NREMT - MEDICAL

What age do children begin to loose their teeth?

6-12 years old

_____ refers closer to the midline of the body

Midline

_____ is further from the midline of the body

Lateral

Pain around the navel that migrates to the right lower quadrant (RLQ) over 12-24 hours

Low-grade fever

Pain worsened by coughing, walking, or jarring movements

Rebound tenderness in the RLQ

These are symptoms of ?

Appendicitis

______ means further away from the point of attachment or origin

Distal

____ provides precise control of oxygen concentration for COPD patients

A Venturi mask

A Venturi mask provides precise control of oxygen concentration for COPD patients. COPD patients rely on hypoxic drive for respiratory stimulation, and uncontrolled high-flow oxygen can suppress this drive. The Venturi mask delivers a consistent FiO2 (24-28% initially) regardless of the patient's breathing pattern, preventing oxygen toxicity while treating hypoxia. You should titrate oxygen therapy to maintain SpO2 between 88-92% in COPD patients.

While other devices can deliver oxygen, they don't provide the same precise control of FiO2. The patient's moderate distress and ability to speak indicate they can tolerate a mask and don't require more aggressive ventilatory support initially.

You are preparing to suction the mouth of an adult patient who is not breathing. As part of the preparation, what should you include and have ready before you begin suctioning your patient?

Container of sterile water

A container of sterile water will allow you to clear an obstruction in the catheter tip or tubing should one develop. Soft, flexible-style catheters are not recommended for the oral cavity when suctioning an adult.

The best method to determine adequate ventilation is to use a combination of ____

Pulse oximetry and capnography

Acute abdomen is classified as _____

Tender with movement and flinches when touched

An "acute abdomen" is a specific diagnosis and an indication for emergency workup. It is the presence of pain at rest or significant tenderness to palpation in combination with signs of peritoneal irritation: guarding/splinting, distention, vomiting, and pain, with or without rebound tenderness (although that would seal the deal!). Normal bowel sounds, even with distension, speaks against an acute abdomen, because the normal bowel peristalsis is one of the first signs with peritonitis. Rectal bleeding with a fever is concerning, but doesn't necessarily mean that the GI tract is not intact. Pain with deep pressure in the right lower quadrant would evoke suspicion of appendicitis, but musculoskeletal pain and even an ovarian cyst could cause this; were it to be rebound in nature, that would be different.

In homeless or impoverished patients, the majority of EMS activations are due to ____

Decompensated chronic illnesses

Patients experiencing homelessness frequently call

EMS due to chronic disease exacerbations rather than acute injuries or infections. Limited access to healthcare, challenges with medication storage, inadequate nutrition, and untreated mental health conditions make managing illnesses like diabetes, heart disease, and lung disease particularly difficult.

Additionally, mental health disorders can complicate care by affecting medication adherence and decision-making. Social support issues rarely lead to EMS activation, but they do lead to many walk-in visits to the emergency rooms, which you may encounter if working as an ED Tech.

Which valve is the atrioventricular valve that separates the LEFT ATRIUM from the LEFT VENTRICLE

Mitral valve

The mitral valve is the AV valve that lies between the left atrium and left ventricle.

When is it an appropriate time to check for a pulse during CPR?

Every 2 minutes

Shortness of breath

Productive cough

Orthopnea

Pulmonary edema

What is the MOST appropriate name for the type of cerebral vascular incident where all symptoms resolve within 24 hours of onset?

Transient Ischemic Attack

When signs and symptoms of a cerebral vascular accident resolve within 24 hours, the condition is referred to as a transient ischemic attack (TIA). Note:

This is not actually an objective within the Basic EMT curriculum.

____ are the minimal acceptable PPE for a potentially deadly droplet pathogen such as COVID-19

A surgical mask and eye protection

A surgical mask and eye protection are the minimal acceptable PPE for a potentially deadly droplet pathogen such as COVID-19, if the pathogen was confirmed to be airborne an N95 mask would be required. Gloves and aggressive cleaning of work uniforms are also recommended but not absolutely required for these pathogens. In an ideal scenario, all body surfaces including any showing skin would be covered by single-use disposable coveralls, however, the majority of American EMS systems are not equipped with a sufficient amount of this equipment.

What are three common compensatory signs seen in the early/middle stages of HYPOVOLEMIC shock?

Tachycardia

Oliguria

Excessively cool skin

In shock, your patient's body fights to maintain perfusion. The heart speeds up (tachycardia) to compensate for pumping less blood with each beat.

The kidneys hold onto fluid by reducing urine output (oliguria). Blood vessels tighten (peripheral vasoconstriction), pulling blood from the skin to protect vital organs, causing cool, pale skin. The body releases stress hormones to squeeze blood vessels and boost heart strength, while the liver releases glucose for energy. These mechanisms temporarily maintain blood pressure but warn you of early shock. When they fail, blood pressure drops below 90 systolic, mental status changes, breathing becomes difficult, pulses weaken, and organs begin to fail. Without rapid treatment, shock becomes irreversible, leading to cardiovascular collapse.

Confusion/hallucinations, tongue fasciculations, and tremulousness are signs of

Delirium Tremens

What is considered the FIRST LINE of defense in fighting the spread of infectious disease in the pre-hospital environment?

Following proper handwashing procedures

When using the OPQRST pain assessment method, which component best helps distinguish between somatic pain (sharp, localized) and visceral pain (dull, poorly localized)?

Quality

Snoring respirations indicate a _________ obstruction

partial airway obstruction

Solid organs in the digestive system are the ?

Liver & Pancreas

3 initial signs of ICP

AMS, Headache , Nausea & Vomiting

Watch for three early signs of increased intracranial pressure(ICP): headache that is worse in the morning or when lying flat, projectile vomiting with nausea, and changes in mental status such as lethargy or irritability. Noticing these symptoms early helps ensure transport before the patient's condition worsens. The appearance of unequal pupils (anisocoria) shows that brain tissue is pressing on the nerve that controls pupil size. This is a late and dangerous sign that needs immediate attention. As part of Cushing's triad, bradycardia signals that increased pressure is affecting the brain stem and the situation has become severe

3 most common signs in anaphylaxis :

Nausea & Vomiting ; Skin rash ; Wheezing

The most common symptoms of anaphylaxis are nausea and vomiting, rash, and wheezing. Petechia, fever, dry mucous membranes, and abdominal tenderness are less common. If stridor, facial swelling, tongue swelling, periorbital edema, or intolerance of oral secretions are present, airway obstruction may be imminent. Keep in mind that just because these are the most common symptoms does not mean that they will be seen with every patient who presents with anaphylaxis.

A 50-year-old patient develops diabetes and hypertension over the past two years, coinciding with a 40-pound weight gain and increasingly sedentary work. What factor most likely contributed to the development of these conditions?

Recent lifestyle changes

Recent lifestyle changes often play a decisive role in the development and management of these conditions. Factors like diet, physical activity, smoking, and stress management are critical in either mitigating or exacerbating genetic predispositions. A comprehensive understanding of a patient's lifestyle is essential not only for treating symptoms but also for guiding patients toward effective lifestyle modifications. These changes can significantly influence long-term health outcomes in spite of genetics.

What mechanism do the blood vessels use to control blood pressure?

Contraction of the smooth muscle

The arteries and veins rely on their smooth muscle to control blood pressure, they can contract (vasoconstriction) to raise the blood pressure. Or dilate (vasodilation) to reduce the blood pressure.

Epinephrine and fluid can also increase blood pressure, but the blood vessels do not release epinephrine or control fluid balance. That is the role of the adrenal glands and the kidneys.

______ is a connection between two blood vessels

Anastomosis

What happens to the temperature of the skin during hypoperfusion?

It cools down

_____ the pressure that blood exerts AGAINST the walls of the vessel

Hydrostatic Pressure

Hypertensive emergency is distinguished from hypertensive urgency by the presence of ________

Acute end-organ damage

Hypertensive emergency is distinguished from hypertensive urgency by the presence of acute end-organ damage, not blood pressure levels alone. Both conditions involve severely elevated blood pressure, but hypertensive emergency requires evidence of acute target organ dysfunction, such as stroke, acute coronary syndrome, pulmonary edema, acute kidney injury, or hypertensive retinopathy. Blood pressure levels, symptom duration, and patient age do not determine the classification. A patient with BP 220/130 without organ damage has urgency, while BP 185/115 with acute stroke is an emergency.

____ the force that tends to pull water into the circulatory system and prevents it from leaving.

Oncotic Pressure

______ is the first heart sound

Lub - S1

_____ commonly known as shingles,

Herpes zoster

Herpes zoster, commonly known as shingles, can cause classic chest pain symptoms primarily due to the inflammation of the sensory nerves in the affected dermatomal area, but in early stages may only be increased sensitivity over one dermatome before eruption occurs.

______ is the diligent and systematic inquiry or investigation into a subject in order to discover or revise facts, theories, applications, etc.

Research

Before ASSISTING with NITROGLYCERIN administration, you must assess the patients blood pressure to ensure it’s above

100 systolic

Before assisting with nitroglycerin administration, you must assess the patient's blood pressure to ensure the systolic pressure is above 100 mmHg (some protocols use 90 or 110 mmHg as the threshold).

This prevents dangerous hypotension, which is a primary contraindication for nitroglycerin. While protocols vary by EMS system regarding standing orders versus medical control authorization, the blood pressure assessment is universally required before each dose.

Acute stress reactions usually manifest in which of the following ways?

As severe anxiety or severe dissociation

An immediate response to a stressful event, often occurring during or shortly after the event itself, is known as an acute stress reaction. An acute stress reaction can manifest as severe anxiety or severe dissociation.

When auscultating heart sounds, what does the S1 "lub" sound indicate?

Closure of the mitral and tricuspid valves

The "lub" is the first heart sound, commonly termed S1, and is caused by turbulence from the closure of the mitral and tricuspid valves at the start of systole.

What structure keeps blood from flowing backwards into the right atrium from the right ventricle?

Tricuspid valve

The tricuspid atrioventricular valve between the right atrium and right ventricle keeps blood from flowing retrograde back into the right atrium when the right ventricle contracts. Its counterpart on the left is the mitral valve.

What is the recommended ratio of chest compressions to rescue breaths in adult CPR with 2 rescuers?

30:2

The recommended ratio of chest compressions to rescue breaths in adult CPR, regardless of the number of rescuers, is 30:2. This ratio ensures that the patient receives adequate circulation, which is vital for providing oxygen to vital tissues and organs.

It also minimizes interruptions in chest compressions, which is the most important factor in the survival of cardiac arrest.

Full dosage of aspirin _____

324mg

_____ can present with anxiety, chest pain, and tachycardia and is often mistaken for a cardiac event

Hypoglycemia

Hypoglycemia can also precipitate cardiac events in fragile patients.

Ideally, the blood glucose should be checked as a part of the primary survey and if below 60mg/dL, a tube of oral glucose should be given.

______ is a potent vasodilator that affects both the ARTERIAL and VENOUS VESSELS

Nitroglycerin

What is a common sign associated with pulmonary edema?

Pink, frothy sputum

Pink, frothy sputum is a classic sign of pulmonary edema, observable during physical examination or patient observation. It results from fluid accumulation in the lungs that mixes with air, creating a characteristic pink and frothy appearance. This is a direct manifestation of the condition and is a key diagnostic indicator. While other symptoms such as chest pain, difficulty speaking, and cool, diaphoretic skin may accompany pulmonary edema, pink, frothy sputum is specific and indicative of this particular respiratory issue.

Contraindications for ASPIRIN :

Active bleeding

Allergy

Children’s or teenagers with viral infections

Pregnant women

You should start _____ on any infant with a HR BELOW 60

BEGIN CPR

Medical term for ringing in ears

Tinnitus

During positive pressure ventilation, which position BEST optimizes LUNG EXPANSION and minimizes aspiration risk?

Semi-Fowlers

The semi-Fowler's position (elevated head position) is the best choice for positive-pressure ventilation

(PPV) because it optimizes lung expansion, makes breathing easier, and lowers the risk of aspiration.

The supine position can compress lung tissue and increase the chance of stomach contents entering the airway, making ventilation much more difficult.

That said, supine is still necessary in some situations, like during CPR or when placing an advanced airway.

Prone positioning can improve oxygenation in ICU patients with ARDS, but it's not used for routine PPV.

______ is autonomic instability and confusion, fever, hypertension, and seizures.

Delirium tremens

DTs or Delirium Tremens is the most severe manifestation of alcohol withdrawal. Symptoms include autonomic instability and confusion, fever, hypertension, and seizures. An MI "Myocardial infarction", DVT "Deep vein thrombosis", and CVA "Cerebrovascular accident" are less likely to be the cause of the symptoms the patient is experiencing

AHA guidelines stipulate that approximately _______ of the anterior-posterior diameter of the chest should be compressed while performing CPR on a CHILD

2 INCHES

Which type of vessels does nitroglycerin dilate ?

Arterial and venous vessels

What are the contraindications for administering nitroglycerin?

Hypotension , Recent use of erectile dysfunction

The absolute contraindications for nitroglycerin include hypotension (systolic BP < 90 mmHg) because the medication's vasodilatory effects can precipitate cardiovascular collapse in already hypotensive patients. Recent use of erectile dysfunction medications like sildenafil or tadalafil creates dangerous drug interactions through additive vasodilation, potentially causing severe hypotension.

A known allergy to nitroglycerin is an absolute contraindication, though rare in practice. Nausea, vomiting, and tachycardia are not contraindications; nausea may actually improve with nitroglycerin if cardiac in origin, and alternative administration routes remain available when oral/sublingual routes are compromised.

______ is an anti platelet agent reduces the clotting ability of blood

Aspirin

What differentiates "signs" from "symptoms" in the setting of medical history and assessment?

Signs are always objective

In general, a person's ability to cope with his own death is based on many factors. Which of the following would NOT be considered an asset in accepting a terminal illness?

Professional background

There are questions like this on the NREMT where

EVERY answer CAN BE CONSIDERED AN ASSET! Of course having a background in hospice or medicine or numerous other backgrounds would be an asset, but only from the point of view of familiarity with the death process. The data point that they want you to know is: Your profession or job has not been shown to help serve as an asset in coping with one's own death. Although there is no guarantee, the other three options have been shown to positively affect how one looks at death. It doesn't matter whether you were a banker, neurosurgeon, or coroner: everyone must deal with his/her own mortality with intangibles such as spirituality, maturity, acceptance, and one's value of life.

The process of oxygenated blood flowing through a vessel to an organ or tissue is called ____

Perfusion

Prehospital management of suspected DVT focuses on preventing clot dislodgement through ______ of the affected extremity

immobilization

______ chest pressure or discomfort that radiates to the arm, jaw, or back because the heart shares nerve pathways with these areas.

Acute coronary syndrome

Male victims in domestic violence account for ___

5% of reported incidents

_____ is normally the FIRST sign of cardiovascular compromise in patients experiencing ANAPHYLAXIS

Tachycardia

Heart rate, measured in beats per minute, is determined by the number of ______

Ventricular contractions in one minute

______ is responsible for the normal function of the patients motor control, reticular activating system (responsible for wakefulness), regulatory centers for the heart rate (pulse), blood pressure, and normal respirations

Brainstem

_____ lie BETWEEN the ribs and PULL THEM closer together when contracted

The intercostal muscles

Which organ FILTERS and REMOVES BACTERIA from the ARTERIAL BLOOD

The spleen

_____ Is characterized by too little blood to supply adequate oxygen and nutrients to parts of the brain

Ischemic stroke

The electrical impulse generated by the sinoatrial (SA) node triggers both ____

Atrial & Ventricular contractions

The proper place to deliver the inward and upward thrusts associated with the Heimlich is halfway between the _____

Umbilicus & Xiphoid Process

Liver ; Gallbladder & Duodenum are part of the

RUQ

The best way to assess the skin color of a patient with DARKER SKIN is to evaluate their ____ , ____ & ____

Nail beds, Mouth & Lips

______ primary role serves as the final electron acceptor in cellular respiration to PRODUCE ATP

Oxygen's

Stomach , Spleen are part of which quadrant?

LUQ

How does EMPHYSEMA contribute to airway limitation by DECREASING _____

The surface area of respiration

The “STRIATED MUSCLES” are found primary in the ____

Limbs

The most ominous sign of worsening ASTHMA is a sudden ____

Decrease in respiratory rate

Beta-2 stimulation from epinephrine relaxes bronchial smooth muscle, producing _____

Bronchodilation

The CRANIUM is made up of several bones that are connected by which joint types?

Fused joints

Which of the following conditions causes oxygenated blood to flow ABNORMALLY from the left side of the heart to the lungs?

A hole between the two ventricles

Which division of the nervous system is responsible for ensuring digestion proceeds after a large meal?

Parasympathetic nervous system

You are obtaining a SAMPLE history from a responsive patient. It should be focused on the ____

Chief Complaint

The pediatrics ____ is longer, floppier and more narrow than an adults

Epiglottis

Sudden onset of chest pain , Consistent cyanosis and low 02 is classing signs of a _______

Pulmonary embolism

Primary assessments 4 steps :

General impression

AVPU

ABC’s

Rapid exams

You arrive on scene of a medical emergency. AFTER forming your general impression, what is the next step in the primary assessment?

Determine the patient's level of consciousness

Platelets are also known as _____

Thrombocytes

What is the function of platelets in the blood ?

To help form blood clots

A patient with severe ASTHMA who has a SUDDENLY decreasing respiratory rate will likely require ______________

Positive pressure ventilations

"Was it related to anything in particular or did it begin all on its own?" is a question relating to

Onset

Which heart valve is located between the right atrium and right ventricle?

Tricuspid valve

What is the strongest independent predictor of mortality in OLDER PATIENTS with community-acquired pneumonia?

Co-morbidity

Which physiological function is primarily regulated by peripheral chemoreceptors located in the CAROTID and AORTIC BODIES

The respiratory rate

The ___ is the thick middle layer of the skin

Dermis

____ refers to the degree to which tissue or organs are recieving delivery of oxygenated blood

Perfusion

Breathing through your nose ________ air due to a large number of mucosal folds within the nasopharynx

Cleans and warms air

_____ is the connection between the scapula and the clavicle

The Acromioclavicular joint

Difficulty urinating is referred to as

Dysuria

Excessive DILATION of the arterioles, capillaries, and veins in the body will have which instantaneous effect.

A drop in blood pressure

Peripheral chemoreceptors in the carotid and aortic bodies monitor levels of ___ , ___ , ____

Oxygen , carbon dioxide and Blood Ph

________ regulates long-term bodily processes such as

mood, metabolism, & sexual development through hormone release

The endocrine system

Medical term for Difficulty swallowing

Dysphagia

By the age of ____ most children have developed to independently express their symptoms and state of health in a way that’s understandable

Age of 4

________ of the cerebrum is responsible for motor movement and personality

The frontal lobe

13 - 18 years is considered which age group

Adolescence