The 50 Questions That Matter Most
After analyzing thousands of paramedic certification exam results, certain topics emerge as the most frequently tested and most commonly missed. These 50 areas represent the highest-yield content for your exam preparation. Master these, and you've covered the foundation of paramedic certification.
Cardiac & ACLS (Questions 1-10)
Cardiac emergencies consistently account for the largest portion of paramedic certification exams.
- What is the first drug given in pulseless VT/VF after the second shock? (Epinephrine 1 mg IV/IO)
- What is the correct adenosine dose for SVT? (6 mg rapid IV push, then 12 mg if needed)
- Name the shockable cardiac arrest rhythms (VF and pulseless VT)
- What is the atropine dose for symptomatic bradycardia? (0.5 mg IV, repeat q3-5min, max 3 mg)
- When should synchronized cardioversion be used? (Unstable tachycardia with a pulse)
- What are the Hs and Ts of reversible cardiac arrest? (Hypovolemia, Hypoxia, H+, Hypo/Hyperkalemia, Hypothermia; Tension pneumo, Tamponade, Toxins, Thrombosis)
- What STEMI criteria require cath lab activation? (ST elevation ≥1mm in 2+ contiguous limb leads or ≥2mm in precordial leads)
- What is the energy for adult defibrillation? (Biphasic: 120-200J, Monophasic: 360J)
- What medication is given for torsades de pointes? (Magnesium sulfate 2g IV)
- When is transcutaneous pacing indicated? (Symptomatic bradycardia unresponsive to atropine)
Airway & Breathing (Questions 11-20)
Airway management questions test both knowledge and clinical judgment.
- What is the gold standard for ETT confirmation? (Waveform capnography)
- When is a nasopharyngeal airway contraindicated? (Suspected basilar skull fracture)
- What is the correct adult ventilation rate with BVM? (1 breath every 6 seconds = 10/min)
- What CPAP pressure is used for pulmonary edema? (5-10 cmH2O)
- What is the difference between stridor and wheezing? (Stridor = upper airway, wheezing = lower airway)
- What medication is given for severe bronchospasm unresponsive to albuterol? (Epinephrine 0.3 mg IM or magnesium 2g IV)
- What is the normal ETCO2 range? (35-45 mmHg)
- How do you size an OPA? (Corner of mouth to earlobe)
- What RSI medications are used? (Sedative: ketamine or etomidate + Paralytic: succinylcholine or rocuronium)
- What is the target SpO2 for COPD patients? (88-92%)
Trauma (Questions 21-30)
Trauma assessment and management are heavily weighted on certification exams.
- What does the X in XABCDE stand for? (eXsanguinating hemorrhage)
- When should a tourniquet be applied? (Life-threatening extremity hemorrhage uncontrolled by direct pressure)
- What is the GCS score for a patient who opens eyes to pain, makes incomprehensible sounds, and withdraws from pain? (8 = E2 + V2 + M4)
- What is the target scene time for critical trauma? (< 10 minutes)
- When is TXA indicated? (Hemorrhagic shock within 3 hours of injury)
- What are the signs of tension pneumothorax? (JVD, absent breath sounds unilaterally, tracheal deviation, hypotension)
- Where do you perform needle decompression? (2nd ICS MCL or 5th ICS AAL)
- What is permissive hypotension? (Targeting SBP 80-90 in penetrating trauma — NOT for TBI)
- When is spinal motion restriction indicated? (Mechanism + midline tenderness, neurological deficit, altered mental status, or distracting injury)
- What is the Cushing reflex? (Hypertension + bradycardia + irregular respirations = increased ICP)
Medical Emergencies (Questions 31-40)
Medical emergencies require rapid differential diagnosis and targeted treatment.
- What blood glucose level defines hypoglycemia? (< 60 mg/dL or < 3.3 mmol/L)
- What is the preferred dextrose concentration? (D10W — lower osmolarity, less tissue damage)
- What is the Cincinnati Stroke Scale? (Facial droop, arm drift, speech abnormality)
- What is the naloxone dose for opioid overdose? (0.4-2 mg IV/IM, or 4 mg IN)
- What is the epinephrine dose for anaphylaxis? (0.3-0.5 mg IM, 1:1,000 concentration)
- How do you differentiate DKA from HHS? (DKA: Type 1, Kussmaul breathing, fruity breath, rapid onset. HHS: Type 2, no Kussmaul, gradual onset, higher glucose)
- What is the seizure medication of choice prehospital? (Midazolam 10 mg IM/IN)
- When does a seizure become status epilepticus? (> 5 minutes of continuous seizure activity)
- What are the signs of organophosphate poisoning? (SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis + miosis + bradycardia)
- What is the antidote for organophosphate poisoning? (Atropine + pralidoxime/2-PAM)
Pharmacology (Questions 41-50)
Drug knowledge is tested extensively on paramedic exams.
- What is the epinephrine concentration for cardiac arrest vs anaphylaxis? (Cardiac: 1:10,000 IV; Anaphylaxis: 1:1,000 IM)
- When is nitroglycerin contraindicated? (SBP < 90, PDE inhibitor use within 24-48h, right-sided MI)
- What dose of aspirin is given for ACS? (324 mg chewed)
- What is the amiodarone dose for refractory VF/VT? (300 mg IV/IO first dose, 150 mg second dose)
- What is the lidocaine dose for VT? (1-1.5 mg/kg IV, repeat 0.5-0.75 mg/kg)
- When is glucagon used? (Hypoglycemia without IV access, beta-blocker or calcium channel blocker overdose)
- What is the diphenhydramine dose for allergic reaction? (25-50 mg IV/IM)
- What is the magnesium sulfate dose for eclampsia? (4-6g IV over 20 minutes)
- What pediatric dose formula uses body weight? (Dose = weight (kg) × mg/kg dosage)
- What is the half-life of naloxone? (30-90 minutes — shorter than most opioids, risk of re-sedation)
FAQ
Are these the actual questions on the paramedic exam?
These are not the exact exam questions, but they represent the most frequently tested topics and concepts. The actual exam uses scenario-based questions that test the same underlying knowledge. Mastering these 50 topics will prepare you for the vast majority of questions you'll encounter.
How should I use this list to study?
Go through each question and answer honestly before revealing the answer. Mark any questions you got wrong or were unsure about. These marked topics become your targeted study priorities. Return to this list weekly to track your progress — your goal is to answer all 50 correctly from memory.
Clinical insights
Top 50 EMS Questions Every Paramedic Must Know becomes easier to retain when you anchor details to bedside priorities: safety first, trend recognition second, and escalation timing third.
Use this framework while reviewing your exam blueprint: identify immediate risk cues, decide the first nursing action, and justify why alternatives are lower priority.
- Re-state the patient risk in one sentence before choosing an intervention.
- Prioritize actions that improve airway, breathing, circulation, or safety monitoring first.
- When options are similar, choose the response that adds assessment clarity before escalation.
- Use Top 50 EMS Questions Every Paramedic Must Know as a cue to review adjacent concepts that commonly appear in mixed-question sets.
