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Free NREMT practice questionsFree AEMT practice questions · Medical/Obstetrics/Gynecology

10 free AEMT practice questions: Endocrine Emergencies Beyond Diabetes

These are real questions from the same bank the app draws from. Each one is written to the NREMT AEMT content specifications and kept inside the AEMT scope of practice. Pick an answer and you get the full rationale, including why the other three options are wrong.

Work through all 10, then move on to the next topic. When you want the full picture, the free AEMT diagnostic covers every topic in one sitting. No account needed for any of it.

Question 1 of 10

An AEMT is caring for a 46-year-old patient in thyroid storm with a temperature of 104.6°F, agitation, and warm moist skin. Intravenous access is established and isotonic crystalloid is running per protocol. Which cooling approach fits this patient?

Show the answer and rationale

Correct answer · Remove excess clothing, apply cool compresses, and cool the compartment

This patient is in thyroid storm with a temperature of 104.6°F, and passive cooling is the right cooling for the field. Take off the excess clothing, put cool compresses on, and cool down the patient compartment. The patient's body is making too much heat. Passive cooling pulls that heat out without doing anything that could make the thyroid storm worse. Passive cooling is also cheap and starts the moment you decide to do it. Start the cooling right away, alongside the oxygen, the fluid, the cardiac monitor, and a quick departure.

Why the others are wrong

Immerse the patient in an ice water bath before loading for transport: Ice water immersion pulls heat out fast. Immersion is more than this patient needs. You also cannot do an ice water bath in a moving ambulance, and passive cooling is the field treatment for thyroid storm.

Delay cooling and give a cool intravenous fluid bolus instead: Fluid treats dehydration, and the fluid running now is part of this patient's care. Fluid is not a way to cool the patient. Giving a bolus instead of cooling leaves the temperature at 104.6°F.

Cool only after the agitation is controlled and the patient is still: Waiting for a calm patient sounds safer for the crew, and agitation does make care harder. The agitation is part of the thyroid storm. Waiting for the agitation to settle means waiting on the same problem you are trying to treat.

Question 2 of 10

A 16-year-old patient with treated hyperthyroidism is agitated and confused two days after a wisdom tooth extraction, with a fever and a racing heart. A parent reports the patient has taken every dose of the thyroid medication on schedule. The vital signs are BP 138/54, P 158, R 28, T 104.1°F, and SpO₂ 98% on room air. Which part of the history most likely tipped this patient into thyroid storm?

Show the answer and rationale

Correct answer · The recent surgery, which is a known trigger in a hyperthyroid patient

The wisdom tooth extraction two days ago most likely tipped this patient into thyroid storm. Thyroid storm almost always starts with a patient who is already hyperthyroid plus a trigger. The triggers are infection, trauma, surgery, or stopping the thyroid medication. The parent says the patient has taken every dose on schedule, so stopping the medication is ruled out. The surgery is the trigger left. Surgery is trauma plus anesthesia. In a hyperthyroid patient, surgery can push the metabolic rate higher than the organs can handle. The fever of 104.1°F is something the thyroid storm produced.

Why the others are wrong

The age of the patient, since storms are most common in adolescence: Age changes a lot of things in medicine, so checking the age is a good habit. Thyroid storm comes from a trigger acting on a hyperthyroid patient. No age starts a thyroid storm on its own.

The dose schedule, since taking every dose can build the hormone up: Checking the medication history is the right first step. Stopping the thyroid medication is what triggers a storm. Taking every dose on schedule keeps the thyroid under control.

The fever, since a rising temperature is what starts the storm: The fever is the most dramatic number in this call. Hyperthermia is the body running hotter because of the thyroid storm. The fever is a result of the storm, not the trigger.

Question 3 of 10

A 78-year-old patient is found unresponsive at home in an unheated house in January. The skin is dry, coarse, and puffy across the face and hands, and there is no shivering. Breathing is slow and shallow. The vital signs are BP 92/58, P 46, R 8, T 89.4°F, and SpO₂ 89% on room air. Which condition best accounts for this whole picture?

Show the answer and rationale

Correct answer · Myxedema coma, the metabolic throttle barely moving

This patient is in myxedema coma, and the cold house pushed the patient into it. Myxedema coma is severe hypothyroidism. The temperature is 89.4°F, the pulse is 46, and the breathing is 8 and shallow. Cold exposure alone could explain a cold, slow patient, but not this patient's skin. The skin is dry, coarse, and puffy across the face and hands. Dry, coarse skin with puffy, non-pitting swelling comes from the thyroid, not from the cold. The lack of shivering fits both conditions. Shivering can also stop in plain hypothermia at this temperature. The skin is what separates myxedema coma from plain hypothermia.

Why the others are wrong

Environmental hypothermia alone from an unheated house in winter: An unheated house in January makes environmental hypothermia the obvious answer, and the cold exposure is part of what happened. A cold, slow patient with no shivering at 89.4°F fits plain hypothermia too. Cold exposure does not explain dry, coarse, puffy skin across the face and hands. The skin points to the thyroid.

Opioid overdose, given the slow breathing and the depressed mental state: A respiratory rate of 8 with a depressed mental status fits an opioid overdose, and checking the pupils is worth doing. An opioid overdose does not make the skin dry, coarse, and puffy across the face and hands.

Hypoglycemia, which produces cold skin and a depressed mental state: Checking a glucose on this patient is correct, and you should do it. A low glucose does not make the skin dry, coarse, and puffy. Myxedema coma often comes with a low glucose, so a low reading would not change the answer.

Question 4 of 10

An AEMT is treating a 70-year-old patient with suspected myxedema coma. Ventilation support is running, the patient is dry and insulated, and the compartment is warm. The vital signs are BP 96/58, P 46, R 10 with ventilation support, and SpO₂ 96%. Which assessment should the AEMT complete next?

Show the answer and rationale

Correct answer · A blood glucose level, since low glucose commonly rides along

This patient has suspected myxedema coma, and the next check is a blood glucose. Always check a glucose in a suspected endocrine emergency. In myxedema coma, low glucose and low sodium commonly come along with the thyroid failure. Low glucose is the one you can fix in the field. A glucose check also keeps you from locking onto one answer too early. This patient is cold and slow and looks like a thyroid problem. A glucose of 38 would change what you do over the next ten minutes. The check costs one finger stick.

Why the others are wrong

A 12-lead electrocardiogram tracing to transmit to the receiving hospital: A 12-lead tracing is within AEMT practice and is worth getting on this patient. The 12-lead does not come before the one number you can correct in an endocrine emergency.

A pupil check to grade the depth of the depressed mental state: A pupil check is part of a neurologic exam, and checking the pupils is reasonable. The pupils will not show you anything you can treat here.

A temperature recheck to confirm the rewarming is working: Rechecking the temperature tells you whether the passive rewarming is working, and the trend matters on a long transport. A trend on a number you are already treating is worth less than a number you have not measured yet.

Question 5 of 10

An AEMT has given a 59-year-old patient in suspected adrenal crisis two 500 mL boluses of isotonic crystalloid. The lung sounds remain clear and the systolic pressure has moved from 74 to 80. The vital signs are BP 80/48, P 120, R 22, and SpO₂ 96% on room air. Which statement describes what this response to fluid means?

Show the answer and rationale

Correct answer · A poor response to fluid is the defining feature of this condition

This patient is in adrenal crisis, and a poor response to fluid is what adrenal crisis does. After two 500 mL boluses, the systolic pressure only moved from 74 to 80. The pressure is still 80/48 with a pulse of 120. In adrenal crisis the body has lost cortisol and aldosterone. Those hormones hold on to sodium and keep the blood vessels tight. Without them the vessels stay loose, and more fluid cannot tighten them back up. That poor response to fluid confirms the diagnosis. This patient needs IV hydrocortisone at the hospital. Do not delay transport to keep chasing the pressure with more fluid on scene.

Why the others are wrong

The fluid is working and a third bolus will finish the job: A pressure going from 74 to 80 can look like the fluid is starting to work. After two boluses, the pressure is still 80/48 and the pulse is still 120, so the shock has not changed. More fluid does not fix adrenal crisis. The fix is IV steroids at the hospital.

The pressure cuff is reading low and should be rechecked manually: Rechecking the pressure by hand is the right move when a cuff reading does not match how the patient looks. This reading does match. A pulse of 120 and respirations of 22 go right along with a pressure of 80/48.

The bleeding source has not been found and fluid is masking it: Looking for a hidden bleed makes sense when fluid does not bring the pressure up and you have no clear cause. Nothing in this patient points to bleeding. The pressure did come up from 74 to 80, so the fluid is not hiding a bleed. Fluid alone just cannot bring back the vessel tone the missing hormones were holding.

Question 6 of 10

A first responder hands over a 58-year-old patient as dehydration from a stomach bug and reports that fluid is all that is needed. The AEMT finds the patient weak and unable to sit up, a systolic pressure that has not moved after a liter of crystalloid, clear lung sounds, and a bottle of prednisone on the counter. The vital signs are BP 78/44, P 126, R 22, and SpO₂ 97% on room air. Which action best reflects sound clinical judgment here?

Show the answer and rationale

Correct answer · Revise the impression to adrenal crisis and request a paramedic intercept

This patient is in adrenal crisis, not dehydration from a stomach bug. The first responder's label does not fit what you are finding. After a liter of crystalloid, the systolic pressure has not moved. The patient is too weak to sit up. There is a bottle of prednisone on the counter. Long-term prednisone suppresses the patient's own adrenal glands. When the patient gets sick, the adrenal glands cannot make enough hormone to hold the pressure up. Taking on the last provider's label without checking it is called handoff bias. At AEMT level, changing the plan means escalating the airway if needed, rethinking the fluid, and requesting a paramedic intercept. Repeating fluid that already failed is not a change in plan. Say the new impression out loud on the radio, because the hospital gets ready for the label you give them.

Why the others are wrong

Continue the fluid plan the first responder started and reassess later: Sticking with another provider's plan makes sense when the plan is working, and undoing a plan for no reason is poor practice. Here the plan has already failed in front of you. The pressure did not move after a liter, and there is a prednisone bottle on the counter.

Document the handoff impression and let the hospital sort out the cause: Documenting the handoff impression is correct, and you should write down what you were told. Passing that label on unchanged while your own findings say otherwise is the handoff bias itself. The hospital loses time getting ready for the wrong problem.

Repeat the liter of crystalloid, since the first one has not finished working: Another liter is the usual move when a pressure has not come up yet. This pressure did not move after the first liter. A pressure that does not respond to fluid is a reason to look past simple dehydration. Adrenal crisis needs steroid replacement at the hospital, and fluid alone does not replace the missing hormone.

Question 7 of 10

A 68-year-old patient with a history of hypothyroidism is found unresponsive to voice in a cool home. The skin is dry, coarse, and puffy, and the patient is not shivering. The vital signs are BP 96/58, P 44, R 6 and shallow, T 89°F, and SpO₂ 84% on room air. The blood glucose level is 62 mg/dL. Which action is the priority?

Show the answer and rationale

Correct answer · Begin positive pressure ventilations

This patient is in myxedema coma, which is a severe low thyroid emergency. This patient has a history of hypothyroidism and was found in a cool home. The skin is dry, coarse, and puffy, the pulse is 44, and the temperature is 89°F. Everything in the body runs cold and slow, and the breathing is what kills first. These patients breathe too slowly and hold on to carbon dioxide. A respiratory rate of 6 with an SpO₂ of 84% is not moving enough air to keep this patient alive. Airway and breathing come before the warming, before the glucose of 62, and before the move to the ambulance. Take over the breathing with positive pressure ventilations first. When you do warm this patient, put the warm packs on the trunk, not the arms and legs. Warming cold arms and legs sends cold, acidotic blood back to a heart that is already irritable.

Why the others are wrong

Apply warm packs and cover with blankets: Warm packs and blankets are part of the care for a cold patient. Warming does nothing for a patient who is not moving air. This patient is breathing 6 times a minute with an SpO₂ of 84%. The warming happens alongside ventilation, not ahead of it.

Give 0.4 mg of naloxone intravenously: Naloxone is for an opioid overdose, which also causes slow, shallow breathing and a decreased level of consciousness. The dry, coarse, puffy skin, the temperature of 89°F, and the pulse of 44 point to a thyroid problem instead. Ventilation is what helps this patient either way.

Move the patient quickly to the ambulance: This patient does need to get out of the cold and into the ambulance. Moving the patient before you support the breathing leaves the patient hypoxic for the whole move. Rough handling is also a risk in a patient this cold.

Question 8 of 10

A 66-year-old patient with a thyroid history is moderately hypothermic at T 87°F and is not shivering. Positive pressure ventilations are already being delivered with high-concentration oxygen. The wet clothing has been cut away and the patient has been dried. Which rewarming action is indicated?

Show the answer and rationale

Correct answer · Apply warm packs to the trunk

This patient is moderately hypothermic at 87°F and is not shivering. Rewarming a patient this cold is aimed at the core. Put the warm packs on the trunk and wrap the patient, including under and around the head. Warming the arms and legs first opens up the blood vessels in the limbs. Cold, acidotic blood from the limbs then flows back into the core. A cold heart is irritable, so move this patient gently and keep the patient horizontal. Cutting away the wet clothing and drying the patient stopped the heat loss. Both are already done here.

Why the others are wrong

Apply warm packs to the hands and feet: The hands and feet feel the coldest, so warming them seems like the right place to start. Warm packs on the hands and feet send cold, acidotic blood back into the core. This patient needs the core warmed first.

Massage the arms and legs to improve circulation: Massage sounds like a way to move warm blood around with no equipment. Rubbing the arms and legs warms the limbs first, and rubbing is rough handling. Rough handling is a risk of its own for a cold, irritable heart.

Immerse the feet in a basin of warm water: Warm water immersion does warm a patient well. Putting only the feet in warm water warms the wrong end of the patient. A moderately hypothermic patient needs the core warmed, not the limbs.

Question 9 of 10

An older adult patient is found unresponsive in a cold apartment after several days of poor oral intake. Assessment reveals hypothermia without shivering, bradycardia, hypotension, and slow, shallow respirations. Skin is dry, coarse, and puffy. Which action is the most appropriate field priority for this patient?

Show the answer and rationale

Correct answer · Support ventilation

This patient is in myxedema coma, the end stage of severe hypothyroidism that was never treated. This is an older adult after several days of poor eating and drinking. The patient has hypothermia with no shivering, bradycardia, hypotension, slow and shallow respirations, and dry, coarse, puffy skin. Breathing is the problem that will kill this patient first, so supporting ventilation comes first. Thyroid hormone sets how fast the body runs. With almost no thyroid hormone, every system slows down. The body makes less heat, so the patient gets cold. The shivering response is weak too. A cold patient who is not shivering is a sign of how sick the patient is, not a sign the patient is warm enough. The heart slows down and squeezes weaker, which gives you the bradycardia and the hypotension. The drive to breathe drops, and the breathing muscles get weak. The patient does not breathe enough and holds on to carbon dioxide. Rising carbon dioxide sedates the patient even more, and the breathing gets even worse. The cycle keeps going unless you breathe for the patient. Slow, shallow respirations mean the patient is not moving enough air, no matter what the pulse oximeter reads. This patient needs positive pressure ventilations, not just oxygen. Airway and breathing come before circulation and before fixing anything metabolic, the same as with any other patient.

Why the others are wrong

Begin aggressive active rewarming: Aggressive active rewarming is the wrong move for this patient. Warming the skin opens up the blood vessels near the surface, and the core temperature drops further. That drop is called afterdrop. Active rewarming can also make the hypotension worse in a patient whose heart is already slow and weak. Rewarm this patient passively. Get the patient out of the cold and cover them with blankets while you support the breathing.

Administer levothyroxine: Levothyroxine is the real treatment for the thyroid problem. Levothyroxine is a hospital medication, not an AEMT medication, and it takes hours to days to work. Levothyroxine does nothing for the breathing problem in front of you right now.

Administer dextrose before checking the airway: You should check a blood glucose. Hypoglycemia is common in myxedema coma, because the slowed metabolism makes less glucose. Airway and ventilation still come before dextrose. Giving a medication to an unresponsive patient before you manage the airway puts the primary assessment out of order.

Question 10 of 10

A 44-year-old patient with a history of a kidney transplant and long-term prednisone use has three days of weakness and abdominal pain. After a full liter of isotonic crystalloid solution, the vital signs are BP 80/50, P 122, R 20, SpO₂ 97%, and T 99.2°F. The blood glucose level is 92 mg/dL. The patient remains alert and is able to swallow safely. Which of the following is the most appropriate next action for the AEMT?

Show the answer and rationale

Correct answer · Request a paramedic intercept and begin rapid transport

This patient is in adrenal crisis. The patient has a kidney transplant, takes prednisone long term, and has had three days of weakness and abdominal pain. After a full liter of isotonic crystalloid, the blood pressure is still 80/50 and the pulse is 122. Taking steroids for a long time shuts down the body's own cortisol production. Under stress, the adrenal glands cannot put out enough cortisol. Without enough cortisol, the blood vessels cannot hold their tone. That's why the pressure did not come up with the fluid. A pressure that does not respond to fluid is a finding. It tells you the problem is not volume. This patient needs IV hydrocortisone at the hospital. Request a paramedic intercept, reassess the lung sounds, and transport rapidly.

Why the others are wrong

Administer a second liter of isotonic crystalloid solution: A second liter treats this as a volume problem. The first liter did not bring the pressure up, and the reason is the missing cortisol. Another bolus does not replace a missing hormone. Repeating a treatment that already failed does not change that.

Administer hydrocortisone from the patient's personal kit: Hydrocortisone does match the problem, because steroid replacement is what fixes adrenal crisis. Giving the hydrocortisone from the patient's personal kit is not an AEMT skill, and steroids are not on the AEMT medication list. Find out whether the patient took a dose, and tell the hospital about the kit at handoff.

Delay treatment until paramedic intercept arrives: Requesting a paramedic intercept is part of the care for adrenal crisis. Holding your care until the intercept arrives is not. Waiting on scene burns the transport time this patient needs, because the fix is at the hospital. Keep caring for the patient and start the transport.

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