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PHECC EMT practice questions

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Question 1Airway and Breathing

What is the normal resting respiratory rate for a healthy adult?

  1. 32 to 40 breaths per minute
  2. 24 to 30 breaths per minute
  3. 12 to 20 breaths per minute Correct answer.
  4. 4 to 8 breaths per minute

Explanation

A healthy adult at rest typically breathes 12 to 20 times per minute. Rates outside this range suggest respiratory compromise or another underlying problem.

Question 2Airway and Breathing

Which structure is the first airway passage the inhaled air enters after the nose?

  1. Bronchus
  2. Larynx
  3. Pharynx Correct answer.
  4. Trachea

Explanation

Air passes from the nose into the pharynx, which is the shared passage behind the nasal and oral cavities. It then continues to the larynx and trachea.

Question 3Airway and Breathing

Which structure is the primary muscle of inspiration during quiet breathing?

  1. Sternocleidomastoid
  2. Pectoralis major
  3. Diaphragm Correct answer.
  4. Rectus abdominis

Explanation

The diaphragm contracts and flattens during quiet inspiration, creating negative intrathoracic pressure that draws air into the lungs. The other muscles listed are accessory or expiratory muscles.

Question 4Airway and Breathing

A patient's oxygen saturation reads 88% on room air. What does this value most directly indicate?

  1. Adequate oxygenation
  2. Hyperventilation
  3. Hypoxaemia Correct answer.
  4. Normal perfusion

Explanation

An SpO2 of 88% is below the normal range of roughly 94 to 100% and indicates hypoxaemia, meaning arterial oxygen is low. It does not by itself confirm the cause or the adequacy of ventilation.

Question 5Airway and Breathing

Which sound is most characteristic of upper airway obstruction from partial laryngeal swelling?

  1. Stridor Correct answer.
  2. Wheeze
  3. Crackles
  4. Pleural rub

Explanation

Stridor is a harsh inspiratory sound caused by turbulent flow through a narrowed upper airway such as the larynx. It signals significant obstruction and requires urgent attention.

Question 6Airway and Breathing

A patient is breathing rapidly and deeply with a fruity odour on the breath. Which condition should be suspected?

  1. Opioid overdose
  2. Diabetic ketoacidosis Correct answer.
  3. Simple faint
  4. Pulmonary embolism

Explanation

Deep, rapid breathing with a fruity or ketotic odour is a classic sign of diabetic ketoacidosis, where the body attempts to blow off carbon dioxide. The odour reflects exhaled ketones.

Question 7Airway and Breathing

What is the primary purpose of a nasopharyngeal airway?

  1. To deliver oxygen at high flow
  2. To suction the lower airway
  3. To seal the airway during ventilation
  4. To maintain a patent airway in a patient with an intact gag reflex Correct answer.

Explanation

A nasopharyngeal airway is a soft tube passed through the nose to keep the upper airway open, and it is well tolerated by patients who still have a gag reflex. It does not seal the airway or deliver oxygen.

Question 8Airway and Breathing

Which of the following is a key sign of inadequate breathing?

  1. Cyanosis of the lips Correct answer.
  2. Strong radial pulse
  3. Regular deep breaths
  4. Warm dry skin

Explanation

Cyanosis of the lips and mucous membranes reflects poor oxygenation and is a concerning sign of inadequate breathing. It may appear late in some patients, so it is not required to identify breathing failure.

Question 9Airway and Breathing

A patient has a suspected cervical spine injury and requires airway opening. Which manoeuvre is appropriate?

  1. Jaw thrust with manual head stabilisation Correct answer.
  2. Turning the head to the side
  3. Neck hyperextension with chin lift
  4. Head tilt with chin lift

Explanation

In suspected cervical spine injury, the jaw thrust with manual head stabilisation opens the airway while limiting neck movement. A head tilt risks displacing the injured spine.

Question 10Airway and Breathing

What is the correct compression-to-ventilation ratio for adult CPR performed by a single rescuer?

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

Explanation

Adult CPR uses 30 compressions followed by 2 ventilations to maximise circulation while limiting interruptions. This ratio applies to one or two rescuers in adult resuscitation.

Question 11Airway and Breathing

A patient's chest does not rise during bag-mask ventilation. What is the most appropriate first action?

  1. Reassess and reposition the airway Correct answer.
  2. Reduce the bag squeeze volume
  3. Continue and observe for improvement
  4. Increase the rate of ventilation

Explanation

Absent chest rise indicates the airway is not open or the mask seal is inadequate, so the airway should be reassessed and repositioned before continuing. Ventilating harder into an obstructed airway risks gastric insufflation.

Question 12Airway and Breathing

Which oxygen delivery device provides the highest inspired oxygen concentration to a spontaneously breathing patient?

  1. Nasal cannula at 2 L/min
  2. Simple face mask at 8 L/min
  3. Venturi mask at 28%
  4. Non-rebreathe mask at 15 L/min Correct answer.

Explanation

A non-rebreathe mask with a reservoir bag at high flow delivers the highest inspired oxygen among the listed devices, approaching 85 to 95%. The other devices deliver lower concentrations.

Question 13Airway and Breathing

A patient with a tracheostomy is in respiratory distress and the stoma is not patent. What should be done first?

  1. Ventilate through the mouth only
  2. Suction the tracheostomy tube
  3. Apply oxygen to the stoma surface
  4. Remove the inner cannula or tube per protocol and assess Correct answer.

Explanation

When a tracheostomy patient deteriorates, the tube itself is a common cause of obstruction, so the inner cannula or tube should be removed per protocol and the airway reassessed. Suctioning or surface oxygen will not relieve a blocked tube.

Question 14Airway and Breathing

Which finding best suggests a tension pneumothorax in a ventilated patient?

  1. Equal chest rise bilaterally
  2. Slow deep breathing with bradycardia
  3. Bilateral coarse crackles
  4. Progressive unilateral absent breath sounds with falling saturation Correct answer.

Explanation

Tension pneumothorax produces progressive deterioration with absent breath sounds on the affected side and falling oxygen saturation as intrathoracic pressure rises. It is a time-critical emergency.

Question 15Airway and Breathing

What is the main risk of ventilating a patient too forcefully with a bag-mask device?

  1. Gastric insufflation and aspiration Correct answer.
  2. Reduced oxygen concentration
  3. Bradycardia from hypoxia
  4. Hypothermia

Explanation

Excessive ventilation pressure inflates the stomach, which raises the risk of regurgitation and aspiration and splints the diaphragm. Ventilation should be delivered just enough to produce visible chest rise.

Question 16Airway and Breathing

A patient is unresponsive with snoring respirations. What is the most likely cause?

  1. Fluid in the alveoli
  2. Bronchospasm
  3. Tongue obstructing the pharynx Correct answer.
  4. Laryngeal spasm

Explanation

In an unresponsive patient, loss of muscle tone allows the tongue to fall back and obstruct the pharynx, producing snoring sounds. Opening the airway with a head tilt or jaw thrust usually relieves it.

Question 17Airway and Breathing

Which condition most strongly suggests the need to assist ventilation rather than simply give supplemental oxygen?

  1. Respiratory rate of 18 with clear speech
  2. Slow shallow breathing with a falling level of consciousness Correct answer.
  3. SpO2 of 96% with mild breathlessness
  4. Mild productive cough

Explanation

Slow shallow breathing with a declining level of consciousness indicates inadequate ventilation, so positive pressure assistance is needed to move air. Supplemental oxygen alone does not correct inadequate minute ventilation.

Question 18Airway and Breathing

Which of the following best describes the role of the epiglottis during swallowing?

  1. It closes over the larynx to protect the airway Correct answer.
  2. It produces sound by vibration
  3. It warms and humidifies inspired air
  4. It generates the pressure for exhalation

Explanation

During swallowing the epiglottis folds over the laryngeal opening to prevent food and fluid entering the trachea. This protects the lower airway from aspiration.

Question 19Airway and Breathing

A conscious adult is coughing forcefully after choking on food. What is the appropriate management?

  1. Give five back blows while they are standing
  2. Deliver abdominal thrusts immediately
  3. Perform a blind finger sweep
  4. Encourage continued coughing and monitor Correct answer.

Explanation

A forceful cough indicates the airway is only partially obstructed and the patient can still move air. Encouraging coughing is more effective and safer than thrusts, which are reserved for ineffective coughing.

Question 20Airway and Breathing

Which statement about pulse oximetry is correct?

  1. It replaces the need to assess respiratory rate
  2. It measures carbon dioxide levels
  3. It is unreliable in poor peripheral perfusion Correct answer.
  4. It measures the adequacy of ventilation directly

Explanation

Pulse oximetry relies on a good peripheral pulse signal, so poor perfusion, cold extremities, or motion can make readings unreliable. It estimates oxygen saturation and does not measure ventilation or carbon dioxide.

Question 21Airway and Breathing

During two-rescuer bag-mask ventilation, what is the recommended role of the second rescuer?

  1. To apply cricoid pressure throughout
  2. To take over compressions immediately
  3. To maintain a two-handed mask seal while the first squeezes the bag Correct answer.
  4. To record the time only

Explanation

With two rescuers, one holds the mask with both hands to create a good seal while the other squeezes the bag to deliver ventilation. This improves seal quality and ventilation effectiveness.

Question 22Airway and Breathing

A patient with severe asthma is exhausted, has a silent chest, and is becoming drowsy. What does this presentation indicate?

  1. Mild exacerbation suitable for home care
  2. Anxiety without physiological compromise
  3. Improving airway function
  4. Imminent respiratory failure Correct answer.

Explanation

A silent chest with exhaustion and drowsiness in severe asthma indicates airflow is so reduced that wheeze is no longer audible, signalling imminent respiratory failure. Urgent ventilatory support and transport are required.

Question 23Airway and Breathing

What is the main reason to avoid hyperventilating a patient with a suspected traumatic brain injury?

  1. It causes immediate pulmonary oedema
  2. It reduces cerebral blood flow through vasoconstriction Correct answer.
  3. It worsens spinal cord injury
  4. It increases intracranial pressure directly

Explanation

Hyperventilation lowers carbon dioxide, which causes cerebral vasoconstriction and reduces cerebral blood flow, potentially worsening ischaemia. Ventilation should target normal carbon dioxide levels unless specifically indicated otherwise.

Question 24Airway and Breathing

A patient has a partial airway obstruction with stridor after inhaling a hot substance causing swelling. Which action is most appropriate?

  1. Keep the patient calm, give high-flow oxygen, and prepare for early advanced airway support Correct answer.
  2. Give abdominal thrusts
  3. Encourage vigorous coughing despite worsening stridor
  4. Attempt blind finger sweeps

Explanation

Stridor from thermal or chemical swelling is an obstructive oedema problem, not a foreign body, so thrusts and sweeps are inappropriate. Calm reassurance, high-flow oxygen, and early preparation for advanced airway management are priorities as swelling can progress rapidly.

Question 25Airway and Breathing

Which finding on capnography most reliably confirms correct placement of a supraglottic airway?

  1. An irregular waveform with no plateau
  2. A regular waveform with each ventilation Correct answer.
  3. A gradually rising baseline only
  4. A persistent flat waveform

Explanation

A regular capnography waveform appearing with each ventilation confirms that exhaled carbon dioxide is reaching the sensor, supporting correct placement. A flat or absent waveform suggests misplacement or no perfusion.

Question 26Airway and Breathing

Which structure connects the oropharynx to the trachea and houses the vocal cords?

  1. The epiglottis
  2. The larynx Correct answer.
  3. The nasopharynx
  4. The esophagus

Explanation

The larynx is the cartilaginous structure between the pharynx and trachea that contains the vocal cords and protects the lower airway.

Question 27Airway and Breathing

What is the recommended oxygen flow rate for a nasal cannula in an adult?

  1. 1 to 6 L/min Correct answer.
  2. 6 to 8 L/min
  3. 15 to 20 L/min
  4. 10 to 15 L/min

Explanation

A nasal cannula typically delivers oxygen at 1 to 6 L/min, providing an FiO2 of about 24% to 44%. Higher flows do not increase concentration reliably and may dry the nasal mucosa.

Question 28Airway and Breathing

Which of the following is a sign of adequate breathing in an adult?

  1. Audible wheezing
  2. Accessory muscle use
  3. Clear speech in full sentences Correct answer.
  4. Cyanosis of the lips

Explanation

The ability to speak in full sentences without gasping indicates sufficient airflow and respiratory effort. Accessory muscle use, cyanosis, and wheezing all suggest respiratory distress.

Question 29Airway and Breathing

An adult patient is unresponsive and not breathing normally. After opening the airway and finding no pulse, what is the correct compression depth for adult CPR?

  1. At least 2 inches (5 cm) Correct answer.
  2. About 1.5 inches (4 cm)
  3. At least 3 inches (7.5 cm)
  4. About 1 inch (2.5 cm)

Explanation

High-quality adult CPR requires compressions of at least 2 inches (5 cm) but not more than 2.4 inches (6 cm). This depth generates adequate intrathoracic pressure to circulate blood.

Question 30Airway and Breathing

A patient with a known history of COPD has an oxygen saturation of 88% on room air and is alert but mildly short of breath. What is the most appropriate initial oxygen therapy?

  1. High-flow oxygen at 15 L/min via non-rebreather
  2. No oxygen, because COPD patients should never receive it
  3. Titrated oxygen to a target saturation of 88% to 92% Correct answer.
  4. Oxygen at 2 L/min until the saturation reaches 100%

Explanation

In COPD with chronic hypercapnia, oxygen should be titrated to a target saturation of 88% to 92% to avoid worsening hypercapnia while correcting hypoxemia. High-flow oxygen without titration can be harmful.

Question 31Airway and Breathing

A 30-year-old is found unresponsive after a suspected opioid overdose with a respiratory rate of 4 per minute and oxygen saturation of 82%. After opening the airway and providing bag-mask ventilation, which medication is most appropriate?

  1. Naloxone Correct answer.
  2. Aspirin
  3. Salbutamol
  4. Glucagon

Explanation

Naloxone is an opioid antagonist that reverses opioid-induced respiratory depression. Ventilation should be supported first, then naloxone given to restore spontaneous breathing.

Question 32Airway and Breathing

A patient has a foreign body airway obstruction and is unable to speak or cough. Which manoeuvre is recommended for a conscious adult?

  1. Lay the patient flat and observe
  2. Perform abdominal thrusts Correct answer.
  3. Give a glass of water
  4. Encourage forceful coughing

Explanation

Abdominal thrusts (Heimlich manoeuvre) are recommended for a conscious adult with a severe foreign body airway obstruction. They create artificial coughs to expel the object.

Question 33Airway and Breathing

A patient is in respiratory arrest with a pulse. Which ventilation rate should be provided with a bag-mask device?

  1. 1 breath every 6 seconds Correct answer.
  2. 1 breath every 3 seconds
  3. 1 breath every 15 seconds
  4. 1 breath every 10 seconds

Explanation

For an adult in respiratory arrest with a pulse, deliver 1 breath every 6 seconds (10 breaths per minute). This rate maintains adequate oxygenation without hyperventilation.

Question 34Airway and Breathing

Which of the following is a contraindication to inserting a nasopharyngeal airway?

  1. A patient with a gag reflex
  2. A patient with mild epistaxis
  3. A patient with a history of asthma
  4. A patient with a suspected basilar skull fracture Correct answer.

Explanation

A nasopharyngeal airway should not be inserted when a basilar skull fracture is suspected because of the risk of passing the tube into the cranial vault. It is also avoided in severe midface trauma.

Question 35Airway and Breathing

A patient with severe asthma is sitting upright, speaking in one-word answers, and has an oxygen saturation of 89% on room air. Which finding most strongly indicates the need for immediate assisted ventilation?

  1. The patient reports chest tightness
  2. The patient is drowsy and confused Correct answer.
  3. The patient is using accessory muscles
  4. The patient has a heart rate of 110

Explanation

Drowsiness and confusion in a severe asthma attack indicate exhaustion and impending respiratory failure, which require immediate assisted ventilation. Accessory muscle use and tachycardia are earlier signs of distress.

Question 36Airway and Breathing

A patient with a suspected cervical spine injury requires airway opening. Which manoeuvre is appropriate?

  1. Hyperextension of the neck
  2. Turning the head to the side
  3. Jaw-thrust with manual in-line stabilization Correct answer.
  4. Head-tilt chin-lift

Explanation

The jaw-thrust with manual in-line stabilization opens the airway without extending the neck, reducing the risk of further spinal injury. The head-tilt chin-lift is avoided in suspected cervical injury.

Question 37Airway and Breathing

A patient has a tracheostomy and is in respiratory distress with the stoma not patent. What should be done first?

  1. Attempt to ventilate through the stoma
  2. Remove the tracheostomy tube
  3. Suction the stoma vigorously
  4. Ventilate through the mouth and nose Correct answer.

Explanation

If the stoma is not patent, ventilation should be attempted through the upper airway (mouth and nose) while preparing to manage the stoma. The stoma may be obstructed or the tube displaced.

Question 38Airway and Breathing

A patient with a suspected tension pneumothorax is being ventilated and suddenly develops severe hypotension, distended neck veins, and absent breath sounds on one side. What is the most appropriate immediate action?

  1. Place the patient in the recovery position
  2. Administer a bronchodilator
  3. Increase the ventilation rate
  4. Perform needle decompression Correct answer.

Explanation

Tension pneumothorax is a life-threatening emergency that requires immediate needle decompression to relieve intrathoracic pressure. Ventilation changes or bronchodilators do not address the underlying pressure.

Question 39Airway and Breathing

A patient with a severe head injury is being ventilated. Which ventilation strategy is most appropriate to avoid secondary brain injury?

  1. Use high tidal volumes to maximize oxygenation
  2. Ventilate only when the oxygen saturation falls below 90%
  3. Hyperventilate to a rate of 20 per minute
  4. Maintain normal ventilation with a rate of 10 per minute Correct answer.

Explanation

In traumatic brain injury, maintaining normocapnia with a normal ventilation rate (about 10 breaths per minute) helps preserve cerebral blood flow. Hyperventilation causes vasoconstriction and can worsen ischemia.

Question 40Airway and Breathing

A patient is being ventilated with a bag-mask device and a reservoir-equipped mask at 15 L/min. Which observation best indicates that the mask seal and ventilation are effective?

  1. A soft, non-distending abdomen during each ventilation
  2. An increasing resistance felt on the bag with each squeeze
  3. Visible chest rise with each squeeze and improving oxygen saturation Correct answer.
  4. A hissing leak heard around the mask throughout inspiration

Explanation

Effective bag-mask ventilation is confirmed by visible chest rise, improving saturations, and audible or palpable air entry, which together show that delivered volume is reaching the lungs rather than leaking or entering the stomach. A persistent leak or rising resistance suggests a poor seal or an obstruction that must be corrected.

Question 41Cardiology and Resuscitation

In an adult, which compression-to-ventilation ratio should be used during two-rescuer CPR with an advanced airway in place?

  1. 15:2
  2. 5:1
  3. 30:2
  4. Continuous compressions with one ventilation every 6 seconds Correct answer.

Explanation

Once an advanced airway is secured, compressions become continuous and ventilations are delivered asynchronously at about 10 per minute (one every 6 seconds). Interrupting compressions for a 30:2 or 15:2 cycle is no longer required.

Question 42Cardiology and Resuscitation

What is the correct compression depth for an adult during CPR?

  1. About 3 cm
  2. About 2 cm
  3. At least 8 cm
  4. At least 5 cm but no more than 6 cm Correct answer.

Explanation

Adult compressions should depress the chest at least 5 cm but not exceed 6 cm to balance perfusion against injury risk. Shallower compressions generate inadequate cardiac output.

Question 43Cardiology and Resuscitation

Which rate of chest compressions is recommended for an adult in cardiac arrest?

  1. 100 to 120 per minute Correct answer.
  2. 60 to 80 per minute
  3. 140 to 160 per minute
  4. As fast as possible

Explanation

A rate of 100 to 120 compressions per minute optimises cardiac output while allowing adequate chest recoil. Rates outside this window reduce filling or perfusion.

Question 44Cardiology and Resuscitation

An adult collapses and is unresponsive with absent breathing. After calling for help and an AED, what should you do next?

  1. Give two rescue breaths first
  2. Check for a radial pulse for one minute
  3. Place the patient in the recovery position
  4. Begin chest compressions immediately Correct answer.

Explanation

For a witnessed collapse with absent breathing, compressions should start without delay to minimise the no-flow interval. Pulse checks are unreliable and time-consuming for lay and EMS rescuers.

Question 45Cardiology and Resuscitation

What does an AED do when it analyses a rhythm?

  1. It delivers a shock automatically without analysis
  2. It detects shockable rhythms and advises or delivers a shock Correct answer.
  3. It provides continuous pacing for bradycardia
  4. It measures blood pressure and oxygen saturation

Explanation

An AED analyses the ECG to identify ventricular fibrillation or pulseless ventricular tachycardia and then advises or delivers a defibrillation shock. It does not measure vital signs or provide pacing.

Question 46Cardiology and Resuscitation

Which rhythm is treated with immediate defibrillation?

  1. Sinus bradycardia
  2. Sinus tachycardia
  3. Asystole
  4. Ventricular fibrillation Correct answer.

Explanation

Ventricular fibrillation produces chaotic electrical activity and is a shockable rhythm requiring immediate defibrillation. Asystole and organised rhythms are not defibrillated.

Question 47Cardiology and Resuscitation

Which finding best indicates that a patient is in cardiac arrest?

  1. Unconscious with a strong carotid pulse
  2. Responsive but complaining of chest pain
  3. Unresponsive with absent or gasping breathing Correct answer.
  4. Dizzy with a blood pressure of 100/60 mmHg

Explanation

Cardiac arrest is recognised by unresponsiveness combined with absent or agonal breathing. Chest pain and dizziness in responsive patients suggest other emergencies.

Question 48Cardiology and Resuscitation

When should adrenaline first be given in adult cardiac arrest?

  1. Only after return of spontaneous circulation
  2. After the first shock in shockable rhythms Correct answer.
  3. Only after three shocks
  4. Immediately in all rhythms

Explanation

In shockable rhythms, adrenaline is given after the first or second shock once initial defibrillation attempts have failed. In non-shockable rhythms it is given as early as possible.

Question 49Cardiology and Resuscitation

A patient's ECG shows a regular narrow-complex tachycardia at 180 per minute with a palpable pulse and stable blood pressure. What is the most appropriate initial management?

  1. Vagal manoeuvres followed by adenosine if unsuccessful Correct answer.
  2. Chest compressions at 100 per minute
  3. Synchronised cardioversion without delay
  4. Immediate unsynchronised defibrillation

Explanation

A stable regular narrow-complex tachycardia is managed initially with vagal manoeuvres, then adenosine if these fail. Synchronised cardioversion is reserved for instability.

Question 50Cardiology and Resuscitation

Which feature indicates that a tachyarrhythmia is causing haemodynamic instability?

  1. Heart rate of 150 per minute during exercise
  2. Palpitations with a normal level of consciousness
  3. Chest pain with hypotension and reduced consciousness Correct answer.
  4. Heart rate of 130 per minute with normal blood pressure

Explanation

Hypotension, ischaemic chest pain, and altered consciousness are signs of instability that may require synchronised cardioversion. Palpitations alone with stable vital signs do not.