Primary Assessment makes up about 37–41% of the NREMT EMR exam. Here are 8 to work
through. When you open an answer, you'll see why it's right and why the other options aren't.
Question 1NRP reviewed
A patient presenting with pinpoint pupils with salivation, lacrimation, bronchorrhea and incontinence is showing signs of
AA sedative-hypnotic toxidrome
BA sympathomimetic toxidrome
CAn anticholinergic toxidrome
DA cholinergic toxidrome
Show the answer
Correct answer: D. A cholinergic toxidrome
Pinpoint pupils with salivation, lacrimation, bronchorrhea and incontinence together define a cholinergic toxidrome. Recognizing a toxidrome lets you treat a poisoning correctly even when the substance is unknown, which is the usual situation in the field.
A. A sedative-hypnotic toxidrome instead presents with depressed mentation and respiratory depression with normal or slightly small pupils.
B. A sympathomimetic toxidrome instead presents with dilated pupils with hypertension, tachycardia, hyperthermia and diaphoresis.
C. An anticholinergic toxidrome instead presents with dilated pupils with hot dry flushed skin, delirium and urinary retention.
D. These findings together define a cholinergic toxidrome.
Question 2NRP reviewed
A patient presenting with dilated pupils with hypertension, tachycardia, hyperthermia and diaphoresis is showing signs of
AAn opioid toxidrome
BA sympathomimetic toxidrome
CA cholinergic toxidrome
DA sedative-hypnotic toxidrome
Show the answer
Correct answer: B. A sympathomimetic toxidrome
Dilated pupils with hypertension, tachycardia, hyperthermia and diaphoresis together define a sympathomimetic toxidrome. Recognizing a toxidrome lets you treat a poisoning correctly even when the substance is unknown, which is the usual situation in the field.
A. An opioid toxidrome instead presents with pinpoint pupils with respiratory depression and depressed mentation.
B. These findings together define a sympathomimetic toxidrome.
C. A cholinergic toxidrome instead presents with pinpoint pupils with salivation, lacrimation, bronchorrhea and incontinence.
D. A sedative-hypnotic toxidrome instead presents with depressed mentation and respiratory depression with normal or slightly small pupils.
Question 3NRP reviewed
A patient presenting with depressed mentation and respiratory depression with normal or slightly small pupils is showing signs of
AA sedative-hypnotic toxidrome
BA sympathomimetic toxidrome
CA cholinergic toxidrome
DAn opioid toxidrome
Show the answer
Correct answer: A. A sedative-hypnotic toxidrome
Depressed mentation and respiratory depression with normal or slightly small pupils together define a sedative-hypnotic toxidrome. Recognizing a toxidrome lets you treat a poisoning correctly even when the substance is unknown, which is the usual situation in the field.
A. These findings together define a sedative-hypnotic toxidrome.
B. A sympathomimetic toxidrome instead presents with dilated pupils with hypertension, tachycardia, hyperthermia and diaphoresis.
C. A cholinergic toxidrome instead presents with pinpoint pupils with salivation, lacrimation, bronchorrhea and incontinence.
D. An opioid toxidrome instead presents with pinpoint pupils with respiratory depression and depressed mentation.
Question 4NRP reviewed
SCENE — 55-year-old with epigastric discomfort he attributes to indigestion. HR 96, BP 138/84, RR 18, SpO2 97%, skin cool and damp, and he is a smoker with diabetes.
The finding that should change your working impression is
Athe blood pressure of 138/84 on your assessment
Bhis history of smoking and diabetes
Cthe epigastric location of the discomfort he describes
Dcool damp skin, which does not accompany simple indigestion
Show the answer
Correct answer: D. cool damp skin, which does not accompany simple indigestion
Indigestion does not make someone sweat at rest. Cool damp skin is a sympathetic response, and in a diabetic smoker with epigastric discomfort it points at infarction presenting atypically rather than at the stomach.
A. This blood pressure is unremarkable.
B. Risk factors raise suspicion but the skin finding changes the impression.
C. Epigastric pain is exactly how atypical infarction presents.
D. Diaphoresis with cool skin is a sympathetic response inconsistent with indigestion.
Question 5
An object has penetrated through a patient's cheek and is bleeding into the mouth, threatening the airway. You should
Apush the object the rest of the way through
Bpack the mouth tightly with rolled dry gauze
Cstabilize the object in place and transport
Dremove the object and control the bleeding
Show the answer
Correct answer: D. remove the object and control the bleeding
You normally stabilize an impaled object in place. The cheek is the recognized exception: you can reach it from both sides, and leaving it in threatens the airway directly. Remove it, then control bleeding inside and out.
A. Pushing it further causes more injury.
B. Tight packing in the mouth blocks the airway it was meant to protect.
C. Stabilizing it in place leaves the object obstructing the airway.
D. The cheek is the accepted exception, because the object threatens the airway and you can reach it from both sides.
Question 6
SCENE — 3-year-old with a barking cough. RR 38, SpO2 95%, stridor audible at rest, sitting upright, no drooling, temperature 100.4°F.
Select the TWO findings that indicate this is more severe than a mild presentation.
Select all that apply.
Athe barking quality of the cough itself
Bthe child choosing to sit upright rather than lie down
Ca temperature of 100.4 degrees Fahrenheit
Dstridor that is audible while the child is at rest
Ea respiratory rate of 38 with visible effort
Show the answer
Correct answers: D, E
Stridor only when upset means mild narrowing. Stridor at rest means the airway is narrowed enough to be heard without any provocation. Add a raised rate and visible effort, and you have a child who may deteriorate, not one who can wait.
A. A barking cough is typical of the condition at any severity.
B. Sitting upright is a comfort position, not a severity marker.
C. A low-grade fever comes with the viral illness whatever the severity.
D. Stridor at rest means the narrowing is enough to hear without provocation.
E. A raised rate with visible effort shows the child is working to compensate.
Question 7
SCENE — 36-year-old, anxious and breathing rapidly after an argument. RR 32, SpO2 100%, HR 108, tingling in both hands, no chest pain, lungs clear.
Before concluding this is anxiety you should consider that
Aa clear chest rules out every significant respiratory cause
Btingling in the hands is only ever caused by anxiety
Cthe same picture occurs in embolism, acidosis and early sepsis
Da saturation of 100 percent excludes any serious cause
Show the answer
Correct answer: C. the same picture occurs in embolism, acidosis and early sepsis
Fast breathing is a symptom with many causes, and several dangerous ones show up with a clear chest and a normal saturation. Anxiety is a fair conclusion only once you've actually thought about those, not skipped past them.
A. A clear chest is exactly what makes embolism easy to miss.
B. Tingling comes from the alkalosis of overbreathing, whatever the cause.
C. Embolism, metabolic acidosis and early sepsis all present this way.
D. A normal saturation fits with several dangerous causes.
Question 8
A 5-month-old has a short audible sound at the end of each exhalation. This grunting most likely represents
Aan attempt to keep the alveoli from collapsing
Ba normal noise heard during and after feeding
Cpartial upper airway obstruction by the tongue base
Da sign that the infant is settled and comfortable
Show the answer
Correct answer: A. an attempt to keep the alveoli from collapsing
Grunting is the infant partly closing the glottis on the way out, which raises end-expiratory pressure and keeps the alveoli open. It's the baby giving itself positive pressure, and it signals serious respiratory compromise.
A. Grunting builds end-expiratory pressure to stop alveolar collapse, and it means serious distress.
B. It isn't a feeding noise, and you should never dismiss it as benign.
C. Upper airway obstruction gives stridor or snoring, which happen on inspiration.
D. Grunting is a compensatory sign of distress, not comfort.
There are 191 EMR Primary Assessment questions in EMS Registry Ready. Try 15
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