngoscopy before RSI.

Question 17: Which of the following is a potential side effect of long-term oxygen therapy?

Hypercapnia (increased CO2 levels) (Correct answer)
Muscle cramps
Hypothermia
Weight gain

Correct answer: Hypercapnia (increased CO2 levels)

In patients with chronic obstructive pulmonary disease (COPD) who have chronic hypercapnia, long-term oxygen therapy can sometimes suppress the hypoxic drive to breathe. This can lead to decreased ventilation and an increase in carbon dioxide (CO2) levels in the blood, resulting in hypercapnia. Careful monitoring of blood gas levels is essential to prevent this complication.

Question 18: Preoxygenation before RSI is performed to extend the apneic window. What SpO2 target indicates adequate preoxygenation?

SpO2 ≥ 93–95% or higher before paralysis (Correct answer)
SpO2 > 80% on room air
Any SpO2 above 70%
SpO2 > 88%

Correct answer: SpO2 ≥ 93–95% or higher before paralysis

Adequate preoxygenation aims for SpO2 ≥93–95% or higher, ideally 100%, to maximize oxygen reserves and extend the safe apneic period during RSI.

Question 19: Which finding indicates right mainstem intubation after ETT placement?

Absent breath sounds on the left with unilateral chest rise (Correct answer)
Gastric gurgling over the epigastrium
Bilateral equal breath sounds
ETCO2 waveform present

Correct answer: Absent breath sounds on the left with unilateral chest rise

Right mainstem intubation occurs when the tube passes too deeply into the right bronchus, causing absent left breath sounds and right-sided chest rise only.

Question 20: Which supraglottic airway device is considered an advanced alternative to BVM ventilation for cardiac arrest?

Oropharyngeal airway
Endotracheal tube only
King LT or LMA (laryngeal mask airway) (Correct answer)
Nasopharyngeal airway alone

Correct answer: King LT or LMA (laryngeal mask airway)

Supraglottic airways like the King LT and LMA can be rapidly placed without visualization and provide effective ventilation during CPR.

Question 21: Pulsus paradoxus greater than 10 mmHg is a classic finding in which condition?

Hypertensive emergency
Aortic stenosis
Tension pneumothorax
Cardiac tamponade (Correct answer)

Correct answer: Cardiac tamponade

Pulsus paradoxus >10 mmHg, an exaggerated fall in BP during inspiration, is a classic sign of cardiac tamponade.

Question 22: What is the antidote for benzodiazepine overdose?

Physostigmine
Flumazenil (Correct answer)
Atropine
Naloxone

Correct answer: Flumazenil

Flumazenil competitively antagonizes benzodiazepine binding at GABA receptors; use cautiously as it can precipitate seizures in chronic BZD users.

Question 23: A patient ingested a large quantity of aspirin (salicylates). Which acid-base disturbance is expected in severe toxicity?

Mixed respiratory alkalosis and metabolic acidosis (Correct answer)
Pure metabolic alkalosis
Pure respiratory acidosis
Metabolic acidosis with respiratory acidosis

Correct answer: Mixed respiratory alkalosis and metabolic acidosis

Salicylate toxicity initially causes respiratory alkalosis (direct stimulation of respiratory center) followed by metabolic acidosis from uncoupled oxidative phosphorylation.

Question 24: Which AMLS assessment finding is most consistent with a lesion in the brainstem?

Hemiplegia with preserved consciousness
Abnormal respiratory patterns and cranial nerve deficits (Correct answer)
Aphasia without motor deficits
Cortical blindness only

Correct answer: Abnormal respiratory patterns and cranial nerve deficits

Brainstem lesions typically cause abnormal respiratory patterns, cranial nerve deficits, and altered consciousness due to the reticular activating system.

Question 25: A patient in acute heart failure presents with severe dyspnea, pink frothy sputum, and SpO2 of 82%. What is the priority airway intervention?

Immediate intubation
Supplemental O2 via nasal cannula
CPAP or BiPAP non-invasive ventilation (Correct answer)
High-flow O2 via simple mask

Correct answer: CPAP or BiPAP non-invasive ventilation

CPAP/BiPAP is the priority intervention for acute pulmonary edema as it improves oxygenation and reduces the work of breathing without intubation.

Question 26: Status epilepticus is defined as a seizure lasting longer than how many minutes?

30 minutes
5 minutes (Correct answer)
2 minutes
10 minutes

Correct answer: 5 minutes

Status epilepticus is defined as continuous seizure activity lasting 5 or more minutes or two seizures without recovery of consciousness between them.

Question 27: Which laboratory finding best differentiates diabetic ketoacidosis (DKA) from hyperosmolar hyperglycemic state (HHS)?

Elevated BUN and creatinine
Presence of significant ketonemia and metabolic acidosis (Correct answer)
Serum glucose above 600 mg/dL
Serum osmolality greater than 320 mOsm/kg

Correct answer: Presence of significant ketonemia and metabolic acidosis

DKA is characterized by significant ketonemia and anion-gap metabolic acidosis, whereas HHS features extreme hyperglycemia and hyperosmolality without significant ketosis or acidosis.

Question 28: Decerebrate posturing in a comatose patient indicates injury at which neurological level?

Cortical level only
Spinal cord at C2
Peripheral nervous system
At or below the midbrain (diencephalon to brainstem) (Correct answer)

Correct answer: At or below the midbrain (diencephalon to brainstem)

Decerebrate posturing (extension of all extremities) indicates injury at the midbrain or below, signaling severe brainstem dysfunction.

Question 29: Which medication is most commonly used for sedation during RSI prior to neuromuscular blockade?

Ketamine or etomidate (Correct answer)
Midazolam alone
Propofol in all patients
Fentanyl alone

Correct answer: Ketamine or etomidate

Ketamine (maintains hemodynamics, bronchodilates) and etomidate (hemodynamically neutral) are the preferred induction agents for RSI in emergency settings.

Question 30: What is the specific antidote for opioid overdose with respiratory depression?

Naloxone (Narcan) (Correct answer)
Physostigmine
N-acetylcysteine
Flumazenil

Correct answer: Naloxone (Narcan)

Naloxone competitively antagonizes opioid receptors and rapidly reverses respiratory depression, miosis, and altered consciousness in opioid overdose.

Question 31: What is the primary advantage of video laryngoscopy over direct laryngoscopy in difficult airways?

Faster intubation time in all patients
Improved glottic visualization without requiring direct line of sight (Correct answer)
Can be used without preoxygenation
Eliminates need for NMBA during RSI

Correct answer: Improved glottic visualization without requiring direct line of sight

Video laryngoscopy provides a magnified indirect view of the glottis via camera, improving visualization in difficult airways without requiring optimal neck positioning.

Question 32: A patient with altered mental status has a blood glucose of 38 mg/dL. IV access cannot be established. What is the most appropriate next intervention?

Intranasal dextrose spray
Oral glucose gel placed in the buccal mucosa
Intramuscular glucagon 1 mg (Correct answer)
Subcutaneous insulin to stabilize glucose

Correct answer: Intramuscular glucagon 1 mg

When IV access is unavailable in a hypoglycemic patient with altered mental status (making oral glucose unsafe), IM glucagon stimulates hepatic glycogenolysis to raise blood glucose.

Question 33: Which of the following is part of the primary survey in patient assessment?

Checking airway, breathing, and circulation (ABC) (Correct answer)
X-ray examination
Detailed medical history
Blood pressure measurement

Correct answer: Checking airway, breathing, and circulation (ABC)

The primary survey in patient assessment focuses on identifying and immediately managing life-threatening conditions. Checking the patient's Airway, Breathing, and Circulation (ABC) is the cornerstone of this survey, as these are the most critical functions for survival. Addressing any issues with ABC takes precedence over other assessments to stabilize the patient.

Question 34: Which finding on the AMLS primary survey is most concerning for spinal cord injury at the C3-C5 level?

Decreased sensation below the knee
Diaphragmatic breathing with loss of intercostal muscle function (Correct answer)
Flaccid lower extremities only
Loss of bladder control alone

Correct answer: Diaphragmatic breathing with loss of intercostal muscle function

Injuries at C3-C5 affect the phrenic nerve origin (C3-C5), impairing intercostal muscles but potentially sparing diaphragm, resulting in diaphragmatic-only breathing.

Question 35: During BVM ventilation, what is the recommended ventilation rate for an adult patient in respiratory arrest?

30 breaths per minute
6–8 breaths per minute
10–12 breaths per minute (one breath every 5–6 seconds) (Correct answer)
20–24 breaths per minute

Correct answer: 10–12 breaths per minute (one breath every 5–6 seconds)

Adult BVM ventilation should deliver 10–12 breaths/minute to avoid hyperventilation, which reduces venous return and worsens outcomes.

Question 36: Which finding on an arterial blood gas (ABG) is most consistent with diabetic ketoacidosis (DKA)?

pH 7.48, PaCO2 50 mmHg, HCO3 34 mEq/L
pH 7.22, PaCO2 20 mmHg, HCO3 8 mEq/L (Correct answer)
pH 7.35, PaCO2 40 mmHg, HCO3 24 mEq/L
pH 7.50, PaCO2 30 mmHg, HCO3 22 mEq/L

Correct answer: pH 7.22, PaCO2 20 mmHg, HCO3 8 mEq/L

DKA produces an anion-gap metabolic acidosis with low pH, low bicarbonate, and compensatory respiratory alkalosis (low PaCO2 from Kussmaul respirations), making option B the characteristic ABG pattern.

Question 37: Which intervention is contraindicated in a patient with ischemic stroke who is a tPA candidate?

Administering anticoagulants prior to tPA (Correct answer)
Performing a 12-lead ECG
Establishing IV access
Checking blood glucose

Correct answer: Administering anticoagulants prior to tPA

Anticoagulants should not be given before tPA in ischemic stroke as they increase bleeding risk and are part of exclusion criteria.

Question 38: Which crystalloid is considered the preferred initial resuscitation fluid in hemorrhagic shock?

3% hypertonic saline
Half-normal saline (0.45% NaCl)
Normal saline (0.9% NaCl) (Correct answer)
5% dextrose in water (D5W)

Correct answer: Normal saline (0.9% NaCl)

Normal saline or lactated Ringer's (isotonic crystalloids) are standard initial resuscitation fluids in hemorrhagic shock.

Question 39: Which vasopressor is the recommended first-line agent for septic shock?

Norepinephrine (Correct answer)
Vasopressin
Epinephrine
Dopamine

Correct answer: Norepinephrine

Norepinephrine is the first-line vasopressor in septic shock due to its potent alpha effects with modest beta activity and favorable side-effect profile.

Question 40: Which of the following is a vital sign that is typically measured during a patient assessment?

Weight
Pupil size
Skin color
Blood pressure (Correct answer)

Correct answer: Blood pressure

Vital signs are objective measurements of the body's most basic functions, indicating the state of a patient's health. Blood pressure is a key vital sign, along with heart rate, respiratory rate, and body temperature, providing crucial information about cardiovascular function. These measurements help healthcare providers monitor a patient's condition and detect changes.

Question 41: Which device is typically used for delivering low-flow oxygen therapy?

CPAP machine
Nasal cannula (Correct answer)
Ventilator
Nebulizer

Correct answer: Nasal cannula

A nasal cannula is the most commonly used device for delivering low-flow oxygen therapy, typically at flow rates between 1 and 6 liters per minute. It consists of two prongs that fit comfortably into the nostrils, providing supplemental oxygen without obstructing the patient's ability to eat, drink, or speak. Other devices like ventilators or CPAP machines deliver higher pressures or volumes, while nebulizers deliver medication.

Question 42: Which symptom cluster best describes normal pressure hydrocephalus (NPH)?

Visual changes and diplopia only
Gait disturbance, urinary incontinence, and dementia (Correct answer)
Sudden severe headache, vomiting, and photophobia
Unilateral weakness and facial droop

Correct answer: Gait disturbance, urinary incontinence, and dementia

NPH classically presents with the triad of gait disturbance (magnetic gait), urinary incontinence, and cognitive decline (dementia).

Question 43: A 55-year-old patient on long-term corticosteroids presents with hypotension, weakness, nausea, and hypoglycemia after abruptly stopping their medication. Which condition is most likely?

Pheochromocytoma
Cushing's syndrome exacerbation
Thyroid storm
Addisonian (adrenal) crisis (Correct answer)

Correct answer: Addisonian (adrenal) crisis

Adrenal crisis occurs when exogenous corticosteroids are abruptly withdrawn, causing acute adrenal insufficiency with hypotension, weakness, nausea, vomiting, and hypoglycemia due to loss of cortisol and aldosterone.

Question 44: What is the first step in a patient assessment?

Administering treatment
Performing a scene size-up (Correct answer)
Performing a physical exam
Obtaining a medical history

Correct answer: Performing a scene size-up

In emergency medical care, the very first step in patient assessment is performing a scene size-up. This involves quickly assessing the safety of the scene for both the rescuer and the patient, identifying potential hazards, and determining the nature of the illness or mechanism of injury. Ensuring scene safety is paramount before approaching the patient and initiating direct care.

Question 45: In a patient with suspected adrenal crisis, which immediate treatment should be administered without waiting for confirmatory lab results?

IM glucagon 1 mg
IV thyroid hormone replacement
IV dexamethasone or hydrocortisone plus fluid resuscitation (Correct answer)
Oral hydrocortisone 20 mg

Correct answer: IV dexamethasone or hydrocortisone plus fluid resuscitation

Adrenal crisis is rapidly fatal if untreated; IV corticosteroid replacement (hydrocortisone or dexamethasone) with aggressive fluid resuscitation must be given empirically without waiting for lab confirmation.

Question 46: What is the recommended tidal volume for ventilated patients to prevent ventilator-induced lung injury?

4 mL/kg actual body weight
10–12 mL/kg actual body weight
6–8 mL/kg ideal body weight (Correct answer)
15 mL/kg actual body weight

Correct answer: 6–8 mL/kg ideal body weight

Lung-protective ventilation uses low tidal volumes of 6–8 mL/kg IBW to prevent barotrauma and volutrauma in ventilated patients.

Question 47: What does OPQRST stand for when assessing a patient’s pain?

Observation, Provocation, Quantification, Radiation, Sensitivity, Time
Observation, Physical exam, Quantification, Severity, Treatment
Onset, Pulse, Quality, Reflex, Sensation, Temperature
Onset, Provocation, Quality, Radiation, Severity, Time (Correct answer)

Correct answer: Onset, Provocation, Quality, Radiation, Severity, Time

The OPQRST mnemonic is a standardized tool used by healthcare professionals to thoroughly assess a patient's pain. It guides the inquiry into the Onset of pain, what Provokes or palliates it, the Quality of the pain, if it Radiates, its Severity on a scale, and the Time or duration it has been present. This comprehensive approach helps in diagnosing and managing pain effectively.

Question 48: Which class of hemorrhagic shock (using ATLS classification) first shows altered mental status?

Class II (15–30% blood loss)
Class III (30–40% blood loss) (Correct answer)
Class IV (>40% blood loss)
Class I (up to 15% blood loss)

Correct answer: Class III (30–40% blood loss)

Class III hemorrhage (30–40% blood volume loss) is the first class associated with altered mental status, anxiety, and confusion.

Question 49: A patient presents with fever of 104°F, tachycardia (HR 148), atrial fibrillation, agitation, and exophthalmos. Which endocrine emergency should be suspected?

Myxedema coma
Thyroid storm (thyrotoxic crisis) (Correct answer)
Hyperosmolar hyperglycemic state
Adrenal crisis

Correct answer: Thyroid storm (thyrotoxic crisis)

Thyroid storm presents with hyperpyrexia, extreme tachycardia, dysrhythmias (especially atrial fibrillation), agitation, and signs of hyperthyroidism such as exophthalmos, reflecting life-threatening excess thyroid hormone activity.

Question 50: Which intervention is definitive for obstructive shock caused by tension pneumothorax?

Needle decompression followed by chest tube thoracostomy (Correct answer)
Immediate intubation
Pericardiocentesis
IV fluid resuscitation

Correct answer: Needle decompression followed by chest tube thoracostomy

Needle decompression (2nd ICS MCL or 4th/5th ICS AAL) releases trapped air, converting tension pneumothorax to simple pneumothorax, followed by chest tube.

Question 51: What is the most common cause of pulmonary embolism (PE)?

Blood clot (deep vein thrombosis) (Correct answer)
Tumor embolism
Air embolism
Fat embolism

Correct answer: Blood clot (deep vein thrombosis)

The most common cause of a pulmonary embolism (PE) is a blood clot, specifically one that originates in the deep veins of the legs or pelvis, a condition known as deep vein thrombosis (DVT). This clot then breaks off, travels through the bloodstream, and lodges in the pulmonary arteries, blocking blood flow to the lungs. Other types of emboli are far less common.

NAEMT Advanced Medical Life Support (AMLS) Exam

The NAEMT AMLS exam evaluates an EMS practitioner's ability to assess and manage common medical emergencies using the AMLS Assessment Pathway, covering respiratory, cardiac, neurological, toxicological, and shock-related conditions.

Questions

60 min

Time Limit

80%

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