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質問 # 22
A 32-year-old female has a history of dysmenorrhea, abdominopelvic pain, and pain when having a bowel movement. She has not been sexually active in 8 months. Her symptoms are most likely caused by
- A. Spontaneous abortion
- B. Premature menopause
- C. An infection that is either bacteria or a virus
- D. Endometrial tissue growing outside the uterus
正解：D
解説：
Comprehensive and Detailed Explanation From Exact Extract:
These symptoms are classic forendometriosis, whereendometrial tissue grows outside the uterus.
Symptoms often include:
* Pelvic pain
* Painful menstruation (dysmenorrhea)
* Painful bowel movements or intercourse
Spontaneous abortion does not apply here due to lack of pregnancy. Premature menopause is rare at this age and presents differently. Infection is less likely in the absence of recent sexual activity or fever.
References:
NREMT Medical - Gynecologic Emergencies
ACOG Guidelines on Endometriosis
National EMS Education Standards - OB/GYN Emergencies
質問 # 23
An 84-year-old patient has a sudden onset of weakness to one side of the body. The patient has a history of hypertension and high cholesterol. The vital signs are BP 176/94 mmHg, P 108/min, R 18/min, and SpO# 97% on room air. For which of the following additional symptoms should the EMT assess? Select the three correct options.
- A. Syncopal episodes
- B. Facial droop
- C. Arm drift
- D. Tremors
- E. Slurred speech
- F. Miosis
正解：B、C、E
解説：
Comprehensive and Detailed Explanation From Exact Extract:
The symptoms described areclassic for a stroke (CVA). Additional hallmark findings include:
* Arm drift(motor weakness or hemiparesis)
* Facial droop(Cranial nerve VII involvement)
* Slurred speech(dysarthria or aphasia)
These form the basis of prehospital stroke assessment tools likeFAST:
* Face drooping
* Arm weakness
* Speech difficulty
* Time to call 911
Miosis (pupil constriction) and tremors are not associated with stroke in EMS context. Syncope is an isolated event and not a reliable CVA symptom.
References:
NREMT Medical Neurological Emergencies
AHA Stroke Recognition Guidelines
EMS National Stroke Protocols - Cincinnati Stroke Scale, FAST
質問 # 24
A 12-year-old male suffered helmet-to-helmet contact while playing football. A bystander states, "He passed out for several seconds, then walked off the field under his own power." He is now unresponsive, and his vital signs are BP 180/110, P 90, and R 6. You should suspect
- A. Epidural hematoma
- B. Intracerebral hematoma
- C. Subarachnoid hemorrhage
- D. Subdural hemorrhage
正解：A
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Anepidural hematomaclassically presents with a"lucid interval"- a brief period of regained consciousness following head trauma, followed by rapid deterioration. This is due to arterial bleeding, often from themiddle meningeal artery, leading to increasing intracranial pressure.
Signs include:
* High blood pressure
* Decreasing respiratory rate
* Altered LOC or unresponsiveness
Subdural hemorrhages are slower venous bleeds, common in elderly patients. Subarachnoid hemorrhage often presents with "worst headache of life." Intracerebral bleeds are less commonly linked to lucid intervals.
References:
NREMT Trauma Module - Head Injuries
AAOS Emergency Care Textbook (11th ed.), Chapter: Head and Spine Trauma Emergency Neurological Life Support (ENLS) Guidelines - Traumatic Brain Injury
質問 # 25
Following insertion of an oropharyngeal airway in an unresponsive 1-year-old male, he develops cyanosis and bradycardia. You should
- A. Continue ventilation with the airway in place
- B. Remove the airway and ventilate him
- C. Increase the ventilation rate to 40-60
- D. Start CPR if his heart rate falls below 100
正解：B
解説：
Comprehensive and Detailed Explanation From Exact Extract:
In infants, improper insertion of an OPA (oropharyngeal airway) can stimulate the vagus nerve, leading to bradycardia or even complete airway obstruction. If cyanosis and bradycardia develop after OPA insertion, immediate removal and resumption of ventilations with a bag-valve mask is critical.
The OPA must be properly sized and inserted only in patients without a gag reflex. Ventilations alone often reverse vagally induced bradycardia.
References:
NREMT Psychomotor Skills - Pediatric Airway
American Heart Association PALS Provider Manual (2020)
Brady Emergency Care (13th ed.) - Pediatric Airway Management
質問 # 26
A 38-year-old patient is unconscious with slow, shallow, and gasping breaths. The patient is not moving.
What should the EMT perform first?
- A. Assess the airway
- B. Auscultate breath sounds
- C. Perform a secondary assessment
- D. Check a carotid pulse
正解：A
解説：
Comprehensive and Detailed Explanation From Exact Extract:
In anyunresponsive patient, the first step is toassess and open the airwayto determine patency and identify obstruction or inadequate breathing.
Gasping respirations (agonal) are not effective; they requireBVM ventilationsupport. The airway must be openbefore checking for a pulse or performing auscultation. A secondary assessment is performed only after primary survey and stabilization.
References:
AHA BLS Provider Manual (2020) - Unresponsive Patient Algorithm
NREMT Airway Skills - Primary Assessment
National EMS Education Standards - Airway, Breathing, Circulation (ABC) Sequence
質問 # 27
A 31-year-old patient has an open femur fracture and an unstable pelvis after falling 15 feet. They are conscious and responsive to verbal stimuli. The vital signs are BP 86/42, P 136, R 24, and SpO# 92% on room air. The patient has which of the following types of shock? Select the two correct options.
- A. Hypovolemic
- B. Distributive
- C. Decompensated
- D. Compensated
- E. Obstructive
正解：A、C
解説：
Comprehensive and Detailed Explanation From Exact Extract:
This is a classic presentation ofhypovolemic shockdue to traumaticblood loss(open femur fracture, pelvic instability). Indicators include:
* Low BP (86/42)= hypotension
* High pulse (P 136)= compensation
* Mental status decline (responsive only to voice)= indicatesdecompensatedshock Obstructive and distributive shock are not applicable. Compensated shock would shownormal BPandalert mental status.
References:
NREMT Shock Management and Trauma Guidelines
National EMS Education Standards - Hemorrhagic and Non-Hemorrhagic Shock AAOS EMT Textbook - Chapter: Types of Shock
質問 # 28
You have achieved ROSC (Return of Spontaneous Circulation) in a 77-year-old female. She remains unresponsive and her vital signs are BP 94/58, P 82, and R 18. In what position should she be placed?
- A. Supine
- B. Left lateral recumbent
- C. Head elevated 45°
- D. Trendelenburg
正解：B
解説：
Comprehensive and Detailed Explanation From Exact Extract:
AfterROSCin an unresponsive patient, theleft lateral recumbent position(also called the recovery position) is preferred to:
* Maintain an open airway
* Prevent aspiration if vomiting occurs
* Promote drainage of secretions
Supine or Trendelenburg positions increase the risk of aspiration. Elevating the head to 45° may reduce intracranial pressure, but it's not standard post-ROSC care in an unresponsive patient unless airway protection is ensured.
References:
NREMT Cardiology Guidelines - Post-Resuscitation Care
American Heart Association BLS/ACLS Algorithms - ROSC Protocol
EMS Education Standards - Transport Positioning
質問 # 29
Heat exhaustion is most frequently associated with
- A. Altered mental status
- B. Bradycardia
- C. Hypovolemia
- D. Hypertension
正解：C
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Heat exhaustionresults from prolonged exposure to elevated temperatures, leading tofluid and electrolyte loss(especially sodium and water), causinghypovolemia. This can result in:
* Tachycardia
* Weakness
* Dizziness
* Profuse sweating
Unlikeheat stroke, mental status is typically preserved in heat exhaustion. Hypertension and bradycardia are not characteristic.
References:
NREMT Environmental Emergencies Module
National EMS Education Standards - Heat-Related Illnesses
AAOS Emergency Care (11th ed.), Chapter: Environmental Emergencies
質問 # 30
A 30-year-old patient has a stab wound to the left forearm that is bleeding profusely. Which of the following interventions should the EMT perform first?
- A. Determine severity of wound
- B. Apply direct pressure
- C. Place a tourniquet
- D. Assess the airway
正解：B
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Thefirst step in hemorrhage controlfor external bleeding is alwaysdirect pressureusing gloved hands or dressing. Only if this fails or the bleeding issevere and life-threatening(especially from extremities) should a tourniquetbe applied.
Assessing the airway is critical in overall trauma care but not thefirst priorityin isolated extremity hemorrhage. Severity assessment is secondary tobleeding control.
References:
NREMT Trauma Skills: Bleeding Control/Shock
Tactical Combat Casualty Care (TCCC) Guidelines - Hemorrhage Management National EMS Education Standards - Soft Tissue Injuries
質問 # 31
Defusing sessions should do which of the following in order to be successful? Select the two correct options.
- A. Have mental health experts present during the session
- B. Allow the open sharing of information
- C. Be held immediately following an incident
- D. Force all providers to provide feedback
- E. Take place 72 hours or more following an incident
正解：B、C
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Defusingis an informal, short-term intervention after acritical incident. It should:
* Occur within hoursof the event (ideally the same shift)
* Encourage voluntary open discussionin a confidential setting
It isnot a full debriefor counseling session and doesn't requiremental health professionalspresent. Forcing participation or waiting too long (e.g., 72+ hours) can reduce its effectiveness.
References:
NREMT EMS Operations - Critical Incident Stress Management (CISM)
International Critical Incident Stress Foundation (ICISF) Guidelines
National EMS Education Standards - Mental Health and Stress Response
質問 # 32
Which of the following components can be determined by assessing the mechanism of injury? Select the two correct options.
- A. Extent of injury
- B. Chances of survival
- C. Need for additional resources
- D. Patient's medical history
- E. Destination facility
正解：A、C
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Mechanism of Injury (MOI)assessment is a cornerstone of trauma care. It helps providers determine:
* Extent of injury: High-speed collisions, falls from height, or penetrating trauma suggest internal injuries even if external signs are limited.
* Need for additional resources: MOI may indicate the necessity ofALS backup,air transport, or technical rescue.
MOI cannot determine a patient'smedical historyor guarantee survival predictions. Thedestination facility depends on multiple factors including triage protocols, vital signs, and local trauma system regulations.
References:
NREMT Trauma Assessment Skills Sheet
National EMS Education Standards - Trauma Module
AAOS Emergency Care and Transportation (11th ed.), Chapter: Mechanism of Injury and Trauma Assessment
質問 # 33
A mountain climber tells you that he came down from a hike because he was coughing up blood. You should suspect
- A. Neoplasm
- B. Pulmonary edema
- C. Pulmonary embolism
- D. Spontaneous pneumothorax
正解：C
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Hemoptysis (coughing up blood)in a physically active person, such as a mountain climber, strongly suggests apulmonary embolism (PE), particularly due to:
* Dehydration
* Prolonged exertion or immobility
* High altitude increasing clot risk
Symptoms may include:
* Shortness of breath
* Chest pain
* Tachypnea
* Hemoptysis
Pulmonary edemagenerally causes pink frothy sputum and is more associated with heart failure.Neoplasm (lung cancer)is possible but much less acute in onset.Spontaneous pneumothoraxcauses dyspnea and pleuritic chest pain but not typically hemoptysis.
References:
NREMT Medical Assessment - Pulmonary and Hematologic Emergencies
AAOS EMT Textbook - Chapter: Respiratory Emergencies
CDC Guidelines - High-Risk Conditions for Pulmonary Embolism
質問 # 34
A 27-year-old patient reports trouble breathing after being struck by a car. Which of the following findings are indicative of a possible chest wall injury? Select the three answer options that are correct.
- A. Occipital depression
- B. Subcutaneous emphysema
- C. Clavicle deformity
- D. Epigastric distension
- E. Unequal rise and fall
- F. Jugular vein distention
正解：B、C、E
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Clavicle deformity suggests potential rib or thoracic trauma. Unequal chest rise may indicate a flail segment, pneumothorax, or hemothorax. Subcutaneous emphysema, the presence of air under the skin, is a classic finding in pneumothorax or tracheobronchial injury.
Occipital depression is not chest related; epigastric distension is a GI symptom; and jugular vein distention would suggest tension pneumothorax or cardiac tamponade, which are more advanced complications.
References:
NREMT Trauma Assessment Guidelines
National EMS Education Standards - Chest Injuries
AAOS Emergency Care and Transportation (11th ed.), Chapter: Chest and Abdominal Trauma
質問 # 35
An unresponsive 79-year-old female has agonal respirations. You should
- A. Begin chest compressions
- B. Open her airway and ventilate her with a BVM
- C. Open her airway and suction until clear
- D. Check for a pulse
正解：D
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Agonal respirations arenot effective breathingand can mimic gasping or snorting. They often occur in cardiac arrest. However, before initiating chest compressions, the EMT mustconfirm pulselessnessby checking acarotid pulse for no more than 10 seconds(AHA 2020 BLS Guidelines).
Only after pulse confirmation (or absence) should compressions begin. Suctioning or ventilating is premature unless a pulse is found.
References:
AHA BLS Provider Manual (2020) - Adult Basic Life Support Algorithm
NREMT Cardiac Arrest Management - Adult Assessment Flow
AAOS EMT Textbook - Chapter: Cardiac Arrest and Resuscitation
質問 # 36
A 58-year-old patient reports chest pain and difficulty breathing after missing their last three hemodialysis treatments. Which of the following signs and symptoms should the EMT suspect to find?
- A. Fever
- B. Crackles
- C. Bradycardia
- D. Hypotension
正解：B
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Missing dialysis leads tofluid overload, causing:
* Pulmonary edema, evident bycrackleson auscultation
* Dyspnea and chest discomfort
Bradycardia is less likely; patients more often present withtachycardiadue to volume stress. Fever would suggest infection (not stated here), and hypotension can occur later, but hypertension is more common in early fluid overload.
References:
NREMT Medical Emergencies - Renal and Dialysis Patients
National Kidney Foundation Guidelines - Missed Dialysis and Pulmonary Symptoms AAOS EMT Textbook - Urologic and Fluid Volume Imbalance
質問 # 37
A 24-year-old patient was involved in an MVC. The EMT is completing the patient care report. Which of the following statements indicate pertinent negatives? Select the two correct options.
- A. "The patient initially refused assessment."
- B. "The patient reported no loss of consciousness."
- C. "The patient reported abdominal tenderness."
- D. "The patient was disruptive and non-compliant with EMS."
- E. "The patient denied neck or back pain."
正解：B、E
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Pertinent negativesare findings that arenot present, butwould be clinically relevant if they were. For example:
* "No neck or back pain"helps rule out spinal injury
* "No loss of consciousness"informs head trauma assessment
Statements about behavior or initial refusal (B, E) may be documented under patient behavior or refusal, but they are not pertinent negatives. Positive findings like abdominal tenderness arepertinent positives.
References:
NREMT Documentation Standards
National EMS Education Standards - Communication and Documentation
Brady Emergency Care (13th ed.) - Patient Care Reporting
質問 # 38
Which of the following would potentially complicate patient care during a helicopter transport?
- A. Position of the patient's head within the aircraft
- B. Maintaining 98% oxygen saturation
- C. Increase in the atmospheric humidity
- D. Use of air splints to immobilize fractures
正解：A
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Theposition of the patient's headwithin the aircraft affectsaccess to airway managementandcrew maneuverability. If the head is oriented away from providers or toward a non-accessible bulkhead, this can delay critical interventions(airway suctioning, ventilations).
Use of air splints, maintaining oxygen saturation, or environmental humidity are not major complications relative tophysical positioningandin-cabin access limitations.
References:
NREMT EMS Operations - Air Medical Transport
NAEMSP (National Association of EMS Physicians): Air Medical Guidelines EMS Helicopter Safety Protocols - FAA Advisory Circulars
質問 # 39
Which of the following actions are appropriate management for two-rescuer pediatric basic life support? Select the three correct options.
- A. Compress the chest one-half the diameter of the chest
- B. Perform compressions at a ratio of 15:2
- C. Perform rescue breathing at a rate of 20 per minute
- D. Start CPR if the pulse rate is 72
- E. Compress at a rate of 180 per minute
- F. Use the two-thumb-encircling-hands technique for infants
正解：A、B、F
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Forpediatric BLS with two rescuers, currentAHA Guidelines (2020)recommend:
* Two-thumb encircling hands technique: Most effective for infants; provides consistent depth and control.
* Compression ratio of 15:2: Enhances ventilation without compromising perfusion.
* Compression depth: 1/3 of chest or approximatelyone-half the chest's depth.
CPR begins ifpulse <60 bpm with signs of poor perfusion, not at 72 bpm. Rate of180/minis excessive; ideal rate is100-120/min.
References:
AHA BLS Provider Manual (2020) - Pediatric BLS Section
NREMT Cardiology & Resuscitation Module
Pediatric Advanced Life Support (PALS) Guidelines
質問 # 40
Reassessment of a patient begins with repeating the
- A. Primary survey
- B. Scene size-up
- C. Secondary assessment
- D. Vital signs
正解：A
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Thereassessment phasein the EMT patient assessment model starts with repeating theprimary survey(also called the primary assessment), which includes:
* Airway
* Breathing
* Circulation
* Disability (mental status)
* Exposure/environment
The purpose is to identify any changes or deterioration in the patient'slife-threatening conditions, especially in dynamic or unstable patients. Only after this do EMTs check vitals and reevaluate secondary complaints.
References:
NREMT Assessment Guidelines - Patient Reassessment
Brady Emergency Care (13th ed.), Chapter: Assessment in EMS
National EMS Education Standards - Patient Assessment
質問 # 41
A 67-year-old patient reports crushing chest pressure. The vital signs are BP 156/98, P 64, R 14, and SpO2 94%. What treatments should the EMT provide first? Select the two correct options.
- A. Give aspirin
- B. Administer oxygen
- C. Assist with nitroglycerin
- D. Lay the patient supine
- E. Apply CPAP
正解：A、B
解説：
Comprehensive and Detailed Explanation From Exact Extract:
The patient's symptoms are consistent withacute coronary syndrome (ACS). Thefirst-line treatmentsare:
* Aspirin(160-325 mg): inhibits platelet aggregation, reducing clot progression.
* Oxygen: administered when SpO# <94% or signs of hypoxia/distress are present.
CPAPis for pulmonary edema or respiratory failure.Nitroglycerinrequires BP >90 systolic and medical direction approval. Laying the patient supine may increase myocardial workload and is inappropriate unless hypotension occurs.
References:
NREMT Cardiology and Resuscitation Guidelines
AHA ACLS Provider Manual (2020) - Acute Coronary Syndrome Treatment
National EMS Education Standards - Cardiovascular Emergencies
質問 # 42
A 42-year-old male states, "I can't breathe" after being shot in his upper thigh. Bystanders have applied direct pressure to his thigh and the bleeding is controlled. You should first
- A. Administer oxygen
- B. Apply a tourniquet
- C. Replace the bystander's dressing with sterile gauze
- D. Assess for other life-threatening injuries
正解：A
解説：
Comprehensive and Detailed Explanation From Exact Extract:
Thepatient's complaint of difficulty breathingis anairway/breathing issueand takes precedence over a controlled extremity bleed. The first action is toadminister oxygenand evaluate respiratory effort.
Though reassessing the wound is important,oxygenation is the prioritywhen airway compromise or respiratory distress is present. Tourniquets are foruncontrolled bleeding, which is not the case here.
References:
NREMT Trauma Assessment Guidelines
National EMS Education Standards - Primary Assessment Priorities
Brady Emergency Care (13th ed.) - Chapter: Patient Assessment
質問 # 43
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