The Medical / OB/GYN category is the largest single content area on the NREMT cognitive exam, accounting for roughly 27 to 31 percent of all questions — close to one in three. The breadth is its main challenge: you're expected to recognize and manage neurologic, respiratory, endocrine, allergic, behavioral, OB/GYN, and toxicologic emergencies across all age groups.
This guide breaks the category into the systems most often tested, lists the doses and decision rules worth memorizing, and walks through several NREMT-style sample questions with full rationales.
What's tested in this category
- Neurologic — stroke (BE-FAST, time of onset), seizure, syncope, altered mental status.
- Respiratory — asthma, COPD exacerbation, CHF/pulmonary edema, pulmonary embolism, pneumonia.
- Endocrine — hypoglycemia, hyperglycemia/DKA, thyroid emergencies.
- Allergic — mild reaction vs anaphylaxis, epinephrine auto-injector use.
- Cardiovascular medical — syncope, hypertensive emergency overlap with the cardiology category.
- Behavioral and psychiatric emergencies, including excited delirium and suicide risk assessment.
- OB/GYN — imminent delivery, pre-eclampsia/eclampsia, post-partum hemorrhage, ectopic pregnancy, vaginal bleeding.
- Toxicology — opioid, sympathomimetic, cholinergic, anticholinergic, sedative-hypnotic toxidromes.
- Infectious disease — sepsis recognition, isolation precautions.
- Environmental — heat illness, hypothermia, drowning, electrical injury.
EMT-scope medications worth memorizing
- Oxygen — titrate to SpO₂ ≥94% in most patients.
- Aspirin — 162–325 mg chewable for suspected ACS.
- Oral glucose — 15–25 g for conscious hypoglycemic patients who can swallow.
- Epinephrine auto-injector — 0.3 mg IM (adult), 0.15 mg IM (pediatric) for anaphylaxis.
- Naloxone — 0.4–2 mg intranasal or IM for suspected opioid overdose with respiratory depression. Repeat every 2–3 minutes if needed.
- Activated charcoal — 1 g/kg orally where local protocols allow, only for awake patients with intact airway.
- Patient-prescribed nitroglycerin and inhalers — assist within scope and protocol.
Not sure how much of this you actually know? Ten questions gives you a readiness score in about three minutes.
Take the free quizStroke recognition — BE-FAST
Time-of-onset is the single most important data point on a stroke call because it determines eligibility for thrombolytics. Always document the time the patient was last seen normal — this isn't necessarily when they were 'found.'
- B — Balance: sudden imbalance or coordination problem.
- E — Eyes: sudden visual loss or double vision.
- F — Face: facial droop on one side.
- A — Arms: arm drift on one side when held out with eyes closed.
- S — Speech: slurred, garbled, or absent speech.
- T — Time: when was the patient last seen normal?
Sample anaphylaxis question
Your turn — pick an answer
A 24-year-old female was stung by a bee 10 minutes ago. She has hives on her chest, audible wheezing, swelling around her lips, and complains of difficulty breathing. BP is 88/56, HR 128. She has a prescribed epinephrine auto-injector in her purse. What is the MOST appropriate next action after applying oxygen?
Rationale
This patient has multi-system anaphylaxis (skin, respiratory, cardiovascular). Epinephrine is the treatment for anaphylaxis and the indication is stronger because she's hypotensive — not a contraindication. Withholding epinephrine in anaphylaxis is the most common preventable cause of death from this condition. Supine positioning is fine adjunctively but doesn't replace epinephrine. Waiting is the worst option — anaphylaxis can progress to airway obstruction within minutes.
Sample diabetic question
Your turn — pick an answer
You respond to a 72-year-old diabetic male who is confused and diaphoretic. His wife says he took his insulin this morning but didn't eat lunch. He is awake, follows commands, and can swallow. Glucose is 38 mg/dL. What is the MOST appropriate intervention?
Rationale
Conscious patient with intact airway and ability to swallow → oral glucose is the EMT-level intervention. D50W requires IV access (AEMT/Paramedic scope in most states). Glucagon IM is also typically AEMT/Paramedic scope. Doing nothing while transporting wastes a critical intervention you can perform now. Oral glucose 15–25 g — confirm the patient can protect their airway before administering.
Sample toxicology question
Your turn — pick an answer
You respond to a 19-year-old male found unresponsive at a party. He has pinpoint pupils, RR of 4, SpO₂ 78%, and slow shallow breathing. There is drug paraphernalia on the table. Your priority intervention is:
Rationale
The patient is in respiratory failure (RR 4, SpO₂ 78%) — his immediate threat is hypoxia, not the opioid itself. BVM ventilation reverses the hypoxia in seconds; naloxone may take a minute or longer to work and only addresses the opioid receptor binding. Apply BVM first, then administer naloxone, then re-evaluate. Non-rebreather is inadequate for inadequate breathing. Recovery position is dangerously inappropriate for a patient with RR 4.
Common medical emergency exam mistakes
- Withholding epinephrine in anaphylaxis because of hypotension — exactly backwards.
- Giving oral glucose to an unresponsive diabetic patient — aspiration risk.
- Treating hypoglycemia and hyperglycemia interchangeably — both cause altered mental status, but management is different.
- Forgetting that naloxone treats the opioid receptor; BVM treats the hypoxia. Hypoxia kills first.
- Missing atypical stroke presentations (sudden severe headache, sudden imbalance, sudden vision loss).
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