Free Emergency Medicine Practice Questions

Question 1

A 34-year-old man develops abrupt palpitations while at work. He is alert, has a blood pressure of 126/78 mm Hg, and has no chest pain or signs of heart failure. His ECG shows an irregular tachycardia at 210-260/min with QRS complexes that vary in width and morphology. An earlier ECG in sinus rhythm shows a short PR interval and a slurred QRS upstroke. Defibrillation pads are applied. Which intravenous drug is appropriate for this rhythm?

Accepted Answer

Procainamide

Answer

Diltiazem

Answer

Amiodarone

Answer

Adenosine

Question 2

After a 3-minute generalized seizure during a febrile illness, a 22-month-old returns to her usual behavior within 20 minutes. This is her first seizure, and it has not recurred. She is fully immunized, has normal development, and has received no antibiotics. In the emergency department she is interactive and well hydrated, with rhinorrhea but no meningismus or focal neurologic findings. The source of fever is being assessed. What additional testing does the seizure itself warrant?

Accepted Answer

No additional neurodiagnostic studies

Answer

Lumbar puncture with cerebrospinal fluid analysis

Answer

EEG to assess the risk of another seizure

Answer

Head CT to exclude an intracranial lesion

Question 3

An 81-year-old woman with atrial fibrillation and chronic kidney disease presents with sudden, severe periumbilical pain and vomiting. She is not anticoagulated. Blood pressure is 142/76 mm Hg and pulse is 104/min. Despite reporting 9/10 pain, she has only mild diffuse abdominal tenderness without guarding. Lactate is 1.6 mmol/L and creatinine is 1.8 mg/dL, unchanged from baseline. Which investigation should take priority?

Accepted Answer

CT angiography of the abdomen and pelvis

Answer

Noncontrast abdominal CT

Answer

Repeat lactate after fluids before ordering imaging

Answer

Duplex ultrasonography of the mesenteric arteries

Question 4

A 74-year-old man is evaluated for pleuritic chest discomfort. Pulse is 84/min, oxygen saturation is 97% on room air, and there are no signs of deep venous thrombosis. He has no prior venous thromboembolism, active cancer, recent surgery, or immobilization. Clinical assessment places him in the low-pretest-probability group for pulmonary embolism. A high-sensitivity D-dimer is 620 ng/mL FEU; the laboratory flags results above 500 ng/mL FEU. Under an age-adjusted D-dimer strategy, how should this result affect imaging?

Accepted Answer

Do not obtain pulmonary vascular imaging because the result is below 740 ng/mL FEU

Answer

Obtain CT pulmonary angiography because the result exceeds the laboratory's fixed cutoff

Answer

Obtain CT pulmonary angiography because the age-adjusted cutoff is 370 ng/mL FEU

Answer

Repeat the D-dimer in 6 hours and use the change to determine whether imaging is needed

Question 5

Nausea and poor oral intake bring a 56-year-old woman taking empagliflozin for type 2 diabetes to the emergency department. She has deep, rapid respirations. Glucose is 186 mg/dL, beta-hydroxybutyrate 5.6 mmol/L, bicarbonate 11 mmol/L, venous pH 7.21, and potassium 4.2 mmol/L. After an initial isotonic fluid bolus, her perfusion is adequate. Which treatment addresses the metabolic disturbance despite the glucose concentration?

Accepted Answer

An IV insulin infusion with dextrose-containing fluids

Answer

Dextrose-containing fluids without insulin

Answer

An insulin infusion, adding dextrose only if hypoglycemia develops

Answer

IV bicarbonate before insulin to normalize the pH

Question 6

A 76-year-old taking apixaban trips over a curb and strikes his head. There was no syncope, and he has no other injury. His neurologic examination is at baseline, Glasgow Coma Scale score is 15, and the initial head CT shows no hemorrhage. Four hours later, he remains asymptomatic with an unchanged examination. His wife can observe him at home and understands return precautions. No other reason for hospitalization is identified. Which disposition best fits these findings?

Accepted Answer

Discharge with his wife and explicit instructions about symptoms of delayed hemorrhage

Answer

Admit for 24 hours of neurologic observation

Answer

Continue observation until a routine 6-hour repeat head CT has excluded delayed bleeding

Answer

Hold apixaban and observe until its anticoagulant effect has worn off

Question 7

Arthrocentesis of a hot, swollen native knee yields cloudy fluid with 108,000 leukocytes/microliter, 94% neutrophils, and needle-shaped, strongly negatively birefringent crystals. Gram stain shows no organisms. The 63-year-old patient has diabetes, a history of gout, a temperature of 39.0°C, and severe pain with passive movement. Blood and synovial fluid cultures have been sent. How should the crystal and Gram-stain results influence immediate care?

Accepted Answer

Begin empiric IV antibiotics and arrange urgent joint-drainage assessment

Answer

Treat as gout with colchicine and review the cultures as an outpatient

Answer

Inject an intra-articular glucocorticoid for the crystal arthritis

Answer

Observe without antibiotics until the synovial culture is positive

Question 8

For 18 hours, a 61-year-old with hypertension has had continuous vertigo, vomiting, and difficulty walking. Symptoms are present at rest, and spontaneous nystagmus is visible. A clinician trained in HINTS testing finds unidirectional horizontal nystagmus, no corrective saccade during horizontal head impulses, and no vertical refixation on alternate cover testing. A noncontrast head CT is normal. Which finding is the decisive reason to continue evaluating for a posterior-circulation stroke?

Accepted Answer

A normal horizontal head-impulse response

Answer

Unidirectional horizontal nystagmus

Answer

Absence of vertical skew

Answer

A normal noncontrast head CT

Question 9

The ultrasound report for a 29-year-old with light vaginal spotting reads "pregnancy of unknown location." Her last menstrual period was approximately 5 weeks ago, and the pregnancy is desired. She has no abdominal pain, syncope, or peritoneal findings. Blood pressure is 118/70 mm Hg, hemoglobin is 12.8 g/dL, and beta-hCG is 1,620 mIU/mL. Transvaginal ultrasound shows no intrauterine gestational sac, adnexal mass, or significant free fluid. She has reliable follow-up and has received ectopic-pregnancy return precautions. What should happen next?

Accepted Answer

Repeat beta-hCG in 48 hours and arrange follow-up transvaginal ultrasound

Answer

Give methotrexate because no intrauterine pregnancy is visible above 1,500 mIU/mL

Answer

Perform uterine aspiration now to establish whether chorionic villi are present

Answer

Arrange routine prenatal follow-up without further serial testing

Question 10

Serial high-sensitivity troponin I values in a 68-year-old man treated for pneumonia and sepsis are 24, 118, and 286 ng/L over 6 hours; the assay's male 99th-percentile upper reference limit is 34 ng/L. His initial hypotension and hypoxemia have resolved. He reports no chest discomfort, serial ECGs show no ischemic changes, and echocardiography shows no regional wall-motion abnormality. Which classification is supported by the information available now?

Accepted Answer

Acute myocardial injury

Answer

Acute myocardial infarction from coronary plaque rupture

Answer

Acute myocardial infarction from oxygen supply-demand imbalance

Answer

Chronic myocardial injury

Free Emergency Medicine Practice Questions

Domain 2: Cardiovascular Disorders 11% of exam

Question 1

Question 2

Domain 5: Endocrine, Metabolic, & Nutritional Disorders 2% of exam

Question 3

Domain 6: Gastrointestinal and Abdominal Disorders 7% of exam

Question 4

Domain 10: Neurologic Disorders 6% of exam

Question 5

Domain 11: Obstetrics and Gynecology 5% of exam

Question 6

Domain 13: Orthopedic Disorders 7% of exam

Question 7

Domain 14: Pediatric Disorders 6% of exam

Question 8

Domain 17: Pulmonary & Respiratory Disorders 6% of exam

Question 9

Domain 20: Traumatic Disorders 11% of exam

Question 10

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