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According to Boyle's Law, what happens to a gas pocket in the pleural space during ascent to 8,000 feet?

The gas pocket will decrease in volume by 25%

The gas pocket will remain unchanged regardless of altitude

The gas pocket will expand due to decreased atmospheric pressure

The gas will be absorbed by surrounding tissues at altitude

to track

2026 Statistics

Key Facts: FP-C Exam

135

Total Questions

IBSC

110

Scored Items

IBSC

2.5h

Exam Time

IBSC

$310

Exam Fee

IBSC 2026

4 years

Certification Valid

IBSC recertification cycle

The FP-C exam contains 135 questions (110 scored) administered over 2.5 hours. Content covers critical care transport medicine with emphasis on altitude physiology, advanced airway management, cardiac emergencies, and trauma resuscitation. The exam is designed for experienced paramedics working in air medical transport. IBSC recommends 3+ years of critical care transport experience before testing.

Sample FP-C Practice Questions

Try these sample questions to test your FP-C exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1According to Boyle's Law, what happens to a gas pocket in the pleural space during ascent to 8,000 feet?

A.The gas pocket will decrease in volume by 25%

B.The gas pocket will remain unchanged regardless of altitude

C.The gas pocket will expand due to decreased atmospheric pressure

D.The gas will be absorbed by surrounding tissues at altitude

Explanation: Boyle's Law states that at constant temperature, gas volume is inversely proportional to pressure. As altitude increases from sea level (760 mmHg) to 8,000 feet (564 mmHg), atmospheric pressure decreases significantly. The trapped gas in a pneumothorax expands proportionally, potentially converting a simple pneumothorax into a tension pneumothorax. This is a critical concern for flight paramedics when transporting patients with pneumothoraces.

2A patient with a traumatic brain injury has a small pneumocephalus identified on CT scan. What is the primary concern regarding air transport?

A.The patient will experience increased oxygen toxicity at altitude

B.Intracranial air will expand, potentially causing increased ICP

C.Lower oxygen levels will worsen the brain injury

D.Vibration from the aircraft will worsen the injury

Explanation: Pneumocephalus (air within the cranial vault) is subject to Boyle's Law. At altitude, the decreased atmospheric pressure causes intracranial air to expand, which can increase intracranial pressure (ICP) and lead to brain herniation. These patients may require ground transport or must fly at the lowest safe altitude with close ICP monitoring. This is particularly critical in patients with traumatic brain injury where ICP is already a concern.

3Which gas law explains why a patient at 10,000 feet experiences hypoxia despite breathing 21% oxygen?

A.Boyle's Law

B.Charles's Law

C.Dalton's Law

D.Henry's Law

Explanation: Dalton's Law states that the total pressure of a gas mixture equals the sum of the partial pressures of each individual gas. At sea level, the partial pressure of oxygen is approximately 159 mmHg (760 × 0.21). At 10,000 feet, total atmospheric pressure drops to 523 mmHg, making the partial pressure of oxygen only about 110 mmHg. While the percentage of oxygen remains 21%, the reduced partial pressure decreases oxygen diffusion across the alveolar-capillary membrane, causing hypobaric hypoxia.

4What is the maximum cabin altitude allowed for pressurized air ambulance aircraft transporting critically ill patients according to CAMTS standards?

A.5,000 feet

B.8,000 feet

C.10,000 feet

D.12,000 feet

Explanation: The Commission on Accreditation of Medical Transport Systems (CAMTS) standards recommend that cabin altitude for pressurized air ambulance aircraft should not exceed 8,000 feet during patient transport. This limitation helps minimize the physiological effects of altitude on patients, including hypobaric hypoxia and gas expansion. Some programs may choose to fly at even lower cabin altitudes for patients with conditions sensitive to pressure changes, such as those with pneumothoraces or intracranial air.

5During a weather-related divert, the pilot and medical crew disagree on whether to continue to the destination or land at the alternate. Which Crew Resource Management (CRM) principle should be applied?

A.The pilot has ultimate authority and the medical crew should comply

B.A collaborative discussion weighing all factors, with the pilot having final authority on airworthiness

C.The most senior crew member makes the decision

D.The decision should be made by the sending facility physician

Explanation: Crew Resource Management (CRM) emphasizes collaborative decision-making while maintaining clear lines of authority. In this scenario, the pilot has final authority regarding aircraft safety and airworthiness, but CRM principles require that all crew members contribute relevant information. The medical crew can provide input on patient stability and urgency, while the pilot provides expertise on weather, fuel, and aircraft capabilities. This collaborative approach leads to safer, more informed decisions.

6A 45-year-old patient in respiratory failure requires rapid sequence intubation (RSI) in a helicopter at 5,000 feet. Which medication combination is most appropriate?

A.Midazolam 10mg IV and succinylcholine 1.5mg/kg IV

B.Etomidate 0.3mg/kg IV and succinylcholine 1.5mg/kg IV

C.Propofol 2.5mg/kg IV only

D.Ketamine 2mg/kg IV without paralytic

Explanation: RSI in the flight environment requires careful consideration of hemodynamic effects and the physiologic changes of altitude. Etomidate (0.3mg/kg) provides reliable sedation with minimal cardiovascular depression, making it ideal for critically ill patients. Succinylcholine (1.5mg/kg) provides rapid paralysis for intubation. The reduced atmospheric pressure at 5,000 feet increases the risk of desaturation, making rapid airway control essential. Alternative agents like ketamine (1-2mg/kg) may also be appropriate depending on patient condition.

7When using a transport ventilator at altitude, which parameter must be adjusted to maintain the same tidal volume delivery?

A.Increase the respiratory rate

B.Decrease the FiO2

C.Increase the inspiratory time

D.No adjustment is needed as ventilators are altitude-compensated

Explanation: Modern transport ventilators are designed to be altitude-compensated, meaning they automatically adjust gas delivery to maintain the set tidal volume regardless of ambient pressure changes. These ventilators use flow sensors and feedback mechanisms to ensure consistent volume delivery. However, clinicians should still monitor exhaled tidal volumes and peak pressures, as extreme altitude changes or equipment malfunction could affect ventilation. Older or pneumatic ventilators may require manual adjustment at altitude.

8A patient with a difficult airway requires a surgical cricothyrotomy during flight. What is the correct anatomical location for the incision?

A.Through the thyroid cartilage

B.Between the thyroid and cricoid cartilages (cricothyroid membrane)

C.Through the cricoid cartilage

D.Between the cricoid and first tracheal ring

Explanation: Surgical cricothyrotomy is performed through the cricothyroid membrane, which lies between the thyroid cartilage (superior) and cricoid cartilage (inferior). This location is superficial, relatively avascular, and contains no major neurovascular structures. The procedure involves a vertical or horizontal incision through the skin and membrane, followed by placement of a cuffed tracheostomy tube. This is the emergency surgical airway of choice when orotracheal intubation fails in the adult patient.

9A patient on mechanical ventilation has the following settings: VC-SIMV, tidal volume 500mL, rate 14, PEEP 5, FiO2 40%. The patient's PaO2 is 58 mmHg and SpO2 is 88%. What is the most appropriate first intervention?

A.Increase the respiratory rate to 18

B.Increase PEEP to 8-10 cm H2O

C.Increase FiO2 to 60%

D.Decrease tidal volume to 400mL

Explanation: This patient has hypoxemic respiratory failure (PaO2 < 60 mmHg on 40% FiO2). The initial PaO2/FiO2 ratio is approximately 145 (58/0.4), indicating moderate ARDS. While increasing FiO2 could help, the first intervention should be to optimize PEEP to improve alveolar recruitment and oxygenation. Increasing PEEP from 5 to 8-10 cm H2O helps prevent alveolar collapse and improves V/Q matching. If hypoxemia persists after optimizing PEEP, then FiO2 can be increased.

10During RSI, a patient receives succinylcholine and develops bradycardia with a heart rate of 42 bpm. What is the most appropriate immediate treatment?

A.Give atropine 0.5mg IV and prepare for transcutaneous pacing

B.Immediately proceed with intubation and reassess after

C.Give epinephrine 1mg IV push

D.Give atropine 1mg IV immediately

Explanation: Succinylcholine can cause bradycardia, especially in pediatric patients or with repeat dosing. Atropine 0.5mg IV (adult dose) is the appropriate treatment for symptomatic bradycardia caused by succinylcholine. The paramedic should also prepare for transcutaneous pacing if the bradycardia does not respond. While proceeding with intubation may be necessary for oxygenation, the bradycardia should be addressed first as it can progress to asystole. The adult atropine dose for bradycardia is 0.5mg IV every 3-5 minutes, maximum 3mg.

About the FP-C Exam

The FP-C certification validates advanced knowledge of critical care transport medicine for flight paramedics. The exam covers eight domains: Safety and Transport Environment (10%), Airway and Ventilation (15%), Cardiac Emergencies (18%), Neurological (12%), Trauma and Burns (12%), Medical Emergencies (15%), OB/GYN and Neonatal (10%), and Laboratory/Diagnostics (8%). The exam consists of 135 items (110 scored, 25 unscored pretest).

Questions

135 scored questions

Time Limit

2.5 hours

Passing Score

~70% (77/110 scored items)

Exam Fee

$310 (IBSC (International Board of Specialty Certification))

FP-C Exam Content Outline

10%

Safety & Transport Environment

Altitude physiology, gas laws, flight stressors, aircraft safety, CAMTS standards, crew resource management, and transport environment considerations

15%

Airway & Ventilation

Advanced airway management, rapid sequence intubation, difficult airway algorithms, mechanical ventilation, transport ventilator management, and special airway considerations

18%

Cardiac Emergencies

Dysrhythmias, ACS management, heart failure, hemodynamic monitoring, vasoactive medications, intra-aortic balloon pump, and post-cardiac arrest care

12%

Neurological

TBI management, stroke care, ICP monitoring, seizure management, neuroprotective strategies, and neurological assessment

12%

Trauma & Burns

Trauma resuscitation, hemorrhage control, burn calculations, compartment syndrome, penetrating trauma, blunt trauma, and shock management

15%

Medical Emergencies

Respiratory failure, sepsis and shock, DKA/HHS, toxicology, environmental emergencies, anaphylaxis, and adrenal crisis

10%

OB/GYN & Neonatal

Maternal emergencies, high-risk obstetrics, neonatal resuscitation, and OB transport considerations

Laboratory & Diagnostics

ABG interpretation, critical lab values, imaging interpretation, and monitoring equipment

How to Pass the FP-C Exam

What You Need to Know

Passing score: ~70% (77/110 scored items)
Exam length: 135 questions
Time limit: 2.5 hours
Exam fee: $310

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

FP-C Study Tips from Top Performers

1Master altitude physiology and gas laws - key difference between FP-C and ground critical care

2Practice RSI scenarios and difficult airway algorithms specific to transport environment

3Know vasoactive medication dosing and titration for flight transport

4Study TBI management protocols including hyperosmolar therapy and ICP targets

5Understand burn calculation formulas (Parkland) and fluid resuscitation

6Review CAMTS safety standards and crew resource management principles

7Practice ABG interpretation and ventilator management

8Study OB emergencies including preeclampsia and neonatal resuscitation

Frequently Asked Questions

What is the FP-C exam?

The FP-C (Flight Paramedic-Certified) is a specialty certification offered by IBSC (International Board of Specialty Certification) that validates advanced knowledge of critical care transport medicine for flight paramedics working in rotor-wing and fixed-wing air medical transport.

How many questions are on the FP-C exam?

The FP-C exam contains 135 total questions: 110 scored items and 25 unscored pretest items. You have 150 minutes (2.5 hours) to complete the computer-based exam.

What is the FP-C passing score?

IBSC uses a scaled scoring system. Approximately 70% of scored items (77/110) is generally needed to pass. The exact passing standard may vary slightly based on exam form.

What are the FP-C eligibility requirements?

You must hold a current, unrestricted paramedic license. IBSC recommends 3+ years of critical care transport experience. While not required, many successful candidates have experience in ICU, emergency department, or air medical transport settings.

What content areas are covered on the FP-C exam?

The FP-C exam covers eight domains: Safety & Transport Environment (10%), Airway & Ventilation (15%), Cardiac Emergencies (18%), Neurological (12%), Trauma & Burns (12%), Medical Emergencies (15%), OB/GYN & Neonatal (10%), and Laboratory & Diagnostics (8%).

How long is FP-C certification valid?

FP-C certification is valid for 4 years. Recertification can be achieved through continuing education or by retaking the exam. IBSC requires ongoing professional development to maintain certification.

How should I prepare for the FP-C exam?

Study systematically across all eight domains. Focus on the largest domains: Cardiac (18%), Airway (15%), and Medical Emergencies (15%). Master altitude physiology and gas laws, which are unique to flight medicine. Use critical care transport textbooks and practice questions. Plan for 3-6 months of dedicated study time.