10 free EMT practice questions: Pediatric, Geriatric & Special Populations

This is not shock because the blood pressure is within the normal range for age: This is the most common pediatric error in EMS, and it comes from adult-shaped thinking where hypotension is a fairly reliable alarm bell. In a child, blood pressure is the last parameter to fall, and by the time it does, arrest is close behind. The key reads that same normal blood pressure as the definition of compensated shock rather than as an all-clear.

This is decompensated shock because the heart rate is markedly elevated: Decompensated shock is real, and this child can get there, but the label is defined by compensation failing, which shows up as hypotension, obtundation, and often a falling or inappropriately slow heart rate. A high heart rate is compensation succeeding, not failing, and this child is fussy but consolable rather than unresponsive. The key names the stage the findings actually match, while this one skips ahead on the wrong criterion.

This is dehydration without shock, and only oral rehydration is indicated: This would be the right read on the same illness caught earlier: dry lips, fewer wet diapers, but warm pink extremities, brisk capillary refill, and a heart rate near baseline. Cool, mottled skin with a 3-second refill means perfusion has already fallen off, and that is the line between dehydration and shock. The key crosses that line, and what follows is shock management and transport rather than a cup of oral rehydration solution.

Continue ventilations alone and reassess in 2 minutes: Continuing ventilations alone and reassessing is exactly right during the first two minutes, when hypoxic bradycardia usually corrects itself once oxygen reaches the lungs. That is what the EMT already did, and the reassessment is the whole point of the question: it was performed, and the answer came back 48 with poor perfusion. Repeating an intervention that has already failed for two minutes only delays the circulation this child no longer has, while the key adds the step the reassessment criteria call for.

Deliver abdominal thrusts for a possible obstruction: Abdominal thrusts belong to a witnessed foreign body obstruction in a responsive patient, and even then an unresponsive patient gets compressions and an airway look rather than thrusts. Nothing here suggests obstruction, since the airway was opened and the ventilations are described as effective, which by definition means air is going in. Drowning fills the lungs with water; it does not plug the airway with an object, so the key treats the failing circulation rather than a blockage that is not there.

Apply the automated external defibrillator first: The AED is the right first move for a witnessed sudden collapse in an older child or an adult, where a shockable rhythm is likely from the start. Pediatric drowning arrest is hypoxic, and hypoxic arrests are overwhelmingly non-shockable, so oxygenation and compressions are the treatment that works. This child also still has a pulse at 48, so there is no arrest rhythm to analyze yet, and the key starts moving blood instead of pausing to look for a rhythm that is very unlikely to be present.

Continue delivering abdominal thrusts with the child positioned supine: Abdominal thrusts are the correct technique, right up until the patient loses consciousness, which is what just happened in this question. In an unresponsive patient thrusts are less effective, harder to deliver well, and provide no circulation to a child whose heart is about to stop from hypoxia. The key switches to the technique that both works on the obstruction and supports perfusion.

Deliver alternating back blows and chest thrusts as used for an infant: Back blows alternating with chest thrusts is the right sequence for a responsive infant under one year, where abdominal thrusts risk injury to the liver and spleen. This patient is five years old, and more decisively, is now unresponsive, at which point the age-specific responsive technique stops being the question. The key uses the unresponsive pathway, which converges on compressions regardless of age.

Perform a blind finger sweep of the mouth before starting compressions: Blind finger sweeps are prohibited at every level and every age. Sweeping a finger through a mouth you cannot see into pushes the object deeper and wedges it more firmly in an airway that is already small. The key permits a look and a removal only when the object is actually visible, which is the safe version of the same instinct.

The Glasgow Coma Scale: scores a patient's motor response among other things, which requires interacting with and often physically stimulating the patient, not a hands-off, sight-and-sound-only tool.

The SAMPLE history: a set of questions asked of the patient or caregiver, a verbal tool rather than a visual/auditory general-impression tool.

The rapid trauma assessment: a hands-on physical exam of the body, the opposite of the equipment-free, hands-off tool described here.

Acute stroke causing the confusion and drowsiness: Stroke does not typically present with a clear precipitant like medication overdose, and vital-sign depression (low BP, slow breathing) is not typical of acute stroke.

Diabetic emergency producing the altered mental status: The clinical picture (medication found, respiratory depression, hypotension) points to toxicity, not diabetes.

Heart failure explaining the low oxygen saturation: While the low SpO₂ could suggest heart failure, the respiratory depression and hypotension in the context of medication overdose make toxicity the primary concern.

Document the patient's current mental status as the baseline and assume any confusion is new: Documenting the current confused state as baseline and assuming any future confusion is new risks missing that this presentation may already represent an acute change from a better baseline.

Skip the mental status assessment entirely, as the patient cannot provide reliable information: Skipping the mental status assessment entirely abandons useful information that caregivers can still provide even when the patient can't reliably report it.

Transport the patient immediately without establishing baseline, as this will be determined at the hospital: Transporting without establishing baseline defers information that's readily available now and useful for the receiving team to have documented.

Perform five back blows followed by five abdominal thrusts: Incorrect. Abdominal thrusts are never used on infants due to risk of abdominal organ injury and reduced effectiveness in this age group.

Perform five abdominal thrusts followed by blind finger sweeps: Incorrect. Abdominal thrusts are contraindicated in infants, and blind finger sweeps are no longer recommended (may lodge object deeper).

Perform back blows only and proceed directly to CPR if the object is not expelled: Incorrect. Back blows alone are insufficient; chest thrusts are a required component of the infant relief sequence.

Hypotensive shock requiring immediate intravenous fluids and rapid transport: Incorrect. The blood pressure is within the expected range for a 4-year-old; hypotension has not developed. This is compensated, not hypotensive, shock.

Decompensated shock with altered mental status requiring airway intervention: Incorrect. The child is alert and crying, so mental status is not significantly altered. Decompensated shock would also show hypotension, which has not developed.

Normal vital signs for a 4-year-old in pain; no evidence of shock: Incorrect. A pulse of 150 and respirations of 32 both exceed the normal ranges, and capillary refill of 3 seconds is delayed. These are not normal pain-related findings; they indicate compensation for shock.

Elderly patients have stronger pain tolerance and rarely experience true chest pain during a heart attack: Incorrect. Elderly patients do not have higher pain tolerance; autonomic and neurologic changes blunt or alter pain perception during cardiac events.

Nausea and fatigue are normal for any 81-year-old and do not warrant concern: Incorrect. While nausea and fatigue are common in elderly patients, they should never be dismissed as normal aging, particularly alongside diaphoresis and anxiety.

The patient's medications, especially metoprolol and lisinopril, completely mask the symptoms: Incorrect. While beta blockers and ACE inhibitors manage cardiac symptoms chronically, they do not mask an acute infarct. These medications instead suggest existing cardiac risk.

Two of three normal sides mean the child is stable: The abnormal breathing side alone being the only one that needs to be abnormal doesn't apply as stated: actually any single side being abnormal, not specifically the breathing side, is enough to signal a problem.

Normal appearance means the child is stable: Normal appearance meaning the child is stable misreads the triangle. This child's appearance and circulation are both normal, but the abnormal work-of-breathing findings still identify a real problem on their own.

All three sides must be abnormal to signal a problem: Requiring all three sides to be abnormal before signaling a problem sets the bar too high: a single abnormal component, like nasal flaring and retractions here, is enough by itself, regardless of what the other two components show.