FP-C Exam Flashcards

Q: What happens if I fail the FP-C exam - how long before I can retest?

IBSC allows a retest after a 30-calendar-day wait, for up to three attempts under this standard rule (confirmed via IBSC's official Exam FAQ page). IBSC's separate Retesting Policy document describes escalating requirements for attempts beyond three - commonly cited as roughly a 6-month wait plus a supporting letter from a medical director - so confirm the current Retesting Policy directly with IBSC before planning a fourth attempt.

Q: How many questions are on the FP-C exam and how much time do I get?

The FP-C exam has 135 total items: 110 scored plus 25 unscored pretest questions, completed in 2.5 hours (150 minutes) of computer-based testing at Prometric or through IBSC's Live Remote Proctoring (LRP).

Q: What is the FP-C passing score?

IBSC sets a criterion-referenced cut score using the Modified-Angoff method rather than a fixed percentage. The current raw cut score is 73 correct out of 110 scored items (roughly 66%). Results are reported pass/fail, with a diagnostic score breakdown provided to unsuccessful candidates.

Q: Do I need employer sponsorship to sit for the FP-C exam?

No. The FP-C does not require employer or program sponsorship. You do need a current, unrestricted paramedic license, and IBSC recommends - but does not strictly require - 3+ years of critical care or flight transport experience before testing.

Q: Which FP-C content domains carry the most weight on the exam?

Airway, Anesthesia & Analgesics (15%) and Cardiac (14%) are the two heaviest-weighted domains, followed by Medical Emergencies (13%) and Trauma & Burn (12%). Together these four domains make up more than half of the scored exam content.

Q: How long is FP-C certification valid, and how do I recertify?

FP-C certification is valid for 4 years. Recertification can be completed either by retaking the exam or through an approved continuing education pathway, commonly cited as around 100 CE credits, before the certification expires.

Question 1

A flight crew inadvertently enters instrument meteorological conditions (IIMC) at night. What is the correct immediate response?

Accepted Answer

Do not continue VFR. Control the aircraft attitude, initiate a climb away from terrain, communicate the situation to ATC/dispatch, confess the IIMC entry, and comply with instrument procedures. Continued VFR flight into IMC is a leading cause of fatal HEMS crashes from spatial disorientation and controlled flight into terrain.

Question 2

What is the 'sterile cockpit' rule and when does it apply?

Accepted Answer

No non-essential conversation or activity is allowed during critical phases of flight, typically taxi, takeoff, landing, and operations below 10,000 ft. It reduces distraction-related errors during the highest-risk phases of a mission.

Question 3

Under Crew Resource Management (CRM), who has authority to abort a flight for a safety concern?

Accepted Answer

Any single crew member, whether pilot, medic, or nurse, can call an abort under the 'three to go, one to say no' principle. CRM empowers every team member to stop a mission without fear of reprisal.

Question 4

What does CAMTS accreditation verify for an air medical transport program?

Accepted Answer

CAMTS (Commission on Accreditation of Medical Transport Systems) sets voluntary safety and quality standards covering aircraft maintenance, crew training, clinical protocols, and risk management for medical transport programs.

Question 5

Why does hypoxia develop at cabin altitude even though FiO2 remains 21%?

Accepted Answer

Per Dalton's Law, total atmospheric pressure falls with altitude, so the partial pressure of oxygen drops even though the fraction of oxygen in air stays 21%. Lower inspired PO2 reduces the alveolar-to-blood oxygen gradient, causing hypoxic hypoxia.

Question 6

A patient with a pneumothorax is being flown at altitude. Which gas law explains the expansion risk, and what's the practical implication?

Accepted Answer

Boyle's Law: pressure and volume are inversely related at constant temperature. As cabin altitude increases and ambient pressure falls, trapped gas expands. An untreated or small pneumothorax can enlarge in flight, so consider decompression before ascent when indicated.

Question 7

What is Time of Useful Consciousness (TUC), and how does it change with altitude?

Accepted Answer

TUC is the time from onset of hypoxia, such as sudden depressurization, until a person can no longer function or protect themselves. TUC shortens dramatically as altitude increases, from roughly 20-30 minutes at 18,000 ft to under a minute above 35,000 ft.

Question 8

What are the two induction agents most favored for RSI in hemodynamically unstable transport patients, and why?

Accepted Answer

Etomidate (0.3 mg/kg IV) and ketamine (1-2 mg/kg IV) are preferred because both are hemodynamically neutral-to-supportive. Etomidate has minimal effect on blood pressure, and ketamine preserves sympathetic tone and airway reflexes, unlike propofol which causes hypotension.

Question 9

Compare the onset and duration of succinylcholine vs. rocuronium for RSI paralysis.

Accepted Answer

Succinylcholine (1-1.5 mg/kg IV): onset 45-60 seconds, duration 5-10 minutes, depolarizing. Rocuronium (1-1.2 mg/kg IV RSI dose): similarly fast onset around 60 seconds but lasts 45-70 minutes, non-depolarizing, a much longer commitment if the airway proves difficult.

Question 10

A patient can't be intubated but CAN be ventilated with a bag-mask. What's the next step in the failed airway algorithm?

Accepted Answer

Insert a supraglottic airway or continue bag-mask ventilation and reattempt intubation with an optimized approach such as a bougie, video laryngoscopy, or repositioning. Surgical airway is reserved for 'can't intubate, can't oxygenate.'

Question 11

What does the DOPE mnemonic assess in a suddenly deteriorating intubated patient?

Accepted Answer

Displacement (tube dislodged or mainstemmed), Obstruction (mucus, kinking, biting), Pneumothorax (often tension), Equipment failure (vent, oxygen source, circuit). Work through DOPE systematically before assuming a clinical decline.

Question 12

How does waveform capnography confirm and continuously monitor ET tube placement?

Accepted Answer

A sustained square waveform with each breath confirms tracheal placement, versus the esophagus, which shows no waveform or one that rapidly decays. Unlike colorimetric detectors, waveform capnography monitors placement continuously throughout transport and reflects ventilation adequacy.

Question 13

What lung-protective tidal volume and plateau pressure targets apply when placing a critically ill patient on the transport ventilator?

Accepted Answer

6 mL/kg of predicted (ideal) body weight, keeping plateau pressure under 30 cmH2O. This ARDSnet lung-protective strategy reduces ventilator-induced lung injury, and PEEP is titrated, commonly starting around 5 cmH2O, to maintain oxygenation.

Question 14

Why is propofol used cautiously for sedation in the hypotensive transport patient?

Accepted Answer

Propofol causes dose-dependent vasodilation and myocardial depression, worsening hypotension. It works well for sedation in hemodynamically stable patients but is often avoided or dose-reduced in shock states in favor of ketamine or fentanyl-based sedation.

Question 15

What confirms a 'failed airway' requiring surgical cricothyrotomy?

Accepted Answer

Can't intubate AND can't oxygenate, whether by bag-mask or supraglottic airway. This combination mandates an immediate surgical airway rather than further intubation attempts.

Question 16

Distinguish DKA from HHS by ketones and typical patient population.

Accepted Answer

DKA: ketosis with an anion-gap metabolic acidosis, more common in Type 1 diabetes, glucose often above 250 mg/dL but can be lower. HHS: minimal or no ketosis, extreme hyperglycemia often above 600 mg/dL with hyperosmolarity and profound dehydration, more common in Type 2 diabetes and older adults.

Question 17

How is the anion gap calculated, and what does an elevated gap suggest?

Accepted Answer

Anion gap = Na+ minus (Cl- plus HCO3-); normal is roughly 8-12 mEq/L. An elevated gap suggests an unmeasured acid is present, such as in DKA, lactic acidosis, toxic alcohol ingestion, or uremia.

Question 18

Per Sepsis-3, what defines septic shock as distinct from sepsis alone?

Accepted Answer

Septic shock is sepsis plus a vasopressor requirement to maintain MAP at or above 65 mmHg AND a serum lactate above 2 mmol/L despite adequate fluid resuscitation. Sepsis alone is infection with organ dysfunction, reflected by a SOFA score increase of 2 or more.

Question 19

What is the first-line vasopressor for septic shock, and what's a typical starting dose?

Accepted Answer

Norepinephrine, typically started around 0.01-0.05 mcg/kg/min and titrated to a MAP goal of at least 65 mmHg. It's preferred over dopamine due to a better safety and arrhythmia profile in most patients.

Question 20

A patient in adrenal crisis needs what immediate treatment beyond fluids?

Accepted Answer

Stress-dose IV hydrocortisone or an equivalent steroid. Adrenal crisis is a relative or absolute cortisol deficiency, and fluids alone won't correct the underlying hormonal deficit driving refractory hypotension.

Question 21

How should naloxone dosing differ between a spontaneously breathing opioid-toxic patient and one in respiratory arrest?

Accepted Answer

In respiratory arrest, give a full reversal dose, such as 2 mg IV/IN. In a spontaneously breathing but obtunded patient, titrate small doses, such as 0.04-0.4 mg, to restore adequate respirations while avoiding acute withdrawal and combativeness.

Question 22

What does an elevated A-a gradient tell you about the cause of a patient's hypoxemia?

Accepted Answer

An elevated A-a gradient (alveolar minus arterial PO2, normal roughly 5-15 mmHg) points to V/Q mismatch, shunt, or a diffusion defect. A normal A-a gradient with hypoxemia instead points to hypoventilation or low inspired oxygen, such as at altitude, as the cause.

Question 23

At what ICP threshold do current Brain Trauma Foundation guidelines recommend treatment, and how is CPP calculated?

Accepted Answer

Treat ICP sustained above 22 mmHg, per BTF 4th edition guidance, updated from the older 20 mmHg threshold. Cerebral Perfusion Pressure (CPP) = MAP minus ICP; the general target is roughly 60-70 mmHg to maintain adequate cerebral blood flow.

Question 24

What is Cushing's Triad and what does it signify?

Accepted Answer

Hypertension with a widened pulse pressure, bradycardia, and irregular respirations, appearing in that order as ICP rises toward herniation. It's a late, ominous sign requiring immediate aggressive ICP management.

Question 25

What are the two mainstay hyperosmolar therapies for acutely rising ICP, and how do they work?

Accepted Answer

Mannitol, an osmotic diuretic that draws fluid out of brain tissue into circulation, and hypertonic saline, which raises serum osmolality and pulls water out of brain cells. Both reduce cerebral edema and buy time en route to neurosurgical intervention.

Question 26

A stroke patient presents with a suspected large vessel occlusion (LVO). Why does destination selection matter for transport?

Accepted Answer

LVO strokes are candidates for mechanical thrombectomy, only available at comprehensive stroke centers. Bypassing a closer primary stroke center for a thrombectomy-capable center can be appropriate if it doesn't unacceptably delay tPA-eligible care, per regional stroke triage protocols.

Question 27

How should a flight team recognize impending brain herniation before Cushing's Triad appears?

Accepted Answer

Watch for a drop in GCS of 2 or more points, a new or worsening unilateral fixed and dilated pupil, or posturing such as decorticate or decerebrate positioning. These precede the late Cushing's Triad and should trigger immediate hyperosmolar therapy and airway reassessment.

Question 28

How does the IABP support cardiac output, and what limits its use compared to Impella?

Accepted Answer

The intra-aortic balloon pump inflates during diastole and deflates just before systole, augmenting coronary perfusion and reducing afterload, but it only augments the heart's own output and needs a reasonably organized rhythm to time to. Impella actively pumps blood via a continuous-flow axial pump and works independent of rhythm.

Question 29

What ECG finding characterizes Wellens syndrome, and why is it dangerous despite the patient often being pain-free?

Accepted Answer

Biphasic or deeply inverted T waves in leads V2-V3, indicating a critical proximal LAD stenosis. Patients are frequently pain-free at the time of the ECG, but Wellens syndrome predicts an impending large anterior MI if untreated, and stress testing is contraindicated.

Question 30

What is the treatment of choice for torsades de pointes?

Accepted Answer

IV magnesium sulfate, roughly 1-2 g, regardless of serum magnesium level, plus correction of the underlying QT-prolonging cause such as electrolytes or offending drugs. Overdrive pacing is used for refractory or recurrent cases.

Question 31

What are the three components of the RUSH exam for undifferentiated shock?

Accepted Answer

Pump (cardiac contractility, effusion or tamponade, wall motion), Tank (volume status via IVC size and collapsibility, lung B-lines, free fluid), and Pipes (aorta for aneurysm or dissection, veins for DVT). It's a rapid bedside ultrasound protocol to classify shock type.

Question 32

How do you distinguish cardiogenic from septic shock at the bedside?

Accepted Answer

Cardiogenic shock presents with cold, clammy skin, low cardiac output, and often elevated filling pressures or pulmonary edema. Septic shock presents with warm, vasodilated skin early on, an infection source, and low SVR with normal-to-high cardiac output. Treatment differs: inotropes or mechanical support versus fluids plus norepinephrine.

Question 33

What amiodarone doses are used during a shock-refractory VF or pulseless VT arrest?

Accepted Answer

300 mg IV/IO push for the first dose, followed by 150 mg for a second dose if VF or pulseless VT persists after subsequent defibrillation attempts, given per ACLS between defibrillation and epinephrine cycles.

Question 34

What MAP goal is typically targeted in shock resuscitation, and how might it change with a concurrent TBI?

Accepted Answer

General shock resuscitation targets a MAP of at least 65 mmHg. With a concurrent TBI, the goal often shifts higher and is individualized to maintain a CPP of 60-70 mmHg, since cerebral perfusion pressure, not just systemic MAP, determines brain perfusion adequacy.

Question 35

What three components make up the 'lethal triad' in trauma, and why does it matter?

Accepted Answer

Coagulopathy, acidosis, and hypothermia, each worsening the others in a vicious cycle that impairs clot formation and increases mortality. Prevention through active warming, minimizing crystalloid, and early blood products is a core damage-control resuscitation principle.

Question 36

What is 'permissive hypotension' in trauma resuscitation, and when is it avoided?

Accepted Answer

Targeting a lower-than-normal SBP of roughly 80-90 mmHg in penetrating or uncontrolled hemorrhage until the bleeding source is controlled, to avoid dislodging early clots with aggressive fluid resuscitation. It is avoided in traumatic brain injury, where adequate cerebral perfusion pressure requires a higher MAP.

Question 37

Using the Parkland formula, calculate 24-hour fluid resuscitation for a 70 kg patient with 30% TBSA burns, and describe the administration schedule.

Accepted Answer

4 mL times 70 kg times 30 equals 8,400 mL of lactated Ringer's over 24 hours, with half given in the first 8 hours from the time of injury, not time of arrival, and the remaining half over the next 16 hours.

Question 38

What ratio of blood products defines a massive transfusion protocol (MTP), and why?

Accepted Answer

1:1:1, packed red blood cells to fresh frozen plasma to platelets. This ratio approximates whole blood composition and helps correct trauma-induced coagulopathy alongside oxygen-carrying capacity, rather than giving PRBCs alone.

Question 39

What are the earliest, most sensitive signs of compartment syndrome, and how do they differ from the classic '5 Ps'?

Accepted Answer

Pain out of proportion to the injury and pain with passive stretch of the affected muscles are the earliest, most sensitive findings. Pallor, paresthesia, pulselessness, and paralysis are late signs, and waiting for them risks irreversible muscle and nerve damage.

Question 40

A trauma patient develops JVD, absent unilateral breath sounds, and hypotension. What's the diagnosis and immediate treatment?

Accepted Answer

Tension pneumothorax. Treat immediately with needle decompression at the 2nd intercostal space midclavicular line, or the 4th/5th intercostal space anterior axillary line, or finger thoracostomy. Do not wait for chest X-ray confirmation.

Question 41

How do preeclampsia and eclampsia differ, and what's the first-line seizure prophylaxis and treatment drug?

Accepted Answer

Preeclampsia is hypertension plus proteinuria or other end-organ dysfunction after 20 weeks gestation, without seizures. Eclampsia adds new-onset grand mal seizures. Magnesium sulfate, with a 4-6 g IV loading dose, is first-line for both seizure prophylaxis and treatment.

Question 42

A laboring patient has a cord prolapse. What's the immediate management?

Accepted Answer

Manually elevate the presenting fetal part off the cord and do not remove your hand until delivery. Position the mother knee-chest or in steep Trendelenburg or left lateral position, give high-flow oxygen, and transport emergently for cesarean delivery. Never attempt to replace the cord.

Question 43

What triggers escalation from PPV to chest compressions in the NRP algorithm, and what's the compression-to-ventilation ratio?

Accepted Answer

If heart rate remains below 60 bpm after 30 seconds of effective positive-pressure ventilation, begin chest compressions at a 3:1 compression-to-ventilation ratio. Epinephrine is added if the heart rate stays under 60 despite adequate compressions and ventilation.

Question 44

How does the Broselow tape estimate a child's weight and guide care?

Accepted Answer

It uses the child's length, measured head-to-heel, as a proxy for weight, then color-codes zones that correspond to pre-calculated drug doses, equipment sizes, and defibrillation energy settings, critical when a scale isn't available in the field.

Question 45

What bruising pattern in an infant should raise suspicion for non-accidental trauma (NAT)?

Accepted Answer

The TEN-4 rule: bruising on the Torso, Ears, or Neck in a child under 4 years old, or any bruising in an infant under 4 months who isn't yet mobile, is highly suspicious for abuse and warrants further investigation.

Question 46

Why is fluid resuscitation more cautious in pediatric DKA than in adult DKA?

Accepted Answer

Children with DKA face an elevated risk for cerebral edema, especially with rapid fluid shifts or overly aggressive correction. Use isotonic fluids and correct glucose and osmolality gradually over roughly 48 hours rather than the faster correction sometimes used in adults.

Question 47

Distinguish croup from bronchiolitis/RSV in a pediatric respiratory patient.

Accepted Answer

Croup presents with a barky, seal-like cough and inspiratory stridor, caused by parainfluenza, and is treated with racemic epinephrine nebulizer and dexamethasone. Bronchiolitis/RSV presents with wheezing and crackles in infants under 2, managed primarily with supportive care such as suction, oxygen, and hydration.

Question 48

How does a JUST Culture distinguish a human error from a reckless act, and why does that distinction matter?

Accepted Answer

JUST Culture separates simple human error, which is consoled and used to fix the system, at-risk behavior, which is coached, and reckless behavior, which draws disciplinary action. It balances individual accountability with a blame-free environment that encourages honest error reporting.

Question 49

What is GAMUT, and why do transport programs report data to it?

Accepted Answer

GAMUT is a national quality-benchmarking database for critical care ground and air medical transport programs. Programs submit clinical and safety metrics to compare performance against peer programs and drive quality improvement.

Question 50

What is CISM, and when is it used in flight and critical care transport?

Accepted Answer

Critical Incident Stress Management is a structured peer-support and debriefing process offered after high-stress or traumatic calls, such as pediatric deaths or difficult resuscitations, to support crew mental health and reduce burnout and PTSD risk.

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