Secondary Assessment

Sample questions.

8 free secondary assessment questions with answers and explanations. MedRelay's full question bank covers every NREMT domain, plus live scenarios that grade the decision, not just the answer.

1. Question 1

   You respond to a 44-year-old male with sudden onset of bright red rectal bleeding. He passed a large volume of blood with clots approximately 30 minutes ago. He feels lightheaded when standing. HR is 138, BP is 88/62. He has a known history of diverticulosis. What does painless bright red rectal bleeding in a patient with diverticulosis most commonly represent?

   • A.Colorectal cancer causing the diverticulosis to bleed
   • B.Ulcerative colitis flare causing the rectal bleeding
   • C.Hemorrhoids — the most common cause of rectal bleeding
   • D.Diverticular hemorrhageCorrect

   Why:Correct. Diverticular hemorrhage: the vasa recta arteries that supply diverticula can erode and bleed massively. Painless (no diverticulitis = no infection/inflammation) bright red or maroon rectal bleeding with hemodynamic compromise in a patient with known diverticulosis is diverticular hemorrhage until proven otherwise. Priority 1 ALS transport — hemodynamic instability from GI hemorrhage requires IV fluid resuscitation and urgent endoscopy/surgery.

2. Question 2

   You are assessing a 77-year-old male who reports feeling dizzy. He is conscious with GCS 15 and vital signs: HR 44, BP 88/60, SpO2 96%. He has no chest pain. He takes metoprolol and lisinopril. On his medication list you also see diltiazem (Cardizem). What medication interaction concern should this raise?

   • A.Metoprolol + diltiazem can cause bradycardiaCorrect
   • B.Diltiazem is a diuretic — the patient is dehydrated
   • C.Lisinopril causes bradycardia — this is the primary culprit
   • D.No concern

   Why:Correct. Beta-blockers and non-dihydropyridine calcium channel blockers (diltiazem, verapamil) both slow AV nodal conduction and heart rate. Combined use can cause severe symptomatic bradycardia and heart block — a known and dangerous drug interaction. HR 44 with hypotension and dizziness in a patient on both warrants ALS intercept for calcium gluconate or glucagon reversal.

3. Question 3

   A 45-year-old female has severe right flank and groin pain and is constantly writhing, unable to stay still. Temperature 37.0 degrees C. What behavioral feature distinguishes renal colic from peritonitis?

   • A.Renal colic patients writhe restlesslyCorrect
   • B.Patients with peritonitis also writhe in pain
   • C.Both conditions cause patients to lie on their left side
   • D.Temperature distinguishes the two

   Why:Correct. Renal colic = writhing restlessly (movement does not worsen ureteral spasm). Peritonitis = completely still (any movement stretches the inflamed peritoneum and worsens pain dramatically). This behavioral distinction is clinically useful even before other assessments.

4. Question 4

   You respond to a 39-year-old male who has had severe right lower back pain for 3 days. He is febrile at 39.6 degrees C. He has costovertebral angle tenderness on the right — significant pain when you percuss the right CVA. He has dysuria and urinary frequency. HR 116, BP 96/68, SpO2 97%. What diagnosis does CVA tenderness with fever and urinary symptoms suggest and why is this patient critically ill?

   • A.Pyelonephritis progressing to urosepsisCorrect
   • B.Simple urinary tract infection — transport Priority 3
   • C.This is a kidney stone — no sepsis concern
   • D.CVA tenderness only indicates kidney stones

   Why:Correct. CVA tenderness with fever and urinary symptoms = pyelonephritis. Combined with tachycardia and hypotension this is urosepsis — the kidney infection has caused systemic infection and hemodynamic compromise. IV antibiotics and fluid resuscitation are urgently needed (ALS). Priority 1 ALS transport — every hour without treatment worsens outcomes.

5. Question 5

   At a apartment hallway, a 42-year-old male has chest pain, normal vitals, and a concerning story. What should you avoid?

   • A.Reassessment
   • B.Transport advice
   • C.Aspirin screen
   • D.False reassuranceCorrect

   Why:Correct. Normal early vitals do not rule out serious illness. Continue assessment and transport planning.

6. Question 6

   At a soccer field, a 30-year-old female stable patient says pain is 6/10 before splinting. What should be documented after splinting?

   • A.Only dispatch code
   • B.Only crew names
   • C.Only mileage
   • D.Pain and PMS againCorrect

   Why:Correct. Pain and distal pulse, motor, and sensation should be reassessed after splinting.

7. Question 7

   A 54-year-old male has a moderate throbbing right-sided headache building over 4 hours, nausea, photophobia, and prior similar headaches. CPSS is negative. BP 132/84. What is the most important distinguishing feature from SAH?

   • A.Light sensitivity — SAH never causes photophobia
   • B.Gradual onset over 4 hours plus prior similar headachesCorrect
   • C.Right-sided location — SAH always causes bilateral headache
   • D.Nausea — SAH never causes nausea

   Why:Correct. Migraine vs SAH: SAH = thunderclap onset + novel worst-ever headache. Migraine = gradual buildup over minutes to hours + history of similar headaches. Both cause nausea and photophobia. Onset pattern and prior headache history are the key distinguishing features. Transport for evaluation if any atypical features are present.

8. Question 8

   You respond to a 67-year-old male with confusion and weakness. His wife says he was hospitalized last month for pneumonia and has been on antibiotics since. Today he has profuse watery diarrhea — 8 episodes since this morning. Temperature is 38.6 degrees C. HR 112, BP 96/68, abdomen tender diffusely. He has been on clindamycin for 4 weeks. What infection does antibiotic use followed by profuse diarrhea and abdominal pain suggest?

   • A.Clostridioides difficile (C. diff) colitisCorrect
   • B.Normal antibiotic side effect — stop the antibiotic and observe
   • C.Appendicitis from the antibiotic exposure
   • D.Standard diarrheal illness — administer oral fluids

   Why:Correct. C. diff colitis: prolonged antibiotic use (especially clindamycin, fluoroquinolones, cephalosporins) disrupts colonic flora allowing C. diff overgrowth. Profuse watery diarrhea after antibiotics with fever and abdominal pain is C. diff until proven otherwise. Hemodynamic compromise (BP 96/68, HR 112) indicates severe disease requiring hospital management.