SCFHS Paramedic Specialist exam questions

The Paramedic Specialist exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Paramedic Specialist practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Airway

   A 4-year-old child needs endotracheal intubation. Using the standard age-based formula, which cuffed tube size should be prepared?

   1. A3.5 mm internal diameter
   2. B4.5 mm internal diameter
   3. C5.5 mm internal diameter
   4. D6.0 mm internal diameter
   Show answer and explanation

   Correct answer: B. 4.5 mm internal diameter

   For cuffed tubes in children older than one year, internal diameter is estimated as age in years divided by 4 plus 3.5, which gives 4.5 mm at 4 years. The next smaller and larger sizes should also be available because the formula is only an estimate.

   Reference: AHA PALS Provider Manual (2020), Airway management

2. Question 2 · Trauma

   An adult with isolated severe traumatic brain injury is being transported. Which minimum systolic blood pressure target is recommended to prevent secondary brain injury?

   1. AAt least 80 mmHg
   2. BAt least 90 mmHg
   3. CAt least 110 mmHg
   4. DAt least 70 mmHg plus the patient's age
   Show answer and explanation

   Correct answer: C. At least 110 mmHg

   Even a single episode of hypotension doubles mortality after severe head injury, and current guidance supports maintaining systolic pressure at 110 mmHg or higher. A target of 90 mmHg was used in older guidelines but is now considered too low in this population.

   Reference: Brain Trauma Foundation Guidelines for Severe TBI, 4th ed. (2016); PHTLS: Prehospital Trauma Life Support, 10th ed. (NAEMT, 2023)

3. Question 3 · Trauma

   A worker has been trapped under rubble with a crushed leg for six hours. Before extrication is completed, which preparation reduces the risk of hyperkalaemia and kidney injury?

   1. AStart intravenous normal saline at 1 to 1.5 litres per hour before the limb is released
   2. BApply a tourniquet and release it slowly after 10 minutes
   3. CGive oral fluids and a high-potassium sports drink
   4. DWithhold intravenous fluids until the limb is free because they might worsen limb swelling
   Show answer and explanation

   Correct answer: A. Start intravenous normal saline at 1 to 1.5 litres per hour before the limb is released

   Release of a crushed limb floods the circulation with potassium, myoglobin and acid, so aggressive fluid loading before release protects the kidneys and heart. Cardiac monitoring is also required, and withholding fluid or giving potassium-rich drinks would increase the danger.

   Reference: Emergency Care in the Streets, 9th ed. (Nancy Caroline, Jones & Bartlett Learning, 2023), Crush injuries and syndromes

4. Question 4 · Shock and Resuscitation

   A man is pale and confused with a heart rate of 145 per minute, blood pressure 80/60 mmHg, respiratory rate 38 and little urine output after a road accident. Which class of haemorrhage does he have?

   1. AClass II, representing 15 to 30% of blood volume lost
   2. BClass IV, representing over 40% of blood volume lost
   3. CClass III, representing 30 to 40% of blood volume lost
   4. DClass I, representing less than 15% of blood volume lost
   Show answer and explanation

   Correct answer: B. Class IV, representing over 40% of blood volume lost

   A heart rate above 140, a low pressure, a respiratory rate above 35, confusion and negligible urine output together identify class IV haemorrhage, which is immediately life-threatening. In lesser classes the pressure is preserved and mental status is only mildly altered.

   Reference: ATLS Student Course Manual, 10th ed. (American College of Surgeons, 2018)

5. Question 5 · Shock and Resuscitation

   Which finding best distinguishes neurogenic shock from haemorrhagic shock after a cervical spinal cord injury?

   1. ABradycardia with warm, dry skin below the level of injury
   2. BTachycardia with cool, clammy skin and pallor below the injury
   3. CA narrowing pulse pressure with profound thirst
   4. DPallor with a rapidly falling haemoglobin result
   Show answer and explanation

   Correct answer: A. Bradycardia with warm, dry skin below the level of injury

   Loss of sympathetic tone causes vasodilatation and unopposed vagal activity, producing hypotension with a slow heart rate and warm, dry skin below the lesion. Haemorrhage elicits a reflex tachycardia with vasoconstriction, which gives the opposite picture, though both can coexist in multiple trauma.

   Reference: PHTLS: Prehospital Trauma Life Support, 10th ed. (NAEMT, 2023), Spinal trauma and neurogenic shock

6. Question 6 · Pediatrics and Neonates

   A 20 kg child is in ventricular fibrillation. What is the energy for the first defibrillation attempt?

   1. A40 J, which is 2 J/kg
   2. B20 J, which is 1 J/kg
   3. C80 J, which is 4 J/kg
   4. D200 J, which is the adult biphasic dose
   Show answer and explanation

   Correct answer: A. 40 J, which is 2 J/kg

   The recommended first dose in paediatric ventricular fibrillation is 2 J/kg, rising to 4 J/kg for later shocks, up to the adult maximum. Using an adult dose at the outset could cause myocardial injury, while too low an energy is less likely to terminate the rhythm.

   Reference: AHA PALS Provider Manual (2020), Cardiac arrest algorithm

7. Question 7 · OB/GYN

   During a breech delivery the umbilical cord is visible at the introitus before the infant. What is the most appropriate management?

   1. APush the cord back inside and encourage the mother to push
   2. BClamp and cut the cord immediately and continue the delivery
   3. CPosition the mother knee-chest, lift the presenting part off the cord and transport urgently
   4. DPlace the mother supine and wait for the contractions to deliver the infant naturally without help
   Show answer and explanation

   Correct answer: C. Position the mother knee-chest, lift the presenting part off the cord and transport urgently

   A prolapsed cord is compressed by the presenting part, so the infant's oxygen supply is at immediate risk. Relieving pressure by hand while keeping the mother in a knee-chest or exaggerated Sims position, and keeping the cord warm and moist, preserves blood flow until caesarean delivery is possible.

   Reference: Emergency Care in the Streets, 9th ed. (Nancy Caroline, Jones & Bartlett Learning, 2023), Abnormal deliveries

8. Question 8 · Medical Emergency

   A 75 kg man is seizing continuously for 8 minutes and intravenous access is unavailable. What is the preferred drug and route?

   1. AMidazolam 5 mg intramuscularly
   2. BMidazolam 10 mg intramuscularly
   3. CMidazolam 20 mg intramuscularly
   4. DPhenytoin 1 g intramuscularly
   Show answer and explanation

   Correct answer: B. Midazolam 10 mg intramuscularly

   For adults over 40 kg, intramuscular midazolam 10 mg stops status epilepticus effectively and is at least as good as intravenous lorazepam, as shown in the RAMPART trial. Intramuscular phenytoin is erratically absorbed and unsuitable.

   Reference: Silbergleit R et al., RAMPART, New England Journal of Medicine (2012)

9. Question 9 · Special Populations

   A 5-year-old has bruises in different stages of healing and a fracture. The caregiver gives a history that does not match the injuries. What should the paramedic do?

   1. AConfront the caregiver and accuse them of abuse at the scene
   2. BTreat the injuries and keep the suspicions private so that trust with the family is not damaged later
   3. CAsk the child to describe the cause repeatedly until clear
   4. DRecord findings and the history verbatim, transport, and notify the authority as protocol requires
   Show answer and explanation

   Correct answer: D. Record findings and the history verbatim, transport, and notify the authority as protocol requires

   When findings are inconsistent with the history, the paramedic's duty is to record facts without speculation, treat and transport the child, and escalate through the mandatory reporting pathway. Accusations can endanger the child and reduce cooperation, while silence leaves the child at continuing risk.

   Reference: Emergency Care in the Streets, 9th ed. (Nancy Caroline, Jones & Bartlett Learning, 2023), Abuse and neglect

10. Question 10 · Cardiac Emergency

    A patient with a pulse has a wide-complex regular tachycardia at 190 per minute, blood pressure 74/40 mmHg and altered consciousness. What is the treatment?

    1. AUnsynchronised defibrillation at the highest available energy setting
    2. BAdenosine 6 mg intravenously followed by 12 mg
    3. CIntravenous amiodarone given slowly over 24 hours
    4. DSynchronised cardioversion, with sedation if the patient is awake
    Show answer and explanation

    Correct answer: D. Synchronised cardioversion, with sedation if the patient is awake

    A tachycardia that causes shock or reduced consciousness is unstable and calls for immediate synchronised cardioversion, since drug therapy takes too long. Synchronisation avoids delivering a shock on the T wave, which could provoke ventricular fibrillation.

    Reference: AHA ACLS Provider Manual (2020), Tachycardia with a pulse

11. Question 11 · Cardiac Emergency

    A patient with ventricular fibrillation has received three shocks and epinephrine. Which drug is given next?

    1. AAmiodarone 150 mg as the first dose given
    2. BSodium bicarbonate 50 mmol as a routine intravenous bolus during arrest
    3. CAmiodarone 300 mg as an intravenous or intraosseous bolus
    4. DAtropine 3 mg as a single intravenous dose
    Show answer and explanation

    Correct answer: C. Amiodarone 300 mg as an intravenous or intraosseous bolus

    In shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, amiodarone 300 mg is given after the third shock, followed by a 150 mg dose if the rhythm persists. Routine bicarbonate and atropine are not recommended in this algorithm.

    Reference: AHA ACLS Provider Manual (2020), Cardiac arrest algorithm

12. Question 12 · Professionalism and Ethics

    A police officer at the scene asks the paramedic for the patient's diagnosis and medications for an unrelated enquiry. The patient has not consented. What is the correct response?

    1. ARelease the whole record at once because the request has come directly from a police officer
    2. BGive a full account verbally so that nothing is written down
    3. CRefuse every request even when a lawful order is shown
    4. DDisclose only what the law or protocol requires, or what is needed to prevent serious harm
    Show answer and explanation

    Correct answer: D. Disclose only what the law or protocol requires, or what is needed to prevent serious harm

    Patient information is confidential and is released without consent only where the law compels it or when disclosure is needed to protect someone from serious harm. Blanket disclosure breaches trust, but refusing a lawful order is also inappropriate, so the minimum necessary is shared and documented.

    Reference: Emergency Care in the Streets, 9th ed. (Nancy Caroline, Jones & Bartlett Learning, 2023), Legal and ethical issues