10 free Paramedic practice questions: Advanced Obstetric and Neonatal Emergencies

A new seizure disorder unmasked by the demands of pregnancy: A first seizure in an adult does deserve a broad differential, and pregnancy is a physiologic stress. A seizure after 20 weeks in a patient with a headache and visual disturbance is eclampsia until something else explains it, and you would be reaching past the obvious cause to call it anything else.

Preeclampsia with severe features, since the pressure is above 160 systolic: The systolic is genuinely in the severe range, and severe features do change the urgency of the call. Severe features describe how bad the preeclampsia is, and once a seizure happens the diagnosis moves to eclampsia regardless of how high or low the pressure sits.

Gestational hypertension, since the pressure rose only late in pregnancy: Hypertension that appears late in pregnancy is a real category and the timing fits. Gestational hypertension is hypertension without the end organ findings, and a patient with a headache, visual change, and now a seizure has moved well past that label.

Hold gentle pressure against the head to keep it back until arrival at the hospital: Counter-pressure with a flat palm is a real part of assisting a delivery, which is what makes this tempting. That palm is there so the head does not deliver explosively and tear the perineum. Holding the head back against a contraction is a different act, and the rule on it is flat: never.

Move the patient to the ambulance and transport her on her left side instead: Transporting on her left side is exactly right for a patient in labor who is not crowning, so the technique is not the problem here, the timing is. With the head visible at the opening you would be carrying her down a flight of stairs during the delivery itself.

Perform a digital vaginal examination to confirm that the cervix is fully dilated: Wanting to confirm full dilation feels like the careful thing to do before committing to a field delivery. You already have the finding that settles it, since a head visible at the opening means the cervix is out of the way, and a digital examination is not an EMS procedure outside of a prolapsed cord and a breech head that has not delivered.

Give blow by oxygen until the saturation reaches the adult normal range: A saturation of 74% is a treat now number in any other patient, so the reflex is a strong one and it comes from a good habit. A newborn in the first minutes of life is the exception, and oxygen given against an adult target over treats a transition that is going normally.

Move the oximeter to a foot, since a hand reading underestimates the true value: Site selection genuinely matters on a newborn, so questioning the probe is the right kind of thinking. The right hand is preductal and is the correct site, while a foot reads postductal and runs lower in the first minutes, so moving the probe would make the number look worse rather than truer.

Begin positive pressure ventilation, since the saturation is below 90%: Escalating when a saturation is that low feels safe, and ventilation is the right answer for a newborn who needs it. Ventilation is driven by apnea, inadequate effort, or a heart rate below 100, and this newborn has a strong cry and a rate of 150.

After 2 minutes, matching the rhythm check interval used in older children: Two minutes is the familiar cycle from older children and adults, so it is an easy habit to import. Newborn resuscitation reassesses far more often than that, and two minutes would leave a newborn on the wrong branch of the algorithm for far too long.

After 15 seconds, since a newborn tolerates almost no time at that rate: The urge to look quickly when a newborn is this sick is understandable, and short pauses feel harmless. Fifteen seconds is not long enough for coordinated compressions to change anything, and every check interrupts the compressions that are doing the work.

After 30 seconds, the same interval used before compressions were started: Thirty seconds is a real interval in this algorithm, which is exactly why it gets carried forward. It belongs to the ventilation step before compressions started, and once compressions are running the interval doubles.

Suction the mouth and nose repeatedly until the returning fluid runs clear: Clearing visible fluid from the mouth and nose is part of the initial steps and it is not wrong to have done it once. Repeated passes chase fluid that is already below the cords, they add vagal stimulation that can slow the heart further, and they push ventilation further away.

Suction the trachea through an endotracheal tube before ventilating: Tracheal suctioning for meconium was taught for years and it still feels like the thorough thing to do. It is no longer part of the algorithm at any level of vigor, and setting up for it delays the ventilation this newborn needs right now.

Stimulate the newborn again and recheck the heart rate in 30 seconds: Stimulation is part of the initial steps and it is what starts most newborns breathing, so repeating it feels harmless. The initial steps are already done here, and a newborn who stays apneic after them has told you stimulation is not going to work, which is the point at which ventilation begins.

50% dextrose at 1 mL per kilogram through a vascular line: This is the adult preparation and the adult reflex, and the dose looks conservative because the volume is small. The concentration is what harms a newborn rather than the volume, and 50% is the most hypertonic option on the list.

25% dextrose at 2 mL per kilogram through a vascular line: The 25% preparation is the one used in older children, so it feels like the pediatric answer and the dose is right for a child. A newborn is not simply a small child here, and the concentration drops again to 10% for the first weeks of life.

Glucose gel rubbed into the cheek, then a repeat glucose check: Glucose gel avoids needing a line and it does work in an older patient who can protect the airway. A newborn this depressed does not reliably swallow, absorption through the cheek is slow and unpredictable, and the glucose needs correcting now.

Administer a normal saline fluid bolus: A saline bolus is the treatment when a blood pressure problem is caused by too little volume, as in hemorrhage, dehydration, or sepsis. This patient's problem is the opposite, a pressure of 178/112 in a syndrome defined by diffuse capillary leak and third spacing, so aggressive fluid pushes toward pulmonary edema without touching the seizure. Volume is not the deficit here, and the key treats the thing that is actively injuring the brain.

Administer furosemide to reduce the blood pressure: Furosemide has a role in pregnancy only for frank pulmonary edema, not as a way to lower blood pressure in preeclampsia. Diuresing a patient whose intravascular volume is already depleted by capillary leak drops placental perfusion and harms the fetus, and the blood pressure is not what is seizing the patient. Even when antihypertensive therapy is warranted in severe preeclampsia, magnesium still goes first to control the seizure, which is what the key does.

Administer 50% dextrose intravenously: Dextrose is the answer when a seizure or altered mental status is caused by hypoglycemia, and checking a glucose on any seizing patient is sound practice. Nothing points that way here, because the two-day headache, the visual disturbance, the new hypertension, and the gestational age all converge on eclampsia. Giving dextrose to a normoglycemic patient treats a condition she does not have while the eclampsia continues untreated.

Administer glucagon intramuscularly: Glucagon works by mobilizing stored glycogen from the liver, which makes it a reasonable choice in an adult diabetic with no vascular access and a liver with stores to release. Neonates have minimal glycogen reserves to begin with, and this one has been drawing on them since delivery against its own high insulin level, so there is very little for glucagon to mobilize. The key supplies glucose directly instead of asking a depleted liver to produce it.

Administer 50% dextrose intravenously: Dextrose 50% is the adult concentration, the right drug at the wrong strength, which is what makes it the most tempting distractor in the set. That hypertonicity is precisely what damages small vessels, risks intraventricular hemorrhage, and can provoke rebound hypoglycemia in a hyperinsulinemic infant. Same molecule, same route, five times the concentration the key uses, and the concentration is the thing being tested.

Administer oral glucose gel: Oral glucose gel is used for a hypoglycemic patient who is awake and able to protect their own airway, and buccal absorption is real. A 45-minute-old newborn with poor tone and a weak cry cannot reliably swallow or protect an airway, so gel risks aspiration and delivers an unpredictable dose. The key uses a route that puts a known quantity of glucose into the circulation immediately, which is what a symptomatic newborn needs.

Wait for the placenta to deliver before the second newborn: This inverts the normal sequence. In a twin birth the second newborn delivers before the placenta does, and waiting for a placenta that will not come until both are out wastes the interval in which the first cord should have been secured.

Apply firm downward pressure on the abdomen: Downward pressure on the abdomen, sometimes described as fundal pressure, is not a field technique for delivering a second twin. It risks uterine injury, placental separation, and worsening of an undiagnosed malpresentation, and the second twin frequently is not in a head-down position.

Pull gently on the first cord to deliver the placenta: Traction on the cord to hurry the placenta is dangerous at any delivery and specifically risks pulling the uterus inside out. It is worse here, because the placenta is still supporting an undelivered second twin, so the delivery sequence would be disrupted at the second newborn's expense.

Peripheral cyanosis by itself means more supplemental oxygen is needed: You'd pick this if blue hands and feet by themselves meant more oxygen was needed. Color lagging in the hands and feet while the trunk is already pink is a peripheral finding, and it's the heart rate response, not the color of the extremities, that tells the paramedic whether the current support is adequate.

A heart rate above 100 means the paramedic can stop reassessing heart rate: You'd pick this if a single favorable number felt like a stopping point. A good heart rate doesn't end reassessment. This newborn also hasn't yet cried or begun breathing on its own, so support continues and the trend keeps being watched.

Peripheral cyanosis after ventilation means chest compressions are indicated: You'd pick this if any residual cyanosis felt like a reason to escalate. Compressions are tied to a heart rate below 60 that isn't responding to ventilation, and a rate of 150 is nowhere near that threshold, so cyanosis by itself doesn't justify adding compressions.