Paramedic Specialist Prometric exam questions with answers

1. Question 1Fundamentals and Operationseasy

   Your ambulance arrives at a roadside collision where fuel is leaking from one vehicle and a patient is visible inside. What should the crew do first?

   1. AApproach quickly and remove the patient before the fuel can ignite
   2. BPark beside the leaking vehicle to shield the patient from traffic
   3. CSwitch off the vehicle ignition then begin patient assessment inside the car
   4. DPark upwind and uphill, and request the fire service before approaching
   Show answer and explanation▾

   Answer: D. Park upwind and uphill, and request the fire service before approaching

   Scene safety comes before patient care, and fuel vapour is flammable and may drift downhill, so positioning upwind and uphill while calling for specialist support protects the crew. Rescuers who become casualties cannot help anyone. Entering the vehicle or parking close to the spill exposes the crew to the very hazard that must be controlled first.

2. Question 2Airwayeasy

   An unresponsive adult with no gag reflex needs an oropharyngeal airway. How is the correct size estimated?

   1. AFrom the tip of the nose to the lobe of the ear
   2. BFrom the upper incisors to the notch at the top of the sternum
   3. CFrom the point of the chin to the tip of the xiphoid process
   4. DFrom the corner of the mouth to the angle of the jaw
   Show answer and explanation▾

   Answer: D. From the corner of the mouth to the angle of the jaw

   An oropharyngeal airway is sized by measuring from the corner of the mouth to the angle of the jaw or earlobe so that the flange rests at the lips and the tip lies just above the epiglottis. Measuring from the nose to the earlobe is the method used for nasopharyngeal airways. A device that is too long can push the epiglottis down and obstruct the airway.

3. Question 3Disastermedium

   During a mass-casualty incident, a paramedic uses the START triage algorithm. An adult who cannot walk is breathing at 34 breaths per minute. Which triage category applies?

   1. ADelayed (yellow)
   2. BMinor (green)
   3. CImmediate (red)
   4. DExpectant (black)
   Show answer and explanation▾

   Answer: C. Immediate (red)

   In START triage, any patient who cannot walk and has a respiratory rate above 30 per minute is placed in the immediate category, because this finding signals a threat to life that is likely to be treatable. Delayed status is reserved for patients who pass the breathing, perfusion and mental-status checks but cannot walk. Expectant status applies only to those who remain apnoeic after the airway is opened.

4. Question 4Traumamedium

   A 30-year-old man has a stab wound to the right chest. He is cyanosed with severe dyspnoea, blood pressure 70/40 mmHg, absent right breath sounds, distended neck veins and tracheal deviation to the left. What is the most appropriate immediate intervention?

   1. ANeedle or finger decompression of the right hemithorax
   2. BPericardiocentesis through the subxiphoid approach
   3. CA three-sided dressing applied over the left chest wall
   4. DRapid fluid bolus and observation of the response
   Show answer and explanation▾

   Answer: A. Needle or finger decompression of the right hemithorax

   The combination of respiratory distress, shock, distended neck veins and unilateral absent breath sounds indicates a tension pneumothorax, which is relieved by decompressing the affected side. Delay allows the mediastinum to shift and cardiac output to collapse. Fluid alone does not treat the obstruction and the other options address different conditions.

5. Question 5Traumahard

   An intubated patient with severe traumatic brain injury has a Glasgow Coma Scale score of 6. There are no signs of herniation. What ventilation target is recommended?

   1. AHyperventilate steadily to an end-tidal value of 20 to 25 mmHg
   2. BAllow permissive hypercapnia with end-tidal values of 50 to 60 mmHg
   3. CKeep end-tidal carbon dioxide at 35 to 40 mmHg
   4. DUse the lowest tolerated rate so that carbon dioxide rises gradually
   Show answer and explanation▾

   Answer: C. Keep end-tidal carbon dioxide at 35 to 40 mmHg

   Carbon dioxide is a potent cerebral vasodilator, so hypocapnia reduces cerebral blood flow and can cause ischaemia while hypercapnia raises intracranial pressure. A normal end-tidal range is therefore targeted, with brief mild hyperventilation reserved for clear signs of herniation. Prolonged aggressive hyperventilation is associated with worse outcomes.

6. Question 6Shock and Resuscitationeasy

   What are the recommended rate and depth of chest compressions for an adult in cardiac arrest?

   1. A80 to 100 per minute, about 3 to 4 cm deep
   2. B120 to 140 per minute, to a depth of about 6 to 8 cm each time
   3. C60 to 80 per minute, about 2 to 3 cm deep
   4. D100 to 120 per minute, at least 5 cm but not more than 6 cm
   Show answer and explanation▾

   Answer: D. 100 to 120 per minute, at least 5 cm but not more than 6 cm

   Current resuscitation guidance recommends compressing at 100 to 120 per minute to a depth of 5 to 6 cm, allowing full chest recoil between compressions. Slower or shallower compressions generate inadequate coronary and cerebral perfusion, while excessive depth risks injury without added benefit.

7. Question 7Shock and Resuscitationhard

   A patient is resuscitated after a witnessed ventricular fibrillation arrest. Blood pressure is 78/40 mmHg and oxygen saturation is 100% on a non-rebreather mask at 15 L/min. Which approach is correct?

   1. AKeep maximum oxygen and hyperventilate to an end-tidal value of 25 mmHg
   2. BWean oxygen to a saturation of 92 to 98% and treat hypotension to keep mean pressure 65 mmHg or more
   3. CAccept a systolic pressure of 70 mmHg to avoid exposing the heart to vasopressors, and keep oxygen unchanged
   4. DWithhold oxygen entirely until a hospital arterial gas is available
   Show answer and explanation▾

   Answer: B. Wean oxygen to a saturation of 92 to 98% and treat hypotension to keep mean pressure 65 mmHg or more

   After return of spontaneous circulation, hyperoxia and hypocapnia are both harmful, so oxygen is titrated to a saturation of 92 to 98% and ventilation to normal carbon dioxide. Hypotension worsens brain and myocardial injury and should be corrected with fluid and vasopressors to keep mean arterial pressure at 65 mmHg or higher.

8. Question 8Environmental and Toxicologyeasy

   A farm worker who sprayed insecticide is drooling, tearful and wheezing, with pinpoint pupils and a heart rate of 48 per minute. Which antidote is indicated?

   1. ANaloxone titrated to the respiratory rate
   2. BAtropine titrated until bronchial secretions dry
   3. CFlumazenil given as a slow intravenous bolus
   4. DHydroxocobalamin given as an intravenous infusion
   Show answer and explanation▾

   Answer: B. Atropine titrated until bronchial secretions dry

   The picture of excess secretions, miosis, bradycardia and bronchospasm is a cholinergic toxidrome from organophosphate poisoning. Atropine blocks muscarinic effects and is titrated to drying of bronchial secretions rather than to heart rate or pupil size. The other antidotes act on opioid, benzodiazepine and cyanide toxicity.

9. Question 9Pediatrics and Neonatesmedium

   A 20 kg child is in asystole and intravenous access is established. What is the correct first dose of epinephrine?

   1. A2 mg, which is 20 mL of the 0.1 mg/mL concentration
   2. B0.2 mg, which is 2 mL of the 0.1 mg/mL concentration
   3. C0.02 mg, which is 0.2 mL of the 0.1 mg/mL concentration
   4. D1 mg, which is 10 mL of the 0.1 mg/mL concentration
   Show answer and explanation▾

   Answer: B. 0.2 mg, which is 2 mL of the 0.1 mg/mL concentration

   The paediatric dose of epinephrine in cardiac arrest is 0.01 mg/kg, so a 20 kg child receives 0.2 mg. At a concentration of 0.1 mg/mL this is 2 mL, repeated every 3 to 5 minutes. A tenfold overdose is a recognised error with the adult dose or the wrong concentration.

10. Question 10OB/GYNmedium

    A woman at 34 weeks of gestation has a generalised tonic-clonic seizure. Her blood pressure is 178/116 mmHg and she has marked ankle oedema. What is the first-line drug to stop the seizure and prevent recurrence?

    1. AMagnesium sulfate 4 g intravenously over 15 to 20 minutes
    2. BDiazepam 10 mg intravenously as the preferred anticonvulsant
    3. CPhenytoin 18 mg/kg intravenously as a loading infusion
    4. DNifedipine 10 mg sublingually as the sole treatment
    Show answer and explanation▾

    Answer: A. Magnesium sulfate 4 g intravenously over 15 to 20 minutes

    Hypertension, oedema and seizure in late pregnancy indicate eclampsia, for which magnesium sulfate is the anticonvulsant of choice and is superior to benzodiazepines or phenytoin in preventing recurrence. Antihypertensives are added to control severe pressure but do not treat the seizure itself. Respiratory rate and reflexes should be monitored for magnesium toxicity.

11. Question 11Medical Emergencymedium

    An unconscious patient with known diabetes has a capillary glucose of 1.8 mmol/L. Two attempts at intravenous access have failed. What is the best treatment?

    1. AOral glucose gel placed in the buccal pouch
    2. BA normal saline bolus through an intraosseous line only
    3. CGlucagon 1 mg intramuscularly
    4. DSubcutaneous insulin to correct the metabolic state
    Show answer and explanation▾

    Answer: C. Glucagon 1 mg intramuscularly

    A patient who cannot safely swallow needs parenteral treatment, and when intravenous access is not available glucagon given intramuscularly raises blood glucose from hepatic glycogen stores. Oral gel carries an aspiration risk in the unconscious, saline does not supply glucose, and insulin would worsen the hypoglycaemia.

12. Question 12Special Populationshard

    An 80-year-old woman who takes bisoprolol has a pelvic fracture after a fall. Her heart rate is 74 per minute and blood pressure 104/62 mmHg, whereas her usual pressure is 160/90 mmHg. How should these findings be interpreted?

    1. AShe may be in significant shock despite near-normal vital signs
    2. BShe is haemodynamically stable and needs no fluid or binder
    3. CThe low heart rate excludes bleeding as a cause of the injury
    4. DThe pressure is acceptable because it is above 100 mmHg systolic
    Show answer and explanation▾

    Answer: A. She may be in significant shock despite near-normal vital signs

    Beta-blockers blunt the tachycardia that normally signals blood loss, and a chronically hypertensive older patient with a pressure far below her baseline may already be hypoperfused. Geriatric trauma patients therefore deteriorate with apparently reassuring numbers, and early binder application and rapid transport are warranted.

13. Question 13Cardiac Emergencyhard

    A 70-year-old patient has a heart rate of 38 per minute, blood pressure 70/40 mmHg, confusion and third-degree atrioventricular block. Atropine 1 mg has had no effect. What is the next step?

    1. AA second dose of atropine 1 mg, followed by observation of the response for effect
    2. BTranscutaneous pacing while preparing a dopamine or epinephrine infusion
    3. CSynchronised cardioversion at 100 joules
    4. DAdenosine 6 mg by rapid intravenous push
    Show answer and explanation▾

    Answer: B. Transcutaneous pacing while preparing a dopamine or epinephrine infusion

    Symptomatic bradycardia unresponsive to atropine should be managed with transcutaneous pacing or a chronotropic infusion, and atropine is often ineffective in high-grade block below the node. Cardioversion and adenosine are treatments for tachyarrhythmias and would be inappropriate.

14. Question 14Patient Safetyeasy

    Which action best reduces the risk of giving treatment to the wrong patient at a multi-patient scene?

    1. AUse two identifiers, such as full name and date of birth, before treating or transferring
    2. BRely on the bed or stretcher position when handing over
    3. CAsk a bystander who appears to know the patient to confirm their identity verbally at the scene
    4. DUse the first name written on the dispatch card only
    Show answer and explanation▾

    Answer: A. Use two identifiers, such as full name and date of birth, before treating or transferring

    Using at least two independent patient identifiers is the standard safeguard against identification errors, because a single identifier or a location is easily mistaken at a busy scene. Positional cues and bystander recall are unreliable and have caused misidentification in practice.

15. Question 15Professionalism and Ethicsmedium

    A competent adult with chest pain has been told of the risks and refuses transport. What is the best action?

    1. ATransport under implied consent despite the explicit refusal
    2. BAsk a relative to sign the refusal in place of the patient
    3. CDocument the capacity assessment, the risks explained and the refusal, and advise on recontacting EMS
    4. DLeave the scene promptly and complete the record later from memory, without noting which risks were discussed
    Show answer and explanation▾

    Answer: C. Document the capacity assessment, the risks explained and the refusal, and advise on recontacting EMS

    A competent adult has the right to refuse care once the risks have been explained, and the paramedic's duty is to confirm capacity, give clear information, and keep a contemporaneous record. Overriding the patient or substituting a relative's signature is not lawful, and omitting documentation leaves the patient and crew unprotected.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.