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PHECC Advanced Paramedic study materials
PHECC Advanced Paramedic study resources

PHECC Advanced Paramedic practice questions

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Question 1Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

In an adult in cardiac arrest with a shockable rhythm, what is the recommended energy setting for the first defibrillation using a manual biphasic defibrillator?

  1. 50 J
  2. 360 J
  3. 200 J
  4. 150 J Correct answer.

Explanation

PHECC advanced life support guidance follows the manufacturer's recommended biphasic energy, with 150 J being the typical default for the first and subsequent shocks on a standard biphasic device. Escalation is only used if the device or local protocol specifies it. Monophasic devices use 360 J.

Question 2Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

An adult in cardiac arrest is in ventricular fibrillation. After the first shock and 2 minutes of CPR, the rhythm remains VF. What is the correct next drug intervention?

  1. Adrenaline 1 mg IV followed by amiodarone 300 mg IV after the third shock Correct answer.
  2. Atropine 3 mg IV immediately
  3. Sodium bicarbonate 50 mL IV
  4. Amiodarone 150 mg IV before adrenaline

Explanation

In shockable cardiac arrest, adrenaline 1 mg is given after the third shock and repeated every 3-5 minutes, with amiodarone 300 mg given after the third shock. Atropine and bicarbonate have no role in routine VF management.

Question 3Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

What is the correct initial synchronised cardioversion energy for an adult with unstable narrow-complex tachycardia using a biphasic defibrillator?

  1. 360 J
  2. 70-120 J Correct answer.
  3. 200 J
  4. 150 J

Explanation

For synchronised cardioversion of a narrow-complex tachycardia, a biphasic energy of approximately 70-120 J is recommended, escalating if unsuccessful. Higher energies are reserved for refractory cases or monophasic devices.

Question 4Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

An adult with severe asthma is not responding to nebulised salbutamol and ipratropium. Which adjunct is recommended in the PHECC guidelines?

  1. Intramuscular adrenaline
  2. Intravenous magnesium sulfate Correct answer.
  3. Intravenous frusemide
  4. Intravenous adrenaline bolus

Explanation

Intravenous magnesium sulfate is recommended for severe or life-threatening asthma not responding to inhaled bronchodilators. It produces smooth muscle relaxation and is given as an infusion.

Question 5Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with anaphylaxis has been given IM adrenaline 0.5 mg into the anterolateral thigh. After 5 minutes there is no improvement. What is the appropriate action?

  1. Give IV adrenaline 1 mg bolus
  2. Give oral antihistamine and observe
  3. Repeat IM adrenaline 0.5 mg Correct answer.
  4. Give nebulised salbutamol alone

Explanation

IM adrenaline may be repeated every 5 minutes if there is no improvement. IV adrenaline is reserved for specialist settings with cardiac monitoring and is not given as a 1 mg bolus. Antihistamines and bronchodilators are adjuncts only.

Question 6Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

What is the correct adult dose of intramuscular adrenaline for anaphylaxis?

  1. 0.5 mg of 1:1,000 solution Correct answer.
  2. 1 mg of 1:10,000 solution
  3. 0.1 mg of 1:10,000 solution
  4. 3 mg of 1:1,000 solution

Explanation

The adult IM adrenaline dose for anaphylaxis is 0.5 mg of the 1:1,000 (1 mg/mL) solution, given into the anterolateral thigh. The 1:10,000 dilution is used for IV administration in monitored settings.

Question 7Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with suspected opioid overdose has a respiratory rate of 6 per minute and SpO2 of 82%. What is the most appropriate initial management?

  1. Oral airway and observation
  2. Naloxone 2 mg IV push
  3. Immediate chest compressions
  4. Assisted ventilation with a bag-valve mask and titrated naloxone Correct answer.

Explanation

Airway and ventilation take priority; assisted ventilation with supplemental oxygen is provided while naloxone is titrated to restore adequate respiration, not full consciousness. This reduces the risk of acute withdrawal and agitation.

Question 8Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

Which finding best indicates adequate chest compression quality during CPR?

  1. Full recoil with a rate of 100-120 per minute and depth of 5-6 cm Correct answer.
  2. Compression depth of 2 cm
  3. Compression rate of 60 per minute
  4. Interruptions of 20 seconds for rhythm checks

Explanation

High-quality CPR requires a rate of 100-120 per minute, depth of 5-6 cm in adults, full chest recoil, and minimising interruptions. These parameters optimise coronary and cerebral perfusion.

Question 9Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient presents with a blood glucose of 2.8 mmol/L and is conscious and able to swallow. What is the first-line treatment?

  1. IM glucagon 1 mg
  2. IV glucagon 1 mg
  3. Oral glucose Correct answer.
  4. IV glucose 10% 100 mL

Explanation

In a conscious patient who can swallow, oral glucose is the safest and least invasive first-line treatment for hypoglycaemia. IV glucose or glucagon are reserved for patients unable to take oral glucose or who are unconscious.

Question 10Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

An adult with suspected stroke has a blood glucose of 3.0 mmol/L. What is the most appropriate interpretation?

  1. Glucose should be ignored until CT
  2. Hypoglycaemia may mimic stroke and must be corrected Correct answer.
  3. This is a normal finding in stroke
  4. Hyperglycaemia is present

Explanation

Hypoglycaemia can produce focal neurological deficits that mimic stroke and must be corrected before stroke is confirmed. Blood glucose measurement is a mandatory step in stroke assessment.

Question 11Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

What is the recommended time window for thrombolysis in acute ischaemic stroke?

  1. Within 24 hours of symptom onset
  2. Within 12 hours of symptom onset
  3. Within 1 hour of symptom onset
  4. Within 4.5 hours of symptom onset Correct answer.

Explanation

Intravenous thrombolysis is generally indicated within 4.5 hours of symptom onset in eligible patients. Prehospital recognition and rapid transport are critical to meeting this window.

Question 12Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with suspected acute coronary syndrome has ongoing chest pain. Which medication is contraindicated if the patient has taken a PDE5 inhibitor within the last 24 hours?

  1. Aspirin
  2. Clopidogrel
  3. GTN Correct answer.
  4. Morphine

Explanation

Glyceryl trinitrate is contraindicated with recent PDE5 inhibitor use because of the risk of profound hypotension. Aspirin, clopidogrel and morphine are not contraindicated on this basis.

Question 13Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

What is the correct adult dose of aspirin in suspected acute coronary syndrome?

  1. 150 mg chewed
  2. 300 mg chewed Correct answer.
  3. 75 mg swallowed
  4. 600 mg IV

Explanation

Aspirin 300 mg is given as a chewed (or dispersible) dose to achieve rapid platelet inhibition in suspected ACS. Lower doses are for long-term maintenance.

Question 14Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient has a tension pneumothorax with severe respiratory distress and hypotension. What is the priority intervention?

  1. Chest x-ray confirmation
  2. Nebulised salbutamol
  3. IV fluids only
  4. Needle decompression Correct answer.

Explanation

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression without waiting for imaging. Delay can lead to cardiac arrest.

Question 15Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

In a patient with a suspected flail chest, which intervention most improves oxygenation?

  1. Tight strapping of the chest
  2. Lying the patient flat
  3. Positive pressure ventilation Correct answer.
  4. High-flow oxygen alone

Explanation

Positive pressure ventilation stabilises the flail segment and improves oxygenation in severe flail chest. Circumferential strapping is harmful as it restricts ventilation.

Question 16Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

What is the recommended initial fluid bolus for an adult with suspected hypovolaemic shock from trauma?

  1. 250 mL crystalloid bolus
  2. 500 mL crystalloid bolus Correct answer.
  3. No fluids under any circumstances
  4. 2 L crystalloid rapid infusion

Explanation

A cautious 500 mL crystalloid bolus is recommended in trauma with signs of hypovolaemia, reassessing after each bolus to avoid worsening bleeding through dilution and raised blood pressure.

Question 17Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient is in hypovolaemic shock from a suspected pelvic fracture. Which manoeuvre is recommended while awaiting transport?

  1. Sit the patient upright
  2. Apply a pelvic binder at the level of the greater trochanters Correct answer.
  3. Flex the hips and knees
  4. Log-roll the patient

Explanation

A pelvic binder applied at the level of the greater trochanters reduces pelvic volume and stabilises the fracture, helping to control bleeding. Log-rolling should be avoided as it can disrupt clot formation.

Question 18Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

Which of the following is the most reliable early indicator of hypoperfusion in a trauma patient?

  1. Prolonged capillary refill and altered mental status Correct answer.
  2. Haemoglobin level
  3. Respiratory rate alone
  4. Blood pressure

Explanation

Prolonged capillary refill, altered mental status and narrowing pulse pressure are early signs of hypoperfusion, before blood pressure falls. Haemoglobin may remain normal initially.

Question 19Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient has a GCS of 13 after head injury, and is otherwise stable. What is the recommended disposition?

  1. Observe at home
  2. Transport to an emergency department Correct answer.
  3. Refer to a GP
  4. Discharge with head injury advice

Explanation

A GCS of 13 after head injury is a significant finding and warrants transport to an emergency department for assessment and imaging. Discharge or home observation is inappropriate.

Question 20Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

Which of the following best describes the purpose of the Cincinnati Prehospital Stroke Scale?

  1. To confirm the type of stroke
  2. To identify patients with suspected stroke for rapid transport Correct answer.
  3. To guide thrombolysis dosing
  4. To measure stroke severity

Explanation

The Cincinnati scale screens for facial droop, arm drift and speech abnormality to identify suspected stroke and expedite transport. It does not distinguish ischaemic from haemorrhagic stroke or guide treatment dosing.

Question 21Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with a severe allergic reaction has stridor and hypotension. Which route of adrenaline administration is preferred in the prehospital setting?

  1. Intramuscular Correct answer.
  2. Subcutaneous
  3. Oral
  4. Intradermal

Explanation

Intramuscular injection into the anterolateral thigh provides rapid, reliable absorption in anaphylaxis. The subcutaneous route is less reliable, particularly in shocked patients.

Question 22Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

Which of the following is a contraindication to the use of nitrous oxide as an analgesic?

  1. Isolated limb fracture
  2. Mild anxiety
  3. Renal colic
  4. Suspected pneumothorax Correct answer.

Explanation

Nitrous oxide is contraindicated where there is a closed air space such as pneumothorax, because it diffuses into the space and can worsen it. It is otherwise useful for analgesia in trauma and colic.

Question 23Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with a suspected cervical spine injury requires airway management. Which manoeuvre best maintains spinal alignment?

  1. Neck extension
  2. Head tilt and chin lift
  3. Jaw thrust with manual in-line stabilisation Correct answer.
  4. Recovery position

Explanation

A jaw thrust with manual in-line stabilisation opens the airway while minimising cervical movement. Head tilt and neck extension can exacerbate spinal injury.

Question 24Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

What is the recommended compression-to-ventilation ratio for adult two-rescuer CPR?

  1. 30:2 Correct answer.
  2. 10:2
  3. 15:2
  4. 5:1

Explanation

Adult two-rescuer CPR uses a 30:2 compression-to-ventilation ratio, consistent with single-rescuer CPR. A 15:2 ratio applies to paediatric resuscitation.

Question 25Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

Which of the following is the most appropriate first action when a patient's cardiac monitor shows asystole?

  1. Give adrenaline 1 mg IV before CPR
  2. Check leads and confirm asystole while starting CPR Correct answer.
  3. Immediate defibrillation
  4. Give atropine 3 mg

Explanation

Asystole must be confirmed by checking leads and connections while CPR is ongoing. Defibrillation is not indicated for asystole, and drugs follow high-quality CPR.

Question 26Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with a severe asthma attack is being treated with nebulised salbutamol. Which additional medication is recommended in the PHECC guidelines for severe asthma unresponsive to initial bronchodilators?

  1. Inhaled ipratropium bromide Correct answer.
  2. Intramuscular adrenaline
  3. Intravenous hydrocortisone
  4. Oral prednisolone

Explanation

PHECC guidelines recommend adding nebulised ipratropium bromide to salbutamol in severe asthma to enhance bronchodilation. Systemic corticosteroids may be considered but are not the first additional inhaled agent. Adrenaline is reserved for life-threatening situations such as impending respiratory arrest.

Question 27Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with suspected sepsis has a blood pressure of 85/50 mmHg and a heart rate of 120 bpm. According to PHECC guidelines, which of the following is the most appropriate initial fluid resuscitation?

  1. 250 mL crystalloid bolus
  2. 500 mL crystalloid bolus Correct answer.
  3. No fluid bolus; vasopressors first
  4. 1000 mL crystalloid bolus

Explanation

PHECC guidelines recommend an initial crystalloid bolus of 500 mL for adults with suspected sepsis and hypotension, reassessing after each bolus. Larger volumes may be given cautiously but require frequent reassessment. Vasopressors are not a prehospital first-line intervention.

Question 28Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient is experiencing an acute asthma exacerbation and has been given nebulised salbutamol with minimal improvement. Which route of administration is preferred for adrenaline in this situation?

  1. Intramuscular Correct answer.
  2. Inhaled
  3. Intravenous
  4. Subcutaneous

Explanation

For severe asthma not responding to nebulised bronchodilators, PHECC guidelines recommend intramuscular adrenaline. The intramuscular route provides reliable absorption and is safer than intravenous adrenaline in the prehospital setting. Subcutaneous and inhaled routes are not preferred for systemic effect.

Question 29Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with known epilepsy is actively convulsing for 3 minutes. According to PHECC guidelines, what is the recommended first-line medication for termination of the seizure?

  1. Intramuscular midazolam
  2. Buccal midazolam Correct answer.
  3. Intravenous diazepam
  4. Oral lorazepam

Explanation

PHECC guidelines recommend buccal midazolam as the first-line benzodiazepine for prolonged seizures in the prehospital setting when intravenous access is not available. It is effective, safe, and easy to administer. Intravenous diazepam may be used if access is established, but buccal midazolam is preferred initially.

Question 30Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with suspected opioid overdose has a respiratory rate of 6 per minute and SpO2 of 82%. After administering naloxone, the patient's respiratory rate improves to 12 per minute. What is the most appropriate next action?

  1. Continue monitoring and reassess frequently Correct answer.
  2. Administer a second dose of naloxone immediately
  3. Begin bag-mask ventilation
  4. Discontinue monitoring as the patient has improved

Explanation

After improvement with naloxone, the patient should be continuously monitored because the effects of naloxone may wear off before the opioid, leading to recurrent respiratory depression. Further doses are given if respiratory depression returns. Bag-mask ventilation is indicated if breathing remains inadequate.

Question 31Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with a suspected cervical spine injury requires airway management. Which manoeuvre is recommended to open the airway while maintaining spinal alignment?

  1. Head-tilt chin-lift
  2. Hyperextension of the neck
  3. Flexion of the neck
  4. Jaw thrust Correct answer.

Explanation

The jaw thrust manoeuvre is recommended for opening the airway in patients with suspected cervical spine injury because it minimises movement of the cervical spine. Head-tilt chin-lift and neck hyperextension can exacerbate spinal injury. Flexion of the neck is not an airway manoeuvre.

Question 32Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient is in cardiac arrest with a shockable rhythm. According to PHECC guidelines, what is the recommended energy setting for the first defibrillation attempt using a biphasic defibrillator?

  1. 200 J Correct answer.
  2. 150 J
  3. 50 J
  4. 100 J

Explanation

PHECC guidelines recommend an initial biphasic defibrillation energy of 200 J for adult cardiac arrest with a shockable rhythm, unless the manufacturer's recommendation specifies otherwise. Subsequent shocks should be of equal or higher energy. Lower energies may be used if the device is pre-set by the manufacturer.

Question 33Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with a suspected tension pneumothorax is showing signs of severe respiratory distress and hypotension. Which of the following is the most appropriate immediate intervention according to PHECC guidelines?

  1. Needle decompression Correct answer.
  2. Positive pressure ventilation
  3. Oxygen therapy
  4. Chest tube insertion

Explanation

Needle decompression is the immediate life-saving intervention for a tension pneumothorax with haemodynamic compromise. Oxygen and ventilation support may be provided but do not relieve the pressure. Chest tube insertion is definitive but requires a higher level of care and is not the first prehospital step.

Question 34Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with a suspected flail chest is in respiratory distress. Which intervention is most appropriate to improve oxygenation according to PHECC guidelines?

  1. Encourage deep breathing exercises
  2. Apply a compression bandage to the chest
  3. Administer oxygen and provide positive pressure ventilation Correct answer.
  4. Place the patient in a supine position

Explanation

For flail chest, the priority is to ensure adequate oxygenation and ventilation. Positive pressure ventilation can splint the flail segment and improve gas exchange. Compression bandaging is not recommended as it restricts chest expansion and can worsen outcomes.

Question 35Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with a suspected pelvic fracture is hypotensive and tachycardic. Which manoeuvre is recommended to reduce pelvic volume and limit haemorrhage while awaiting transport?

  1. Application of a pelvic binder Correct answer.
  2. Manual compression of the abdomen
  3. Log-rolling the patient
  4. Traction to the lower limbs

Explanation

Applying a pelvic binder is recommended to stabilise the pelvis, reduce pelvic volume, and limit further bleeding in suspected pelvic fracture with haemodynamic instability. Log-rolling is used for spinal precautions but does not reduce pelvic volume. Traction and abdominal compression are not appropriate.

Question 36Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with a severe head injury has a Glasgow Coma Scale score of 8. According to PHECC guidelines, which of the following is the most appropriate airway management?

  1. Apply supplemental oxygen via a non-rebreather mask
  2. Insert an oropharyngeal airway
  3. Place the patient in the recovery position
  4. Perform endotracheal intubation Correct answer.

Explanation

A GCS of 8 or less indicates a need for definitive airway management. PHECC guidelines recommend endotracheal intubation for patients with severe head injury and GCS ≤8 to protect the airway and ensure adequate ventilation. Basic airway adjuncts may be used temporarily but are not definitive.

Question 37Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient is suspected of having a fractured femur. Which of the following is the most appropriate prehospital management according to PHECC guidelines?

  1. Apply a traction splint Correct answer.
  2. Immobilise with a board splint
  3. Apply a vacuum splint
  4. Encourage weight-bearing

Explanation

A traction splint is recommended for suspected femoral shaft fractures to reduce pain, align the bone, and minimise blood loss. Vacuum splints and board splints are not specifically designed for traction and may not provide adequate stabilisation. Weight-bearing is contraindicated.

Question 38Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with a known history of angina complains of chest pain that has not been relieved by rest and two doses of sublingual glyceryl trinitrate (GTN). According to PHECC guidelines, what is the recommended next action?

  1. Encourage the patient to walk around
  2. Administer aspirin and prepare for transport Correct answer.
  3. Administer morphine for pain relief
  4. Administer a third dose of GTN

Explanation

PHECC guidelines recommend administering aspirin (if not contraindicated) and transporting the patient with suspected acute coronary syndrome when chest pain is not relieved by GTN. A third dose of GTN may be considered in some protocols but is not the priority; morphine may be used for pain but aspirin and transport are key.

Question 39Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient with a suspected stroke has a blood glucose level of 3.0 mmol/L. According to PHECC guidelines, what is the most appropriate initial management?

  1. Administer oral glucose gel
  2. Administer intramuscular glucagon
  3. Administer intravenous glucose Correct answer.
  4. Withhold glucose and transport immediately

Explanation

Hypoglycaemia can mimic stroke and must be corrected. PHECC guidelines recommend intravenous glucose (e.g., dextrose 10%) for a conscious patient with hypoglycaemia and suspected stroke. Oral glucose may be used if the patient can swallow safely, but IV glucose is preferred in the stroke pathway.

Question 40Advanced Paramedic clinical practice (PHECC Clinical Practice Guidelines)

A patient is experiencing an acute dystonic reaction after receiving an antiemetic. Which medication is recommended for treatment according to PHECC guidelines?

  1. Metoclopramide
  2. Diphenhydramine
  3. Procyclidine Correct answer.
  4. Ondansetron

Explanation

Procyclidine is recommended for the treatment of acute dystonic reactions in PHECC guidelines. It is an anticholinergic agent that rapidly reverses dystonia. Diphenhydramine may be used in some settings but is not the first-line in PHECC; ondansetron and metoclopramide are antiemetics that can cause or worsen dystonia.

Question 41Patient assessment and clinical decision-making

A patient is breathing 24 times per minute with an SpO2 of 89% on room air. Which category best describes this respiratory status?

  1. Bradypnoea with hyperoxia
  2. Normal ventilation with hypercapnia
  3. Tachypnoea with hypoxaemia Correct answer.
  4. Respiratory rate normal, oxygenation adequate

Explanation

A rate above the accepted adult upper limit of about 20/min defines tachypnoea, and an SpO2 below 94% on room air indicates hypoxaemia. Combining the two gives tachypnoea with hypoxaemia.

Question 42Patient assessment and clinical decision-making

When assessing the airway of an unresponsive patient, which finding most strongly suggests partial obstruction?

  1. Regular chest rise and fall
  2. Audible stridor on inspiration Correct answer.
  3. Central cyanosis of the lips
  4. Silent chest with no air movement

Explanation

Stridor is turbulent airflow through a narrowed upper airway and is a hallmark of partial obstruction. A silent chest suggests complete obstruction or absent effort, not partial obstruction.

Question 43Patient assessment and clinical decision-making

In the AVPU scale, a patient who responds only to a painful stimulus is recorded as which grade?

  1. P Correct answer.
  2. V
  3. U
  4. A

Explanation

AVPU grades responsiveness as Alert, responds to Voice, responds to Pain, and Unresponsive. A patient who only responds to pain is therefore graded P.

Question 44Patient assessment and clinical decision-making

Which set of vital signs is most consistent with a patient in compensated hypovolaemic shock?

  1. Bradycardia with a widened pulse pressure
  2. Bradycardia with warm peripheries
  3. Tachycardia with a narrow pulse pressure Correct answer.
  4. Tachycardia with bounding peripheral pulses

Explanation

Early compensation for blood loss raises heart rate and increases peripheral resistance, narrowing the gap between systolic and diastolic pressures. A narrow pulse pressure with tachycardia is typical of compensated shock.

Question 45Patient assessment and clinical decision-making

A patient has a GCS of E2 V3 M5. What is the total score and what does it indicate?

  1. 11, indicating mild head injury
  2. 8, indicating the need for intubation
  3. 10, indicating moderate head injury Correct answer.
  4. 9, indicating severe head injury

Explanation

Adding eye 2, verbal 3 and motor 5 gives a total of 10. A GCS of 9 to 12 is conventionally classified as moderate impairment.

Question 46Patient assessment and clinical decision-making

During a primary survey, which finding should prompt you to move immediately to catastrophic haemorrhage control before completing the airway check?

  1. A small abrasion on the forearm
  2. Oozing from a scalp laceration
  3. Bruising over the lower abdomen
  4. Bright red blood spurting from a thigh wound Correct answer.

Explanation

Life-threatening external bleeding is addressed first in a catastrophic haemorrhage step before airway, breathing and circulation. Arterial spurting from a limb wound is the clearest example of such bleeding.

Question 47Patient assessment and clinical decision-making

An adult with suspected opioid toxicity has a respiratory rate of 6/min and pinpoint pupils. Which assessment finding is most directly explained by the drug effect?

  1. Hyperventilation
  2. Hypoventilation Correct answer.
  3. Hypertension
  4. Hyperthermia

Explanation

Opioids depress the medullary respiratory centre, producing slow, shallow breathing known as hypoventilation. Pinpoint pupils are a supportive sign of the same toxidrome.

Question 48Patient assessment and clinical decision-making

Which single question is most useful when taking a history from a patient with chest pain to characterise the symptom?

  1. Ask whether they have eaten recently
  2. Ask the patient to describe the pain in their own words Correct answer.
  3. Ask whether they have any allergies
  4. Ask how far they live from the hospital

Explanation

An open question inviting the patient to describe the pain yields the character, site, radiation and associated features needed for differential diagnosis. Closed or unrelated questions do not characterise the symptom.

Question 49Patient assessment and clinical decision-making

A patient's capillary refill time is 5 seconds and the skin is cool and mottled. What does this most suggest?

  1. Isolated respiratory failure
  2. Poor peripheral perfusion Correct answer.
  3. Adequate peripheral perfusion
  4. Raised intracranial pressure

Explanation

Prolonged capillary refill with cool, mottled skin indicates reduced peripheral perfusion, often from vasoconstriction or shock. These are signs of poor tissue perfusion.

Question 50Patient assessment and clinical decision-making

A trauma patient has a systolic blood pressure of 78 mmHg and a heart rate of 130/min. Which interpretation is most appropriate?

  1. Compensated shock with normal perfusion
  2. Normal findings for an adult at rest
  3. Decompensated shock requiring urgent intervention Correct answer.
  4. Isolated anxiety with no physiological compromise

Explanation

A systolic pressure below about 90 mmHg with marked tachycardia indicates that compensatory mechanisms are failing, which defines decompensated shock. This warrants urgent resuscitation and transport.