PHECC Paramedic Written Exam (Ireland)

Which of the following is the primary indication for the insertion of a supraglottic airway device (such as the i-gel) by a Paramedic under PHECC guidelines?

• AConscious patients requiring supplementary oxygen therapy
• BUnconscious patients in cardiac arrest who lack protective airway reflexes
• CPatients with severe asthma who are wheezing but talking in sentences
• DConscious patients presenting with acute foreign body airway obstruction

Under PHECC guidelines, which of the following is considered the gold standard for confirming and continuously monitoring the placement of an advanced airway device?

• AAuscultation of bilateral breath sounds and epigastrium
• BObservation of chest rise and fall during ventilation
• CContinuous waveform capnography
• DPresence of condensation in the tube

In a 'cannot intubate, cannot ventilate' situation where a patient's airway is completely obstructed and basic techniques have failed, which of the following is the recognised emergency rescue airway procedure used in the pre-hospital setting?

• ASurgical tracheostomy
• BNeedle cricothyroidotomy
• CRetrograde intubation
• DDigital intubation

When performing bag-mask ventilation on an adult patient with a bag-valve-mask (BVM) and an oxygen reservoir, what flow rate of oxygen should be delivered to the bag?

• A2 to 4 L/min
• B6 to 8 L/min
• C10 to 12 L/min
• D15 L/min or higher

Which anatomical landmarks should a Paramedic use to correctly measure the size of a nasopharyngeal airway (NPA) before insertion?

• AFrom the tip of the nose to the angle of the jaw
• BFrom the tip of the nose to the earlobe
• CFrom the corner of the mouth to the earlobe
• DFrom the center of the incisors to the angle of the jaw

During CPR, what is the clinical consequence of ventilating a patient too rapidly or with excessive volume (hyperventilation)?

• AIncreased coronary perfusion pressure due to thoracic expansion
• BDecreased intrathoracic pressure leading to increased venous return
• CIncreased intrathoracic pressure leading to decreased venous return and cardiac output
• DImproved gas exchange and higher arterial carbon dioxide levels

During the transport of an intubated cardiac arrest patient, the EtCO2 waveform on the monitor suddenly drops from 35 mmHg to near zero. What should be the Paramedic's first suspicion and action?

• AThe patient has achieved ROSC; immediately stop compressions to check a pulse.
• BThe endotracheal tube has become displaced or extubated; immediately assess tube placemen…
• CThe monitor is malfunctioning; continue ventilating and ignore the capnography.
• DThe patient's body temperature has dropped; increase room heating.

What is the maximum recommended duration for a single suctioning attempt of an adult patient's airway to minimize the risk of hypoxia?

• A5 seconds
• B15 seconds
• C30 seconds
• D45 seconds

Which of the following is an absolute contraindication to the insertion of an oropharyngeal airway (OPA)?

• AAn unconscious patient without a gag reflex
• BA semi-conscious patient with an active gag reflex
• CA patient presenting with a suspected basilar skull fracture
• DA patient in cardiorespiratory arrest

In a ventilated adult patient with a severe traumatic brain injury, what is the target End-Tidal CO2 (EtCO2) range under PHECC guidelines to avoid secondary brain injury?

• A20 to 25 mmHg (2.6 to 3.3 kPa)
• B35 to 40 mmHg (4.6 to 5.3 kPa)
• C45 to 50 mmHg (5.9 to 6.6 kPa)
• D55 to 60 mmHg (7.2 to 7.9 kPa)

What is the primary physiological purpose of pre-oxygenating a patient with 100% oxygen prior to attempting advanced airway insertion?

• ATo wash out nitrogen from the lungs and build a reservoir of oxygen in the functional res…
• BTo increase the patient's heart rate and cardiac output to handle insertion stress
• CTo dilate the trachea and vocal cords to facilitate easy tube passage
• DTo suppress the patient's respiratory drive and reduce resistance

When assessing the larynx during direct laryngoscopy, which grading system is commonly used to describe the view of the vocal cords and glottic opening?

• AMallampati Classification
• BCormack-Lehane Scale
• CGCS Airway Score
• DAPGAR Airway Grade

Under PHECC Clinical Practice Guidelines, what is the standard dose and administration method of Aspirin for a patient with suspected Acute Coronary Syndrome (ACS)?

• A75 mg chewed
• B150 mg swallowed with water
• C300 mg chewed
• D600 mg swallowed with water

A patient with suspected hypoglycemia is unconscious, and the Paramedic is unable to establish intravenous access. What is the preferred drug, dose, and route of administration under PHECC guidelines?

• AGlucagon 1 mg intramuscular (IM)
• BGlucose 10% 100 mL intravenous (IV) infusion
• CGlucagon 10 mg intramuscular (IM)
• DOral glucose gel 25 g rubbed on the buccal mucosa

What is the standard dose, concentration, and route of Adrenaline for an adult patient experiencing severe anaphylaxis under PHECC CPGs?

• A0.5 mg of 1:1,000 (1 mg/mL) intramuscular (IM)
• B0.5 mg of 1:10,000 (0.1 mg/mL) intravenous (IV)
• C1 mg of 1:1,000 (1 mg/mL) subcutaneous (SC)
• D1 mg of 1:10,000 (0.1 mg/mL) intramuscular (IM)

Under PHECC guidelines, what is the primary clinical indication for the administration of Naloxone?

• AAcute respiratory depression associated with known or suspected opioid overdose
• BSevere bronchospasm unresponsive to salbutamol nebulizers
• CUnconsciousness of unknown etiology with normal pupil size and respiration
• DCardiac arrest of suspected cardiac etiology

Which of the following represents an absolute contraindication to the administration of Glyceryl Trinitrate (GTN) by a Paramedic?

• ASystolic blood pressure greater than 150 mmHg
• BA history of mild asthma
• CUse of sildenafil (Viagra) or other phosphodiesterase inhibitors within the last 24 hours
• DHeart rate between 60 and 80 beats per minute

According to the PHECC Clinical Practice Guidelines, what is the target oxygen saturation range for a patient with an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD)?

• A94% to 98%
• B88% to 92%
• C98% to 100%
• D80% to 85%

During cardiac arrest resuscitation of an adult patient in shock-refractory Ventricular Fibrillation (VF), what is the first dose of Amiodarone administered, and after which shock should it be given?

• A150 mg IV/IO, administered after the 1st shock
• B300 mg IV/IO, administered after the 3rd shock
• C150 mg IV/IO, administered after the 3rd shock
• D300 mg IV/IO, administered after the 5th shock

What is the primary pharmacological mechanism of action of Tranexamic Acid (TXA) when administered to a trauma patient with severe hemorrhage?

• AIt acts as a direct vasoconstrictor to narrow damaged blood vessels.
• BIt is an antifibrinolytic that inhibits the conversion of plasminogen to plasmin, prevent…
• CIt promotes platelet aggregation by stimulating Von Willebrand factor.
• DIt neutralizes heparin in the circulation to accelerate coagulation.

Which of the following is a potential side effect or hazard of Entonox (50% nitrous oxide and 50% oxygen) administration that a Paramedic must consider?

• ASevere bronchospasm in patients with asthma
• BExpansion of air-filled cavities in the body (e.g., pneumothorax)
• CSystemic hypertension and tachycardia
• DIrreversible respiratory depression in healthy adults

For a patient experiencing prolonged active seizures (status epilepticus) in the pre-hospital setting, what is the preferred non-intravenous route and drug administered by a Paramedic under PHECC guidelines?

• ADiazepam rectally
• BMidazolam buccally or intranasally
• CLorazepam intramuscularly
• DPhenytoin orally

What is the maximum single dose and maximum cumulative 24-hour dose of Paracetamol for an adult patient weighing over 50 kg under PHECC guidelines?

• A500 mg single / 2 g daily
• B1 g single / 4 g daily
• C1 g single / 8 g daily
• D2 g single / 6 g daily

Under what clinical circumstances is the administration of Atropine indicated for a patient presenting with bradycardia under PHECC guidelines?

• AAny heart rate below 60 beats per minute, regardless of symptoms
• BBradycardia accompanied by signs of hemodynamic instability (e.g., hypotension, altered m…
• CAsymptomatic bradycardia in a well-conditioned athlete
• DBradycardia associated with a high-grade second-degree or third-degree AV block in a stab…

Under PHECC Clinical Practice Guidelines, what is the primary indication and route of administration for Benzylpenicillin?

• ASevere respiratory distress from suspected bacterial pneumonia; administered via nebulizer
• BSuspected meningococcal disease presenting with a non-blanching purpuric rash; administer…
• COpen extremity fractures to prevent osteomyelitis; administered orally
• DAnaphylactic shock unresponsive to Adrenaline; administered IV

What is the correct compression-to-ventilation ratio for a single-rescuer or two-rescuer CPR on an adult patient in cardiac arrest under PHECC guidelines?

• A15:2
• B30:2
• C30:1
• D15:1

Which of the following cardiac arrest rhythms is classified as 'shockable' by an automated external defibrillator (AED) or manual defibrillator?

• AAsystole
• BPulseless Electrical Activity (PEA)
• CPulseless Ventricular Tachycardia (VT)
• DNormal Sinus Rhythm

What is the correct hand placement for performing chest compressions on an adult patient in cardiac arrest?

• AOn the upper half of the sternum
• BOn the lower half of the sternum
• CDirectly over the xiphoid process
• DOn the left side of the chest over the apex of the heart

According to PHECC and international resuscitation standards, what is the recommended depth and rate of chest compressions for an adult patient?

• ADepth of 3 to 4 cm; rate of 80 to 100 compressions per minute
• BDepth of 5 to 6 cm; rate of 100 to 120 compressions per minute
• CDepth of 7 to 8 cm; rate of 120 to 140 compressions per minute
• DDepth of 5 to 6 cm; rate of 80 to 100 compressions per minute

A cardiac arrest patient's ECG shows a slow, wide-complex electrical rhythm, but no carotid pulse is palpable. What is the correct immediate management sequence under PHECC guidelines?

• AAdminister a manual shock at maximum energy, then resume compressions.
• BResume chest compressions immediately, establish vascular access, and administer Adrenali…
• CPerform a 12-lead ECG to identify the specific block before starting compressions.
• DInitiate transcutaneous pacing immediately to capture the rhythm.

Which of the following ECG findings is diagnostic of an acute ST-segment elevation myocardial infarction (STEMI) requiring activation of the primary PCI pathway?

• AST-segment depression of >1 mm in two contiguous leads
• BST-segment elevation of >1 mm in two or more contiguous leads (with specific chest lead c…
• CPR-segment prolongation greater than 0.20 seconds
• DPresence of prominent U waves in precordial leads

Which of the following lists the reversible causes of cardiac arrest that a Paramedic must systematically consider and treat during resuscitation (the '4 H's and 4 T's')?

• AHyperthermia, Headache, Hypoxia, Hypoglycemia / Trauma, Tension, Tachycardia, Toxicity
• BHypoxia, Hypovolemia, Hyperkalemia/Hypokalemia, Hypothermia / Tension pneumothorax, Tampo…
• CHypotension, Hyperventilation, Hypoxia, Herniation / Thrombosis, Tetanus, Trauma, Toxins
• DHypovolemia, Hyponatremia, Hypoxia, Heartburn / Tamponade, Tracheitis, Thrombosis, Toxici…

A patient with a narrow-complex tachycardia at a rate of 180 bpm is conscious but complains of chest discomfort and has a blood pressure of 85/50 mmHg. What is the classification of this patient, and what is the definitive pre-hospital intervention?

• AStable tachycardia; treat with vagal maneuvers and Adenosine.
• BUnstable tachycardia; prepare for immediate synchronized cardioversion (Advanced Paramedi…
• CStable tachycardia; administer a 500 mL fluid bolus and monitor.
• DUnstable tachycardia; administer Amiodarone 300 mg over 1 hour.

What is the term used to describe the proportion of time during cardiac arrest resuscitation in which active chest compressions are being performed, and what is the target percentage?

• ACompression fraction; target of at least 60% (ideally >80%)
• BPerfusion ratio; target of at least 50%
• CResuscitation yield; target of at least 75%
• DRecoil index; target of 100%

Where should a Paramedic place the defibrillator pads on an adult patient to perform manual defibrillation in the standard antero-lateral configuration?

• AOne pad on the upper left chest, and the other pad on the upper right chest
• BOne pad on the upper right chest (sternum/infraclavicular), and the other pad on the lowe…
• COne pad on the sternum, and the other pad directly on the spine between the scapulae
• DBoth pads on the left chest, spaced 2 cm apart

Immediately following Return of Spontaneous Circulation (ROSC) in an adult patient, what should be the Paramedic's target oxygen saturation range, and what is the primary post-resuscitation intervention?

• A100% saturation; immediately transport at high speed.
• B94% to 98% saturation; perform a 12-lead ECG, assess airway patency, and manage blood pre…
• C88% to 92% saturation; administer a 2 L fluid bolus.
• D90% to 95% saturation; hyperventilate the patient to clear built-up lactic acid.

A 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF. Which wall of the left ventricle is affected, and which coronary artery is most likely occluded?

• AAnterior wall; Left Anterior Descending (LAD) artery
• BInferior wall; Right Coronary Artery (RCA)
• CLateral wall; Circumflex (LCx) artery
• DSeptal wall; Left Main Coronary Artery

Which safety action is paramount for a Paramedic prior to delivering a shock with a manual defibrillator to a patient in cardiac arrest?

• ATurn off the cardiac monitor to prevent damage.
• BEnsure the patient is in a wet environment to maximize shock conductivity.
• CLoudly command 'Stand clear' and visually verify that no one is touching the patient or t…
• DPerform three quick ventilations to inflate the lungs.

In the assessment of a patient presenting with acute chest pain, what does the 'P' stand for in the OPQRST assessment framework?

• APalpitations
• BProvocation / Palliation
• CPressure
• DPulses

Which of the following clinical features is most characteristic of cardiac-related chest pain (angina/ischemia) rather than musculoskeletal chest pain?

• ASharp pain that increases significantly when taking a deep breath
• BWell-localized pain that can be reproduced by pressing on the chest wall
• CDull, crushing, or squeezing substernal pressure that may radiate to the left arm or jaw
• DPain that is completely relieved by changing body position

Under PHECC guidelines, what is the correct compression-to-ventilation ratio for two-rescuer CPR on a child (from 1 year of age to puberty) in cardiac arrest?

• A30:2
• B15:2
• C15:1
• D3:1

On an ECG monitor, how is Ventricular Tachycardia (VT) distinguished from Supraventricular Tachycardia (SVT)?

• AVT presents with a narrow QRS complex (<0.12 seconds), while SVT presents with a wide QRS…
• BVT presents with a wide QRS complex (>=0.12 seconds) and absence of P waves, while SVT ty…
• CVT has a highly irregular rhythm, while SVT is always regular.
• DVT displays prominent P waves preceding every QRS complex, while SVT has no P waves.

When assessing a pulse in an unresponsive infant (under 1 year of age), where should a Paramedic check for a pulse, and for how long?

• ACarotid artery; for at least 15 seconds
• BBrachial (or femoral) artery; for no more than 10 seconds
• CRadial artery; for exactly 10 seconds
• DApical pulse over the chest; for 30 to 60 seconds

Which clinical criteria must be met to justify the application and use of an Automated External Defibrillator (AED) on a patient?

• AThe patient is breathing rapidly and complaining of severe chest pain.
• BThe patient is unresponsive, has absent or abnormal breathing (agonal gasps), and has no…
• CThe patient has collapsed but is answering questions coherently.
• DThe patient is having a tonic-clonic seizure but has a strong radial pulse.

What is the primary underlying pathophysiology of cardiogenic shock following a massive myocardial infarction?

• ASevere vasodilation leading to relative hypovolemia
• BLoss of myocardial contractility leading to decreased cardiac output and tissue hypoperfu…
• CMechanical obstruction of blood flow through the vena cava
• DSevere systemic infection causing endothelial damage