Build NREMT-style items that work. Dan Limmer and Chuck Allias sit down again with Todd Vreeland—former NREMT exam coordinator and Philly Fire medic—to turn blueprinting into crisp, Registry-style questions. They break down stems, keyed answers, and the art of writing plausible (not random) distractors; show how to keep choices equal in length and tense; and strip out “dark and stormy night” fluff so the stem follows the flow of a call. You’ll hear when negatives are fair game, how to fold repeated verbs into the stem, order numeric lists, and mine students' fill-ins for real-world distractors. They touch on timing (why MC items read in ~half a minute), updating items as guidelines evolve, and what’s different about clinical judgment/TEI items. Finish with a simple style sheet and a team review process that removes clues, raises difficulty correctly, and produces fair, focused items that separate knowing from guessing.