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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.

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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

Passive cooling is the field move, and the lesson spells out what it looks like: get the excess clothing off, put cool compresses on, and drop the temperature of the compartment you are working in. You are pulling heat out of a body that is generating too much of it, using nothing that could make the storm worse. It runs alongside the oxygen, the fluid for the dehydration, the cardiac monitoring, and a prompt departure, rather than after them. Passive cooling is cheap, it starts the moment you decide to do it, and nothing about this patient gives you time to stage it.

Why the others are wrong

Immerse the patient in an ice water bath before loading for transport: Ice water immersion moves heat fast, which is exactly why it looks like the aggressive right answer. It goes past what this patient needs, it is not something a moving ambulance can do, and the lesson calls for passive cooling.

Delay cooling and give a cool intravenous fluid bolus instead: Fluid is genuinely part of the care here, because the vomiting and diarrhea have dehydrated this patient. Fluid is not a cooling method, and substituting it means the temperature stays where it is.

Cool only after the agitation is controlled and the patient is still: Waiting for a calmer patient sounds safer for the crew, and agitation does make care harder. The agitation is part of the storm, so waiting for it to settle means waiting for the thing 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

Thyroid storm almost always starts with a known hyperthyroid patient plus something that tips them over, and the lesson gives you the list: infection, trauma, surgery, or stopping their thyroid medication. The parent has already ruled out the medication half, which leaves the procedure two days ago. Surgery is trauma with an anesthetic on top of it, and in a patient whose throttle is already running fast that is enough to push the metabolic rate past what the organs can absorb. The fever is what the storm produced, not what produced the storm.

Why the others are wrong

The age of the patient, since storms are most common in adolescence: Age is a real modifier in a lot of medicine, so checking it is a good habit. Thyroid storm is defined by a trigger acting on a hyperthyroid patient, and no age range starts one on its own.

The dose schedule, since taking every dose can build the hormone up: Reading the medication list is exactly right and it is the first thing to check. Stopping the medication is what triggers a storm, while taking it on schedule is what keeps the throttle under control.

The fever, since a rising temperature is what starts the storm: The fever is the most dramatic number in front of you, which makes it easy to promote to a cause. Hyperthermia is the body literally burning hotter, which makes it a result rather than a 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

Cold and slow is half the answer, and the skin is the other half. Environmental hypothermia will hand you a cold, bradycardic patient with slow breathing, and in an unheated house in January that read is reasonable. What the environment does not do is make the skin dry, coarse, and puffy with non-pitting swelling of the face and hands. That is thyroid, and it is the finding that separates the two. Add the absence of shivering, which tells you the metabolic furnace is not producing heat, and you have myxedema coma with the cold house as the thing that pushed the patient into it.

Why the others are wrong

Environmental hypothermia alone from an unheated house in winter: The unheated house in January makes this the obvious read, and cold exposure is genuinely part of what happened. Exposure does not explain dry, coarse, puffy skin with swelling of the face and hands, which is what points at the thyroid.

Opioid overdose, given the slow breathing and the depressed mental state: A rate of 8 with a depressed mental status is the respiratory picture of an opioid, and checking the pupils is worth doing. An opioid does not drop a core temperature to 89.4°F or thicken the skin over months.

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 produce the puffy skin, the coarse texture, or a core temperature this low on its own.

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

Always check a glucose in a suspected endocrine emergency. In myxedema coma specifically, hypoglycemia and hyponatremia commonly ride along with the thyroid failure, and the low glucose is the one you can actually correct in the field. It also protects you from anchoring: the picture in front of you is cold and slow and it looks like thyroid, and a glucose of 38 would change your next ten minutes completely. A number you can fix costs one finger stick, so go get it.

Why the others are wrong

A 12-lead electrocardiogram tracing to transmit to the receiving hospital: Acquiring and transmitting a tracing is within AEMT practice and it is worth doing on this patient. It does not come before the one correctable number in an endocrine emergency.

A pupil check to grade the depth of the depressed mental state: Pupils are part of a neurologic exam and checking them is reasonable. They will not hand you anything you can treat here, and they are not what the lesson asks for in an endocrine emergency.

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

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

Hypotension that responds poorly to fluid is the defining feature of adrenal crisis, and recognizing it is most of the question. A hypotensive patient who does not respond to fluid is not a patient who needs more fluid, they are a patient whose problem was never volume. Aldosterone is part of what holds the vessels in tone, and without it a liter of crystalloid is chasing a leak you cannot plug in the field. Treat the non-response as a finding. It tells you what the problem is, and it tells you the fix lives at the hospital.

Why the others are wrong

The fluid is working and a third bolus will finish the job: A six-point rise looks like movement in the right direction, which is why the next bag is so tempting. The National Registry wants you to read that weak response as the finding it is, not as permission to keep pushing volume.

The pressure cuff is reading low and should be rechecked manually: Repeating a number that disagrees with the patient is a good habit, and a manual pressure is worth taking. This number agrees with a patient who is tachycardic, weak, and vomiting, so the reading is not the problem.

The bleeding source has not been found and fluid is masking it: Questioning a low pressure and hunting for blood is sound practice on many calls. Nothing here points at blood, and the fluid has not masked anything, since the pressure barely moved.

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

Handoff bias is inheriting the previous provider's label and treating it as established. You were handed dehydration, and the findings do not fit it: a pressure that will not move after a liter, weakness that keeps the patient flat, and a steroid bottle sitting on the counter. Changing the plan at AEMT scope means escalating the airway, changing the volume decision, or requesting a paramedic intercept, and it does not mean repeating an intervention that already failed. Name the new impression out loud, because the label you put on the radio is the one the hospital prepares for.

Why the others are wrong

Continue the fluid plan the first responder started and reassess later: Continuity of care is a real value and undoing another provider's plan for no reason is poor practice. The reason here is not nothing, since the plan has already failed in front of you and a new piece of history has appeared.

Document the handoff impression and let the hospital sort out the cause: Documenting what you were told is correct and you should do it. Passing a label along unchanged while your own findings contradict it is the definition of the bias, and it costs the hospital preparation time.

Repeat the liter of crystalloid, since the first one has not finished working: Another liter is the most common move on a pressure that has not come up, which is exactly why it is the trap. Fluid that fails is telling you the problem was never volume.

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

Myxedema coma is the whole body running cold and slow, and the part that kills first is the breathing. These patients hypoventilate and retain carbon dioxide, and a rate of 6 with a saturation of 84% is not moving enough air to keep anyone alive. Airway and breathing adequacy come before the warming, before the sugar, and before the move to the truck, so you take over the ventilation first. Rewarming here aims at the core, so warm packs belong on the trunk rather than the limbs, because warming cold arms and legs sends cold acidotic blood back toward a heart that is already irritable.

Why the others are wrong

Apply warm packs and cover with blankets: Warming a cold patient feels like the obvious first move, and warmth is genuinely part of the care. It does nothing for a patient who is not moving air, and the warming is a step you take alongside ventilation rather than ahead of it.

Give 0.4 mg of naloxone intravenously: Slow shallow breathing with a decreased level of consciousness is the opioid picture, so the reflex makes sense. The dry coarse puffy skin, the temperature of 89°F, and the pulse of 44 belong to a thyroid problem, and ventilation is what saves either patient anyway.

Move the patient quickly to the ambulance: The patient does need to come out of the cold and into the ambulance. Hurrying a severely cold, hypoventilating patient there before you support the breathing leaves them hypoxic for the whole move, and rough handling is its own risk in a cold patient.

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

Rewarming a moderately or severely hypothermic patient is aimed at the core, so warm packs go on the trunk and the patient gets wrapped, including under and around the head. Warming the arms and legs opens the peripheral circulation and sends cold, acidotic blood from the limbs back into the core, which is the result you are working to avoid. Handling is part of the treatment as well: a cold heart is irritable, so the patient is moved gently and kept horizontal. Cutting away the wet clothing and drying the patient, already done here, is what stopped the heat loss in the first place.

Why the others are wrong

Apply warm packs to the hands and feet: Cold hands and feet are the part you can feel, so they are the part you want to warm. Warming the extremities first returns cold acidotic blood to the core, which is the opposite of what this patient needs.

Massage the arms and legs to improve circulation: Rubbing looks like a way to move warm blood around with no equipment. It is peripheral rewarming and rough handling at the same time, and rough handling of a cold, irritable heart carries its own risk.

Immerse the feet in a basin of warm water: Immersion warms effectively, and aiming it at the feet 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

The picture: hypothermia without shivering, bradycardia, hypotension, slow and shallow respirations, and dry, coarse, puffy skin in an older adult after days of poor oral intake, is myxedema coma, the end stage of severe untreated hypothyroidism. The field priority is supporting ventilation, because that is the part of this presentation that will kill the patient first. The mechanism connects every finding to one cause. Thyroid hormone sets the body's metabolic rate, and in its near-absence every system slows. Heat production falls, which is why the patient is hypothermic and, critically, why there is no shivering: the shivering response itself is blunted, so the absence of shivering in a cold patient is a sign of severity rather than a sign that the patient is warm enough. The heart slows and contractility drops, producing the bradycardia and hypotension. Most importantly, the respiratory drive itself is depressed and the respiratory muscles weaken, so the patient hypoventilates and retains carbon dioxide. Rising carbon dioxide is itself sedating, which deepens the unresponsiveness and worsens the hypoventilation further: a loop that closes on its own unless ventilation is supported from the outside. That loop is why ventilation outranks everything else here, and it is the reasoning the item is testing. Slow, shallow respirations mean an inadequate minute volume regardless of what a pulse oximeter reads, so this patient needs positive pressure ventilations rather than only supplemental oxygen. Airway and breathing come before circulation and before any metabolic correction, exactly as in any other patient.

Why the others are wrong

Begin aggressive active rewarming: Aggressive active rewarming is contraindicated. Warming the skin dilates peripheral vessels and drops the core temperature further through afterdrop, and it can worsen hypotension in a patient whose heart is already slow and poorly contractile. Rewarming here is passive: remove the patient from the cold, insulate with blankets, while ventilation is supported.

Administer levothyroxine: Levothyroxine is the definitive treatment, but it is a hospital medication, not an AEMT-scope field intervention, and its effect takes hours to days. It does nothing for the ventilation problem in front of the AEMT right now.

Administer dextrose before checking the airway: A blood glucose level should be obtained, and hypoglycemia is common in myxedema coma because the metabolic slowdown impairs glucose production, so it is a real concern. Airway and ventilation always come before administering dextrose. Giving a medication to an unresponsive patient with an unsupported airway inverts the order of the primary assessment.

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 · Administer another bolus of isotonic crystalloid solution

Prehospital management of suspected adrenal crisis is supportive: continued isotonic crystalloid administration despite a blunted pressor response, glucose correction if indicated, and rapid transport, since definitive corticosteroid replacement is hospital-level care and administering a patient's own emergency hydrocortisone kit is not a nationally standardized AEMT action.

Why the others are wrong

Withhold further intravenous fluid resuscitation: Withholding fluid because of a blunted response is the real error this option tests: adrenal crisis hypotension often does not fully resolve with fluid, but the correct response is to continue fluid administration, not stop it.

Administer hydrocortisone from the patient's personal kit: Whether an AEMT administers the patient's own prescribed hydrocortisone kit is a local-protocol and medical-direction decision, not a nationally standardized AEMT action; continuing indicated fluid resuscitation is the action that does not depend on local protocol.

Delay treatment until paramedic intercept arrives: Delaying an indicated, in-scope intervention like continued fluid resuscitation is not appropriate while awaiting intercept; treatment continues without pause.

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