Free EMT Secondary Assessment Practice Test – Part 2

1. When using the OPQRST mnemonic to assess a patient’s pain, what does the “Q” represent?

2. During a secondary assessment physical examination, which technique should generally be performed FIRST for each body region?

3. A 58-year-old male complains of abdominal pain. When asked to describe the quality of his pain, he says, “It feels like someone is stabbing me with a knife.” Which condition should the EMT consider based on this description?

4. During a secondary assessment of a trauma patient, the EMT notes that the patient’s abdomen is distended and firm, with bruising around the umbilicus. The patient is hypotensive and tachycardic. These findings are MOST suggestive of:

5. A 62-year-old female complains of chest pain. When asked about radiation, she states, “The pain goes into my left arm and jaw.” Which follow-up question would BEST assess the “T” component of OPQRST?

6. An EMT is performing a secondary assessment on a patient with suspected spinal injury. When palpating the spine, which technique is MOST appropriate?

7. A 45-year-old male presents with sudden-onset, severe chest pain that he rates as 10/10. He describes the pain as “tearing” and says it radiates to his back between his shoulder blades. He appears diaphoretic and anxious. Blood pressure is 168/98 in the right arm and 145/82 in the left arm. Which finding is MOST concerning for a life-threatening condition?

8. A 28-year-old male was struck in the head during an assault. He is alert but confused, with a visible laceration to his left temporal region. During the secondary assessment, the EMT notes that his left pupil is dilated and reacts sluggishly to light, while his right pupil is normal. The patient’s mental status begins to deteriorate. These findings are MOST consistent with:

9. A 34-year-old female complains of right lower quadrant abdominal pain. Using OPQRST, the EMT learns: the pain started gradually 12 hours ago near her umbilicus and migrated to the RLQ; it worsens with movement and coughing; she describes it as sharp; it does not radiate; she rates it 7/10; and it has been constant since moving to the RLQ. She has nausea and low-grade fever. Which condition do these findings MOST strongly suggest?

10. A 56-year-old male was found unconscious at the bottom of a staircase. During the rapid secondary assessment, the EMT notes clear fluid draining from his left ear and bruising behind his left ear. His left eye appears bruised (“raccoon eyes” sign). These findings are MOST indicative of:

11. What does the “A” in the SAMPLE history mnemonic stand for?

12. Which of the following is the correct technique for obtaining an accurate radial pulse in an adult patient?

13. A 58-year-old male with chest pain tells you he takes “a water pill” and “something for my sugar.” Which follow-up question would be MOST effective for clarifying this information?

14. An EMT is obtaining a blood pressure on a 72-year-old female with dizziness. The EMT inflates the cuff to 180 mmHg and begins slowly releasing the pressure. The first Korotkoff sound is heard at 156 mmHg, and the sounds disappear at 88 mmHg. Which documentation is MOST accurate?

15. A 44-year-old female with abdominal pain provides the following SAMPLE history: Symptoms include cramping, lower abdominal pain that started 6 hours ago; Allergies to penicillin; Medications include birth control pills; Past history of two vaginal deliveries; Last meal was breakfast 4 hours ago; Events leading up include no known trigger. Which additional information would be MOST important to obtain?

16. A 22-year-old male presents after being found unresponsive at a party. Vital signs are: blood pressure 100/70 mmHg, pulse 52 and regular, respirations 10 and shallow, SpO2 92% on room air. His skin is pale, cool, and diaphoretic. Which interpretation of these vital signs is MOST accurate?

17. During a SAMPLE history, a 65-year-old male with shortness of breath reports “congestive heart failure” as a past medical condition. He states he takes “a bunch of pills” but cannot remember their names. His wife, who is present, mentions he was hospitalized “a few months ago” and “they changed his medications.” Which approach would be MOST effective for obtaining complete medication information?

18. An EMT responds to a 4-year-old child with a high fever. The child is alert, crying, and clinging to the parent. Vital signs are: heart rate 130, respiratory rate 34, blood pressure 90/60, temperature 39.5°C (103.1°F), capillary refill < 2 seconds. The child's skin is warm and flushed. How should the EMT interpret these findings?

19. A 55-year-old male with crushing chest pain is being assessed. When asked about the events leading up to his symptoms, he says, “I was just watching TV when it started.” The pain has been present for 20 minutes and is 8/10 in severity. Which follow-up question about the “Events” component would be MOST clinically relevant?

20. A paramedic team has just intubated a 68-year-old male in cardiac arrest. The EMT is asked to monitor end-tidal carbon dioxide (EtCO2) via capnography. The initial EtCO2 reading is 12 mmHg. Which interpretation of this value is MOST accurate?

21. During a head-to-toe examination of a trauma patient, which anatomical region should be assessed FIRST after completing the primary assessment?

22. A 58-year-old female complains of sudden-onset severe headache. When obtaining the history, she says, “This is the worst headache of my life.” Which condition should the EMT suspect based on this statement?

23. During a head-to-toe examination of a motorcyclist who was thrown from his bike, you note clear fluid draining from his left ear. No blood is visible in the fluid. What does this finding MOST likely indicate?

24. A 66-year-old male with a history of atrial fibrillation complains of sudden onset of right-sided weakness and difficulty speaking. His wife reports the symptoms began about 45 minutes ago. Which additional history question is MOST critical for determining treatment options?

25. During a secondary assessment of a patient who fell from a ladder, you palpate the cervical spine and note step-off deformity at the C5 level. The patient reports numbness in both arms but can move his legs. Which statement BEST describes the clinical significance of this finding?

26. A 42-year-old male complains of chest pain. He describes the pain as sharp, worse when he breathes deeply, and improved when he sits forward. He reports he had a “bad cold” two weeks ago. He has no history of heart disease. Based on this history, which condition should the EMT consider MOST likely?

27. You are performing a head-to-toe examination on an unresponsive 24-year-old male found at the bottom of a staircase. During assessment of the head, you note unequal pupils (left 6mm and fixed, right 3mm and reactive). There is a contusion on the left temporal region. What do these findings MOST likely indicate?

28. A 35-year-old female complains of severe right lower quadrant abdominal pain that started 12 hours ago. She reports nausea and one episode of vomiting. She says her last menstrual period was 2 weeks ago. She denies fever. Which additional history question is MOST important for narrowing the differential diagnosis?

29. During assessment of the chest in a trauma patient, you note paradoxical movement of the left chest wall. The left anterior chest moves inward during inspiration and outward during expiration. Which statement BEST describes the significance and immediate management of this finding?

30. A 68-year-old male with a history of COPD is found sitting upright in bed, using accessory muscles to breathe. He can only speak one or two words at a time. His wife reports he has been “getting worse over the past three days” with increased cough and green sputum. She also mentions he ran out of his “inhaler medications” one week ago. Which aspect of this history is MOST significant for understanding the cause of his current presentation?

31. During a secondary assessment, the EMT uses the mnemonic DCAP-BTLS to systematically evaluate for signs of injury. What does the “T” in this mnemonic represent?

32. When assessing a patient’s pain using OPQRST, which component asks the patient to describe what the discomfort feels like?

33. A 28-year-old male fell from a ladder and landed on his left side. During the secondary assessment, the EMT palpates the left lower ribs and notes the patient winces and pulls away. There is no visible bruising or deformity. Which finding should the EMT document?

34. A 56-year-old male describes his chest discomfort as “a heavy weight sitting on my chest.” When asked about radiation, he says, “It goes to my jaw and left arm.” Based on this OPQRST assessment, which condition should the EMT be MOST concerned about?

35. During a secondary assessment of an unconscious patient, the EMT notes that the pupils are unequal in size. The right pupil is 4mm and reactive to light; the left pupil is 6mm and fixed (non-reactive). This finding MOST strongly suggests:

36. A patient with abdominal pain reports that the discomfort is relieved by drawing her knees up to her chest. Which component of OPQRST does this information address?

37. A 45-year-old male was involved in a motor vehicle collision. During the rapid trauma assessment, the EMT notes deformity, contusions, and swelling to the right thigh. The right leg appears shorter than the left and is externally rotated. Palpation reveals crepitus. Based on these findings, which injury should the EMT suspect?

38. A 62-year-old female complains of sudden, severe abdominal pain that began 2 hours ago while watching television. She describes the pain as “tearing” and rates it 10/10. She says the pain radiates to her back between her shoulder blades. She has a history of hypertension but is not compliant with her medications. Based on this OPQRST assessment, which condition should the EMT consider as the MOST likely diagnosis?

39. During assessment of a patient with difficulty breathing, the EMT notes that the patient is using accessory muscles to breathe, has intercostal retractions, and is sitting upright leaning forward on his hands. These findings indicate:

40. A 34-year-old male complains of right lower quadrant abdominal pain. Using OPQRST, the EMT learns: pain started gradually yesterday near the umbilicus and migrated to the right lower quadrant; pain is sharp and constant; nothing makes it better; walking and coughing make it worse; pain is 8/10; and it has been present for about 18 hours. Based on this assessment, which condition is MOST likely?

41. What does the “M” in the SAMPLE mnemonic represent?

42. During a secondary assessment physical exam, which technique should the EMT use to assess for crepitus in a suspected fracture?

43. When obtaining a SAMPLE history from a patient who speaks limited English, which approach is MOST appropriate?

44. A 34-year-old male complains of right lower quadrant abdominal pain after a fall from a ladder. During the physical exam, the EMT notes tenderness and guarding in the RLQ. The patient’s abdomen feels rigid to palpation. Which condition should the EMT suspect based on these findings?

45. A 22-year-old female complains of abdominal pain. When asked about her last menstrual period, she says, “About six weeks ago.” She is not on birth control. Which component of SAMPLE should the EMT explore further based on this response?

46. During a head-to-toe physical exam of an unconscious patient, the EMT notices clear fluid draining from the patient’s left ear following a motor vehicle crash. There is also bruising behind the left ear. What should the EMT do?

47. A 65-year-old male with severe lower back pain tells the EMT he has “bad kidneys” and takes “a water pill.” He also mentions having “prostate problems.” Which aspect of this history should prompt the EMT to consider a more serious underlying condition?

48. A 45-year-old male was involved in a motor vehicle crash. During the rapid secondary assessment, the EMT notes the patient has a contusion on the left chest wall, decreased breath sounds on the left, and severe respiratory distress. The trachea appears slightly deviated to the right. Which injury should the EMT suspect and what is the immediate priority?

49. A 40-year-old male was found unconscious by bystanders. A bystander hands the EMT the patient’s wallet, which contains a card stating “Type 1 Diabetic – Insulin Pump.” The patient is unresponsive with rapid, deep respirations and fruity-smelling breath. Which SAMPLE component is MOST critical to confirm with bystanders?

50. During a secondary assessment of a patient who fell from a roof, the EMT palpates the pelvis and notes instability and severe pain. The patient’s blood pressure is 88/54 mmHg, pulse is 124, and skin is pale and diaphoretic. What is the MOST appropriate action?