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Kuwait MOH Paramedic practice questions

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Question 1Airway Management, Ventilation, and Oxygenation

A 24-year-old man is breathing room air and has an SpO2 of 88%. Which initial oxygen delivery method is most appropriate?

  1. Simple face mask at 5 L/min
  2. Non-rebreather mask at 10-15 L/min Correct answer.
  3. Venturi mask at 24%
  4. Nasal cannula at 2 L/min

Explanation

Severe hypoxaemia below 90% on room air needs a high FiO2 immediately, and a non-rebreather mask with a reservoir delivers the highest concentration available without positive pressure. Low-flow devices such as a 2 L/min nasal cannula cannot correct this degree of desaturation.

Question 2Airway Management, Ventilation, and Oxygenation

Which structure is the narrowest point of the adult airway and therefore the most common site of obstruction by a foreign body?

  1. Cricoid ring Correct answer.
  2. Thyroid cartilage
  3. Vocal cords
  4. Glottis

Explanation

The cricoid ring is the only complete cartilaginous ring of the airway and forms the narrowest point in adults. A foreign body that passes the cords commonly lodges at this level.

Question 3Airway Management, Ventilation, and Oxygenation

When using a bag-valve-mask with two rescuers on an adult, what ventilation rate is recommended during cardiac arrest?

  1. 20 breaths per minute
  2. 2 breaths per minute
  3. 10 breaths per minute Correct answer.
  4. 6 breaths per minute

Explanation

Current resuscitation guidance recommends about 10 ventilations per minute in the adult cardiac arrest patient when an advanced airway is in place, avoiding hyperventilation. Excessive rates raise intrathoracic pressure and reduce cardiac output.

Question 4Airway Management, Ventilation, and Oxygenation

Which finding best indicates correct placement of a supraglottic airway device?

  1. A small air leak at the pilot balloon
  2. A resistance felt during bag squeeze
  3. A chest rise with each delivered breath Correct answer.
  4. A gurgling sound over the epigastrium

Explanation

Visible chest rise with each ventilation and absence of epigastric sounds confirm that the device is seated in the airway and the lungs are being ventilated. Auscultation and waveform capnography should also be used to confirm.

Question 5Airway Management, Ventilation, and Oxygenation

A patient with a suspected cervical spine injury requires airway management. Which technique best maintains spinal alignment during bag-valve-mask ventilation?

  1. Head tilt with chin lift
  2. Tongue-jaw lift alone
  3. Jaw thrust with manual in-line stabilisation Correct answer.
  4. Neck extension with a shoulder roll

Explanation

The jaw thrust with manual in-line stabilisation opens the airway without extending the cervical spine. Head tilt and chin lift can worsen a cervical injury.

Question 6Airway Management, Ventilation, and Oxygenation

What is the primary purpose of preoxygenation before endotracheal intubation?

  1. To replace alveolar nitrogen with oxygen and extend safe apnoea time Correct answer.
  2. To increase carbon dioxide clearance
  3. To reduce the risk of aspiration
  4. To relax the vocal cords

Explanation

Preoxygenation with high-flow oxygen denitrogenates the functional residual capacity, creating an oxygen reservoir that prolongs the time before desaturation during apnoea. This is essential when intubation takes longer than expected.

Question 7Airway Management, Ventilation, and Oxygenation

Which device is preferred for delivering supplemental oxygen to a spontaneously breathing patient with chronic obstructive pulmonary disease whose target SpO2 is 88-92%?

  1. Venturi mask at 28% Correct answer.
  2. Bag-valve-mask at 15 L/min
  3. Non-rebreather mask at 15 L/min
  4. Nasal cannula at 6 L/min

Explanation

A Venturi mask delivers a controlled, predictable FiO2 regardless of inspiratory flow, which suits patients who need a precise target range. Nasal cannula and reservoir masks give variable concentrations that are hard to titrate.

Question 8Airway Management, Ventilation, and Oxygenation

Which statement correctly describes the function of the epiglottis during swallowing?

  1. It seals the nasopharynx
  2. It controls vocal cord tension
  3. It vibrates to produce sound
  4. It covers the glottis to prevent aspiration Correct answer.

Explanation

During swallowing the epiglottis folds over the laryngeal inlet, directing food and fluid into the oesophagus and protecting the airway. Loss of this reflex is a key reason for aspiration in obtunded patients.

Question 9Airway Management, Ventilation, and Oxygenation

A trauma patient has a large volume of blood and vomit in the oropharynx and requires ventilation. Which step should be performed first?

  1. Attach capnography
  2. Insert an oropharyngeal airway
  3. Apply cricoid pressure
  4. Suction the airway Correct answer.

Explanation

Visible secretions and blood must be cleared with suction before any airway adjunct or ventilation attempt, because obstruction by fluid prevents effective oxygenation. Suctioning first also reduces aspiration risk.

Question 10Airway Management, Ventilation, and Oxygenation

Which finding on waveform capnography most strongly suggests oesophageal intubation?

  1. A plateau-shaped waveform
  2. End-tidal CO2 of 35 mmHg
  3. Absent or rapidly fading end-tidal CO2 Correct answer.
  4. A waveform that persists for six breaths

Explanation

Oesophageal placement produces no alveolar CO2, so the capnogram is flat or shows only a brief low-amplitude trace that fades. Persistent end-tidal CO2 over several breaths confirms tracheal placement.

Question 11Airway Management, Ventilation, and Oxygenation

A patient's SpO2 is 94% on a non-rebreather mask at 15 L/min, but the reservoir collapses with each inspiration. What is the most likely cause?

  1. The patient has carbon monoxide poisoning
  2. The pulse oximeter probe is misplaced
  3. The oxygen flow is insufficient for the patient's minute ventilation Correct answer.
  4. The mask seal is too tight against the face

Explanation

A collapsing reservoir indicates that the patient's inspiratory demand exceeds the delivered flow, so the reservoir is emptied faster than it refills. Increasing the flow or using a device with a higher output corrects the problem.

Question 12Airway Management, Ventilation, and Oxygenation

When performing needle cricothyrotomy for a cannot-intubate, cannot-ventilate situation in an adult, which landmark is correct?

  1. Between the first and second tracheal rings
  2. Through the cricothyroid membrane below the thyroid cartilage Correct answer.
  3. Just above the thyroid cartilage
  4. At the level of the cricoid ring

Explanation

The cricothyroid membrane lies between the thyroid cartilage and the cricoid cartilage and is relatively avascular and superficial, making it the standard site for emergency needle or surgical cricothyrotomy in adults.

Question 13Airway Management, Ventilation, and Oxygenation

Which parameter is the most reliable indicator of effective chest compressions plus ventilation during CPR?

  1. Palpable radial pulse
  2. End-tidal CO2 above 10 mmHg Correct answer.
  3. Pupil size
  4. Skin colour

Explanation

End-tidal CO2 reflects pulmonary blood flow, so a value above 10 mmHg suggests adequate cardiac output during CPR and is a recognised quality indicator. Values below this threshold are associated with poor compression quality.

Question 14Airway Management, Ventilation, and Oxygenation

A patient with a tracheostomy is in respiratory distress and the tube cannot be suctioned. What is the priority action?

  1. Increase the oxygen flow through the tube
  2. Instil saline into the tube
  3. Remove the tracheostomy tube and assess the stoma Correct answer.
  4. Deflate the cuff and ventilate through the stoma

Explanation

An obstructed tracheostomy tube that cannot be cleared is a life-threatening emergency; removing the tube allows assessment and ventilation through the stoma or upper airway. Leaving an obstructed tube in place prevents oxygenation.

Question 15Airway Management, Ventilation, and Oxygenation

Which statement correctly describes the difference between a partial and a complete airway obstruction in a conscious adult?

  1. A complete obstruction always produces a strong cough
  2. A patient with a complete obstruction can speak but not cough
  3. A patient with a partial obstruction can often speak or cough Correct answer.
  4. Both types present with stridor and normal speech

Explanation

In partial obstruction some airflow remains, so the patient may speak, cough, or produce stridor, whereas complete obstruction abolishes airflow and speech. Recognising this difference determines whether to encourage coughing or intervene.

Question 16Airway Management, Ventilation, and Oxygenation

Which oxygen delivery device provides the most consistent FiO2 in a patient with a high respiratory rate?

  1. Venturi mask Correct answer.
  2. Non-rebreather mask
  3. Nasal cannula
  4. Simple face mask

Explanation

A Venturi mask uses an air-entrainment jet to deliver a fixed oxygen concentration independent of the patient's inspiratory flow, making it reliable when respiratory rate is high. Other devices give variable FiO2.

Question 17Airway Management, Ventilation, and Oxygenation

A patient with severe asthma has SpO2 of 89% and is tiring. Which action is most appropriate?

  1. Encourage the patient to breathe more slowly
  2. Give low-flow oxygen only
  3. Provide high-flow oxygen and prepare for assisted ventilation Correct answer.
  4. Withhold oxygen to avoid carbon dioxide retention

Explanation

Severe asthma with desaturation and fatigue signals impending respiratory failure, so high-flow oxygen and preparation for assisted ventilation are required. Withholding oxygen risks worsening hypoxia.

Question 18Airway Management, Ventilation, and Oxygenation

Which action best prevents gastric insufflation during bag-valve-mask ventilation?

  1. Squeezing the bag forcefully and rapidly
  2. Ventilating at 25 breaths per minute
  3. Using the largest available tidal volume
  4. Delivering each breath over about one second with just enough volume for chest rise Correct answer.

Explanation

Slow, gentle ventilation over about one second with only enough volume to produce visible chest rise keeps peak airway pressure low and reduces air entering the stomach. Rapid forceful breaths raise oesophageal pressure and cause gastric distension.

Question 19Airway Management, Ventilation, and Oxygenation

Which finding indicates that a patient has an inadequate minute volume despite a normal respiratory rate?

  1. Shallow chest excursion with a quiet breath sound Correct answer.
  2. Clear speech in full sentences
  3. SpO2 of 98% on room air
  4. Respiratory rate of 16 per minute

Explanation

Minute volume depends on tidal volume as well as rate, so shallow breathing with poor chest excursion can produce hypoventilation even at a normal rate. Auscultation and capnography help confirm the inadequacy.

Question 20Airway Management, Ventilation, and Oxygenation

Which is the correct sequence when inserting an oropharyngeal airway in an adult?

  1. Insert after inflating the cuff of an endotracheal tube
  2. Insert with the tip pointing toward the occiput without rotation
  3. Insert directly with the tip pointing toward the chin
  4. Insert upside down and rotate 180 degrees as it passes the palate Correct answer.

Explanation

The adult oropharyngeal airway is inserted upside down and rotated 180 degrees as it passes the hard palate, which prevents the tongue from being pushed back. It should only be used in patients without a gag reflex.

Question 21Airway Management, Ventilation, and Oxygenation

Which statement about pulse oximetry is correct?

  1. It measures arterial oxygen tension directly
  2. It is unaffected by nail polish or ambient light
  3. It detects hypoventilation before desaturation occurs
  4. It is unreliable in the presence of poor perfusion or methaemoglobinaemia Correct answer.

Explanation

Pulse oximetry estimates haemoglobin saturation and depends on adequate pulsatile perfusion, so poor perfusion, dyshaemoglobinaemias, and signal interference reduce its reliability. It also lags behind changes in ventilation.

Question 22Airway Management, Ventilation, and Oxygenation

A patient with a suspected opioid overdose has a respiratory rate of 4 per minute and SpO2 of 82%. What is the priority intervention?

  1. Apply a nasal cannula at 2 L/min
  2. Give oral naloxone
  3. Place the patient in the recovery position
  4. Assist ventilation with a bag-valve-mask and high-flow oxygen Correct answer.

Explanation

Opioid-induced hypoventilation with severe hypoxaemia requires immediate assisted ventilation with high-flow oxygen while naloxone is prepared. Ventilation takes priority because the patient is not moving adequate air.

Question 23Airway Management, Ventilation, and Oxygenation

A patient with a known difficult airway requires intubation. Which pre-intubation strategy best reduces the risk of desaturation during the attempt?

  1. Hyperventilating the patient with room air
  2. Delaying preoxygenation until after induction
  3. Preoxygenating with high-flow oxygen for several minutes and using apnoeic oxygenation Correct answer.
  4. Removing all oxygen devices before laryngoscopy

Explanation

Adequate preoxygenation plus apnoeic oxygenation maintains the oxygen reservoir during laryngoscopy and prolongs safe apnoea time. This is particularly important in a predicted difficult airway.

Question 24Airway Management, Ventilation, and Oxygenation

During rapid sequence intubation, a patient's SpO2 falls from 96% to 78% after two failed attempts. What is the most appropriate next action?

  1. Administer a second dose of neuromuscular blocker
  2. Oxygenate with bag-valve-mask and consider a rescue airway Correct answer.
  3. Continue attempts until the tube is placed
  4. Increase the sedative dose

Explanation

Repeated desaturation during intubation attempts mandates reoxygenation with bag-valve-mask ventilation and consideration of a rescue device rather than persisting. Continued attempts without oxygenation risk hypoxic injury or cardiac arrest.

Question 25Airway Management, Ventilation, and Oxygenation

Which physiological change explains why elderly patients desaturate more rapidly during apnoea than young adults?

  1. Increased functional residual capacity
  2. Decreased closing volume
  3. Reduced functional residual capacity and increased oxygen consumption relative to reserve Correct answer.
  4. Higher alveolar ventilation at baseline

Explanation

Ageing reduces functional residual capacity and elastic recoil, decreasing the oxygen reservoir, while oxygen consumption remains relatively high. This shortens the time to desaturation during apnoea.

Question 26Airway Management, Ventilation, and Oxygenation

A 70-year-old man with a history of COPD is breathing spontaneously with SpO2 88% on room air. Which oxygen delivery device provides the most reliable and controlled FiO2 for this patient while avoiding hypercapnia?

  1. Non-rebreather mask at 15 L/min
  2. Nasal cannula at 6 L/min
  3. Simple face mask at 10 L/min
  4. Venturi mask set at 24% Correct answer.

Explanation

A Venturi mask uses a fixed orifice to entrain a precise ratio of room air, delivering a predictable FiO2 (e.g., 24%, 28%, 35%) regardless of the patient's inspiratory flow. In COPD patients with chronic hypercapnia, this controlled low FiO2 helps avoid worsening hypercapnia while correcting hypoxaemia. The other devices deliver variable and often higher FiO2 that cannot be precisely titrated.

Question 27Airway Management, Ventilation, and Oxygenation

During bag-valve-mask ventilation of an adult patient in cardiac arrest, which technique best minimises gastric insufflation while maintaining adequate tidal volume?

  1. Delivering each breath over 1 second with just enough volume to see chest rise Correct answer.
  2. Squeezing the bag forcefully until the chest rises prominently
  3. Ventilating as fast as possible to maximise minute volume
  4. Using the largest tidal volume the bag can deliver with each squeeze

Explanation

Gastric insufflation occurs when airway pressure exceeds the lower oesophageal sphincter opening pressure, which happens with excessive volume or rapid, forceful ventilation. Delivering a breath over about 1 second with only enough volume to produce visible chest rise keeps peak airway pressure low and reduces the risk of gastric distension. Forceful or rapid large-volume breaths raise airway pressure and increase the likelihood of air entering the stomach.

Question 28Airway Management, Ventilation, and Oxygenation

A patient with a suspected cervical spine injury requires airway management after a motor vehicle collision. Which manoeuvre is most appropriate to open the airway while minimising spinal movement?

  1. Hyperextension of the neck
  2. Jaw thrust with manual in-line stabilisation Correct answer.
  3. Placement of an oropharyngeal airway without any manual manoeuvre
  4. Head-tilt chin-lift

Explanation

In a patient with suspected cervical spine injury, the jaw thrust manoeuvre lifts the mandible and tongue forward without extending the neck, and it should be performed with manual in-line stabilisation to restrict spinal movement. The head-tilt chin-lift and neck hyperextension both extend the cervical spine and risk worsening a spinal injury. An oropharyngeal airway alone does not relieve obstruction caused by the tongue falling back and does not open the airway.

Question 29Airway Management, Ventilation, and Oxygenation

A patient with a tracheostomy is in respiratory distress. The tracheostomy tube cannot be suctioned and the patient's SpO2 is falling. What is the most appropriate initial action?

  1. Remove the tracheostomy tube and ventilate via the stoma or upper airway Correct answer.
  2. Instil 5 mL of normal saline into the tracheostomy tube and suction again
  3. Increase the oxygen flow through the tracheostomy mask
  4. Insert a suction catheter forcefully to dislodge the obstruction

Explanation

When a tracheostomy tube cannot be suctioned and the patient is deteriorating, the tube is likely obstructed by a mucus plug or blood clot. The priority is to remove the obstructed tube and establish ventilation through the stoma or, if possible, the upper airway. Leaving an obstructed tube in place or attempting forceful suctioning delays definitive relief and can worsen hypoxia.

Question 30Airway Management, Ventilation, and Oxygenation

During rapid sequence intubation, a patient with a known difficult airway becomes hypoxic (SpO2 72%) after two unsuccessful laryngoscopy attempts. Which action is most appropriate next?

  1. Insert an oropharyngeal airway and wait for the oxygen saturation to improve spontaneously
  2. Attempt a third laryngoscopy with a different blade immediately
  3. Administer a further dose of neuromuscular blocker and continue attempts
  4. Perform bag-valve-mask ventilation with a 100% oxygen and consider a supraglottic airway Correct answer.

Explanation

After failed intubation attempts and falling oxygen saturation, the priority is to restore oxygenation rather than persist with laryngoscopy. Bag-valve-mask ventilation with 100% oxygen, often with an oropharyngeal airway and two-person technique, should be performed, and a supraglottic airway should be considered as a rescue device. Further attempts without reoxygenation increase the risk of hypoxic brain injury and cardiac arrest.

Question 31Patient Assessment and Clinical Decision-Making

A 28-year-old driver is alert and speaking normally after a low-speed collision. Which finding best supports triaging him as low priority during the primary survey?

  1. He can state his name, place, and time without hesitation Correct answer.
  2. He reports mild neck stiffness when turning his head
  3. His radial pulse is 118 beats per minute
  4. His respiratory rate is 26 breaths per minute

Explanation

Orientation to person, place, and time is part of the disability assessment in the primary survey and indicates an intact cerebral cortex with adequate perfusion and oxygenation. A fully oriented patient with no other abnormal primary survey findings is triaged as lower priority.

Question 32Patient Assessment and Clinical Decision-Making

During the secondary survey of a trauma patient, which element is specifically assessed as part of the focused history?

  1. Mechanism of injury and events surrounding the incident Correct answer.
  2. Palpation of the pelvic ring
  3. Auscultation of breath sounds bilaterally
  4. Pupillary response to light

Explanation

The focused history in the secondary survey gathers the mechanism of injury, the patient's symptoms, allergies, medications, past medical history, last meal, and events preceding the incident. Physical examination components such as pupils, breath sounds, and pelvic palpation belong to the head-to-toe examination rather than the history.

Question 33Patient Assessment and Clinical Decision-Making

A patient with severe asthma is being assessed. Which single finding most reliably indicates a life-threatening deterioration requiring immediate intervention?

  1. Inability to complete a full sentence in one breath
  2. Silent chest on auscultation with decreasing respiratory effort Correct answer.
  3. Use of accessory muscles with a respiratory rate of 30
  4. Audible wheeze throughout both lung fields

Explanation

A silent chest with diminishing respiratory effort signals that airflow is so severely reduced that wheeze can no longer be generated, which is an impending respiratory arrest sign. Accessory muscle use, tachypnoea, and speech difficulty indicate serious distress but not the same imminent failure.

Question 34Patient Assessment and Clinical Decision-Making

An adult is found unresponsive, not breathing normally, and has no palpable carotid pulse. According to basic life support principles, what is the immediate priority?

  1. Obtain a full set of vital signs including blood glucose
  2. Attach an automated external defibrillator before starting compressions
  3. Begin chest compressions at an adequate rate and depth Correct answer.
  4. Perform two rescue breaths before any compressions

Explanation

When unresponsiveness is combined with absent normal breathing and no pulse, cardiac arrest is present and high-quality chest compressions must start immediately to maintain coronary and cerebral perfusion. Defibrillation, ventilation, and diagnostics follow once compressions are underway.

Question 35Patient Assessment and Clinical Decision-Making

A 62-year-old reports crushing central chest pain radiating to the left arm with sweating and nausea. Which action best reflects correct clinical decision-making in the prehospital setting?

  1. Withhold oxygen regardless of saturation because it may be harmful
  2. Reassure the patient and arrange routine transport without further assessment
  3. Obtain a 12-lead ECG promptly and prepare for acute coronary syndrome management Correct answer.
  4. Wait for the pain to resolve before deciding on transport priority

Explanation

The presentation is typical of acute coronary syndrome, so an early 12-lead ECG is essential to identify ST-elevation and activate the appropriate reperfusion pathway. Prompt recognition and priority transport directly affect myocardial salvage.

Question 36Patient Assessment and Clinical Decision-Making

A patient is confused, clammy, and has a capillary blood glucose of 2.4 mmol/L. Which interpretation is most appropriate?

  1. Hypoglycaemia is the likely cause of the altered mental status Correct answer.
  2. The glucose value is within normal limits and unrelated to symptoms
  3. The clammy skin suggests hyperglycaemia rather than hypoglycaemia
  4. Confusion indicates a primary psychiatric cause

Explanation

A capillary glucose of 2.4 mmol/L is well below the normal range and is a common reversible cause of altered consciousness, diaphoresis, and confusion. Treating the hypoglycaemia should be prioritised while continuing the assessment.

Question 37Patient Assessment and Clinical Decision-Making

Which set of observations best defines a complete set of baseline vital signs in the prehospital assessment of an adult?

  1. Pain score and past medical history only
  2. Blood glucose and urine output only
  3. Respiratory rate, oxygen saturation, pulse rate, blood pressure, temperature, and level of consciousness Correct answer.
  4. Pupil size, grip strength, and skin colour only

Explanation

A complete baseline observation set includes respiratory rate, oxygen saturation, pulse, blood pressure, temperature, and a measure of consciousness such as the Glasgow Coma Scale or AVPU. These values establish a reference against which later trends can be compared.

Question 38Patient Assessment and Clinical Decision-Making

A 70-year-old with a history of heart failure presents with breathlessness, bilateral basal crackles, and pink frothy sputum. Which assessment conclusion is most consistent with these findings?

  1. Anaphylaxis requiring intramuscular adrenaline
  2. Acute pulmonary oedema with possible cardiogenic cause Correct answer.
  3. Tension pneumothorax requiring needle decompression
  4. Simple viral upper respiratory tract infection

Explanation

Bilateral basal crackles with pink frothy sputum in a patient with known heart failure strongly suggest pulmonary oedema from left ventricular failure. Positioning, oxygen titration, and cautious fluid and pressure management are guided by this recognition.

Question 39Patient Assessment and Clinical Decision-Making

A trauma patient has a blood pressure of 88/60 mmHg, a pulse of 126 beats per minute, and cool, pale extremities. What is the most appropriate interpretation?

  1. Decompensated hypovolaemic shock requiring urgent intervention Correct answer.
  2. Isolated hypertension requiring antihypertensive treatment
  3. Compensated shock with normal perfusion
  4. A normal physiological response to pain

Explanation

Hypotension with tachycardia and cool, pale peripheries indicates decompensated shock, most likely haemorrhagic in the trauma setting. The loss of compensatory vasoconstriction means perfusion is failing and rapid volume and haemorrhage control measures are needed.

Question 40Patient Assessment and Clinical Decision-Making

During assessment of an older adult who fell, which finding most strongly suggests a hip fracture rather than a simple soft tissue injury?

  1. Pain reproduced by gentle hip flexion
  2. A small abrasion over the knee
  3. Localised bruising over the greater trochanter
  4. Shortened, externally rotated leg with inability to bear weight Correct answer.

Explanation

Limb shortening with external rotation and an inability to bear weight is the classic deformity of a displaced femoral neck or intertrochanteric fracture. Analgesia, immobilisation, and careful handling are indicated.

Question 41Patient Assessment and Clinical Decision-Making

A patient with a suspected stroke has a blood glucose of 3.0 mmol/L. Why must this be corrected before concluding that the deficit is due to stroke?

  1. Glucose has no influence on neurological function
  2. Low glucose improves neurological examination findings
  3. Hypoglycaemia can mimic focal neurological deficits and must be excluded as a stroke mimic Correct answer.
  4. Hypoglycaemia confirms the diagnosis of ischaemic stroke

Explanation

Hypoglycaemia is a recognised stroke mimic that can produce focal deficits, confusion, and altered consciousness. Correcting glucose is a standard step in stroke assessment because it may fully reverse the deficit and changes management entirely.

Question 42Patient Assessment and Clinical Decision-Making

An unresponsive patient is breathing spontaneously with snoring respirations and has a Glasgow Coma Scale of 6. What is the most appropriate airway decision?

  1. Place the patient in a sitting position to improve breathing
  2. Apply a nasal cannula at 2 litres per minute
  3. No airway intervention is needed because breathing is present
  4. Insert an oropharyngeal airway if no gag reflex is present and prepare for advanced airway support Correct answer.

Explanation

A Glasgow Coma Scale of 6 with snoring indicates that the tongue is obstructing the airway and protective reflexes are likely lost. An oropharyngeal airway or other definitive airway adjunct, along with suction and positioning, is required to maintain patency.

Question 43Patient Assessment and Clinical Decision-Making

A 34-year-old is anxious, tachycardic, and tachypnoeic with perioral tingling and carpopedal spasm after a stressful event. Which assessment finding would most support hyperventilation syndrome over a pulmonary embolus?

  1. Unilateral leg swelling with pleuritic chest pain
  2. Sudden onset of sharp chest pain with haemoptysis
  3. Oxygen saturation persistently below 90 percent on room air
  4. Clear chest with no hypoxia and symptoms relieved by controlled breathing Correct answer.

Explanation

Hyperventilation syndrome typically presents with a clear chest, normal or near-normal oxygenation, and resolution of symptoms when breathing rate is controlled. Features of venous thromboembolism such as unilateral leg swelling, pleuritic pain, haemoptysis, or persistent hypoxaemia point away from a benign cause.

Question 44Patient Assessment and Clinical Decision-Making

A patient is found with pinpoint pupils, a respiratory rate of 6, and a decreased level of consciousness. Which clinical decision is most appropriate?

  1. Withhold naloxone because the pupils are constricted
  2. Assume alcohol intoxication and observe without intervention
  3. Administer a bronchodilator and discharge after improvement
  4. Support ventilation and consider opioid toxicity as the likely cause Correct answer.

Explanation

Pinpoint pupils, hypoventilation, and depressed consciousness form the classic opioid toxidrome. Ventilatory support is the immediate priority, and naloxone is considered when opioid toxicity is suspected to reverse respiratory depression.

Question 45Patient Assessment and Clinical Decision-Making

During the assessment of a patient with severe abdominal pain, which finding most strongly suggests a ruptured abdominal aortic aneurysm?

  1. Epigastric burning relieved by antacids
  2. Tearing abdominal or back pain with a pulsatile abdominal mass and hypotension Correct answer.
  3. Right lower quadrant tenderness with rebound
  4. Diffuse cramping pain relieved by defecation

Explanation

Tearing abdominal or back pain with a pulsatile mass and hypotension is the classic triad of a leaking or ruptured abdominal aortic aneurysm. This is a surgical emergency requiring rapid transport and haemorrhage control rather than prolonged scene assessment.

Question 46Patient Assessment and Clinical Decision-Making

A patient with a suspected cervical spine injury is being assessed. Which approach best reflects current spinal assessment principles?

  1. Immediate log-rolling to test for pain before stabilisation
  2. Omission of neurological assessment to avoid provoking injury
  3. Routine application of traction to realign the spine
  4. Manual in-line stabilisation with assessment of motor and sensory function and application of a collar as indicated Correct answer.

Explanation

Spinal motion restriction begins with manual in-line stabilisation, followed by a structured assessment of motor and sensory function to document baseline neurological status. Traction and unprotected movement risk worsening injury.

Question 47Patient Assessment and Clinical Decision-Making

A patient has a large burn to the anterior trunk and both anterior thighs. Using the rule of nines for an adult, what approximate total body surface area is affected?

  1. 45 percent
  2. 36 percent
  3. 27 percent Correct answer.
  4. 18 percent

Explanation

The anterior trunk represents 18 percent and each anterior thigh represents 4.5 percent, so two anterior thighs add 9 percent, giving approximately 27 percent. Accurate surface area estimation guides fluid resuscitation and burn centre referral.

Question 48Patient Assessment and Clinical Decision-Making

A patient is drowsy with a respiratory rate of 8 and oxygen saturation of 84 percent on room air. Which interpretation and action is most appropriate?

  1. Assume the saturation reading is artefactual and take no action
  2. Administer high-flow oxygen and reassess ventilation, preparing for assisted ventilation Correct answer.
  3. Give oral fluids to improve the level of consciousness
  4. Withhold oxygen because the patient is breathing spontaneously

Explanation

A saturation of 84 percent with a respiratory rate of 8 indicates inadequate ventilation and severe hypoxaemia. Oxygen must be applied and ventilation supported, with preparation for bag-mask assistance if respiratory effort remains inadequate.

Question 49Patient Assessment and Clinical Decision-Making

A 45-year-old with a known seizure disorder has a persistent generalized seizure lasting more than five minutes. What is the most appropriate clinical decision?

  1. Observe and wait for the seizure to self-terminate
  2. Treat as status epilepticus and prepare for anticonvulsant therapy and airway support Correct answer.
  3. Restrain the limbs to stop the movements
  4. Insert a bite block between the teeth

Explanation

A generalised seizure lasting longer than five minutes meets the operational definition of status epilepticus and requires active anticonvulsant treatment. Protecting the airway, providing oxygen, and monitoring for complications take priority over passive observation.

Question 50Patient Assessment and Clinical Decision-Making

A patient with a history of chronic obstructive pulmonary disease has an oxygen saturation of 88 percent and is drowsy. Which approach to oxygen therapy is most appropriate?

  1. Administer the highest possible flow regardless of saturation
  2. Titrate oxygen to a target saturation range while monitoring respiratory rate and consciousness Correct answer.
  3. Use a non-rebreather mask at 15 litres for all COPD patients
  4. Withhold oxygen entirely to avoid suppressing respiratory drive

Explanation

In COPD, oxygen is titrated to a target saturation range, commonly 88 to 92 percent, with close monitoring of respiratory rate and consciousness. This corrects hypoxaemia while reducing the risk of hypercapnia and respiratory depression.