10 free EMT practice questions: Focused History (SAMPLE / OPQRST)

Ongoing alcohol intoxication; the findings will clear with time: This reads the hallucinations and agitation as alcohol still on board, and intoxication does produce confusion and perceptual disturbance. This patient has had none since admission three days ago, so the timeline is reversed. These findings are withdrawal escalating, not intoxication resolving, and they will not clear without treatment.

A primary psychiatric disorder with hallucinations: A primary psychiatric disorder, like a manic or psychotic episode, can produce agitation and vivid hallucinations without any drug or alcohol trigger. What it does not produce is a pulse of 138, a blood pressure of 172/98, and a temperature of 101.8°F; those are autonomic findings that point to a physiologic cause, not a psychiatric one.

Alcoholic hallucinosis, in which mentation and vital signs stay intact: Alcoholic hallucinosis is the closer look-alike: it appears 12 to 48 hours after the last drink and produces vivid hallucinations while the patient stays oriented, with normal vital signs. That clear sensorium and stable vitals separate it from DTs. This patient is disoriented, with a pulse of 138 and a temperature of 101.8°F, placing this case in delirium tremens instead.

Sudden onset difficulty breathing indicates the patient requires supplemental oxygen administration before completing the rest of the secondary assessment: Oxygen is appropriate for most dyspneic patients regardless of how their symptoms began, so a 15-minute sudden onset doesn't uniquely dictate when to apply it or let you skip ahead of the rest of the secondary assessment. The real significance of the onset is recognizing an acute process, not sequencing a treatment step; this answers a different question than the one asked.

Sudden onset difficulty breathing means the patient requires advanced airway management more urgently than a patient with gradual onset: EMTs don't perform advanced airway management like intubation, that falls under paramedic scope, so onset timing can't make a skill you don't carry "more urgent." This confuses acuity of presentation with scope of practice.

Sudden onset difficulty breathing indicates the condition cannot be asthma, which develops over a longer period: Asthma exacerbations can start abruptly within minutes once a trigger causes bronchospasm, so the 15-minute onset here doesn't rule it out. Sudden onset narrows the field toward acute processes broadly, it doesn't exclude one specific diagnosis like asthma.

The hysterectomy performed 15 years ago: The hysterectomy fits the P for past medical history, and gynecologic surgery is a legitimate thing to document, but it happened 15 years ago and involves an organ system with no link to cardiac ischemia, so it carries no weight in a chest pain call.

The hypothyroidism managed with daily medication: Hypothyroidism on daily medication looks tempting because it is a chronic condition sitting right next to diabetes in the same SAMPLE history, but treated hypothyroidism does not accelerate coronary artery disease the way diabetes does; untreated, severe hypothyroidism can cause bradycardia or pericardial effusion, but nothing here suggests the thyroid disease is uncontrolled, so it does not explain the chest pain.

The appendectomy performed 10 years ago: The appendectomy 10 years ago is accurate past surgical history, but it is remote and involves the GI tract, giving you nothing that speaks to this patient's cardiac risk or current pain.

The name of the physician who prescribed each of the four medications: The medications element sounds like an inventory of the prescribing record. The prescriber's name does not tell the EMT or the receiving facility what is currently circulating in the patient.

Whether the patient has ever reacted badly to any of the four medications: This merges the medications element with the allergies element. A previous reaction belongs under allergies; it is important, but it is not what completes the medications element.

How long the patient has been taking each of the four prescribed medications: How long a medication has been taken gets confused with how often it is taken. Duration of therapy is background; the element asks what the patient is taking and how it is being taken.

Record it under quality, and transport the patient sitting upright: The patient just described a change in how the breathing feels, and quality does cover the patient's own words for the sensation, like tight or crushing. The finding here is positional, worse lying down and better sitting forward, which belongs under provocation and palliation, not quality.

Record it under provocation and palliation, and place the patient supine: Supine is the routine position for assessing a breathing complaint. The patient already demonstrated the opposite by sitting back up and reporting worse breathing lying flat, with an SpO₂ of 90%. Forcing supine ignores the positioning finding just gathered and worsens hypoxia instead of treating it.

Record it under onset, and transport the patient in a position of comfort: A change tied to lying down feels like a timing clue. Onset covers what the patient was doing when the difficulty breathing began, two days ago, not how position now affects it. That belongs under provocation and palliation, a separate OPQRST element.

Obtain the whole history from the staff member, who knows the patient well: A patient with a developmental disability sounds unable to give a reliable account. This patient is alert, answering, and engaged, and bypassing the patient discards the only firsthand description of the symptom.

Limit the questions to those the patient can answer with yes or no: Closed questions feel easier for the patient. Yes-or-no questions constrain the account and put the EMT's wording in place of the patient's; the patient is already answering in sentences.

Postpone the history until a guardian can be reached by telephone: Gathering a history gets confused with obtaining consent from a legal representative. Waiting on a telephone call delays care while the patient who can describe the symptom is sitting in front of the EMT.

Interrupt as soon as the account moves off the abdominal discomfort: Controlling the interview feels like efficiency. Interrupting is one of the named hazards of interviewing; it costs rapport and often cuts off the detail that explains the complaint.

Switch to questions the patient can answer with a single word: Closed questions bring the account back under control fastest. They also replace the patient's own account with the EMT's assumptions, which is how relevant history gets missed.

Let the patient continue uninterrupted until the account is finished: This over-applies the rule against interrupting. Free rein is the technique for the opening minutes, not for the whole interview; without periodic summarizing the EMT never gets the complaint pinned down.

Have the adult child answer so the history is not delayed: An older patient answering slowly seems like an unreliable historian. This patient is alert, oriented, and answering appropriately; the slow responses are a sensory and pacing issue, not a mental status one.

Raise the volume of the questions and shorten them to yes-or-no answers: Volume is the reflex response to a patient who asks for repetition. Shouting does not correct a hearing deficit that the patient's own device corrects, and yes-or-no questions strip the account down to the EMT's assumptions.

Have the adult child repeat each question loudly to the patient: Relaying through family feels like a workaround for the hearing problem. It inserts a second person between the EMT and the patient's own words when the device that removes the barrier is on the table.

“Is the discomfort crushing, like a weight on the chest?”: Supplying a familiar descriptor seems to help a patient who is struggling to explain a symptom. It is a leading question: it hands the patient the classic answer and the EMT can no longer tell whether the description came from the patient.

“Is the discomfort retrosternal or epigastric?”: Clinical vocabulary sounds precise and professional. Professional jargon is a named hazard of interviewing; a patient who does not know the words will guess or agree, and the answer is then worthless.

“Do you have any history of angina, and did it start with exertion?”: It gathers two useful pieces of history in one breath. Two questions at once produce one ambiguous answer, and the EMT cannot tell which half the patient responded to.

“What were you doing when the pain started?”: This is a real and important question that you should ask on this patient. It is the O for Onset, and it is what separates chest pain that started during exertion from chest pain that started at rest. That makes it the closest distractor here, because it and the key are both anchored to the beginning of the symptom. The clinching split is that Onset asks what was happening, while Time asks how long ago it happened.

“Does the pain radiate anywhere?”: Asking about radiation is the R, region and radiation, the question that catches chest pain traveling to the jaw, the left arm, or through to the back. It is squarely relevant to this patient, just filed under a different letter. Nothing about it addresses duration or the moment of onset, which is what the item asked for.

“What does the pain feel like?”: Asking what the pain feels like is the Q for Quality, and it is deliberately open-ended so the patient supplies the word, crushing, tearing, burning, pressure, rather than being led to one. Like the other two wrong choices, it belongs in this same history on this same patient. The item is testing which letter each question maps to, and a description of the sensation is quality, not time.