PHECC Advanced Paramedic Written Exam (Ireland)

You are treating a patient with symptomatic bradycardia (heart rate 34 bpm, blood pressure 82/50 mmHg, diaphoretic). According to the PHECC Clinical Practice Guidelines (CPGs), what is the first-line pharmacotherapeutic intervention?

• AAdrenaline 1 mg IV.
• BAtropine 600 mcg IV.
• CAmiodarone 150 mg IV.
• DAtropine 3 mg IV.

A 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF, with reciprocal ST depression in leads I and aVL. An Advanced Paramedic performs a right-sided ECG which shows 1.5 mm ST elevation in lead V4R. Which of the following is contraindicated in this patient's management?

• AAspirin 300 mg chewed.
• BGlyceryl Trinitrate (GTN) administration.
• CIntravenous sodium chloride 0.9% bolus.
• DOxygen therapy if oxygen saturation is 90%.

During a resuscitation attempt for a patient in refractory Ventricular Fibrillation (VF), the team has delivered three shocks and administered the first dose of Adrenaline. According to the PHECC cardiac arrest guidelines, what is the drug and dose that should be administered next?

• AAmiodarone 150 mg IV/IO.
• BLidocaine 100 mg IV/IO.
• CAtropine 3 mg IV/IO.
• DAmiodarone 300 mg IV/IO.

While managing a patient in cardiac arrest, you monitor continuous waveform capnography. During CPR, you note a sudden, sustained increase in End-Tidal Carbon Dioxide (ETCO2) from 12 mmHg to 42 mmHg. What does this clinical change most likely indicate?

• AReturn of Spontaneous Circulation (ROSC).
• BDisplacement of the endotracheal tube into the esophagus.
• CAn improvement in chest compression depth and rate.
• DThe development of a tension pneumothorax.

You are treating an unstable patient with monomorphic Ventricular Tachycardia (VT) who has a palpable pulse but displays signs of poor perfusion (altered mental status, chest pain, hypotension). What is the preferred immediate treatment under the PHECC guidelines?

• AAmiodarone 150 mg IV infusion over 10 minutes.
• BUnsynchronized defibrillation at maximum energy.
• CSynchronized cardioversion.
• DVagal maneuvers followed by Adenosine IV.

Which of the following 12-lead ECG criteria is most characteristic of a Left Bundle Branch Block (LBBB)?

• AQRS duration ≥ 120 ms, rSR' pattern in lead V1, and slurred S waves in leads I and V6.
• BPR interval > 200 ms with a normal QRS complex.
• CQRS duration ≥ 120 ms, dominant S wave in V1, and broad, notched R waves in leads I, aVL,…
• DST-segment elevation in leads V1 to V4 with reciprocal depression in II, III, aVF.

You arrive on scene to find a 65-year-old male collapsed. The monitor shows Ventricular Fibrillation (VF). You deliver a shock. According to the current ERC and PHECC resuscitation guidelines, what is the immediate next step?

• AResume chest compressions immediately for 2 minutes without checking the rhythm or pulse.
• BPerform a rhythm check on the monitor to see if the shock was successful.
• CCheck the carotid pulse for up to 10 seconds to assess for ROSC.
• DAdminister Adrenaline 1 mg IV immediately.

A renal dialysis patient is found lethargic and hypotensive. The ECG shows tall, symmetrical, peaked T waves, a widened QRS complex (140 ms), and flattened P waves. Which of the following pharmacotherapeutic agents is indicated first to stabilize the cardiac membrane?

• ASodium Bicarbonate 8.4% IV.
• BSalbutamol 5 mg nebulized.
• CCalcium Chloride 10% IV.
• DInsulin and Dextrose infusion.

A 28-year-old female presents with rapid palpitations and chest tightness. The monitor shows a regular, narrow-complex tachycardia at 190 bpm. Her blood pressure is 118/76 mmHg. Vagal maneuvers are unsuccessful. What is the next clinical step under the PHECC guidelines?

• AAdminister Adenosine 6 mg rapid IV bolus followed by a saline flush.
• BPerform synchronized cardioversion at 50 Joules.
• CAdminister Amiodarone 150 mg IV over 10 minutes.
• DAdminister Adenosine 12 mg rapid IV bolus.

Which of the following describes the Sgarbossa criteria, which are used to identify acute myocardial infarction in the presence of a Left Bundle Branch Block (LBBB)?

• AST elevation ≥ 1 mm in leads II, III, aVF, and reciprocal depression ≥ 1 mm in lead aVL.
• BST depression ≥ 2 mm in leads V1 to V4 with upright T waves.
• CPR interval prolongation > 200 ms with progressive lengthening until a QRS is dropped.
• DConcordant ST elevation ≥ 1 mm in any lead, concordant ST depression ≥ 1 mm in leads V1-V…

A 19-year-old male athlete collapses during training. The ECG shows a short PR interval (<120 ms), a widened QRS complex (>120 ms), and a slurred upstroke of the QRS complex (delta wave). What is the underlying condition indicated by these findings?

• ALong QT syndrome.
• BBrugada syndrome.
• CWolff-Parkinson-White (WPW) syndrome.
• DArrhythmogenic Right Ventricular Dysplasia (ARVD).

What is the primary physiological mechanism by which Glyceryl Trinitrate (GTN) exerts its therapeutic effect in patients with acute cardiogenic pulmonary edema?

• AVenodilation, which reduces venous return (preload) and decreases myocardial workload.
• BArteriodilation, which increases systemic vascular resistance (afterload).
• CPositive inotropy, which increases the force of myocardial contraction.
• DChronotropic blockade, which slows the heart rate to allow better filling.

When interpreting an ECG, how do you distinguish between Mobitz Type I (Wenckebach) and Mobitz Type II second-degree atrioventricular (AV) block?

• AMobitz Type I has a constant PR interval; Mobitz Type II features progressive shortening…
• BMobitz Type I features a complete dissociation between P waves and QRS complexes; Mobitz…
• CMobitz Type I features progressive PR interval prolongation prior to a dropped QRS; Mobit…
• DMobitz Type I has a QRS width > 120 ms; Mobitz Type II always has a normal QRS width (< 1…

A 78-year-old male is complaining of dizziness and fatigue. The monitor reveals P waves at a rate of 80 bpm and QRS complexes at a regular rate of 30 bpm. There is no relationship or correlation between the P waves and the QRS complexes. What block is represented?

• AFirst-degree AV block.
• BMobitz Type II second-degree AV block.
• CThird-degree (complete) AV block.
• DLeft Bundle Branch Block.

You are treating a patient with polymorphic Ventricular Tachycardia (Torsades de Pointes) who has a pulse but is hemodynamically unstable. According to the PHECC CPGs, what is the indicated pharmacological therapy?

• AAmiodarone 300 mg IV bolus.
• BAdenosine 6 mg rapid IV bolus.
• CMagnesium Sulfate 2 g IV infusion.
• DLidocaine 100 mg IV.

A patient presents with signs of cardiogenic shock. The 12-lead ECG confirms an acute right ventricular infarction (ST elevation in V4R). The patient's blood pressure is 78/44 mmHg. What is the most appropriate first-line intervention to support their blood pressure?

• AStart a Dopamine infusion at 10 mcg/kg/min.
• BAdminister a 250-500 mL bolus of Sodium Chloride 0.9% IV.
• CAdminister a sublingual GTN tablet.
• DAdminister Morphine 2 mg IV.

During resuscitation of a patient in Pulseless Electrical Activity (PEA), which of the following represents the primary role of the Advanced Paramedic?

• AImmediate unsynchronized defibrillation at 200 Joules.
• BHigh-quality CPR, securing the airway, and systematically identifying and treating the re…
• CAdministering Amiodarone 300 mg after the second cycle of CPR.
• DHyperventilating the patient at a rate of 25-30 breaths per minute.

A 50-year-old female has been resuscitated from VF cardiac arrest. She is unresponsive but has a stable blood pressure of 112/70 mmHg. What are the key management priorities for post-ROSC care under the PHECC guidelines?

• AHyperventilate to lower ETCO2 to 25 mmHg to reduce intracranial pressure.
• BAdminister an immediate IV bolus of Amiodarone 150 mg to prevent recurrence.
• CRapidly infuse 2 liters of ice-cold saline to induce hypothermia.
• DOptimize ventilation and oxygenation (SpO2 94-98%, normocapnia), perform a 12-lead ECG, m…

Which clinical sign is part of Beck's Triad, which indicates the presence of acute cardiac tamponade?

• AHypertension, bradycardia, and irregular respirations.
• BTracheal deviation, unilateral absent breath sounds, and hyperresonance.
• CTachycardia, tachypnea, and warm, dry skin.
• DHypotension, jugular venous distention (JVD), and muffled heart sounds.

A 60-year-old male presents with sudden onset of severe dyspnea and pleuritic chest pain. His heart rate is 110 bpm, respiratory rate is 28 breaths/min, and SpO2 is 88% on room air. The 12-lead ECG shows sinus tachycardia with an S1Q3T3 pattern. What is the most likely diagnosis?

• AAcute Inferior STEMI.
• BAcute Pulmonary Embolism.
• CAcute Pericarditis.
• DSpontaneous Pneumothorax.

Where should the V4 electrode be placed when performing a standard 12-lead ECG?

• AFourth intercostal space at the right sternal border.
• BFifth intercostal space in the midclavicular line.
• CFourth intercostal space at the left sternal border.
• DFifth intercostal space in the anterior axillary line.

A 45-year-old male presents with episodic, severe chest pain at rest. During an episode, the 12-lead ECG shows transient ST-segment elevation in leads V2-V4 that resolves completely after the pain subsides. What is the most likely diagnosis?

• AVasospastic (Prinzmetal) Angina.
• BAcute Myocardial Infarction.
• CStable Angina Pectoris.
• DAortic Dissection.

An Advanced Paramedic is reviewing a 12-lead ECG and notes biphasic or deeply inverted T waves in leads V2 and V3, with no significant ST-segment elevation or Q waves. The patient is currently pain-free. What is the significance of this ECG pattern?

• ABenign early repolarization, which is a normal variant in young adults.
• BWellens' Syndrome, indicating critical stenosis of the left anterior descending (LAD) cor…
• CAcute posterior myocardial infarction requiring emergent bypass surgery.
• DDigitalis effect, showing therapeutic levels of digoxin.

Which ECG finding is diagnostic of a first-degree atrioventricular (AV) block?

• AA progressively lengthening PR interval until a QRS is dropped.
• BA QRS complex wider than 120 milliseconds.
• CComplete dissociation between P waves and QRS complexes.
• DA constant PR interval greater than 200 milliseconds (0.20 seconds).

A 40-year-old male is complaining of sudden, severe, tearing chest pain radiating to his back. His blood pressure in his right arm is 160/90 mmHg, and in his left arm is 120/70 mmHg. What life-threatening condition should be suspected?

• AAcute Myocardial Infarction.
• BTension Pneumothorax.
• CAcute Pulmonary Embolism.
• DAcute Aortic Dissection.

Under the PHECC Advanced Paramedic CPGs, what is the correct dose and route of Benzylpenicillin for an adult patient with suspected meningococcal septicemia?

• A600 mg IV or IM.
• B1.2 g IV or IO.
• C2 g IV or IO.
• D1.2 g IM only.

You are treating a patient with severe multi-system trauma who is hemodynamically unstable. According to the PHECC guidelines on Tranexamic Acid (TXA) administration, which of the following is a key inclusion criterion?

• ATraumatic brain injury with a Glasgow Coma Scale (GCS) of 15.
• BHemorrhage from a minor laceration controlled with direct pressure.
• CAny traumatic hemorrhage regardless of the time elapsed since the injury.
• DActive or suspected severe hemorrhage where the time since injury is less than 3 hours.

An Advanced Paramedic is preparing to administer Fentanyl to an adult patient with severe pain from a bilateral femur fracture. What is the standard titrated intravenous (IV) dose of Fentanyl under the PHECC CPG formulary?

• A100 mcg rapid IV push, repeated once after 10 minutes.
• B50 mcg by slow IV injection, titrated to effect (with 100 mcg intranasally as the needle-…
• C1 to 2 mcg/kg rapid IV bolus.
• D50 mcg IM, repeated every 15 minutes.

Which of the following conditions represents an absolute contraindication to the pre-hospital administration of Tenecteplase (TNK-tPA) for a patient with a confirmed STEMI?

• AAge greater than 75 years.
• BSystolic blood pressure of 140 mmHg.
• CHistory of ischemic stroke 5 years ago.
• DActive internal bleeding or history of hemorrhagic stroke at any time.

According to the PHECC Formulary, what is the primary contraindication to the administration of Amiodarone?

• AHistory of asthma or reactive airway disease.
• BSevere conduction disorders (such as high-degree AV block) and cardiogenic shock.
• CRenal failure or ongoing hemodialysis.
• DAcute myocardial infarction.

Which of the following best describes the pharmacodynamic action of Glucagon when administered for hypoglycemia?

• AIt stimulates the breakdown of stored glycogen in the liver into glucose (glycogenolysis).
• BIt directly supplies exogenous glucose to the bloodstream.
• CIt stimulates the pancreas to release insulin, lowering blood sugar.
• DIt delays gastric emptying and increases glucose absorption in the gut.

An Advanced Paramedic is caring for a 5-year-old child who is experiencing a severe asthma attack refractory to nebulized Salbutamol. The CPGs authorize the administration of Hydrocortisone. What is the correct paediatric dose of Hydrocortisone?

• A100 mg IV.
• B4 mg/kg IV or IO (slowly).
• C10 mg/kg IM.
• D2 mg/kg IV.

What is the recommended dose and administration rate of Ondansetron for an adult patient experiencing severe nausea and vomiting?

• A8 mg rapid IV bolus.
• B4 mg IM injection.
• C4 mg administered by slow intravenous (IV) injection over at least 30 seconds.
• D8 mg oral disintegrating tablet (ODT) only.

You are treating a patient with acute bronchospasm. You administer nebulized Salbutamol 5 mg. What is the primary cellular mechanism of action of Salbutamol?

• ABlockade of muscarinic acetylcholine receptors, preventing bronchoconstriction.
• BInhibition of phosphodiesterase, increasing intracellular cGMP.
• CStimulation of beta-2 adrenergic receptors, increasing intracellular cAMP and causing smo…
• DStimulation of alpha-1 adrenergic receptors, causing mucosal vasoconstriction.

What is the standard dose and pharmacodynamic role of Ipratropium Bromide when co-administered with Salbutamol for severe asthma under the PHECC guidelines?

• A250 mcg nebulized; it stimulates beta-2 receptors to relax bronchial smooth muscle.
• B500 mcg IV; it acts as a rapid anti-inflammatory steroid.
• C500 mcg nebulized; it blocks muscarinic receptors to produce parasympathetic-mediated bro…
• D1 mg nebulized; it increases mucus production to clear the airway.

An Advanced Paramedic is managing a patient in status epilepticus. According to the PHECC guidelines, if intravenous access is established, what is the first-line medication and dose?

• AMidazolam 10 mg IM.
• BDiazepam 10 mg IV (slowly over 2 minutes).
• CDiazepam 5 mg IV rapid push.
• DPhenytoin 15 mg/kg IV infusion.

A 40-year-old male has ingested a large quantity of a tricyclic antidepressant (TCA). He is unresponsive, hypotensive, and the ECG shows sinus tachycardia with a QRS width of 150 ms. Which of the following medications is indicated to treat the cardiotoxic effects of this overdose?

• AAmiodarone 150 mg IV over 10 minutes.
• BFlumazenil 500 mcg IV.
• CNaloxone 1.6 mg IV.
• DSodium Bicarbonate 8.4% IV.

You are treating a patient who has accidentally injected himself with a high dose of a beta-blocker. He is bradycardic (HR 36 bpm) and hypotensive (BP 70/40 mmHg) and is unresponsive to Atropine. Which of the following is the specific pharmacological antidote used in this situation?

• ANaloxone IV.
• BCalcium Chloride IV.
• CGlucagon IV.
• DSodium Bicarbonate IV.

A patient is unresponsive with slow, shallow respirations (rate 4 breaths/min) and pinpoint pupils following a suspected heroin overdose. What is the primary clinical endpoint when administering Naloxone under the PHECC guidelines?

• ARestoration of a normal Glasgow Coma Scale (GCS) score of 15.
• BDilation of the pupils to a normal reactive size.
• CComplete elimination of the drug from the patient's system.
• DRestoration of adequate respiratory rate and depth, not necessarily full consciousness.

What is the primary mechanism of action of Aspirin when administered to a patient experiencing an acute coronary syndrome (ACS)?

• AIrreversible inhibition of cyclooxygenase-1 (COX-1), preventing the synthesis of thrombox…
• BDirect lysis of existing fibrin clots within the coronary arteries.
• CActivation of antithrombin III, blocking the conversion of fibrinogen to fibrin.
• DBlockade of glycoprotein IIb/IIIa receptors on the platelet membrane.

You are treating a patient with a confirmed STEMI being transported to a primary PCI (PPCI) centre. After Aspirin 300 mg, the PHECC CPG authorises a P2Y12 inhibitor loading dose of Ticagrelor 180 mg orally. What is the primary pharmacodynamic role of Ticagrelor?

• AIt blocks thrombin-mediated conversion of fibrinogen to fibrin.
• BIt inhibits ADP-induced platelet aggregation by blocking the P2Y12 receptor.
• CIt causes direct coronary vasodilation to improve myocardial perfusion.
• DIt inhibits cyclooxygenase to reduce prostaglandin synthesis.

Which of the following medications in the Advanced Paramedic formulary is administered to manage severe bronchodilator-resistant asthma by acting as a physiological antagonist to calcium-mediated smooth muscle contraction?

• AMagnesium Sulfate IV.
• BHydrocortisone IV.
• CSalbutamol nebulized.
• DIpratropium Bromide nebulized.

What is the cellular mechanism of action of Atropine when administered to treat symptomatic bradycardia?

• AIt stimulates beta-1 adrenergic receptors, increasing heart rate and contractility.
• BIt acts as a competitive antagonist at muscarinic acetylcholine receptors, blocking paras…
• CIt stimulates nicotinic receptors at the neuromuscular junction.
• DIt blocks cardiac sodium channels, shortening the action potential.

During the administration of Morphine for severe pain, which of the following represents the most critical side effect that the Advanced Paramedic must monitor for?

• ATachycardia and hypertension.
• BRespiratory depression and hypotension.
• CHyperthermia and muscle rigidity.
• DExtrapyramidal symptoms and dystonia.

Under the PHECC guidelines for managing acute hypoglycemia, what is the correct volume and concentration of Dextrose IV to administer to an adult patient?

• A100 mL of Dextrose 10% IV.
• B50 mL of Dextrose 50% IV.
• C250 mL of Dextrose 5% IV.
• D100 mL of Dextrose 50% IV.

You are treating a patient in refractory ventricular fibrillation. Amiodarone is unavailable due to a supply shortage. According to the CPGs, Lidocaine may be administered. What is the correct initial dose of Lidocaine IV/IO for this indication?

• A100 mg IV/IO bolus for all patients.
• B5 mg/kg slow IV infusion.
• C1 to 1.5 mg/kg IV/IO bolus.
• D0.1 mg/kg IV/IO bolus.

What is the primary indication for the pre-hospital administration of Sodium Thiosulfate under advanced protocols?

• AOrganophosphate poisoning.
• BTricyclic antidepressant overdose.
• CAcute cyanide poisoning.
• DIron ingestion overdose.