EMT Secondary Assessment Practice Test

25 practice questions

Choose an answer, then check it under Show answer.

1. Question 1 of 25Easy

   While obtaining a SAMPLE history from an alert adult patient with abdominal pain, which question best assesses the events preceding the illness?

   1. AA. Have you ever had an episode of severe abdominal pain like this before?
   2. BB. Are you currently taking any prescription or over-the-counter medications?
   3. CC. When was the last time you consumed anything to eat or drink?
   4. DD. What were you doing when the abdominal discomfort first started?
   Show answer to question 1

   Answer: D. What were you doing when the abdominal discomfort first started?

   Asking what the patient was doing when the discomfort started directly investigates the events leading up to the illness or injury, which is the E in SAMPLE. Inquiring about past episodes evaluates past medical history, while asking about food intake addresses last oral intake.

2. Question 2 of 25Medium

   A 66-year-old man's knee struck the dashboard in a car crash. His right hip is painful, and his leg is bent at the hip, turned inward, and drawn across the midline. These findings suggest:

   1. AA. a fracture of the femoral shaft
   2. BB. an anterior hip dislocation
   3. CC. a posterior hip dislocation
   4. DD. a fracture of the kneecap only
   Show answer to question 2

   Answer: C. a posterior hip dislocation

   A dashboard impact can drive the head of the femur backward out of its socket. A posterior hip dislocation typically leaves the leg flexed, rotated inward and adducted.

   Why the other options are wrong

   • AA femoral shaft fracture causes thigh deformity and possible shortening, not this fixed hip position.
   • BAn anterior dislocation usually leaves the leg extended and turned outward.
   • DA kneecap fracture would not fix the hip in flexion, inward rotation and adduction.

3. Question 3 of 25Medium

   A 32-year-old female sustained blunt head trauma in a motor vehicle collision. On reassessment, her Glasgow Coma Scale score drops from 13 to 8, and her left pupil is 7 mm and nonreactive to light while her right pupil is 3 mm and reactive. What does this pupillary change most likely indicate?

   1. AA. Direct traumatic injury to the optic nerve of the right eye
   2. BB. Impending brainstem herniation compressing cranial nerve III
   3. CC. Severe systemic hypoxia affecting both cerebral hemispheres
   4. DD. Sudden release of excessive sympathetic nervous system hormones
   Show answer to question 3

   Answer: B. Impending brainstem herniation compressing cranial nerve III

   A unilateral dilated and nonreactive pupil in a head trauma patient with worsening mental status indicates rising intracranial pressure and impending uncal herniation compressing the oculomotor nerve (cranial nerve III). Direct optic nerve damage would impair sensory input to that eye rather than produce an ipsilateral blown pupil associated with severe intracranial deterioration.

4. Question 4 of 25Easy

   An EMT responds to a private residence for a "sick person" dispatch. Upon arrival, the patient states, "I called 911 because my chest started hurting sharply about 30 minutes ago whenever I take a deep breath." The patient's spouse adds that the patient skipped breakfast and has a history of diabetes. What is the patient's chief complaint?

   1. AA. Pleuritic chest pain
   2. BB. Skipped meal
   3. CC. Sick person
   4. DD. History of diabetes
   Show answer to question 4

   Answer: A. Pleuritic chest pain

   The chief complaint is the primary symptom or concern that prompted the patient to seek emergency medical care, which in this case is the sharp chest pain worsened by inspiration. "Sick person" is the dispatch nature of call, not the clinical chief complaint. While skipping a meal and having diabetes are relevant historical details, they do not represent the acute reason 911 was called.

5. Question 5 of 25Medium

   A 63-year-old man is pale, with cold, mottled fingers and a weak radial pulse. The pulse oximeter shows an erratic waveform and a reading of 81%. What is the best interpretation of this reading?

   1. AA. Poor peripheral perfusion may be making the reading unreliable.
   2. BB. The reading is reliable because circulation does not affect oximetry.
   3. CC. The reading alone proves he needs bag-valve-mask ventilation.
   4. DD. Moving the probe to a toe will give a more accurate reading.
   Show answer to question 5

   Answer: A. Poor peripheral perfusion may be making the reading unreliable.

   Pulse oximetry depends on pulsatile blood flow in the capillary bed. Cold, poorly perfused fingers and an erratic waveform make the number unreliable, so treat him based on the overall clinical picture, including oxygen as indicated.

   Why the other options are wrong

   • BOximeters need adequate pulsatile blood flow, and poor perfusion commonly causes false or absent readings.
   • CThe need for ventilation is judged by the rate and depth of breathing, not by an unreliable number.
   • DToes are often even more poorly perfused in a patient like this and would not improve accuracy.

6. Question 6 of 25Hard

   A 24-year-old female with a history of asthma presents with moderate expiratory wheezing and dyspnea. Her family hands you two inhalers from her nightstand: fluticasone and albuterol. Which medication is appropriate for acute relief of her bronchospasm?

   1. AA. Albuterol, because it is an inhaled corticosteroid that reduces airway swelling
   2. BB. Fluticasone, because it rapidly halts inflammatory mediator release
   3. CC. Albuterol, because it is a fast-acting beta-2 agonist bronchodilator
   4. DD. Fluticasone, because it immediately relaxes bronchial smooth muscle
   Show answer to question 6

   Answer: C. Albuterol, because it is a fast-acting beta-2 agonist bronchodilator

   Albuterol is a short-acting beta-2 adrenergic agonist that rapidly relaxes smooth muscle tissue around constricted airways to provide fast relief during an acute asthma attack. Fluticasone is an inhaled corticosteroid used for long-term daily maintenance to reduce chronic inflammation and does not provide immediate bronchodilation.

7. Question 7 of 25Medium

   A 58-year-old male is found unresponsive on his living room floor with snoring respirations and no reported history. What physical examination strategy should the EMT use during the secondary assessment?

   1. AA. A rapid, systematic head-to-toe physical examination
   2. BB. A focused examination limited to the cardiovascular system
   3. CC. A modified exam directed only by bystander statements
   4. DD. An assessment restricted solely to the central nervous system
   Show answer to question 7

   Answer: A. A rapid, systematic head-to-toe physical examination

   When a medical patient is unresponsive and cannot articulate a chief complaint, the EMT must perform a rapid, systematic head-to-toe examination to uncover clues about the underlying etiology and identify any occult injuries. Limiting the assessment to a single body system risks missing crucial physical findings like transdermal medication patches, trauma, or signs of hypoperfusion.

8. Question 8 of 25Hard

   A 70-year-old woman with severe anemia is pale, short of breath on exertion, and has a pulse of 118/min. Her SpO2 reads 98%. How should you interpret the pulse oximeter reading?

   1. AA. Her oxygen delivery is normal, so the cause must be anxiety
   2. BB. The high reading proves she does not need transport
   3. CC. Anemia causes pulse oximeters to read falsely low
   4. DD. Saturation can be normal while total oxygen content is low
   Show answer to question 8

   Answer: D. Saturation can be normal while total oxygen content is low

   Pulse oximetry measures the percentage of hemoglobin carrying oxygen, not the total amount of oxygen. In severe anemia, the few red cells present may be fully saturated while oxygen delivery to the tissues is poor.

   Why the other options are wrong

   • AHer pallor, rapid pulse and breathlessness reflect poor oxygen delivery, not anxiety.
   • BA normal saturation does not rule out serious illness in severe anemia.
   • CAnemia does not cause falsely low readings; the reading can look normal despite poor oxygen delivery.

9. Question 9 of 25Hard

   An 84-year-old woman with type 2 diabetes has been increasingly confused for 3 days. Her mucous membranes are very dry, her glucose meter reads above 600 mg/dL, and her breathing is normal in depth with no fruity odor. Which condition is most likely?

   1. AA. Hypoglycemia with severe dehydration
   2. BB. Diabetic ketoacidosis
   3. CC. An acute ischemic stroke
   4. DD. Hyperosmolar hyperglycemic state
   Show answer to question 9

   Answer: D. Hyperosmolar hyperglycemic state

   Hyperosmolar hyperglycemic state usually affects older adults with type 2 diabetes. It develops over days with extremely high glucose, severe dehydration and altered mental status, typically without the deep breathing and ketones of ketoacidosis.

   Why the other options are wrong

   • AHer meter shows very high, not low, blood glucose.
   • BKetoacidosis usually causes deep, rapid breathing and a fruity breath odor, which are absent.
   • CA stroke does not explain a glucose above 600 mg/dL and dehydration developing over days.

10. Question 10 of 25Medium

    You are assessing a conscious patient who was punched in the face during an altercation. The patient states, "My teeth do not fit together right when I bite down." Which injury should you suspect?

    1. AA. Sphenoid sinus rupture
    2. BB. Nasal septum hematoma
    3. CC. Mandibular fracture
    4. DD. Temporal bone fracture
    Show answer to question 10

    Answer: C. Mandibular fracture

    Dental malocclusion, or the feeling that the teeth do not bite together properly, is a classic finding associated with fractures of the mandible or maxilla. A nasal septum hematoma causes airway obstruction or localized septal swelling but does not alter dental alignment.

11. Question 11 of 25Medium

    A 25-year-old woman says she feels anxious and has tingling in her hands and a racing heart. She has a history of panic attacks. Which approach is best?

    1. AA. Have her breathe into a paper bag to slow her breathing
    2. BB. Tell her it is only anxiety and she does not need care
    3. CC. Ask her to hold her breath for as long as she can
    4. DD. Assess for medical causes before attributing it to anxiety
    Show answer to question 11

    Answer: D. Assess for medical causes before attributing it to anxiety

    Symptoms that look like anxiety can be caused by hypoxia, dysrhythmias, pulmonary embolism or hypoglycemia. Complete an assessment, including vital signs and pulse oximetry, before concluding that anxiety is the cause.

    Why the other options are wrong

    • ARebreathing into a bag can cause hypoxia and is not recommended.
    • BDismissing her symptoms can miss a serious medical cause.
    • CBreath-holding is not a recommended treatment and does not address the cause.

12. Question 12 of 25Medium

    A 68-year-old patient with a history of congestive heart failure presents with orthopnea and severe dyspnea. Auscultation of the lower posterior lung fields reveals fine, bubbling, or popping sounds during inspiration. Which sound is being described?

    1. AA. Crackles
    2. BB. Rhonchi
    3. CC. Pleural rub
    4. DD. Wheezes
    Show answer to question 12

    Answer: A. Crackles

    Crackles (formerly called rales) are fine, moist, or popping sounds typically heard during inspiration as collapsed or fluid-filled alveoli pop open, common in congestive heart failure. Rhonchi are lower-pitched, coarse rattling sounds caused by thick mucus secretions in larger bronchial airways.

13. Question 13 of 25Easy

    What is the main role of insulin in the body?

    1. AA. It breaks down fat to produce ketones
    2. BB. It allows glucose to move from the blood into cells
    3. CC. It releases stored glucose from the liver
    4. DD. It increases how much glucose is absorbed from food
    Show answer to question 13

    Answer: B. It allows glucose to move from the blood into cells

    Insulin, made by the pancreas, allows glucose to move from the blood into the cells, where it is used for energy. Without insulin, glucose builds up in the blood while the cells starve.

    Why the other options are wrong

    • AKetones are produced when fat is broken down because insulin is lacking, not because of insulin.
    • CReleasing stored glucose from the liver is the role of glucagon.
    • DInsulin does not increase absorption of glucose from the digestive tract.

14. Question 14 of 25Easy

    After delivering a baby, you notice the mother's abdomen is still very large and strong contractions continue. What should you suspect?

    1. AA. The placenta is about to rupture
    2. BB. A second baby may be delivered
    3. CC. The uterus has turned inside out
    4. DD. She is having a normal postpartum reaction
    Show answer to question 14

    Answer: B. A second baby may be delivered

    An abdomen that remains large with continued strong contractions after a birth suggests a second baby. Be prepared for another delivery, which often follows within minutes, and request additional help.

    Why the other options are wrong

    • AThe placenta separates and delivers; it does not rupture.
    • CAn inverted uterus appears as a mass at the vaginal opening, usually with heavy bleeding and shock.
    • DAfter a single birth the uterus begins to shrink, so a large abdomen with strong contractions is not expected.

15. Question 15 of 25Medium

    A 61-year-old right-handed man suddenly has weakness of his right arm and leg and cannot find the words to speak. Where is the stroke most likely located?

    1. AA. The right side of the brain
    2. BB. The spinal cord in the neck
    3. CC. The cerebellum on the right side
    4. DD. The left side of the brain
    Show answer to question 15

    Answer: D. The left side of the brain

    Each side of the brain controls the opposite side of the body, and the language center is usually on the left. Right-sided weakness with aphasia points to the left hemisphere.

    Why the other options are wrong

    • AA stroke on the right side of the brain typically causes left-sided weakness.
    • BA problem in the cervical spinal cord would not cause loss of language.
    • CCerebellar strokes mainly cause loss of balance and coordination, not aphasia with one-sided weakness.

16. Question 16 of 25Easy

    Which heart valve prevents blood from flowing backward from the left ventricle into the left atrium?

    1. AA. Tricuspid valve
    2. BB. Mitral valve
    3. CC. Pulmonic valve
    4. DD. Aortic valve
    Show answer to question 16

    Answer: B. Mitral valve

    The mitral, or bicuspid, valve lies between the left atrium and left ventricle and closes when the ventricle contracts, preventing backflow.

    Why the other options are wrong

    • AThe tricuspid valve is between the right atrium and right ventricle.
    • CThe pulmonic valve is between the right ventricle and the pulmonary artery.
    • DThe aortic valve is between the left ventricle and the aorta.

17. Question 17 of 25Hard

    A 66-year-old man with poorly controlled hypertension has sudden, severe chest pain that he describes as tearing, radiating to his back between his shoulder blades. His blood pressure is 178/96 mmHg in the right arm and 142/80 mmHg in the left. Which condition is most likely?

    1. AA. Stable angina
    2. BB. Aortic dissection
    3. CC. Pulmonary embolism
    4. DD. Spontaneous pneumothorax
    Show answer to question 17

    Answer: B. Aortic dissection

    A tear in the inner wall of the aorta classically causes sudden, severe tearing pain that radiates to the back. A large difference in blood pressure between the arms is a key clue, and hypertension is a major risk factor.

    Why the other options are wrong

    • AStable angina is predictable pressure with exertion that is relieved by rest.
    • CPulmonary embolism causes sudden dyspnea and pleuritic pain, not a large difference in arm pressures.
    • DA pneumothorax causes sudden dyspnea with diminished breath sounds on one side.

18. Question 18 of 25Easy

    An EMT arrives at a private residence for an 82-year-old male who appears confused and disoriented. What is the most reliable method to determine if the patient's confusion represents an acute change?

    1. AA. Ask a family member or caregiver about the patient's usual mental status
    2. BB. Wait fifteen minutes and re-evaluate the patient's responsiveness using the AVPU scale
    3. CC. Perform a comprehensive cranial nerve evaluation during the physical exam
    4. DD. Check the expiration dates and indications on the patient's prescription bottles
    Show answer to question 18

    Answer: A. Ask a family member or caregiver about the patient's usual mental status

    Asking a reliable caregiver or family member provides the clearest insight into whether altered mentation is chronic, such as baseline dementia, or an acute change requiring immediate intervention. While reviewing prescription bottles may provide clues regarding medical history, it does not confirm the patient's day-to-day cognitive functioning. Cranial nerve exams and repeated AVPU checks evaluate current status but cannot differentiate chronic deficits from new ones.

19. Question 19 of 25Medium

    A 16-year-old girl has sudden, severe pain on one side of her lower abdomen with nausea and vomiting that began while she was playing volleyball. She has no vaginal bleeding, and a home pregnancy test was negative. What should you suspect?

    1. AA. Normal menstrual cramps
    2. BB. Ovarian torsion
    3. CC. Muscle strain from the game
    4. DD. Food poisoning from lunch
    Show answer to question 19

    Answer: B. Ovarian torsion

    Sudden, severe one-sided pelvic pain with nausea and vomiting, often during activity, suggests ovarian torsion, which cuts off blood flow to the ovary. Prompt transport is needed to save the ovary.

    Why the other options are wrong

    • AMenstrual cramps are usually on both sides and not this sudden or severe.
    • CA muscle strain does not usually cause vomiting with sudden, severe pelvic pain.
    • DFood poisoning causes diffuse cramping and diarrhea, not sudden one-sided pain.

20. Question 20 of 25Medium

    A 28-year-old construction worker sustained a crush injury to his right calf two hours ago. The skin is intact, but the calf is visibly swollen, tense, and firm. The patient reports extreme pain when you gently dorsiflex his foot. Distal pulses remain palpable. These physical findings should raise immediate suspicion for:

    1. AA. rupture of the Achilles tendon
    2. BB. deep vein thrombosis
    3. CC. acute compartment syndrome
    4. DD. complete transection of the tibial nerve
    Show answer to question 20

    Answer: C. acute compartment syndrome

    Severe pain out of proportion to physical appearance, tense tissue swelling, and excruciating pain upon passive stretching of the affected muscle group are classic early hallmarks of acute compartment syndrome, during which distal pulses often remain intact until late stages. Achilles tendon rupture typically presents with an inability to plantarflex and a palpable defect at the heel cord rather than tense compartment swelling.

21. Question 21 of 25Hard

    A 9-year-old boy with a ventriculoperitoneal shunt for hydrocephalus has had a worsening headache, vomiting, and increasing sleepiness since this morning. What should you suspect?

    1. AA. A stomach virus causing dehydration
    2. BB. A migraine, which is common at his age
    3. CC. Shunt blockage with rising brain pressure
    4. DD. Low blood sugar from skipping breakfast
    Show answer to question 21

    Answer: C. Shunt blockage with rising brain pressure

    A shunt drains excess fluid from the brain into the abdomen. Headache, vomiting and decreasing responsiveness in a child with a shunt suggest a blocked shunt and rising intracranial pressure, which requires prompt transport.

    Why the other options are wrong

    • AA stomach virus would not explain progressive sleepiness in a child with a shunt.
    • BAssuming a migraine in a child with a shunt can miss a life-threatening malfunction.
    • DGlucose should be checked, but these symptoms in a shunt patient point first to shunt failure.

22. Question 22 of 25Medium

    A 69-year-old man with emphysema breathes out slowly through pursed lips. What does this technique accomplish?

    1. AA. It keeps small airways open by creating back-pressure.
    2. BB. It increases the amount of carbon dioxide that he retains.
    3. CC. It blocks irritants from entering his lungs.
    4. DD. It shows that he is about to stop breathing.
    Show answer to question 22

    Answer: A. It keeps small airways open by creating back-pressure.

    Exhaling through pursed lips creates back-pressure that keeps weakened small airways from collapsing, allowing more trapped air to leave the lungs. Many patients with COPD use it on their own.

    Why the other options are wrong

    • BPursed-lip breathing helps empty the lungs, which supports carbon dioxide removal rather than retention.
    • CPursing the lips during exhalation does not filter inhaled air.
    • DPursed-lip breathing is a compensating technique, not a sign of impending respiratory arrest.

23. Question 23 of 25Easy

    When conducting a focused physical assessment on an adult patient with an isolated, closed, angulated forearm fracture, what is the most appropriate initial evaluation of that limb?

    1. AA. Apply gentle manual traction to restore anatomic alignment
    2. BB. Palpate the fracture site firmly to evaluate for bony crepitus
    3. CC. Assess pulse, motor, and sensory function distal to the injury
    4. DD. Measure the forearm circumference to monitor for compartment syndrome
    Show answer to question 23

    Answer: C. Assess pulse, motor, and sensory function distal to the injury

    The initial physical evaluation of an injured extremity must always begin with checking distal circulatory, motor, and sensory function to detect neurovascular compromise before any manipulation. Applying traction or splints occurs only after baseline distal neurovascular status has been documented. Attempting to elicit crepitus intentionally causes unnecessary pain and risks further tissue damage.

24. Question 24 of 25Hard

    A 30-year-old man collapsed in a store. Witnesses say all four of his limbs jerked for about 2 minutes. He bit his tongue, was incontinent of urine, and has been confused for 20 minutes. Which conclusion is best supported?

    1. AA. A simple faint, because fainting can cause incontinence
    2. BB. A panic attack, because he was confused afterward
    3. CC. An allergic reaction, because he collapsed suddenly
    4. DD. A seizure, because of the tongue bite and long confusion
    Show answer to question 24

    Answer: D. A seizure, because of the tongue bite and long confusion

    Prolonged rhythmic jerking, a bitten tongue and a long period of confusion afterward point to a generalized seizure. After a simple faint, patients usually become alert again within a minute or two.

    Why the other options are wrong

    • AIncontinence can occur with fainting, but a faint does not cause a bitten tongue and prolonged confusion.
    • BPanic attacks do not cause unconsciousness with generalized jerking and a postictal period.
    • CAn allergic reaction would cause hives, swelling or breathing problems, none of which are described.

25. Question 25 of 25Hard

    A 76-year-old woman presents with altered mental status, fever, and a blood pressure of 74/40 mmHg. Upon examination, her knees and lower extremities display a patchy, purplish-blue, net-like discoloration. How should the EMT interpret and document this skin finding?

    1. AA. Ecchymosis, indicating traumatic tissue extravasation from an unobserved fall
    2. BB. Mottling, indicating severe microvascular hypoperfusion and sluggish blood flow
    3. CC. Erythema, indicating a superficial bacterial infection of the subcutaneous tissue
    4. DD. Urticaria, indicating a systemic histamine-mediated type I hypersensitivity reaction
    Show answer to question 25

    Answer: B. Mottling, indicating severe microvascular hypoperfusion and sluggish blood flow

    Mottling (livedo reticularis) appears as a patchy, purplish-blue, lace-like discoloration caused by severe cutaneous microvascular hypoperfusion and stagnant blood flow, frequently seen in advanced septic shock. It is a critical indicator of severe circulatory failure. Ecchymosis refers to localized bruising from ruptured vessels, and erythema refers to uniform redness typically caused by inflammation or superficial vasodilation.

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