By: Sean Ewen, MD, Executive Director

Medical certification exams, especially in the EMS field, are known for their challenging multiple choice questions. Preparing a strategy, and practicing it, is necessary to excel in these exams. Here is my method for answering these questions. Also available below is a video presentation of this method.

1. Don’t look at the answers yet.
Cover up the answers with your hands or a blank sheet of paper. Don’t be tempted to read them before the question as it can lead you to make incorrect assumptions.

2. Read the end of the question stem.
If there is more than one sentence in the question, skip to the last sentence where the actual question or requirement is posed.

3. Figure out what type of information the question is requesting.
There are generally two types of questions being asked in the EMS field: the next step in a sequence or for a piece of knowledge.

4. Read the rest of the question stem (take notes if needed).
This is usually some sort of patient scenario. Some people find it helpful to take notes about the key points of the scenario and summarize it into one sentence or a few words. Then think of the patient's likely diagnosis and next steps or interventions.

5. Think of possible answers.
Without looking at the answer choices available, think or write down possible answers to the question.

6. Try to match your answer with one of the available choices.
Often, you’ll find an answer choice that comes close or even exactly the same as what you were thinking. If it’s not there, then use the process of elimination to identify the best available answer.

Let’s go through an example. Try practicing the testing strategy to answer this question:

You arrive at the home of a 57 year old female that is complaining of respiratory difficulty. She is on home oxygen via nasal cannula and complains of trouble breathing all day. There is diffuse wheezing across the lung fields bilaterally. She has a barrel-shaped chest. Her blood pressure is 140/90, respiratory rate 24, heart rate 110 and spO2 of 92%. What is the most appropriate intervention?

A. Contact medical direction and request approval to administer an albuterol nebulizer.

B. Initiate rapid transport to the hospital.

C. Administer high-flow oxygen via bag-valve-mask.

D. Administer high-flow oxygen via nonrebreather.

First, cover up the answer choices. Then, skip to the end of the question stem to figure out what type of information is being asked. “What is the most appropriate intervention?” is asking you to reply with the most appropriate next step in your assessment. And in order to know what should come next, I’ll likely need to determine the most appropriate diagnosis for this patient along with the treatment options that exist for an EMT for this condition.

Now move on to read the rest of the question stem to find out more about this scenario. You take notes of pertinent facts, such as: “middle aged female, breathing trouble, home O2, wheezing, barrel chest - COPD, hypertensive, slight tachypnea, tachycardia, low normal spO2”.

A barrel-shaped chest is a hallmark sign of COPD along with home oxygen and wheezing. She’s already on oxygen and it appears she is experiencing a COPD exacerbation, although it’s not life-threatening at this moment. If I’ve already taken her vital signs and listened to her chest, I should be through the primary assessment and starting to think of interventions. What can I do for someone with some breathing trouble and wheezing that has COPD? She doesn’t need assisted ventilations at this point, but opening up her airways could do some good. What can I give her as an EMT to accomplish this? Either assisting with a prescribed inhaler or nebulized albuterol.

I think a correct answer would involve administering either an inhaler or nebulizer, which may require medical direction. Now I can uncover the answer choices and see if there is a choice that matches. And indeed, the very first choice matches my answer.

Try practicing this method for all the multiple choice questions you encounter so that you can quickly and efficiently answer questions on your NREMT exam and other exams that you may encounter during your healthcare career.