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SCFHS Classification Exam – Paramedics Specialist: free practice test

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Practice test questions with answers and explanations

Try the questions in the test above first, then open each one here to see the correct answer and why every other option is wrong.

01A paramedic contacts the base hospital physician by radio and receives an order for a medication dose that is not covered by the standing orders. This is an example of:

Practice question Unit: Fundamentals and Operations

  1. AOffline control through standing orders

    Offline direction is provided in advance through written protocols and standing orders, without real-time contact.

  2. BRetrospective quality review

    Retrospective review happens after the call, such as chart audits.

  3. COnline (direct) medical direction ✓ Correct answer

    Real-time orders from a physician by radio or phone are online (direct) medical direction.

  4. DProspective protocol development

    Prospective activities, such as writing protocols and training, occur before any call.

Reference: SCFHS Paramedics Specialist Exam Blueprint (2024), Section 1: Fundamentals and Operations, p. 2; Nancy Caroline's Emergency Care in the Streets, 9th ed., Chapter 1: EMS Systems, and Chapter 4: Medical, Legal, and Ethical Issues

02A 40-year-old man has inspiratory stridor and a hoarse voice after a wasp sting on the neck. What does the stridor indicate?

Practice question Unit: Airway

  1. AFluid filling the alveoli in both lower lobes

    Fluid in the alveoli produces crackles, not stridor.

  2. BSpasm of the lower airway bronchioles

    Bronchiolar spasm causes wheezing, mostly on expiration.

  3. CNarrowing of the upper airway around the larynx ✓ Correct answer

    Inspiratory stridor is a high-pitched sound from partial obstruction of the upper airway, such as laryngeal edema.

  4. DAir collecting in the pleural space

    Air in the pleural space reduces breath sounds rather than causing stridor.

Reference: SCFHS Paramedics Specialist Exam Blueprint (2024), Section 2: Airway, p. 2; Nancy Caroline's Emergency Care in the Streets, 9th ed., Chapter 16: Airway Management; Sanders' Paramedic Textbook (formerly Mosby's Paramedic Textbook), 6th ed. (2024), section on airway management and ventilation

03During START, a non-walking adult is not breathing. You reposition the airway, and he starts breathing at 12 per minute. What is his category?

Practice question Unit: Disaster

  1. ARed (immediate) ✓ Correct answer

    A patient who breathes only after the airway is opened is tagged immediate.

  2. BGreen (minor)

    A patient who needed airway repositioning to breathe is not minor.

  3. CYellow (delayed)

    Breathing only after airway repositioning places him above delayed.

  4. DBlack (deceased)

    Black applies only if he still does not breathe after repositioning.

Reference: SCFHS Paramedics Specialist Exam Blueprint (2024), Section 3: Disaster, p. 2; Nancy Caroline's Emergency Care in the Streets, 9th ed., Chapter 48: Incident Management and Mass-Casualty Incidents

04An unrestrained driver slid forward and down under the steering wheel in a frontal crash. Which injury pattern is most expected?

Practice question Unit: Trauma

  1. AHead and facial injuries from the windshield

    Head and face strikes are typical of the up-and-over path.

  2. BKnee, femur, and posterior hip dislocation ✓ Correct answer

    In the down-and-under path the knees hit the dashboard, transferring force to the femur and hip.

  3. CLeft-sided rib, spleen, and kidney injuries

    Left-sided chest and spleen injuries are typical of a driver's-side lateral impact.

  4. DWhiplash from neck hyperextension

    Neck hyperextension is typical of rear impacts.

Reference: SCFHS Paramedics Specialist Exam Blueprint (2024), Section 4: Trauma, p. 2; PHTLS: Prehospital Trauma Life Support, 10th ed., Chapter 4: The Physics of Trauma

05A stabbing victim has a wound to the left chest, BP 74/50 mmHg, distended neck veins, absent breath sounds on the left, and rising airway resistance during ventilation. What type of shock is this?

Practice question Unit: Shock and Resuscitation

  1. ACardiogenic

    The heart muscle itself is not failing.

  2. BNeurogenic

    There is no spinal injury picture.

  3. CSeptic

    There is no sign of infection.

  4. DObstructive ✓ Correct answer

    Tension pneumothorax blocks venous return to the heart, which is obstructive shock.

Reference: SCFHS Paramedics Specialist Exam Blueprint (2024), Section 5: Shock and Resuscitation, p. 2; PHTLS: Prehospital Trauma Life Support, 10th ed., Chapter 3: Shock: Pathophysiology of Life and Death

06A 70-year-old woman was found in a hot apartment during a heat wave. Her temperature is 41 °C and she is confused. Her daughter asks if you can give paracetamol to bring the fever down. What is the best reply?

Practice question Unit: Environmental and Toxicology

  1. AYes, oral paracetamol and fluids are first-line for this temperature

    Paracetamol acts on the fever set point, which is not raised in heat stroke.

  2. BNo; antipyretics do not work here and rapid external cooling is needed ✓ Correct answer

    Heat stroke is failure of heat loss, so antipyretics are ineffective; rapid cooling is the treatment.

  3. CYes, but after the temperature is above 42 °C

    There is no temperature at which antipyretics become effective for heat stroke.

  4. DNo; she should be warmed slowly to avoid hypothermia

    She is hyperthermic; warming would be harmful.

Reference: SCFHS Paramedics Specialist Exam Blueprint (2024), Section 6: Environmental and Toxicology, p. 2; Nancy Caroline's Emergency Care in the Streets, 9th ed., Chapter 39: Environmental Emergencies; PHTLS: Prehospital Trauma Life Support, 10th ed., Chapter 19: Environmental Trauma I: Heat and Cold

07A 4-year-old with vomiting and diarrhea is pale with cool hands. Using the PALS formula for the lower limit of systolic BP in children aged 1 to 10 years, below what value is he hypotensive?

Practice question Unit: Pediatrics and Neonates

  1. A70 mm Hg

    70 mm Hg is the threshold for infants, not a 4-year-old.

  2. B74 mm Hg

    This value does not match the formula.

  3. C90 mm Hg

    90 mm Hg is the threshold used for children older than 10 years.

  4. D78 mm Hg ✓ Correct answer

    The formula is 70 + (2 × age in years): 70 + 8 = 78 mm Hg.

Reference: SCFHS Paramedics Specialist Exam Blueprint (2024), Section 7: Pediatrics and Neonates, p. 2; Nancy Caroline's Emergency Care in the Streets, 9th ed., Chapter 44: Pediatric Emergencies; AHA PALS Provider Manual (2025)

08The baby's head is crowning rapidly with each contraction. How should you manage the head?

Practice question Unit: OB/GYN

  1. APull gently on the head to speed up the delivery

    Pulling can injure the baby and the perineum.

  2. BTell the mother to cross her legs until you reach hospital

    Holding back a birth is dangerous for the baby.

  3. CPush the head back with firm pressure to slow delivery

    Pushing the head back in is never appropriate.

  4. DGently control the head with light pressure ✓ Correct answer

    Light pressure on the head, avoiding the fontanelles, controls delivery and reduces tearing.

Reference: SCFHS Paramedics Specialist Exam Blueprint (2024), Section 8: OB/GYN, p. 2; Nancy Caroline's Emergency Care in the Streets, 9th ed., Chapter 42: Obstetrics

09A 34-year-old woman 10 days after knee surgery has sudden pleuritic chest pain and shortness of breath. HR 118, SpO2 89%, lungs clear, one calf swollen. What is the most likely cause?

Practice question Unit: Medical Emergency

  1. APulmonary embolism ✓ Correct answer

    Recent surgery, a swollen calf, sudden pleuritic pain, tachycardia and hypoxia with clear lungs strongly suggest pulmonary embolism.

  2. BPneumonia with lobar consolidation

    Pneumonia usually causes fever and focal crackles.

  3. CPanic disorder with hyperventilation

    Hypoxia is not explained by panic; this is a diagnosis of exclusion.

  4. DAcute exacerbation of asthma

    There is no wheeze or asthma history.

Reference: SCFHS Paramedics Specialist Exam Blueprint (2024), Section 9: Medical Emergency, p. 2; Nancy Caroline's Emergency Care in the Streets, 9th ed., Chapter 17: Respiratory Emergencies

10A 28-year-old has sharp chest pain that is worse lying down and better leaning forward, after a recent cold. The ECG shows widespread concave ST elevation with PR depression. What is most likely?

Practice question Unit: Cardiac Emergency

  1. AAnterior STEMI from LAD occlusion

    STEMI follows a coronary territory with reciprocal changes.

  2. BAcute pericarditis ✓ Correct answer

    Positional pleuritic pain, diffuse concave ST elevation and PR depression after a viral illness suggest pericarditis.

  3. CPneumothorax with chest wall pain

    Pneumothorax does not cause these ECG findings.

  4. DPulmonary embolism with RV strain

    PE does not cause widespread ST elevation with PR depression.

Reference: SCFHS Paramedics Specialist Exam Blueprint (2024), Section 11: Cardiac Emergency, p. 2; AHA ACLS Provider Manual (2025); Nancy Caroline's Emergency Care in the Streets, 9th ed., Chapter 18: Cardiovascular Emergencies

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