22 Medical & Obstetrics/Gynecology Practice Questions & Answers
Every Medical & Obstetrics/Gynecology practice question from the Paramedic (NREMT) Practice Test, with the correct answer and a short explanation.
Start practice test →1. A 68-year-old woman is found at 06:30 with right-sided weakness and slurred speech. Her family states she went to bed acting completely normal at 22:00. When reporting the time last known well, which time should the paramedic use?
- A.The estimated midpoint between bed and discovery
- B.06:30, when the family first found the deficits
- C.22:00, when she was last seen acting normally✓ Answer
- D.The time the crew arrived at the patient's side
Last known well is defined as the last time the patient was seen at her neurologic baseline, not the time symptoms were discovered. Because she may have stroked at any point during the night, 22:00 is the time that determines eligibility for thrombolytics and thrombectomy, so hospitals must receive it accurately.
Source: AHA/ASA prehospital stroke care — 'last known well' definition; National EMS Education Standards (2021), Medicine: Neurology (paramedic C,C)Report a problem with this question
2. An adult has been seizing continuously for 7 minutes despite a patent airway and oxygen. Vascular access is available and the blood glucose is 96 mg/dL. Which medication is first-line for this patient?
- A.Midazolam, a benzodiazepine, given IM or IV✓ Answer
- B.Dextrose 50%, given before any other drug
- C.Phenytoin, loaded slowly by the IV route
- D.Magnesium sulfate, infused over 10 minutes
A seizure lasting more than 5 minutes is status epilepticus, and benzodiazepines such as midazolam are the first-line treatment because they rapidly enhance GABA-mediated inhibition. Phenytoin is a second-line agent, dextrose is indicated only for confirmed hypoglycemia, and magnesium is first-line only for eclampsia.
Source: National EMS Education Standards (2021), Medicine: Neurology — seizure/status epilepticus (paramedic C,C); status epilepticus defined as seizure >5 min, benzodiazepine first-lineReport a problem with this question
3. A 61-year-old man is confused with slurred speech, and his family fears a stroke. The primary survey reveals no immediate life threats. Which action should the paramedic perform next?
- A.Request an air medical intercept
- B.Give naloxone for possible overdose
- C.Measure the blood glucose level✓ Answer
- D.Complete a prehospital stroke scale
Every patient with altered mental status or stroke-like symptoms gets a blood glucose check before further stroke workup, because hypoglycemia is the classic stroke mimic and is immediately reversible with dextrose. Running a stroke scale first risks transporting a treatable metabolic problem as a stroke.
Source: National EMS Education Standards (2021), Medicine: Neurology — decreased level of responsiveness; rule: blood glucose before treating any altered mental status (AEIOU-TIPS differential)Report a problem with this question
4. A 9-year-old with deep, rapid respirations, a fruity breath odor, vomiting, and dry mucous membranes has a glucometer reading of 'HIGH.' Which intervention is the prehospital management priority?
- A.Begin an isotonic crystalloid fluid infusion✓ Answer
- B.Assist ventilations to slow the deep breathing
- C.Administer an insulin bolus to lower glucose
- D.Give sodium bicarbonate to correct acidosis
This child is in diabetic ketoacidosis, and the prehospital priority is isotonic fluid resuscitation for the profound osmotic-diuresis dehydration. Insulin and bicarbonate are hospital therapies, and the deep Kussmaul respirations are respiratory compensation for metabolic acidosis that must not be suppressed.
Source: National EMS Education Standards (2021), Medicine: Endocrine — diabetic emergencies (paramedic C,C); DKA prehospital priority = fluid resuscitation; Kussmaul respirations are compensatoryReport a problem with this question
5. An 82-year-old with type 2 diabetes has been weak for several days. She is profoundly dehydrated with an altered mental status, a glucose of 720 mg/dL, no unusual breath odor, and no deep or rapid respirations. Which condition is most likely?
- A.Hyperosmolar hyperglycemic state (HHS)✓ Answer
- B.Sepsis with high glucose readings
- C.Diabetic ketoacidosis (DKA) from type 1
- D.A stroke with stress hyperglycemia
HHS occurs in older type 2 diabetics: residual insulin prevents significant ketosis, so glucose climbs very high (often above 600 mg/dL) over days, producing profound dehydration and altered mental status without Kussmaul respirations or a fruity breath odor. The absence of ketotic signs is what separates it from DKA.
Source: National EMS Education Standards (2021), Medicine: Endocrine — diabetic emergencies; HHS = type 2, glucose often >600 mg/dL, profound dehydration, minimal ketosisReport a problem with this question
6. A 54-year-old who takes daily prednisone stopped it abruptly 3 days ago during a flu-like illness. He is hypotensive at 78/50 mmHg despite 1 liter of crystalloid, and his glucose is 58 mg/dL. Which condition best explains this presentation?
- A.Myxedema coma from thyroid failure
- B.Acute adrenal (Addisonian) crisis✓ Answer
- C.Hypovolemia from vomiting and poor intake
- D.Septic shock from the viral illness
Chronic steroid use suppresses the adrenal glands, so abrupt cessation during physiologic stress leaves the body unable to mount a cortisol response. The result is adrenal crisis: hypotension refractory to fluids combined with hypoglycemia, often with hyponatremia and hyperkalemia. Simple hypovolemia or early sepsis would typically respond better to fluid and would not explain the low glucose.
Source: National EMS Education Standards (2021), Medicine: Endocrine — adrenal disease; Addisonian crisis = steroid-dependent patient + missed doses/stress, fluid-refractory hypotension with hypoglycemiaReport a problem with this question
7. A farm worker exposed to an organophosphate pesticide has salivation, tearing, vomiting, pinpoint pupils, bradycardia, and airway-flooding secretions. After decontamination, atropine should be titrated to which endpoint?
- A.A heart rate above 100 per minute
- B.Drying of the airway secretions✓ Answer
- C.A total fixed dose of 3 milligrams
- D.Return of the pupils to normal size
In cholinergic poisoning the immediate life threat is bronchorrhea and bronchospasm drowning the airway, so atropine is repeated until secretions dry and ventilation improves. Pupil size and heart rate are unreliable endpoints, and there is no fixed maximum dose — severe poisonings can require very large cumulative amounts.
Source: National EMS Education Standards (2021), Medicine: Toxicology — cholinergic toxidrome (SLUDGEM/DUMBELS); atropine titrated to drying of secretions plus pralidoximeReport a problem with this question
8. A man is found with pinpoint pupils, cyanosis, a strong radial pulse, and 4 breaths per minute next to drug paraphernalia. Which action should the paramedic take first?
- A.Give naloxone first and wait for it to work
- B.Perform immediate endotracheal intubation
- C.Ventilate with a bag-valve mask and oxygen✓ Answer
- D.Apply a nonrebreather mask at 15 liters
Hypoxia is what kills opioid-poisoned patients, so ventilation and oxygenation with a bag-valve mask come before naloxone. A rate of 4 breaths per minute cannot move adequate air, making a passive nonrebreather insufficient, and immediate intubation is premature when BVM ventilation and naloxone will likely restore breathing. Naloxone is then titrated to adequate respirations, not full wakefulness.
Source: National EMS Education Standards (2021), Medicine: Toxicology — opioid toxidrome; rule: ventilate first, naloxone titrated to adequate respirationsReport a problem with this question
9. In midwinter, an entire family at home reports headache, nausea, and dizziness. Each member's SpO2 reads 100% on room air. Why should the paramedic distrust these pulse oximetry readings?
- A.CO poisoning always drives the SpO2 reading low
- B.Room-air readings mean little without capnography
- C.The device counts carboxyhemoglobin as oxyhemoglobin✓ Answer
- D.Cold winter extremities falsely raise the SpO2
A whole household symptomatic in winter suggests carbon monoxide poisoning. Standard pulse oximeters cannot distinguish carboxyhemoglobin from oxyhemoglobin, so the SpO2 reads falsely normal or high even with dangerous CO levels. Assessment requires CO-oximetry, and treatment is high-flow oxygen with hyperbaric therapy considered for severe cases.
Source: National EMS Education Standards (2021), Medicine: Toxicology — carbon monoxide poisoning (paramedic C,C); pulse oximetry falsely normal, CO-oximetry requiredReport a problem with this question
10. A patient who intentionally overdosed on amitriptyline is drowsy with a blood pressure of 84/50 mmHg, and the monitor shows a QRS duration of 140 ms. Which medication is indicated?
- A.Calcium chloride by slow IV push
- B.Sodium bicarbonate by IV bolus✓ Answer
- C.Flumazenil titrated intravenously
- D.Glucagon by intramuscular injection
Tricyclic antidepressants block cardiac sodium channels, producing QRS widening, hypotension, and seizures. Sodium bicarbonate both loads sodium and alkalinizes the blood, overcoming the channel blockade and narrowing the QRS. Calcium is the antidote pattern for calcium-channel blockers, glucagon for beta-blockers, and flumazenil is a benzodiazepine antagonist that can provoke seizures here.
Source: National EMS Education Standards (2021), Medicine: Toxicology; TCA overdose with widened QRS → sodium bicarbonate (sodium-channel blockade reversal)Report a problem with this question
11. An agitated 24-year-old has a blood pressure of 190/104 mmHg, a heart rate of 138, dilated pupils, and skin that is hot and drenched in sweat. Which toxidrome do these findings indicate?
- A.Opioid, such as illicit fentanyl
- B.Sympathomimetic, such as cocaine✓ Answer
- C.Anticholinergic, such as jimson weed
- D.Cholinergic, such as an insecticide
Hypertension, tachycardia, and mydriasis occur in both sympathomimetic and anticholinergic toxidromes, so the skin is the discriminator: sympathomimetic patients are diaphoretic, while anticholinergic patients are hot but dry. Cholinergic poisoning produces pinpoint pupils with secretions, and opioids produce miosis with respiratory depression.
Source: National EMS Education Standards (2021), Medicine: Toxicology — toxidromes; diaphoresis distinguishes sympathomimetic from anticholinergicReport a problem with this question
12. After a bee sting, a 30-year-old develops hives, wheezing, lip swelling, and a blood pressure of 82/50 mmHg. Which medication should the paramedic administer first?
- A.Epinephrine 0.3 mg IM in the thigh✓ Answer
- B.Methylprednisolone 125 mg by IV push
- C.Albuterol 2.5 mg by nebulizer mask
- D.Diphenhydramine 50 mg by the IV route
This is anaphylaxis — airway, breathing, and circulatory compromise after an exposure — and intramuscular epinephrine in the anterolateral thigh (adult 0.3–0.5 mg of 1:1,000) is always the first drug because its alpha and beta effects reverse vasodilation, bronchospasm, and edema. Antihistamines, steroids, and nebulized bronchodilators are adjuncts that must never delay epinephrine.
Source: National EMS Education Standards (2021), Medicine: Immunology — anaphylaxis (paramedic C,C); IM epinephrine 0.3–0.5 mg 1:1,000 is first-line, never delayed for adjunctsReport a problem with this question
13. An 88-year-old nursing-home resident has new confusion today. Her temperature is 35.9°C, heart rate 112, respirations 24, blood pressure 96/58 mmHg, and her urinary catheter bag contains foul-smelling urine. Which condition is most likely?
- A.Sepsis arising from a urinary source✓ Answer
- B.An acute ischemic stroke event
- C.Dehydration without infection
- D.Dementia with evening sundowning
Geriatric sepsis is frequently afebrile or even hypothermic, and new confusion may be the only presenting symptom. A suspected infection source (foul catheter urine) combined with systemic signs — hypothermia, tachycardia, tachypnea, borderline hypotension, and altered mentation — meets the sepsis picture and demands early recognition, oxygen, fluids, and a sepsis-capable destination.
Source: National EMS Education Standards (2021), Medicine: Infectious Diseases — sepsis/septic shock (paramedic C,C); geriatric atypical presentation (afebrile sepsis, confusion as sole symptom)Report a problem with this question
14. A febrile 3-year-old is lethargic and mottled with a heart rate of 168 and a capillary refill of 4 seconds, but the blood pressure of 94/60 mmHg is normal for age. Which interpretation of these findings is best?
- A.Decompensated shock that needs pressors
- B.Compensated shock that needs rapid treatment✓ Answer
- C.A simple fever that needs antipyretics
- D.No shock, because the pressure is normal
Children compensate powerfully with tachycardia and vasoconstriction, so blood pressure falls only late, just before arrest. Tachycardia, delayed capillary refill, mottling, and lethargy with a fever indicate compensated septic shock, and aggressive treatment must begin now — waiting for hypotension means waiting for decompensation.
Source: National EMS Education Standards (2021), integrated pediatric content; pediatric assessment triangle — blood pressure falls late in pediatric shock, tachycardia and poor perfusion are early signsReport a problem with this question
15. A 58-year-old man with cirrhosis and heavy alcohol use suddenly vomits a large amount of bright-red blood. He is pale with a heart rate of 124. Which source of bleeding is most likely?
- A.Ruptured esophageal varices✓ Answer
- B.A Mallory-Weiss tear from retching
- C.Diverticular bleeding in the colon
- D.A perforated duodenal ulcer
Cirrhosis causes portal hypertension, which distends fragile veins in the lower esophagus; their rupture produces the classic massive, bright-red hematemesis in an alcoholic patient. A Mallory-Weiss tear follows repeated retching and usually bleeds less, diverticular bleeding presents as hematochezia rather than vomiting, and a perforated ulcer presents primarily with peritonitis. Manage this patient as hemorrhagic shock with rapid transport.
Source: National EMS Education Standards (2021), Medicine: Abdominal and Gastrointestinal Disorders — acute GI hemorrhage (paramedic C,C); esophageal varices in the cirrhotic patientReport a problem with this question
16. A 26-year-old woman had a syncopal episode with sudden, one-sided lower abdominal pain. Her last menstrual period was 7 weeks ago, her blood pressure is 86/54 mmHg, and her heart rate is 122. Which condition must the paramedic suspect first?
- A.Rupture of an ovarian cyst
- B.Rupture of an ectopic pregnancy✓ Answer
- C.Pelvic inflammatory disease (PID)
- D.Appendicitis in an early stage
Any woman of childbearing age with abdominal pain plus syncope or shock is a ruptured ectopic pregnancy until proven otherwise, because tubal rupture causes rapid, concealed intraperitoneal hemorrhage. The 7-week missed period strongly supports the diagnosis; a ruptured cyst, early appendicitis, and PID rarely produce this degree of hemodynamic collapse.
Source: National EMS Education Standards (2021), Medicine: Gynecology / Obstetrics — ectopic pregnancy; rule: childbearing-age abdominal pain with shock = ruptured ectopic until proven otherwiseReport a problem with this question
17. A woman at 34 weeks of gestation has painless, bright-red vaginal bleeding, and her uterus is soft and nontender. Which condition is most consistent with this presentation?
- A.Placental abruption
- B.Placenta previa✓ Answer
- C.Normal bloody show
- D.Uterine rupture
Placenta previa bleeds painlessly with a soft, nontender uterus because the placenta overlies the cervical os and separates without uterine injury. Abruption causes painful bleeding with a rigid, tender uterus, and rupture causes tearing pain with shock. In any third-trimester bleeding, never perform a vaginal examination — it can convert previa bleeding into catastrophic hemorrhage.
Source: National EMS Education Standards (2021), Obstetrics — third-trimester bleeding; previa = painless bright-red bleeding with soft uterus, no vaginal examinationReport a problem with this question
18. A woman at 36 weeks of gestation is having a generalized seizure at home. Which medication is first-line for this patient?
- A.Magnesium sulfate by IV infusion✓ Answer
- B.Calcium gluconate by slow IV push
- C.Diazepam, as the definitive therapy
- D.Phenytoin loaded intravenously
A seizure in late pregnancy is eclampsia until proven otherwise, and magnesium sulfate is the first-line treatment because it both stops and prevents eclamptic seizures. Benzodiazepines are only an adjunct when magnesium fails, and calcium gluconate is the antidote for magnesium toxicity (lost deep tendon reflexes, then respiratory depression), not a seizure treatment.
Source: National EMS Education Standards (2021), Obstetrics — preeclampsia/eclampsia (paramedic C,C); magnesium sulfate first-line, calcium is the toxicity antidoteReport a problem with this question
19. During an imminent field delivery, the paramedic sees a loop of umbilical cord protruding from the vagina while contractions continue. Which action is most appropriate?
- A.Gently replace the cord back into the vagina
- B.Insert a gloved hand to lift the fetus off the cord✓ Answer
- C.Coach the mother to push and deliver quickly
- D.Cover the cord dry and transport her lying supine
A prolapsed cord is compressed between the presenting part and the pelvis, cutting off fetal circulation, so the paramedic inserts a gloved hand to lift the presenting part off the cord and keeps it there until relieved at the hospital. The mother goes into a knee-chest or hips-elevated position, the cord is kept moist, and it is never pushed back in; pushing would worsen the compression.
Source: National EMS Education Standards (2021), Obstetrics — abnormal delivery: prolapsed cord; lift presenting part off cord, knee-chest position, keep cord moist, never replaceReport a problem with this question
20. During a field delivery, the infant's head delivers and then retracts tightly against the perineum, and the shoulders will not deliver with normal guidance. Which action should the paramedic take?
- A.Hyperflex the hips and apply suprapubic pressure✓ Answer
- B.Pull the head downward with steady traction
- C.Apply firm pressure on the uterine fundus
- D.Push the head back in and transport at once
The turtle sign indicates shoulder dystocia: the anterior shoulder is impacted behind the pubic symphysis. The McRoberts maneuver — hyperflexing the mother's hips onto her abdomen — rotates the pelvis to free the shoulder, combined with suprapubic (never fundal) pressure. Fundal pressure worsens the impaction, and forceful traction on the head risks brachial plexus injury.
Source: National EMS Education Standards (2021), Obstetrics — abnormal delivery: shoulder dystocia; McRoberts maneuver plus suprapubic (never fundal) pressureReport a problem with this question
21. A newborn has been dried, warmed, and stimulated for 30 seconds but is still gasping with a heart rate of 80 beats per minute. Which action should the paramedic take next?
- A.Begin positive-pressure ventilation at 40-60/min✓ Answer
- B.Continue stimulation with blow-by oxygen only
- C.Give epinephrine while preparing to ventilate
- D.Start chest compressions at once at a 3:1 ratio
Newborn resuscitation is driven by heart rate, and a rate below 100 with apnea or gasping calls for positive-pressure ventilation at 40-60 breaths per minute — the single most important intervention, because neonatal bradycardia is almost always caused by hypoxia. Compressions at 3:1 begin only if the rate stays below 60 after 30 seconds of effective ventilation, and epinephrine comes later still.
Source: AHA/AAP Neonatal Resuscitation Program (NRP) algorithm; National EMS Education Standards (2021) — neonatal resuscitation (paramedic C,C): HR <100 + apnea/gasping → PPV 40-60/min; compressions 3:1 only if HR <60 after 30 s effective PPVReport a problem with this question
22. Police have handcuffed a severely agitated man and left him lying prone. His skin is hot and he is sweating profusely. Which action by the paramedic is most appropriate?
- A.Wait for full sedation before any assessment
- B.Get him off his stomach and monitor him closely✓ Answer
- C.Add a hobble tie so he cannot kick the crew
- D.Keep him prone, since that position controls him
Prone and hobble restraint impair chest-wall movement and can cause restraint asphyxia, and the risk of sudden cardiac arrest is highest in severe agitation with hyperthermia and exhaustion. The paramedic must reposition the patient supine or laterally at once, then provide continuous monitoring with cooling, fluids, and sedation per protocol — this is a medical emergency, not merely a custody problem.
Source: National EMS Education Standards (2021), Medicine: Psychiatric/Behavioral — severe agitation/agitated delirium; rule: never prone or hobble restraint (restraint asphyxia), continuous reassessment of restrained patientsReport a problem with this question
Practice questions modeled on the NREMT paramedic examination specifications and the National EMS Education Standards. Drug doses, device settings, and other figures that national guidelines revise are deliberately not tested — always follow your medical director, current guidelines, and local protocols. Not medical advice, and not affiliated with or endorsed by the National Registry of Emergency Medical Technicians (NREMT) or NHTSA. Study the official materials at nremt.org. Official NREMT →