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

Ongoing alcohol intoxication; the findings will clear with time: Alcohol intoxication can cause confusion and seeing things that are not there. This patient has not had a drink since admission 3 days ago. These findings are withdrawal getting worse, not intoxication wearing off. They will not clear up without treatment.

A primary psychiatric disorder with hallucinations: A psychiatric disorder, like a manic or psychotic episode, can cause agitation and vivid hallucinations with no alcohol involved. A psychiatric disorder does not give you a pulse of 138, a blood pressure of 172/98, and a temperature of 101.8°F. Vital signs like these point to a physical cause in the body.

Alcoholic hallucinosis, in which mentation and vital signs stay intact: Alcoholic hallucinosis also causes vivid hallucinations after a patient stops drinking. Alcoholic hallucinosis shows up 12 to 48 hours after the last drink. The patient stays oriented, and the vital signs stay normal. This patient is disoriented, with a pulse of 138 and a temperature of 101.8°F. Those findings put this patient in DTs.

Sudden onset difficulty breathing indicates the patient requires supplemental oxygen administration before completing the rest of the secondary assessment: Oxygen is right for most patients with trouble breathing, no matter how the trouble started. A sudden onset does not decide when you give oxygen. A sudden onset also does not let you skip the rest of the secondary assessment. The question asks what the onset tells you, and option A answers a question about treatment order.

Sudden onset difficulty breathing means the patient requires advanced airway management more urgently than a patient with gradual onset: Advanced airway management is outside EMT scope. Intubation is a paramedic skill. How fast the trouble started cannot make a skill you do not carry more urgent.

Sudden onset difficulty breathing indicates the condition cannot be asthma, which develops over a longer period: An asthma attack can start within minutes once a trigger causes bronchospasm. A 15 minute onset does not rule asthma out. Sudden onset narrows the list to acute problems, and asthma is still on that list.

The hysterectomy performed 15 years ago: The hysterectomy goes under the P for past medical history, and you should document it. The surgery was 15 years ago, and the organs involved have no link to blood flow to the heart. The hysterectomy tells you nothing about this chest pain.

The hypothyroidism managed with daily medication: Hypothyroidism is a chronic condition listed right next to the diabetes. Treated hypothyroidism does not speed up coronary artery disease the way diabetes does. Severe, untreated hypothyroidism can cause bradycardia or fluid around the heart. Nothing here says this patient's thyroid disease is out of control, so the thyroid does not explain the chest pain.

The appendectomy performed 10 years ago: The appendectomy is accurate surgical history, but the surgery was 10 years ago and involved the digestive tract. Old belly surgery gives you no information about this patient's heart risk or current pain.

The name of the physician who prescribed each of the four medications: The prescriber's name belongs to the prescription record. The name of the doctor does not tell you or the hospital what is actually in the patient's system right now.

Whether the patient has ever reacted badly to any of the four medications: A past bad reaction to a medication belongs under the allergies part of SAMPLE. A past reaction matters, but a past reaction does not complete the medications part.

How long the patient has been taking each of the four prescribed medications: How long the patient has been on a medication is background information. The medications part asks what the patient is taking and how the patient is taking each one.

Record it under quality, and transport the patient sitting upright: Quality covers the patient's own words for how the breathing feels, like tight or crushing. This finding is about position. The breathing is worse lying down and better sitting forward. Position changes belong under provocation and palliation, not quality.

Record it under provocation and palliation, and place the patient supine: Lying supine is a routine position for many exams. This patient sat back up and said the breathing is worse lying flat, and the SpO₂ is 90%. Laying the patient supine ignores what you just found and makes the hypoxia worse.

Record it under onset, and transport the patient in a position of comfort: Onset covers what the patient was doing when the trouble breathing started, 2 days ago. Onset does not cover how position affects the breathing now. Position goes under provocation and palliation.

Obtain the whole history from the staff member, who knows the patient well: The staff member knows the patient well and is a good source for details. Taking the whole history from staff skips a patient who is alert and answering. You lose the only firsthand description of the discomfort.

Limit the questions to those the patient can answer with yes or no: Yes or no questions can seem easier for the patient. Yes or no questions limit the answers and put your words in place of the patient's words. This patient is already answering in sentences.

Postpone the history until a guardian can be reached by telephone: A guardian matters for consent from a legal representative, not for getting the history. Waiting on a phone call delays care. The patient who can describe the discomfort is sitting right in front of you.

Interrupt as soon as the account moves off the abdominal discomfort: Cutting the patient off looks like the fast way to get to the abdominal discomfort. Interrupting is one of the named hazards of an interview. You lose rapport with the patient, and you can cut off the detail that explains the complaint.

Switch to questions the patient can answer with a single word: Questions with one-word answers get the interview under control fastest. Closed questions also replace the patient's own account with your guesses. You miss important history that way.

Let the patient continue uninterrupted until the account is finished: Not interrupting is the right move for the opening minutes, not for the whole interview. Without summarizing along the way, you never get the abdominal complaint pinned down.

Have the adult child answer so the history is not delayed: Slow answers from an older patient can sound like the patient is not a reliable source. This patient is alert, oriented, and answering appropriately. The slow answers come from hearing and pacing, not from a mental status problem.

Raise the volume of the questions and shorten them to yes-or-no answers: Talking louder is a common response to a patient who asks you to repeat things. Shouting does not fix a hearing problem that the patient's own hearing aid fixes. Yes or no questions also cut the patient's answers down to your own guesses.

Have the adult child repeat each question loudly to the patient: Having family repeat the questions sounds like a way around the hearing problem. Relaying through the adult child puts a second person between you and the patient's own words. The hearing aid that fixes the problem is already on the bedside table.

“Is the discomfort crushing, like a weight on the chest?”: Offering a word like crushing seems to help a patient who is struggling to describe the discomfort. Asking if the discomfort is crushing, like a weight on the chest, is a leading question. You are handing the patient the classic answer. After that, you cannot tell if the description came from the patient or from you.

“Is the discomfort retrosternal or epigastric?”: Retrosternal and epigastric are precise medical words. A patient who does not know those words will guess or just agree. Then the answer tells you nothing.

“Do you have any history of angina, and did it start with exertion?”: A history of angina and whether it started with exertion are both useful to know. Asking about both at the same time is two questions in one. The patient gives you one answer, and you cannot tell which question it answers.

“What were you doing when the pain started?”: "What were you doing when the pain started?" is a good question to ask this patient. That question is the O, for Onset. Onset tells you whether the chest pain started during exertion or at rest. Onset and Time both deal with the start of the pain, and only Time asks how long ago it started.

“Does the pain radiate anywhere?”: Asking whether the pain radiates is the R, for Region and Radiation. The radiation question catches chest pain that travels to the jaw, the left arm, or through to the back. This patient should get the radiation question too. Radiation tells you nothing about how long the pain has lasted.

“What does the pain feel like?”: Asking what the pain feels like is the Q, for Quality. The question is left open on purpose so the patient picks the word, like crushing, tearing, burning, or pressure. You ask this one on this patient too. A description of how the pain feels is quality, not time.