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Free NREMT practice questionsFree EMT practice questions · Patient Treatment and Transport

9 free EMT practice questions: Neurological & EENT Emergencies

These are real questions from the same bank the app draws from. Each one is written to the NREMT EMT content specifications and kept inside the EMT 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 9

A 6-year-old is brought to the EMT by their mother, who states that the child placed a small plastic bead into their left ear canal approximately 2 hours ago. The EMT can visualize part of the bead in the outer ear canal. The child is uncomfortable but alert and not in acute distress. Their hearing in the right ear is normal. There is no visible trauma or sign of infection in the affected ear. What is the EMT's most appropriate action?

Show the answer and rationale

Correct answer · Transport the child to the emergency department for evaluation and removal by a physician

Transport this child so a physician can remove the bead. The bead is partly visible in the outer ear canal after 2 hours, with no infection or trauma. Any attempt to grab the bead or flush it can push it deeper toward the eardrum, the tympanic membrane. The eardrum is thin enough to tear from pressure or from a tool at the wrong angle. Removing a foreign body from the ear canal is outside EMT scope of practice. Removal takes an otoscope and instruments that only a physician or an ear, nose, and throat provider has. Your job is to get the child to the emergency department, not to try to pull the bead out.

Why the others are wrong

Use a cerumen curette or small curved instrument to carefully remove the bead from the ear canal: A cerumen curette is made to scoop out soft earwax while you can see it. A curette is not made to grab a smooth plastic bead. Using one on this bead can push the bead deeper toward the eardrum. Removing the bead is outside EMT scope anyway.

Gently flush the ear canal with warm water to dislodge and remove the bead: Flushing with warm water is a real technique for some objects in the ear canal. Water pressure can wedge a smooth plastic bead deeper or push the bead against the eardrum and tear it. Irrigation is also outside EMT scope.

Observe and reassure the parent that the bead will likely work itself out within 1-2 weeks: A bead that has stayed in the ear canal for 2 hours has no way out on its own. Waiting with no plan to remove the bead can lead to the bead getting stuck, an infection, or hearing loss. The child needs to get to a provider who can take the bead out safely.

Question 2 of 9

A 45-year-old patient struck the left temple in a motor-vehicle accident. During the EMT's assessment, clear fluid is noted draining slowly from the left ear canal. The patient is alert and oriented but reports dizziness. Vital signs are BP 138/82 mmHg, P 88/min, R 16/min, and the airway is patent. The clear fluid is suspected to be cerebrospinal fluid from a basilar skull fracture. How should the EMT manage this drainage?

Show the answer and rationale

Correct answer · Position on the affected (left) side, place a loose sterile dressing over the ear without packing it, and transport

This patient has a basilar skull fracture with cerebrospinal fluid (CSF) draining from the left ear. The patient hit the left temple, and clear fluid is draining slowly from the left ear canal. CSF draining after head trauma must never be blocked or sealed. Blocking the drainage can raise the pressure inside the skull and make the patient's neurological status worse. Position the patient on the left side so gravity helps the fluid drain out. Place a loose sterile dressing over the ear without packing the canal, and transport.

Why the others are wrong

Gently pack sterile gauze into the ear canal to seal off the drainage pathway and prevent further loss of cerebrospinal fluid: Sterile gauze packed into the ear canal seals off the path the CSF is draining through. Sealing off CSF drainage can raise the pressure inside the skull and make the patient's neurological status worse. CSF drainage is never packed or blocked.

Apply direct manual pressure over the external ear, as for any external bleeding, until the drainage slows and stops: Direct pressure is how you control external bleeding. Clear fluid from the ear after a head injury is not bleeding. Holding pressure over the ear traps the fluid the same way packing does, and the pressure inside the skull goes up.

Irrigate the ear canal gently with normal saline to flush away debris and reduce the risk of infection during transport: Irrigating with saline is a way to flush debris out of an ear. This ear canal is an open path into the skull. Flushing saline into the canal brings in an infection risk, and irrigation is not part of managing CSF drainage.

Question 3 of 9

An EMT responds to a patient who has just completed a generalized tonic-clonic seizure and is now post-ictal. The patient is confused and drowsy but breathing spontaneously at 18 breaths per minute with clear air exchange. The airway is clear of secretions. What is the appropriate immediate management?

Show the answer and rationale

Correct answer · Place the patient in the recovery position and monitor airway, breathing, and circulation

This patient is post-ictal, the confused and drowsy period after a seizure. The patient is breathing on their own at 18 a minute with clear air exchange, and the airway is clear right now. A confused, drowsy patient may not clear secretions or vomit on their own. Roll the patient onto the side, into the recovery position. On the side, secretions and vomit drain out of the mouth instead of into the airway. Suction as needed. Keep monitoring the airway, breathing, and circulation while the confusion clears.

Why the others are wrong

Restrain the patient's limbs to prevent recurrence of seizure activity: Holding the limbs down is not done even while a seizure is still going. During an active seizure, you move things out of the way and pad what you can. Trying to hold the patient still can injure the patient, and force does not stop a seizure. This patient's seizure has already ended.

Immediately obtain IV access and prepare to administer seizure-prevention medication: Seizure medication is for status epilepticus. Status epilepticus is a prolonged seizure, or seizures that repeat without the patient returning to baseline mental status in between. This patient had one seizure, and the seizure has ended. IV access and seizure medication are also outside EMT scope. For status epilepticus, you call for ALS and transport.

Keep the patient upright and alert by engaging them in conversation during transport: Sitting upright and talking works for a patient who is awake enough to protect the airway. This patient is confused and drowsy. Upright, secretions and vomit cannot drain out of the mouth the way they do in the recovery position.

Question 4 of 9

A 55-year-old patient is found seated in a chair at home by family members. Bystanders report the patient stood up from dinner, then suddenly collapsed into the chair. When the EMT arrives 2 minutes later, the patient is alert, oriented, and able to recall the entire event. Vital signs are BP 124/78 mmHg, P 88/min (regular), R 16/min, and SpO₂ 98% on room air. The patient denies chest pain, difficulty breathing, or weakness and has no focal neurological deficits. The patient reports feeling lightheaded for a moment and then 'waking up' in the chair. Which of the following is the most appropriate assessment of this episode?

Show the answer and rationale

Correct answer · The patient had a brief syncopal episode with rapid recovery; transport for evaluation

This patient had a syncopal episode, which means fainting. The patient stood up from dinner, felt lightheaded, and collapsed into the chair. Two minutes later the patient is alert, oriented, and remembers the whole event. The vital signs are normal and there are no focal neurological deficits. Standing up caused a quick drop in blood flow to the brain. The patient passed out, and blood flow came back once the patient was sitting. Fainting can be the only sign of a hidden heart rhythm problem or another serious cause, even when the exam looks normal. That's why this patient still needs transport for evaluation.

Why the others are wrong

The patient is experiencing a stroke requiring immediate neurological assessment: A stroke shows up as a focal deficit, like weakness on one side, a facial droop, or slurred speech. Those deficits stay, and they need a stroke scale and fast transport. This patient has no focal neurological deficits and remembers the whole event. Those findings point away from a stroke.

The patient is having a seizure and must be protected from further injury and given oxygen: A seizure is shaking followed by a postictal period. A postictal patient is confused, cannot remember the event, and is slow to get back to normal. Some also lose bladder control or bite the tongue. This patient remembers the entire episode and was alert and oriented right away. A patient who is alert right away is not postictal. Protecting the patient and giving oxygen are right for a seizure, and this was not a seizure.

The patient is in cardiac arrest and requires CPR immediately: Cardiac arrest means no pulse, no breathing, and no response, and that patient needs CPR right away. This patient is alert, oriented, and talking. The pulse is 88 and regular, respirations are 16, and the SpO₂ is 98%. A patient who is talking to you is not in cardiac arrest.

Question 5 of 9

A 72-year-old patient is found unresponsive by family members. Vital signs are BP 168/94 mmHg, P 54/min, and respirations irregular and slow at 12/min. The patient's pupils are equal and reactive, but the patient does not move spontaneously and does not respond to verbal stimuli. When the EMT applies a painful stimulus, the patient extends both arms and legs rigidly. What do these findings indicate?

Show the answer and rationale

Correct answer · Decerebrate posturing indicates severe brainstem dysfunction and rising ICP

This patient has decerebrate posturing from rising pressure inside the skull. When you apply a painful stimulus, both arms and legs extend out stiff. Decerebrate posturing points to a problem in the midbrain and upper brainstem. The vital signs show Cushing's triad. The blood pressure is high at 168/94, the pulse is slow at 54, and the breathing is slow and irregular at 12 a minute. Rising intracranial pressure (ICP) is squeezing the brainstem, and the brain is starting to herniate. Take control of the airway and support the breathing. Good ventilation keeps carbon dioxide from building up in the blood. Transport rapidly to a hospital that has neurosurgery.

Why the others are wrong

The patient is in a light level of coma and will likely recover consciousness soon: Reactive pupils in a patient who is only unresponsive can look like a milder problem that will clear up on its own. Decerebrate posturing to pain means a deep coma, not a light one. The Cushing's triad of 168/94, a pulse of 54, and irregular breathing at 12 shows a brainstem under more and more pressure. A brainstem under rising pressure does not clear up on its own.

The patient is in cardiac arrest and requires immediate CPR: A slow pulse in a patient who does not respond can look like cardiac arrest is close. This patient has a pulse of 54 and is breathing on their own at 12 a minute, even if the breathing is irregular. CPR is not indicated. A slow pulse with a high blood pressure points to rising pressure in the skull causing a Cushing's response, not a heart that has stopped.

The patient is having a tonic-clonic seizure and requires airway protection: Stiff, straight arms and legs can look like the rigid part of a seizure. A tonic-clonic seizure brings rhythmic, alternating jerking of the limbs. Seizure activity does not hold the limbs stiff and straight only when you apply pain. This patient's posturing is a fixed response to pain, which is decerebrate posturing.

Question 6 of 9

A 44-year-old patient with a history of migraines reports acute onset of right-sided weakness and visual disturbance 15 minutes ago. The patient reports experiencing a similar visual disturbance (shimmering lights at the edge of vision, lasting 20 minutes) about 20 minutes before the weakness began, which is typical for the patient's migraine aura. On examination, the EMT finds the right arm is weak (4/5 strength), but speech is normal and the patient is alert and oriented. The patient has had this exact pattern with migraines at least five times in the past 2 years, always with complete recovery. Vital signs are stable. Which of the following is the most appropriate EMT action?

Show the answer and rationale

Correct answer · Recognize this may be the patient's migraine with aura, but transport urgently because acute stroke must be ruled out

This may be the patient's usual migraine with aura, but you have to treat the weakness as a possible acute stroke. A migraine with aura can cause short-lived focal deficits, like the right arm weakness here, that look just like a stroke. The patient has had this same pattern at least five times and always recovered. An EMT still cannot rule out an acute stroke in the field, no matter how similar the past episodes were. Transport urgently so the hospital can evaluate for a stroke.

Why the others are wrong

Recognize this as her typical migraine with aura, given prior episodes with full recovery; reassure her and let her rest at home: Letting the patient rest at home leans completely on the past pattern. You cannot confirm the same thing is happening this time. An EMT cannot rule out an acute stroke in the field, even with a history of the same episodes.

This presentation is definitely a stroke; immobilize for spinal precautions and transport for emergency imaging: Spinal motion restriction is for a patient with an injury mechanism that calls for it. Nothing in this question describes an injury. B also calls this definitely a stroke. A migraine with aura can look just like a stroke, so you cannot call it definite in the field.

Diagnose this as a migraine aura and administer oxygen to reverse the neurological deficits: Oxygen treats neither a migraine aura nor a stroke, so oxygen will not reverse the right arm weakness or the visual disturbance. Giving oxygen is also no substitute for urgent transport and a hospital evaluation.

Question 7 of 9

A 41-year-old patient has an altered mental status. Bystanders report the patient was confused and stumbling before collapsing. The vital signs are BP 88/56 mmHg, P 104/min, R 12/min and shallow, and SpO₂ 88% on room air. The patient is unresponsive to verbal stimulus but grimaces to pain. The history indicates type 2 diabetes treated with metformin. The blood glucose level is 52 mg/dL. What is the most appropriate immediate action?

Show the answer and rationale

Correct answer · Withhold oral glucose, insert a nasopharyngeal airway, assist ventilations with a BVM and oxygen, and transport rapidly

This patient has hypoglycemia with a level of consciousness too low to protect the airway, and the breathing is not adequate. The glucose is 52 mg/dL. The patient does not respond to voice and only grimaces to pain. At this level of consciousness, you cannot trust the patient to swallow or protect the airway. Anything you put in the mouth, glucose included, can block the airway or be aspirated. That's why you hold the oral glucose. The respirations are 12/min, which is a normal rate, but each breath is shallow. Shallow breaths do not move enough air, and the SpO2 of 88% shows it. Breathing that shallow needs assisted ventilations, not just oxygen. A patient who still grimaces to pain may still have a gag reflex, so a nasal airway is the adjunct to use. Assist ventilations with a BVM and oxygen, and transport fast. A higher level of care can then give IV dextrose.

Why the others are wrong

Administer 15 g of oral glucose gel and monitor for response: A glucose of 52 mg/dL is true hypoglycemia. Oral glucose gel is the standard EMT treatment when the patient is awake enough to swallow and handle secretions. This patient does not respond to voice and only grimaces to pain, so you cannot trust the airway. Gel in this patient's mouth risks aspiration instead of fixing the low sugar.

Attempt to have the patient swallow glucose tablets with water and recheck glucose in 5 minutes: Glucose tablets with water are for a patient alert enough to chew and swallow safely. This patient responds only to pain, so tablets and water can be aspirated. Waiting 5 minutes to recheck also delays care for breathing that is already too shallow.

Administer 25 mL of 50% dextrose intravenously and establish an intravenous line: IV dextrose, 25 mL of 50%, is the definitive fix for hypoglycemia. IV dextrose is an AEMT and paramedic intervention, and starting an IV is outside EMT scope. As the EMT, your job here is the airway, the breathing, and fast transport.

Question 8 of 9

A 67-year-old patient has sudden onset right facial droop, slurred speech, and right-sided weakness that started 45 minutes ago. The EMT recognizes a possible acute stroke. A family member says, "Please take us to General Hospital. That's where our family doctor is." The nearest hospital, Central Medical, is 10 minutes away and has a certified stroke center. General Hospital is 25 minutes away and does not have stroke capability. What is the appropriate transport decision?

Show the answer and rationale

Correct answer · Transport to Central Medical, the stroke center, for time-critical stroke care

This patient is having an acute stroke. The right facial droop, the slurred speech, and the right-sided weakness started 45 minutes ago. Part of the brain has lost its normal blood flow. You cannot tell a clot from a bleed in the field, and you do not need to. The hospital treatments for stroke only work within a limited time. If a clot is the cause, the hospital can give clot-busting medicine. That medicine has to start within hours of when the patient was last known well, up to 4.5 hours in some patients. Every minute of delay costs brain tissue. Take this patient to the closest stroke-capable hospital and call ahead so the team is ready. Central Medical is 10 minutes away and is a certified stroke center.

Why the others are wrong

Honor the family's request and transport the patient to General Hospital: Family wishes do count in a lot of EMS decisions. With stroke symptoms that started 45 minutes ago, the destination follows what the patient needs medically, not what the family prefers. General Hospital has no stroke capability.

Transport to General Hospital; the extra 15 minutes will not change the outcome: A few extra minutes to a preferred hospital can be fine for a stable patient. General Hospital has no stroke capability at all. After the 25 minute drive, this patient would still need a transfer to a stroke center. That transfer loses far more than 15 minutes.

Delay transport until medical direction confirms the appropriate destination facility: Calling medical direction fits when the right destination is unclear. Here the closest hospital, Central Medical, is already a certified stroke center. Waiting on scene for a confirmation only uses up treatment time.

Question 9 of 9

A patient sustains a penetrating eye injury with a small object impaled in the globe. Which of the following is the most appropriate EMT management?

Show the answer and rationale

Correct answer · Stabilize the object in place and apply a rigid eye shield over both eyes

This is a penetrating eye injury with an impaled object. An object impaled in the eye always gets stabilized in place and never removed. Use a rigid shield, not a soft patch or a pressure patch. The rigid shield rests on the bony rim around the eye, so nothing presses on the eyeball or the object. Cover the uninjured eye too. Both eyes move together, which is called consensual movement. When the good eye moves, the injured eye moves with it and the injury gets worse.

Why the others are wrong

Remove the object carefully and cover the injured eye with a pressure dressing: Removing an impaled object, even carefully, can cause more damage and bleeding you cannot control. A pressure dressing then pushes right on the injured eyeball. The object has to stay in place and be stabilized.

Irrigate the eye with saline and secure a gauze patch over the injured eye only: Irrigation is for chemical burns to the eye. This eye has an impaled object in it, not a chemical. Patching only the injured eye also lets the good eye keep moving, and the injured eye moves with it.

Apply direct pressure over the object with a bulky dressing to control bleeding: Direct pressure with a bulky dressing is how you control bleeding in most wounds. Pressing over an impaled object in the eye can push the object deeper and force out what is inside the eye. A rigid shield that does not touch the eye is used instead of any kind of pressure.

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