AEMT Practice Test Welcome to your AEMT Practice Test 1. AEMT: Airway Respiration and Ventilation When considering the use of CPAP in patients with respiratory distress, which of the following conditions is typically considered a contraindication? Chronic obstructive pulmonary disease 'COPD' Pulmonary edema Pneumothorax Asthma None 2. AEMT: Airway Respiration and Ventilation During the assessment of a patient with respiratory distress, you notice tracheal deviation. This finding most likely suggests: A foreign body airway obstruction Tension pneumothorax Severe asthma attack Pulmonary embolism None 3. AEMT: Airway Respiration and Ventilation The primary purpose of performing an end-tidal CO2 (ETCO2) measurement in a patient with suspected respiratory compromise is to: Confirm proper endotracheal tube placement Evaluate the patient's ventilatory status Measure the oxygenation level Assess the metabolic rate None 4. AEMT: Airway Respiration and Ventilation In the context of airway management, the term "sniffing position" is best described as: The head-tilt-chin-lift maneuver A prone position with elevated chest A supine position with the head on a flat surface A position with the head and neck brought into alignment as if sniffing None 5. AEMT: Airway Respiration and Ventilation In managing a patient with a flail chest, the AEMT should understand that the underlying danger is: Massive hemothorax Paradoxical chest wall movement Simple pneumothorax Rib fractures None 6. AEMT: Airway Respiration and Ventilation When providing ventilatory support to a patient with severe head trauma, it is crucial to avoid hyperventilation because it can lead to: Increased intracranial pressure Decreased cerebral perfusion Alkalosis Hypoxia None 7. AEMT: Airway Respiration and Ventilation Select the most appropriate device for providing high-flow oxygen to a COPD patient in respiratory distress: Nasal cannula Non-rebreather mask Venturi mask Simple face mask None 8. AEMT: Airway Respiration and Ventilation Which of the following is the most appropriate initial step when managing a patient with severe respiratory distress and suspected epiglottitis? Immediate intubation Administering a high dose of corticosteroids Providing humidified oxygen without disturbing the patient Performing a tracheotomy None 9. AEMT: Airway Respiration and Ventilation What is the primary rationale for using a bougie during endotracheal intubation? To suction secretions from the airway To facilitate the placement of the endotracheal tube in difficult airways To deliver medications directly into the trachea To provide a channel for fiberoptic scope insertion None 10. AEMT: Airway Respiration and Ventilation In the prehospital management of a patient with severe asthma not responding to nebulized albuterol, the next best step is to: Administer epinephrine intramuscularly Increase the dose of albuterol Initiate CPAP therapy Provide intravenous corticosteroids None 11. AEMT: Airway Respiration and Ventilation The most appropriate oxygen delivery device for a patient with a tracheostomy who requires 40% FiO2 is: Tracheostomy collar Venturi mask adapted for tracheostomy Nasal cannula at 6 L/min Simple mask over the stoma None 12. AEMT: Airway Respiration and Ventilation When performing a needle cricothyrotomy, the needle should be inserted: At a 45-degree angle caudally Perpendicular to the skin At a 45-degree angle cephalad In the midline, directed towards the feet None 13. AEMT: Airway Respiration and Ventilation The use of a PEEP valve is contraindicated in patients with: Pulmonary edema Chronic bronchitis Undrained pneumothorax Severe pneumonia None 14. AEMT: Airway Respiration and Ventilation In patients with suspected spinal injury, which airway maneuver is recommended to open the airway? Head-tilt-chin-lift Jaw-thrust without head extension Modified chin lift Neck hyperextension None 15. AEMT: Airway Respiration and Ventilation The main purpose of the oropharyngeal airway 'OPA' is to: Facilitate suctioning Provide a channel for endotracheal intubation Prevent the tongue from obstructing the airway Deliver oxygen directly to the lungs None 16. AEMT: Airway Respiration and Ventilation The most appropriate method to confirm tube placement following endotracheal intubation in the field is: Auscultation of breath sounds Visualization of tube passing through the vocal cords End-tidal CO2 monitoring Chest x-ray None 17. AEMT: Airway Respiration and Ventilation Which of the following best describes the primary advantage of using a capnography in patients undergoing mechanical ventilation? It helps in adjusting the oxygen concentration. It monitors the patient's respiratory rate. It provides continuous monitoring of ventilation and perfusion. It assesses the effectiveness of chest compressions during CPR. None 18. AEMT: Airway Respiration and Ventilation In a patient with severe respiratory distress, the primary reason for the administration of inhaled beta-2 agonists is to: Decrease inflammation in the airways. Reduce pulmonary congestion. Dilate the bronchi and bronchioles. Increase oxygenation. None 19. AEMT: Airway Respiration and Ventilation When managing a patient with a suspected tension pneumothorax, the AEMT should be prepared to perform: Chest physiotherapy. High-flow oxygen therapy. Needle decompression. Immediate intubation. None 20. AEMT: Airway Respiration and Ventilation The use of a non-rebreather mask is indicated for patients who: Require low concentrations of oxygen. Need a controlled oxygen concentration. Are hyperventilating. Require high concentrations of oxygen. None 21. AEMT: Airway Respiration and Ventilation The primary concern when providing positive pressure ventilation to a patient with a suspected head injury is to avoid: Hypoventilation. Hyperventilation. Hyperoxygenation. Hypoxemia. None 22. AEMT: Airway Respiration and Ventilation In the context of airway management, the Sellick maneuver is used to: Open the airway in a trauma patient. Facilitate visualization during laryngoscopy. Prevent aspiration during intubation. Assist in the placement of an oropharyngeal airway. None 23. AEMT: Airway Respiration and Ventilation Which of the following is a critical step in the care of a patient with a tracheostomy tube who is experiencing respiratory distress? Administering a high concentration of inhaled steroids. Performing endotracheal intubation. Suctioning the tracheostomy tube. Placing the patient in a prone position. None 24. AEMT: Airway Respiration and Ventilation The most appropriate method to confirm the position of a nasogastric tube in a patient who is unconscious is: Auscultation of air injected into the tube. Visual inspection of the oropharynx. Confirmation with a chest x-ray. Measurement of pH of aspirated contents. None 25. AEMT: Cardiology and Resuscitation When analyzing a 12-lead ECG, ST-segment elevation is noted in leads II, III, and aVF. This is most indicative of an infarct in which region of the heart? Anterior wall Posterior wall Lateral wall Inferior wall None 26. AEMT: Cardiology and Resuscitation In the context of advanced cardiac life support, the recommended initial dose of epinephrine for an adult patient in cardiac arrest is: 0.1 mg 1 mg 10 mg 0.5 mg None 27. AEMT: Cardiology and Resuscitation Capnography is utilized during CPR to: Confirm the presence of a pulse. Evaluate the effectiveness of chest compressions. Measure the patient's body temperature. Assess the level of consciousness. None 28. AEMT: Cardiology and Resuscitation Which of the following rhythms is typically treated with synchronized cardioversion? Ventricular fibrillation Stable ventricular tachycardia Asystole Pulseless electrical activity None 29. AEMT: Cardiology and Resuscitation The first-line antiarrhythmic medication for a patient with stable wide complex tachycardia is: Amiodarone Adenosine Lidocaine Atropine None 30. AEMT: Cardiology and Resuscitation Which of the following is NOT a common side effect of nitroglycerin? Hypotension Headache Tachycardia Hyperglycemia None 31. AEMT: Cardiology and Resuscitation In the setting of acute coronary syndrome, the purpose of administering aspirin is to: Reduce pain Decrease inflammation Inhibit platelet aggregation Increase myocardial oxygen supply None 32. AEMT: Cardiology and Resuscitation A patient presents with a rapid irregular pulse, palpitations, and light-headedness. The ECG shows a narrow complex rhythm with no discernible P waves and an irregularly irregular rhythm. This presentation is most consistent with: Atrial fibrillation Atrial flutter Ventricular tachycardia Supraventricular tachycardia None 33. AEMT: Cardiology and Resuscitation During a resuscitation attempt, you notice a sine wave pattern on the monitor. This ECG finding is most consistent with: Ventricular fibrillation Torsades de Pointes Hyperkalemia Supraventricular tachycardia None 34. AEMT: Cardiology and Resuscitation The presence of J waves on an ECG is typically associated with: Hypothermia Hypercalcemia Hyperkalemia Hypokalemia None 35. AEMT: Cardiology and Resuscitation In the context of cardiology, the term "door-to-balloon time" refers to: The time from hospital arrival to the administration of thrombolytic therapy The time from symptom onset to the initiation of CPR The time from hospital arrival to the opening of a blocked coronary artery via angioplasty The time from the onset of a myocardial infarction to the restoration of blood flow None 36. AEMT: Cardiology and Resuscitation A patient with a history of chronic obstructive pulmonary disease 'COPD' is experiencing a ventricular tachycardia episode. What consideration should be made when administering amiodarone? Increase the dose due to decreased absorption Administer rapidly to ensure effectiveness Monitor for potential respiratory compromise Avoid use due to contraindication in COPD patients None 37. AEMT: Cardiology and Resuscitation The primary electrical pacemaker of the heart, responsible for setting the rhythm, is the: Atrioventricular (AV) node Sinoatrial 'SA' node Bundle of His Purkinje fibers None 38. AEMT: Cardiology and Resuscitation In a patient with suspected acute myocardial infarction, which of the following medications is typically administered to alleviate chest pain and improve blood flow to the myocardium? Furosemide Nitroglycerin Dopamine Epinephrine None 39. AEMT: Cardiology and Resuscitation Which of the following conditions is a contraindication for the administration of nitroglycerin? Recent use of phosphodiesterase inhibitors Hypertension Stable angina Chronic obstructive pulmonary disease None 40. AEMT: Cardiology and Resuscitation For a patient experiencing an acute stroke, the preferred method of oxygen delivery is: High-flow nasal cannula Non-rebreather mask Nasal cannula at 2-4 L/min Venturi mask None 41. AEMT: Cardiology and Resuscitation During a cardiac arrest, after how many minutes of hypoxia do irreversible brain damage begin to occur? 1-2 minutes 4-6 minutes 10-12 minutes 15-20 minutes None 42. AEMT: Cardiology and Resuscitation A patient presents with a heart rate of 280 beats per minute, a narrow QRS complex, and no discernible P waves. This ECG finding is most consistent with which of the following conditions? Atrial fibrillation Ventricular fibrillation Atrial flutter Supraventricular tachycardia (SVT) None 43. AEMT: Cardiology and Resuscitation The use of a mechanical chest compression device in CPR is primarily recommended in situations where: High-quality manual compressions are not feasible The patient is a child The cardiac arrest occurred due to hypothermia There is a shortage of personnel to perform CPR None 44. AEMT: Cardiology and Resuscitation In the context of cardiology, what does the term "electrical-mechanical dissociation" refer to? The absence of a pulse despite a normal ECG rhythm A delay in the mechanical response of the heart to electrical stimulation The synchronization of the heart's electrical and mechanical activity A situation where the electrical activity of the heart is faster than the mechanical contraction None 45. AEMT: Cardiology and Resuscitation In the setting of acute heart failure, which of the following ECG findings is least likely to be observed? Q waves Peaked T waves ST-segment elevation Left bundle branch block None 46. AEMT: Cardiology and Resuscitation For a patient experiencing cardiogenic shock, which of the following interventions is the most critical? Administration of high-flow oxygen Intravenous fluid resuscitation Immediate reperfusion therapy Application of an external pacemaker None 47. AEMT: Trauma When assessing a patient with a suspected pelvic fracture, which of the following signs would be the most indicative of a severe hemorrhage and potential internal organ injury? Localized bruising on the pelvis Crepitus on palpation of the pelvic region Hematuria Pain on palpation at the iliac crests None 48. AEMT: Trauma In the management of an open chest wound, why is it recommended to apply an occlusive dressing that is secured on three sides? To allow air to escape during exhalation To prevent the development of a pneumothorax To facilitate negative pressure ventilation To reduce the risk of infection None 49. AEMT: Trauma When assessing a patient with blunt abdominal trauma, which of the following findings would most likely suggest a diaphragmatic rupture? Absence of bowel sounds in the abdomen Presence of bowel sounds in the chest Guarding and rigidity of the abdominal wall Ecchymosis around the umbilicus None 50. AEMT: Trauma What is the primary concern when managing a patient with a suspected tension pneumothorax? Rapid fluid resuscitation Immediate needle decompression High-flow oxygen administration Stabilization of the chest wall None 51. AEMT: Trauma A patient with a flail chest will most likely exhibit which of the following respiratory patterns? Rapid, shallow respirations Slow, deep respirations Unilateral chest movement Paradoxical chest movement None 52. AEMT: Trauma During the secondary assessment of a trauma patient, you notice a 'seat belt sign' across the abdomen. What complication should be most concerning for this patient? Abdominal aortic aneurysm Hollow organ perforation Myocardial contusion Diaphragmatic rupture None 53. AEMT: Trauma In the context of spinal injuries, which of the following assessment findings is most predictive of a spinal cord injury? Tenderness along the spine Priapism in male patients Deformity of the vertebral column Paradoxical breathing None 54. AEMT: Trauma In the case of a traumatic amputation of a limb, which of the following is the most critical initial action? Applying a tourniquet to the stump Searching for the amputated part Administering pain medication Checking for a distal pulse None 55. AEMT: Trauma When evaluating a patient with a facial injury, which symptom would most strongly suggest a basilar skull fracture? Periorbital ecchymosis Subconjunctival hemorrhage Hemotympanum Jaw clenching None 56. AEMT: Trauma When treating a patient with burns from a lightning strike, what unique complication should the AEMT be most alert for? Myocardial infarction Compartment syndrome Anaphylactic shock Rhabdomyolysis None 57. AEMT: Trauma In a patient with a suspected pelvic fracture, which of the following interventions should be avoided to prevent exacerbating the injury? Pelvic binding Log roll Application of a traction splint Supine positioning None 58. AEMT: Trauma For a patient with a suspected cervical spine injury, which of the following airway management techniques is most appropriate? Head tilt-chin lift maneuver Jaw-thrust maneuver without head extension Blind finger sweep Rapid sequence intubation with cervical hyperextension None 59. AEMT: Trauma What is the primary concern when managing a patient with a penetrating neck injury at the level of the cricoid cartilage? Air embolism Esophageal perforation Spinal cord injury Laryngeal disruption None 60. AEMT: Trauma Which of the following is the most likely cause of hypotension in a trauma patient with no external bleeding, periorbital ecchymosis, and Battle's sign? Tension pneumothorax Intracranial hemorrhage Cardiac tamponade Spinal shock None 61. AEMT: Trauma Which of the following is the most appropriate initial step when treating a patient with a penetrating injury to the abdomen and signs of shock? Perform a detailed secondary assessment Administer high-flow oxygen and initiate rapid transport Apply direct pressure over the wound Administer oral fluids to maintain blood pressure None 62. AEMT: Obstetrics and Gynecology During a breech delivery, the AEMT notices the presence of meconium-stained amniotic fluid. What is the most appropriate initial action? Prepare for immediate neonatal resuscitation. Apply gentle pressure to the baby's head. Encourage the mother to push harder. Perform a cesarean section. None 63. AEMT: Obstetrics and Gynecology In the context of obstetric emergencies, what is the primary concern associated with a prolapsed umbilical cord? Maternal hemorrhage Neonatal infection Fetal hypoxia Uterine rupture None 64. AEMT: Obstetrics and Gynecology An AEMT is attending a delivery and observes a limb presentation. What is the most appropriate next step? Attempt to reposition the limb. Prepare for a vaginal delivery. Initiate rapid transport to a medical facility. Apply gentle traction to the limb. None 65. AEMT: Obstetrics and Gynecology During a postpartum assessment, the AEMT notes that the patient's fundus is boggy and located above the expected level at the umbilicus. What is the most appropriate initial action? Administer IV fluids. Encourage breastfeeding. Perform uterine massage. Prepare for immediate surgery. None 66. AEMT: Obstetrics and Gynecology An AEMT is assessing a pregnant patient who is experiencing severe abdominal pain and vaginal bleeding at 32 weeks of gestation. The patient's blood pressure is 90/60 mmHg, and her pulse is 120 bpm. What is the most likely diagnosis? Ectopic pregnancy Placental abruption Gestational diabetes Preeclampsia None 67. AEMT: Obstetrics and Gynecology An AEMT is caring for a patient in labor who suddenly experiences a seizure. The patient's medical history is unknown. What is the most likely condition? Eclampsia Epilepsy Hypoglycemia Migraine None 68. AEMT: Obstetrics and Gynecology A pregnant patient at 38 weeks gestation is experiencing contractions every 3 minutes, each lasting 45 seconds. The cervix is dilated to 4 cm. What stage of labor is she in? First stage, latent phase First stage, active phase Second stage, latent phase Second stage, active phase None 69. AEMT: Obstetrics and Gynecology An AEMT is delivering a baby and notices that the umbilical cord is wrapped around the newborn's neck. What is the first action the AEMT should take? Clamp and cut the cord immediately. Gently lift the cord over the baby's head. Prepare for neonatal resuscitation. Apply gentle traction to the cord. None 70. AEMT: Obstetrics and Gynecology An AEMT is called to assist with a home birth where the mother is known to have polyhydramnios. What complication is the mother MOST at risk for during labor? Precipitous delivery Uterine atony Prolapsed umbilical cord Gestational diabetes None 71. AEMT: Obstetrics and Gynecology During the third trimester, a patient presents with sudden swelling in her face and hands, a headache, and visual disturbances. What condition should the AEMT suspect? HELLP syndrome Ectopic pregnancy Preeclampsia Braxton Hicks contractions None 72. AEMT: Obstetrics and Gynecology A patient in her second trimester of pregnancy presents with painless, bright red vaginal bleeding. Which condition is most likely responsible for her symptoms? Placenta previa Placental abruption Uterine rupture Ectopic pregnancy None 73. AEMT: Obstetrics and Gynecology In the case of a postpartum hemorrhage, which medication is MOST likely to be administered to promote uterine contraction? Oxytocin Ibuprofen Acetaminophen Methotrexate None 74. AEMT: Obstetrics and Gynecology A newborn's APGAR score at 1 minute is 6. What is the most appropriate initial action? Initiate full neonatal resuscitation. Provide positive pressure ventilation. Administer supplemental oxygen. Continue observation and reassess at 5 minutes. None 75. AEMT: Obstetrics and Gynecology What is the primary concern for an AEMT when managing a patient with suspected eclampsia? Controlling the seizures Managing the delivery Monitoring for infection Providing pain management None 76. AEMT: Obstetrics and Gynecology When assessing a patient in labor, the AEMT finds the fetal heart rate to be 80 bpm. What is the most appropriate immediate action? Prepare for immediate delivery. Administer oxygen to the mother. Change the mother's position. Initiate rapid transport to a hospital. None 77. AEMT: Obstetrics and Gynecology In the case of shoulder dystocia during delivery, what maneuver should the AEMT FIRST attempt? Cesarean section McRoberts maneuver Suprapubic pressure Episiotomy None 78. AEMT: Obstetrics and Gynecology A pregnant patient with a known history of heroin use is in labor. The AEMT should be MOST prepared to manage which condition in the newborn? Hyperactivity Respiratory depression Congenital heart defects Hypoglycemia None 79. AEMT: Obstetrics and Gynecology If a pregnant patient's blood type is Rh-negative, the AEMT should understand the primary risk involves which of the following? Maternal diabetes Neonatal jaundice Hemolytic disease of the newborn Maternal hypertension None 80. AEMT: Obstetrics and Gynecology An AEMT is assessing a pregnant patient in her third trimester who presents with unilateral swelling and pain in her left leg, along with dyspnea. What condition should be HIGHLY suspected? Deep vein thrombosis (DVT) Varicose veins Musculoskeletal injury Cellulitis None 81. AEMT: Obstetrics and Gynecology When managing a patient with a suspected ectopic pregnancy, the AEMT understands that the primary risk is: Gestational diabetes Uterine rupture Placental abruption Preterm labor None 82. AEMT: Obstetrics and Gynecology An AEMT responds to a call for a pregnant patient experiencing a seizure. Upon arrival, the patient's family reports no history of epilepsy. What is the FIRST step the AEMT should take in managing this patient? Initiate antiepileptic drug therapy Assess for signs of trauma Position the patient on her left side Administer magnesium sulfate None 83. AEMT: Obstetrics and Gynecology In a case where the AEMT observes a dark, purplish mass protruding from the vagina post-delivery, the MOST likely diagnosis is: Vaginal hematoma Uterine inversion Cervical laceration Placental remnants None 84. AEMT: Obstetrics and Gynecology During a postpartum visit, a patient reports persistent feelings of sadness, anxiety, and thoughts of harming herself or the baby. What condition should the AEMT suspect? Baby blues Postpartum depression Postpartum psychosis Normal stress of new motherhood None 85. AEMT: Obstetrics and Gynecology A pregnant patient at 30 weeks gestation presents with sudden, severe abdominal pain, a rigid abdomen, and absent fetal heart tones. What is the MOST likely diagnosis? Braxton Hicks contractions Placental abruption Uterine rupture Ectopic pregnancy None 86. AEMT: Obstetrics and Gynecology An AEMT is attending to a patient who is 2 weeks postpartum and presents with fever, uterine tenderness, and malodorous lochia. What condition is MOST likely? Endometritis Postpartum blues Urinary tract infection Mastitis None 87. AEMT: Obstetrics and Gynecology When encountering a pregnant patient with a known history of spina bifida, what is the AEMT's primary concern regarding the fetus? Chromosomal abnormalities Congenital heart defects Neurological defects Gastrointestinal defects None 88. AEMT: EMS Operations When managing a patient in a confined space rescue situation, what is the AEMT's primary consideration? Ensuring rapid patient extraction Maintaining patient privacy Coordinating with the fire department for ventilation Personal and team safety None 89. AEMT: EMS Operations What is the most appropriate AEMT response when dealing with a chemical spill at an industrial site? Begin decontamination of all workers on-site Evacuate the area and contact hazardous materials (HazMat) experts Collect samples of the chemical for analysis Neutralize the chemical with a counter-agent None 90. AEMT: EMS Operations When considering the safety of the scene, which of the following is the MOST critical aspect that an AEMT should assess first upon arrival? The presence of bystanders The nature of the incident Potential environmental hazards Availability of exit routes None 91. AEMT: EMS Operations What is the MOST appropriate action for an AEMT when dealing with a hostile patient who is verbally threatening the crew? Engage in verbal confrontation to assert control Withdraw from the scene and wait for law enforcement Restrain the patient immediately to prevent escalation Offer financial incentives to cooperate None 92. AEMT: EMS Operations During a large-scale disaster response, what is the key factor in prioritizing EMS resources? The geographic size of the affected area The total number of EMS personnel available The severity and urgency of patients' conditions The proximity to the nearest hospital None 93. AEMT: EMS Operations How should an AEMT approach the scene of a motor vehicle collision where there is a risk of vehicle fire? Enter the vehicle immediately to start patient care Secure a water source for fire suppression before approaching Approach from an upwind, uphill, and upstream position Wait for fire department clearance before approaching the scene None 94. AEMT: EMS Operations In the context of EMS operations, what is the primary purpose of utilizing the Incident Command System (ICS)? To provide legal protection for EMS personnel To establish a clear command hierarchy and improve communication To allocate financial resources for emergency operations To ensure that patients receive bills for services rendered None 95. AEMT: EMS Operations In an emergency involving hazardous materials, what is the AEMT's first priority? Decontamination of the patients Identification of the hazardous material Personal protection and safety Immediate treatment of injured patients None 96. AEMT: EMS Operations During an interfacility transfer, the AEMT notices a significant change in the patient's condition. What is the FIRST action the AEMT should take? Continue to the destination without delay Notify the receiving facility of the change in condition Stop the ambulance and wait for further instructions Return to the sending facility None 97. AEMT: EMS Operations How should an AEMT act when encountering a downed electrical wire near a vehicle accident scene? Secure the wire with non-conductive material Immediately remove patients from the vicinity of the wire Assume the wire is live and establish a safe perimeter Contact utility services to identify the wire None 98. AEMT: EMS Operations In a mass casualty incident (MCI), what is the AEMT's primary role during the triage process? Providing definitive care to critical patients Rapidly categorizing patients based on the severity of their injuries Documenting the medical history of all involved patients Transporting patients to the hospital None 99. AEMT: EMS Operations What is the primary reason for an AEMT to follow standard operating procedures (SOPs) during emergency operations? To minimize legal liability for the EMS agency To ensure consistent and predictable responses to emergencies To accelerate the promotion process within the agency To avoid interaction with other emergency services None 100. AEMT: EMS Operations When an AEMT is called to a scene where a patient is experiencing severe respiratory distress in a potentially hazardous environment, what is the initial step? Administer high-flow oxygen immediately Assess the environment for safety before patient contact Begin ventilatory support without delay Obtain a detailed patient history None 1 out of 100 Time is Up! Time's up