Free NREMT Practice Questions
Secondary Assessment
Focused history and exam. Confirm findings that change care, then lock the transport plan.
What you'll master
- ✓OPQRST / SAMPLE when it matters most
- ✓Focused exams by chief complaint
- ✓Medication and allergy risk checks
- ✓Documentation‑ready summaries
Common misses
- –Missing meds/allergies
- –Incomplete focused exams
- –Weak handoff summaries
Sample questions.
25 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.
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?
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.
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?
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.
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?
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.
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?
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.
Question 5
At a apartment hallway, a 42-year-old male has chest pain, normal vitals, and a concerning story. What should you avoid?
Why:Correct. Normal early vitals do not rule out serious illness. Continue assessment and transport planning.
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?
Why:Correct. Pain and distal pulse, motor, and sensation should be reassessed after splinting.
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?
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.
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?
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.
Question 9
You respond to a 54-year-old male who has been having progressive difficulty swallowing solids for 6 weeks that has now progressed to difficulty swallowing liquids. He has lost 8 kg. He is a 40-pack-year smoker. He drinks alcohol daily. On assessment you palpate a hard non-tender lymph node at the left supraclavicular fossa. This specific lymph node location has a classic eponym. What is Virchow's node and what does it indicate?
Why:Correct. Virchow's node (Troisier's sign): hard non-tender left supraclavicular lymphadenopathy indicating metastatic spread from intra-abdominal or thoracic malignancy via the thoracic duct. Combined with progressive dysphagia (solid to liquid), significant weight loss, and heavy tobacco and alcohol use this is esophageal cancer with metastatic disease until proven otherwise. Urgent oncological evaluation.
Question 10
You respond to a 48-year-old male with sudden onset of painless vision loss in his left eye that developed over 1-2 seconds. He reports it came on like a curtain of black from above, was complete for about 10 minutes, and then resolved. He is now fully sighted. No pain. GCS 15. BP is 162/98. This is his second such episode in 3 days. What does repeated brief monocular vision loss indicate?
Why:Correct. Amaurosis fugax = retinal TIA: transient monocular blindness from emboli passing through the ophthalmic artery. Carotid plaque is the most common source. The ipsilateral carotid territory is at high risk for ischemic stroke from the same embolic source. Repeated episodes (3 days) indicate ongoing risk. Priority 1 stroke center evaluation for carotid imaging and anticoagulation consideration.
Question 11
A stable medical patient says the pain is sharp and worse with inspiration. Which OPQRST element is this?
Why:Correct. Sharp describes quality, and worse with inspiration describes provocation.
Question 12
At a warehouse, a 27-year-old male with abdominal pain has black stools and dizziness. What should this suggest?
Why:Correct. Black stools and dizziness can suggest GI bleeding and perfusion risk.
Question 13
You respond to a 58-year-old male who reports that whenever he stands up from a seated position he feels dizzy for 15-20 seconds before it resolves. He reports this has been happening for 2 weeks and is getting more frequent. Today he fainted standing up in his kitchen. HR is 82 supine, 104 standing. BP is 128/80 supine, 96/62 standing. What is this finding called and what is the minimum BP drop that defines it?
Why:Correct. Orthostatic hypotension definition: systolic BP drop of at least 20 mmHg or diastolic drop of at least 10 mmHg within 3 minutes of standing. This patient has a 32 mmHg systolic drop — meeting criteria. Common causes: dehydration, antihypertensive medications, diuretics, autonomic neuropathy, adrenal insufficiency. Transport for evaluation and cause identification.
Question 14
A 61-year-old male has left upper quadrant pain and left shoulder pain developing 3 hours after an MVC. HR 124, BP 94/70. Left rib tenderness. What injury explains LUQ pain with left shoulder pain after blunt trauma?
Why:Correct. Splenic injury with Kehr's sign: blood accumulating under the left hemidiaphragm irritates the phrenic nerve, referring pain to the left shoulder. Delayed presentation (3 hours) suggests a contained splenic hematoma that has slowly expanded. Priority 1 trauma center.
Question 15
You are assessing a 73-year-old female who fell and struck her head. She is on warfarin with a documented INR of 3.2. She has a small laceration to her occiput. GCS is 15, she denies neck pain, and she is neurologically intact. She says she feels fine and wants to refuse transport. What is the specific risk that makes this refusal particularly dangerous?
Why:Correct. Anticoagulated patients with head trauma — even seemingly minor — have significantly elevated risk of delayed intracranial hemorrhage. A normal neurological exam immediately after injury provides false reassurance. Subdural and epidural hematomas can expand hours after the initial injury in anticoagulated patients. This is a well-documented cause of preventable death. Document the specific risk in any refusal.
Question 16
At a mall corridor, a 46-year-old female with shortness of breath has fever and productive cough. Which exam finding is useful?
Why:Correct. Lung sounds can help assess respiratory illness and response to treatment.
Question 17
You respond to a 44-year-old male with right-sided weakness that started this morning. He also has right-sided face and arm numbness. BP is 182/108. GCS is 14. He has no known cardiac history but reports palpitations during the past month. On assessment the cardiac monitor shows an irregularly irregular rhythm with no discernible P waves. What is the clinical significance of the atrial fibrillation in the context of his stroke symptoms?
Why:Correct. AF-caused cardioembolic stroke: AF causes left atrial appendage thrombus formation from stagnant blood. Emboli travel to the cerebral circulation causing ischemic stroke. Cardioembolic strokes often have specific management differences (anticoagulation therapy, LAA closure). The month of prior palpitations suggests paroxysmal AF — this history is critical for the stroke team. Priority 1 stroke center transport.
Question 18
A 49-year-old heavy smoker with 6 weeks of a hard fixed non-tender 3 cm right cervical lymph node and 2 weeks of progressive dysphagia. Temperature is 37.0 degrees C. What does this presentation suggest?
Why:Correct. Hard fixed non-tender cervical lymphadenopathy persisting over 6 weeks combined with progressive dysphagia in a heavy smoker is head and neck squamous cell carcinoma with nodal metastasis until proven otherwise. Tender mobile nodes indicate infection. Hard fixed non-tender nodes indicate malignancy. Urgent oncological transport.
Question 19
You respond to a 55-year-old male with progressive shortness of breath over 6 weeks and bilateral ankle edema. On assessment you find that his neck veins are distended while he is sitting upright at 45 degrees. His JVD is present at 45 degrees of elevation. What does JVD at 45 degrees indicate about central venous pressure?
Why:Correct. Normal JVD: visible only when patient is supine or at low elevation angles. Visible JVD at 45 degrees or higher indicates significantly elevated central venous pressure from right heart failure, tamponade, tension pneumothorax, or severe pulmonary hypertension. Combined with ankle edema and dyspnea this is right heart or biventricular failure. High-flow oxygen, upright positioning, Priority 1 ALS.
Question 20
You are assessing a 68-year-old male with progressive weakness over 3 days. He now cannot lift his arms above his head and reports difficulty swallowing. He had a gastrointestinal illness 2 weeks ago. His vital signs are: HR 78, BP 128/82, SpO2 96%, RR 16. He has diminished deep tendon reflexes in all extremities. He is extremely concerned about his breathing. What syndrome should you suspect and why is airway monitoring critical?
Why:Correct. Progressive ascending weakness with diminished reflexes following gastrointestinal illness is Guillain-Barré syndrome until proven otherwise. Diaphragm paralysis causing respiratory failure can occur suddenly with little warning. Priority 1 ALS transport. Serial respiratory assessment every 5 minutes.
Question 21
At a grocery store, a 35-year-old female stable patient says pain is 6/10 before splinting. What should be documented after splinting?
Why:Correct. Pain and distal pulse, motor, and sensation should be reassessed after splinting.
Question 22
A 33-year-old male has an acute flexor tenosynovitis of the right index finger — uniformly swollen, held flexed, tender along the entire tendon sheath, and exquisitely painful with passive extension. Temperature is 38.9 degrees C. What are the four Kanavel signs?
Why:Correct. Kanavel's four signs: (1) uniform digit swelling, (2) resting flexed posture, (3) tenderness along the entire tendon sheath, (4) extreme pain with passive extension. All four indicate suppurative flexor tenosynovitis — infection in the closed tendon sheath causes pressure necrosis within 24-48 hours. Urgent hand surgery irrigation is required.
Question 23
Using the Rule of Nines for a patient with burns to: right arm, entire anterior trunk, entire posterior trunk, and head and neck. What is the TBSA?
Why:Correct. Rule of Nines: right arm = 9%, anterior trunk = 18%, posterior trunk = 18%, head and neck = 9%. Total = 54% TBSA. Burns over 20% TBSA in adults are major burns. Burns involving the head and neck carry inhalation injury risk. Priority 1 transport to a burn center.
Question 24
At a fitness center, a 24-year-old female stable trauma patient has tenderness over the ribs. What should you assess?
Why:Correct. Rib injury can affect breathing. Assess breath sounds, work of breathing, and pain.
Question 25
At a grocery store, a 36-year-old female stable trauma patient has tenderness over the ribs. What should you assess?
Why:Correct. Rib injury can affect breathing. Assess breath sounds, work of breathing, and pain.
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