ABEM Qualifying Examination (QE) — Questions and Answers

Question 1: What is stroke sign?

Arm rash
Itchy eyes
Facial droop (Correct answer)
High fever

Correct answer: Facial droop

Facial droop is a classic and easily recognizable sign of a stroke, often affecting one side of the face. It occurs due to damage to the brain areas that control facial muscles. This symptom is part of the FAST mnemonic (Face, Arm, Speech, Time) and indicates a need for urgent medical evaluation for potential stroke.

Question 2: What is used to assess stroke?

FAST exam (Correct answer)
ABCDE
APGAR
BLS

Correct answer: FAST exam

The FAST exam (Face drooping, Arm weakness, Speech difficulty, Time to call emergency services) is a widely recognized and simple mnemonic used to quickly assess for common signs of a stroke. This rapid assessment helps identify potential stroke victims, enabling prompt medical attention and improving outcomes. Early recognition and treatment are critical for stroke management.

Question 3: A patient with known Addison's disease presents with hypotension, weakness, and hyponatremia with hyperkalemia. What is the immediate treatment?

IV hydrocortisone and normal saline (Correct answer)
Vasopressors first
Oral prednisone
Fludrocortisone alone

Correct answer: IV hydrocortisone and normal saline

Adrenal crisis requires immediate IV hydrocortisone (stress-dose) and aggressive IV normal saline to restore volume and cortisol deficiency.

Question 4: A patient with a stab wound to zone II of the neck is hemodynamically stable with an expanding hematoma. What is the correct management?

MRI neck
Immediate surgical exploration (Correct answer)
Observation and serial exams
CT angiography of the neck

Correct answer: Immediate surgical exploration

An expanding hematoma in zone II neck trauma indicates vascular injury requiring immediate surgical exploration.

Question 5: A 65-year-old diabetic presents with painful ophthalmoplegia, ptosis, and normal pupillary response. What is the most likely etiology?

Myasthenia gravis
Cavernous sinus thrombosis
Microvascular ischemic CN III palsy (Correct answer)
Posterior communicating artery aneurysm

Correct answer: Microvascular ischemic CN III palsy

Diabetic microvascular ischemia causes pupil-sparing CN III palsy because the pupillomotor fibers travel on the outside of the nerve and are spared by ischemia that affects the inner fibers.

Question 6: A 30-year-old with fever, painless ulcer on the penis, and bilateral inguinal lymphadenopathy is diagnosed with primary syphilis. He has a documented penicillin allergy with anaphylaxis. What is the recommended alternative?

Doxycycline 100 mg BID for 14 days
Ceftriaxone 1 g IM daily for 10 days
Desensitization followed by penicillin G benzathine (Correct answer)
Azithromycin 1 g single dose

Correct answer: Desensitization followed by penicillin G benzathine

Penicillin G benzathine is the only proven treatment for all stages of syphilis; in penicillin-allergic patients with primary syphilis, doxycycline is acceptable but desensitization is preferred in non-pregnant patients with neurosyphilis or pregnancy.

Question 7: A scuba diver surfaces too quickly and develops joint pain, dyspnea, and marbling of the skin. Which chamber pressure is used in hyperbaric oxygen therapy for decompression sickness?

2.0 ATA
1.5 ATA
2.8 ATA (Correct answer)
3.5 ATA

Correct answer: 2.8 ATA

US Navy Treatment Table 6 uses 2.8 ATA with 100% oxygen to maximize bubble reabsorption and treat decompression illness.

Question 8: A patient falls on a flexed, pronated wrist and presents with dorsal wrist pain. X-ray shows a distal radius fracture with volar angulation and dorsal displacement of the carpus. This fracture pattern is called:

Colles' fracture
Smith's fracture (Correct answer)
Chauffeur's fracture
Barton's fracture

Correct answer: Smith's fracture

Smith's fracture (reverse Colles') involves volar angulation of the distal radius, occurring from a fall on a flexed wrist, in contrast to the dorsal angulation of a Colles' fracture.

Question 9: A patient with fever and rigors after returning from sub-Saharan Africa has a peripheral blood smear showing ring-form parasites in >5% of RBCs with multiple parasites per RBC. Which malaria species is most likely?

Plasmodium falciparum (Correct answer)
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae

Correct answer: Plasmodium falciparum

Plasmodium falciparum causes high-density parasitemia (>5% RBCs infected), multiple ring forms per cell, and is responsible for cerebral malaria and life-threatening complications.

Question 10: A 25-year-old with a stab wound to the left chest develops JVD, hypotension, and muffled heart sounds. What procedure is indicated?

Bilateral needle decompression
Intubation
Chest tube insertion
Needle pericardiocentesis or ED thoracotomy (Correct answer)

Correct answer: Needle pericardiocentesis or ED thoracotomy

Beck's triad (JVD, hypotension, muffled heart sounds) indicates cardiac tamponade requiring pericardiocentesis or ED thoracotomy.

Question 11: How does the ABEM body of knowledge relate to daily professional practice?

It is relevant only for academic research
It only applies during certification exams
It provides the foundational framework that guides decision-making and standard practices (Correct answer)
It is theoretical and has limited practical application

Correct answer: It provides the foundational framework that guides decision-making and standard practices

The body of knowledge provides the foundational framework of principles, standards, and best practices that professionals use to guide their daily decision-making, ensure consistent quality, and maintain alignment with industry standards.

Question 12: A patient with a known seizure disorder is brought in seizing. He received 4 mg of lorazepam IV and continues to seize at 10 minutes. What is the next intervention?

Proceed directly to intubation and propofol
Administer phenobarbital 20 mg/kg IV
Load with fosphenytoin or levetiracetam IV (Correct answer)
Administer a second dose of lorazepam 4 mg IV

Correct answer: Load with fosphenytoin or levetiracetam IV

After benzodiazepine failure, the next step in status epilepticus management per guidelines is a second-line antiepileptic such as fosphenytoin, valproate, or levetiracetam.

Question 13: What is the PRIMARY purpose of obtaining ABEM certification in American Board of Emergency Medicine?

To demonstrate verified competency and adherence to professional standards (Correct answer)
To bypass educational requirements
To satisfy a personal achievement goal
To guarantee employment in the field

Correct answer: To demonstrate verified competency and adherence to professional standards

Professional certification demonstrates that an individual has met established competency standards through verified assessment. It provides assurance to employers, clients, and the public that the certified professional possesses the knowledge and skills required for competent practice.

Question 14: A patient on ACE inhibitor presents with serum potassium of 6.8 mEq/L and peaked T-waves on ECG. What is the FIRST treatment to administer?

Insulin plus dextrose
Kayexalate
Calcium gluconate IV (Correct answer)
Sodium bicarbonate IV

Correct answer: Calcium gluconate IV

Calcium gluconate is the first-line treatment in hyperkalemia with ECG changes because it stabilizes the cardiac membrane immediately.

Question 15: A 58-year-old male presents with acute onset tearing chest pain radiating to the back, BP 180/100 in the right arm and 140/85 in the left arm. The most likely diagnosis is:

Esophageal rupture
STEMI
Aortic dissection (Correct answer)
Pulmonary embolism

Correct answer: Aortic dissection

Aortic dissection classically presents with tearing back pain and a blood pressure differential >20 mmHg between arms.

Question 16: A patient presents with fever, hepatosplenomegaly, and pancytopenia after returning from a tropical trip; a bone marrow biopsy shows macrophages engulfing red blood cells and platelets. What is the diagnosis?

Disseminated histoplasmosis
Malignant tertian malaria
Hemophagocytic lymphohistiocytosis
Visceral leishmaniasis (kala-azar) (Correct answer)

Correct answer: Visceral leishmaniasis (kala-azar)

Visceral leishmaniasis (kala-azar) causes macrophage invasion of the reticuloendothelial system, presenting with fever, massive splenomegaly, and pancytopenia in a returning traveler.

Question 17: A 45-year-old presents with sudden facial drooping involving the forehead, inability to close the eye, and loss of taste on the anterior two-thirds of the tongue. What is the most likely diagnosis?

Bell's palsy (idiopathic peripheral CN VII palsy) (Correct answer)
Ramsay Hunt syndrome
Central (cortical) stroke affecting CN VII
Acoustic neuroma

Correct answer: Bell's palsy (idiopathic peripheral CN VII palsy)

Peripheral CN VII palsy (Bell's palsy) involves upper and lower face including forehead, distinguishing it from central lesions which spare the forehead due to bilateral cortical representation.

Question 18: What helps de-escalate agitated patient?

Restraints only
Sedation first
Yelling
Verbal de-escalation (Correct answer)

Correct answer: Verbal de-escalation

Verbal de-escalation techniques are the preferred first-line approach for managing agitated patients, aiming to reduce their distress and prevent escalation to physical aggression. This involves using calm, respectful communication, active listening, empathy, and offering choices to help the patient regain control and cooperate with care. It prioritizes patient safety and autonomy over immediate physical restraint or sedation.

Question 19: When performing a diagnostic peritoneal lavage (DPL), a positive result for blunt abdominal trauma includes which finding?

Bile on gross inspection only
Amylase > 20 IU/L
RBC > 100,000 cells/µL on lavage return (Correct answer)
WBC > 100 cells/µL on lavage return

Correct answer: RBC > 100,000 cells/µL on lavage return

DPL is positive for hemoperitoneum when lavage fluid contains >100,000 RBC/µL in blunt trauma.

Question 20: A 70-year-old presents with sudden loss of pain and temperature sensation over his right arm and leg, with left-sided face numbness, and left-sided Horner syndrome. Which vessel is most likely occluded?

Left anterior inferior cerebellar artery
Right anterior cerebral artery
Left posterior inferior cerebellar artery (Correct answer)
Right middle cerebral artery

Correct answer: Left posterior inferior cerebellar artery

Left PICA occlusion causes lateral medullary (Wallenberg) syndrome with left-sided Horner and facial sensory loss, and crossed (right-sided) body pain/temperature loss via spinothalamic tract.

Question 21: A patient presents with tetanus following a puncture wound. Which medication directly addresses the pathophysiology of muscle spasms in tetanus?

Penicillin G
Metronidazole
Benzodiazepines (Correct answer)
Tetanus immune globulin (TIG)

Correct answer: Benzodiazepines

Tetanus toxin blocks inhibitory neurotransmitter release (glycine and GABA), causing muscle spasms best managed with benzodiazepines that enhance GABA activity.

Question 22: During thoracentesis for a large hemothorax, you immediately drain 1,500 mL of blood. What does this finding indicate?

Chylothorax
Normal post-traumatic finding
Lung laceration only
Massive hemothorax requiring immediate thoracotomy (Correct answer)

Correct answer: Massive hemothorax requiring immediate thoracotomy

Immediate drainage of ≥1,500 mL blood (or >200 mL/hr) indicates massive hemothorax requiring operative intervention.

Question 23: Which foundational principle is MOST important for success in the American Board of Emergency Medicine profession?

Maximizing financial returns on every engagement
Specializing in only one narrow area of practice
Commitment to continuous learning, ethical practice, and quality outcomes (Correct answer)
Maintaining the minimum requirements for certification

Correct answer: Commitment to continuous learning, ethical practice, and quality outcomes

Success in any professional field requires a commitment to continuous learning to stay current, ethical practice to maintain trust and integrity, and a focus on quality outcomes that serve stakeholders and the public interest.

Question 24: A ABEM professional discovers a conflict of interest in a current assignment. What is the MOST ethical course of action?

Ignore it if no one else has noticed
Disclose the conflict immediately and recuse if necessary (Correct answer)
Continue the assignment but document the conflict later
Handle it privately without informing stakeholders

Correct answer: Disclose the conflict immediately and recuse if necessary

Ethical standards require immediate disclosure of conflicts of interest. Transparency protects both the professional's integrity and the stakeholders' interests. Recusal may be necessary to maintain objectivity.

Question 25: A patient presents with fever, cough, and bilateral hilar lymphadenopathy after disturbing bat guano in an Ohio cave. Bronchoalveolar lavage reveals intracellular yeast within macrophages. What is the treatment for severe pulmonary disease?

Amphotericin B lipid complex (Correct answer)
Voriconazole IV loading dose
Fluconazole 400 mg daily PO
Itraconazole 200 mg TID for 3 days then BID

Correct answer: Amphotericin B lipid complex

Severe or disseminated histoplasmosis requires amphotericin B lipid formulation as initial therapy, followed by step-down to itraconazole after clinical improvement.

Question 26: A trauma patient requiring emergent intubation has a full stomach. Which RSI modification reduces aspiration risk?

Pre-oxygenation with BVM at high flow
Rapid sequence with minimal bag-mask ventilation (Correct answer)
Positioning the patient in reverse Trendelenburg
Sellick maneuver (cricoid pressure) during bag-mask ventilation

Correct answer: Rapid sequence with minimal bag-mask ventilation

RSI with succinylcholine or rocuronium minimizes the interval of apnea without bag-mask ventilation to reduce aspiration risk in full stomach.

Question 27: A patient with end-stage renal disease on dialysis presents with shortness of breath, JVD, crackles, and BP 200/110. What is the most appropriate ED treatment?

Morphine and observation
Beta-blockers only
Nitroglycerin and emergent dialysis (Correct answer)
Furosemide 40 mg IV

Correct answer: Nitroglycerin and emergent dialysis

ESRD patients are anuric and unresponsive to diuretics; nitroglycerin for afterload reduction and emergent dialysis is definitive treatment for flash pulmonary edema.

Question 28: A 30-year-old female presents with acute knee injury after pivoting. To test anterior cruciate ligament integrity, which maneuver is performed with the knee at 20-30 degrees of flexion while translating the tibia anteriorly on the femur?

Valgus stress test
Patellar apprehension test
Lachman test (Correct answer)
McMurray test

Correct answer: Lachman test

The Lachman test is the most sensitive clinical test for ACL rupture, performed at 20-30 degrees of flexion to relax the posterior capsule and isolate ACL function.

Question 29: A patient on lithium presents with coarse tremor, ataxia, and confusion with a lithium level of 2.8 mEq/L. Which intervention is most critical?

Administer sodium bicarbonate IV
Administer thiamine 100 mg IV
Begin hemodialysis (Correct answer)
Give activated charcoal

Correct answer: Begin hemodialysis

Severe lithium toxicity (level >2.5 mEq/L with neurological symptoms) requires hemodialysis, as lithium is not protein-bound and is dialyzable.

Question 30: A ABEM certified professional is asked to provide services outside their scope of competence. The CORRECT ethical response is to:

Accept the work to gain new experience
Accept and learn as they go
Decline and refer to a qualified professional (Correct answer)
Accept but charge a lower rate

Correct answer: Decline and refer to a qualified professional

Ethical practice requires professionals to work within their scope of competence. Accepting work beyond one's qualifications can lead to substandard results and potential harm. Referring to qualified professionals ensures proper service delivery.

Question 31: How does the ABEM body of knowledge relate to daily professional practice?

It provides the foundational framework that guides decision-making and standard practices (Correct answer)
It is theoretical and has limited practical application
It is relevant only for academic research
It only applies during certification exams

Correct answer: It provides the foundational framework that guides decision-making and standard practices

Question 32: A 35-year-old is restrained in a head-on collision. He presents with his right hip in flexion, adduction, and internal rotation with severe pain. What is the most likely diagnosis?

Posterior hip dislocation (Correct answer)
Anterior hip dislocation
Intertrochanteric hip fracture
Central acetabular fracture-dislocation

Correct answer: Posterior hip dislocation

Posterior hip dislocation, the most common type, presents with the hip flexed, adducted, and internally rotated — the classic 'dashboard injury' pattern.

Question 33: An 8-month-old presents with high fever, bulging anterior fontanelle, and irritability. What is the most appropriate next step?

CT head before lumbar puncture
IV antibiotics then lumbar puncture (Correct answer)
Lumbar puncture immediately
Blood cultures only

Correct answer: IV antibiotics then lumbar puncture

IV antibiotics should be administered promptly in suspected bacterial meningitis before LP if signs of elevated ICP are present.

Question 34: A 4-year-old swallowed a button battery 3 hours ago. X-ray shows it in the esophagus. What is the correct management?

Immediate endoscopic removal (Correct answer)
Administer activated charcoal
Induce vomiting
Observe 24 hours and repeat X-ray

Correct answer: Immediate endoscopic removal

Esophageal button batteries require immediate endoscopic removal due to rapid tissue necrosis from electrical current and alkaline injury.

Question 35: Which finding on bedside ultrasound is MOST diagnostic of pneumothorax?

Mirror image artifact
B-lines bilaterally
Hepatization of lung tissue
Absence of lung sliding with A-lines (Correct answer)

Correct answer: Absence of lung sliding with A-lines

Absence of lung sliding combined with A-lines (and a lung point) on ultrasound is highly sensitive and specific for pneumothorax.

Question 36: A patient is bitten by a copperhead snake and develops local swelling to the forearm. Which of the following is the STRONGEST indication for antivenom (Crotalidae polyvalent immune Fab)?

Isolated thrombocytopenia without bleeding
Bite site pain and erythema only
Swelling progressing across one joint boundary (Correct answer)
Nausea and vomiting without systemic bleeding

Correct answer: Swelling progressing across one joint boundary

Rapidly progressive edema crossing joint boundaries indicates significant envenomation and warrants antivenom (CroFab) to prevent compartment syndrome and tissue necrosis.

Question 37: Which foundational principle is MOST important for success in the American Board of Emergency Medicine profession?

Maintaining the minimum requirements for certification
Maximizing financial returns on every engagement
Commitment to continuous learning, ethical practice, and quality outcomes (Correct answer)
Specializing in only one narrow area of practice

Correct answer: Commitment to continuous learning, ethical practice, and quality outcomes

Question 38: A ABEM certified professional is asked to provide services outside their scope of competence. The CORRECT ethical response is to:

Decline and refer to a qualified professional (Correct answer)
Accept but charge a lower rate
Accept and learn as they go
Accept the work to gain new experience

Correct answer: Decline and refer to a qualified professional

Question 39: What causes altered mental status?

Blood loss
Anxiety
Multiple causes (Correct answer)
Only drugs

Correct answer: Multiple causes

Altered mental status (AMS) is a broad term indicating a change in a person's usual level of awareness or responsiveness. It can be caused by a wide array of medical conditions, including metabolic disturbances (e.g., hypoglycemia, electrolyte imbalances), infections, drug overdose, head injuries, stroke, hypoxia, and psychiatric conditions. Therefore, a thorough diagnostic workup is essential to identify the underlying cause.

Question 40: A patient presents with narrow-complex tachycardia at 160 bpm, regular rhythm, and hemodynamic stability. Vagal maneuvers fail. What is the FIRST-LINE pharmacologic treatment?

Diltiazem 0.25 mg/kg IV
Metoprolol 5mg IV
Amiodarone 150mg IV
Adenosine 6mg rapid IV push (Correct answer)

Correct answer: Adenosine 6mg rapid IV push

Adenosine 6mg rapid IV push is first-line for stable SVT because it transiently blocks AV nodal conduction and terminates re-entry circuits.

Question 41: A patient arrives in hemorrhagic shock after a high-speed MVA. Pelvis is unstable on examination with an 'open book' pattern on X-ray. Despite 2L of IV crystalloid, BP remains 70/40. What is the most immediate intervention?

Apply a pelvic binder and activate massive transfusion protocol (Correct answer)
Emergent CT angiography of the pelvis
Immediate exploratory laparotomy
Bilateral femoral arterial angioembolization

Correct answer: Apply a pelvic binder and activate massive transfusion protocol

A pelvic binder reduces pelvic volume and tamponades venous hemorrhage from the pelvic plexus while MTP addresses the lethal triad of coagulopathy.

Question 42: A patient presents with locked-in syndrome after a pontine stroke. Which finding would you expect on examination?

Decerebrate posturing with intact consciousness
Preserved vertical gaze and blinking with quadriplegia (Correct answer)
Absence of all brainstem reflexes
Bilateral miosis and pinpoint pupils only

Correct answer: Preserved vertical gaze and blinking with quadriplegia

Locked-in syndrome from ventral pontine lesions spares the midbrain, preserving vertical eye movements and blinking (controlled by CN III/IV and superior colliculus) while causing quadriplegia.

Question 43: What is a common asthma treatment?

Aspirin
Albuterol (Correct answer)
Insulin
Atropine

Correct answer: Albuterol

Albuterol is a short-acting beta-agonist (SABA) bronchodilator commonly used to treat asthma symptoms. It works by relaxing the smooth muscles in the airways, opening them up and making it easier to breathe. This medication provides rapid relief for acute asthma attacks and is a cornerstone of asthma management.

Question 44: A patient presents with altered mental status, hyperthermia, lead-pipe rigidity, and markedly elevated CPK after starting haloperidol two weeks ago. What distinguishes neuroleptic malignant syndrome (NMS) from serotonin syndrome?

NMS presents with diarrhea; SS presents with constipation
NMS has slower onset and lead-pipe rigidity; SS has rapid onset and clonus/hyperreflexia (Correct answer)
NMS always has a higher temperature than SS
NMS is caused by serotonin excess; SS is caused by dopamine blockade

Correct answer: NMS has slower onset and lead-pipe rigidity; SS has rapid onset and clonus/hyperreflexia

NMS develops over days-weeks with lead-pipe rigidity and lacks the clonus/hyperreflexia of serotonin syndrome, which has rapid onset (hours) after serotonergic drug exposure.

Question 45: A 7-year-old presents with 3 days of fever, hip pain, and refusal to bear weight. WBC is 18,500, ESR 60, CRP 4.8 mg/dL, and temperature 38.9°C — meeting all 4 Kocher criteria. Ultrasound shows an effusion. What is the definitive treatment?

IV antibiotics alone for 6 weeks
NSAIDs and bed rest with repeat labs in 48 hours
Emergent surgical joint irrigation and debridement (Correct answer)
Joint aspiration alone with IV antibiotics

Correct answer: Emergent surgical joint irrigation and debridement

Septic arthritis of the hip requires emergent surgical irrigation and debridement plus antibiotics to prevent articular cartilage destruction and avascular necrosis.

Question 46: What is a FAST exam used for?

Head trauma
Infection
Internal bleeding (Correct answer)
Liver enzymes

Correct answer: Internal bleeding

A FAST (Focused Assessment with Sonography for Trauma) exam is a rapid ultrasound scan performed in emergency settings. Its primary purpose is to quickly identify free fluid, typically blood, in specific body cavities like the pericardium, perihepatic, perisplenic, and pelvic regions. This helps detect significant internal bleeding in trauma patients, guiding immediate management decisions.

Question 47: A 45-year-old woman presents with sudden syncope. ECG shows a prolonged QTc of 520ms and polymorphic VT. The first-line treatment is:

Magnesium sulfate IV (Correct answer)
Lidocaine IV
Amiodarone IV
Synchronized cardioversion

Correct answer: Magnesium sulfate IV

Torsades de pointes (polymorphic VT with prolonged QT) is treated first with IV magnesium sulfate 1-2g regardless of serum magnesium level.

Question 48: A patient with pelvic fracture and hemodynamic instability has a negative FAST. What is the next most appropriate intervention?

DPL
CT pelvis with contrast
Repeat FAST
Pelvic binder application and angioembolization or operative packing (Correct answer)

Correct answer: Pelvic binder application and angioembolization or operative packing

Pelvic binder reduces pelvic volume and hemorrhage; angioembolization or preperitoneal packing addresses arterial and venous bleeding.

Question 49: A patient presents with fever, neck stiffness, and photophobia. CSF shows glucose 30 mg/dL, protein 180 mg/dL, and 800 WBC/µL (90% neutrophils). Which empiric antibiotic regimen is most appropriate for an immunocompetent adult?

Vancomycin + ceftriaxone + ampicillin
Ceftriaxone alone
Meropenem + vancomycin
Vancomycin + ceftriaxone + dexamethasone (Correct answer)

Correct answer: Vancomycin + ceftriaxone + dexamethasone

Bacterial meningitis in an immunocompetent adult is treated with vancomycin plus a third-generation cephalosporin; dexamethasone reduces inflammation and improves outcomes, particularly in S. pneumoniae meningitis.

Question 50: In American Board of Emergency Medicine, what is the PRIMARY purpose of conducting regular safety drills and exercises?

To evaluate employee performance reviews
To ensure personnel can respond effectively in emergencies (Correct answer)
To satisfy insurance requirements only
To reduce daily workload

Correct answer: To ensure personnel can respond effectively in emergencies

Regular safety drills ensure that all personnel are prepared to respond effectively during actual emergencies. Practice builds muscle memory, identifies gaps in emergency procedures, and improves overall response times.

Question 51: When a ABEM professional faces pressure to compromise professional standards, the BEST response is to:

Comply to maintain workplace relationships
Document the pressure and uphold professional standards (Correct answer)
Ignore the pressure and continue without reporting
Immediately resign from the position

Correct answer: Document the pressure and uphold professional standards

Professionals should document any pressure to compromise standards and continue upholding their professional obligations. Documentation creates a record of the situation while maintaining ethical integrity.

Question 52: A 55-year-old presents with thunderclap headache of maximal intensity at onset. CT head is negative. What is the next most appropriate step?

Order MRI brain without contrast
Start IV dexamethasone
Perform lumbar puncture to evaluate for xanthochromia (Correct answer)
Discharge with analgesics and neurology follow-up

Correct answer: Perform lumbar puncture to evaluate for xanthochromia

A negative CT does not rule out subarachnoid hemorrhage; lumbar puncture to detect xanthochromia is required when CT is negative in the setting of thunderclap headache.

Question 53: A newborn delivered in the ED has no spontaneous respirations. After drying and stimulation, the heart rate is 80 bpm. What is the next step?

IV epinephrine
Chest compressions
Positive pressure ventilation (Correct answer)
Intubation only

Correct answer: Positive pressure ventilation

Positive pressure ventilation is indicated when HR is below 100 bpm or respirations are absent after initial newborn stabilization steps.

Question 54: A patient with diabetes presents with nausea, vomiting, blood glucose 520 mg/dL, pH 7.20, bicarbonate 10, and ketones positive. What is the most critical initial intervention?

Insulin infusion immediately
IV fluid resuscitation with normal saline (Correct answer)
Dextrose 50% IV
Sodium bicarbonate infusion

Correct answer: IV fluid resuscitation with normal saline

IV fluid resuscitation is the most critical first step in DKA to restore intravascular volume before initiating insulin therapy.

Question 55: A construction worker collapses on a hot summer day with core temperature of 41.5°C, anhidrosis, and delirium. What is the MOST effective cooling method to reduce core temperature rapidly?

Misting fans and evaporative cooling
Ice water immersion (Correct answer)
Ice packs to axillae, groin, and neck
Cooling blanket set at 20°C

Correct answer: Ice water immersion

Ice water immersion provides the fastest rate of core cooling (0.2°C/min) for exertional heat stroke and is the gold standard cooling method.

Question 56: What is the MOST effective way for new ABEM professionals to build competency in their field?

Studying certification materials exclusively
Learning entirely through trial and error
Combining formal education, mentored practice, and ongoing professional development (Correct answer)
Focusing solely on the most advanced topics

Correct answer: Combining formal education, mentored practice, and ongoing professional development

Building professional competency requires a multi-faceted approach: formal education provides foundational knowledge, mentored practice develops applied skills under guidance, and ongoing professional development ensures continuous growth and currency in the field.

Question 57: A 25-year-old at 10 weeks gestation presents with vaginal bleeding and an empty uterus on ultrasound with no intrauterine pregnancy. β-hCG is 1,800 mIU/mL. What is the next step?

Repeat β-hCG in 48 hours (Correct answer)
Emergency laparotomy
Dilation and curettage
Immediate methotrexate

Correct answer: Repeat β-hCG in 48 hours

When β-hCG is below the discriminatory zone (~2,000 mIU/mL) and no IUP is seen, serial β-hCG in 48 hours is appropriate to differentiate ectopic from early IUP.

Question 58: What tool evaluates mental status?

ABG
CBC
GCS (Correct answer)
BMI

Correct answer: GCS

The Glasgow Coma Scale (GCS) is a standardized neurological assessment tool used to objectively measure a person's level of consciousness. It evaluates eye-opening, verbal response, and motor response, providing a numerical score that helps clinicians assess the severity of brain injury or altered mental status and monitor changes over time.

Question 59: A hiker returns from the Appalachian Trail with fever, headache, and a petechial rash spreading centripetally from the wrists and ankles. What is the treatment of choice?

Amoxicillin-clavulanate
Azithromycin
Ceftriaxone
Doxycycline (Correct answer)

Correct answer: Doxycycline

Doxycycline is the drug of choice for Rocky Mountain Spotted Fever (Rickettsia rickettsii) in all age groups, including children.

Question 60: A 22-year-old college student presents with fever, severe headache, photophobia, and a non-blanching petechial rash. Which action is most critical and time-sensitive?

Give dexamethasone and await CT results
Obtain blood cultures before any treatment
Administer IV ceftriaxone immediately without waiting for LP (Correct answer)
Perform LP to identify organism before antibiotics

Correct answer: Administer IV ceftriaxone immediately without waiting for LP

Bacterial meningitis with petechial rash (suggesting meningococcemia) requires immediate IV antibiotics; any delay for cultures or CT is unacceptable given mortality risk.

Question 61: A 20-year-old football player receives a direct blow to his shoulder and develops a visible step deformity with elevation of the distal clavicle. Which structures are disrupted in a grade III acromioclavicular separation?

Glenohumeral joint capsule and rotator cuff
Both the acromioclavicular and coracoclavicular ligaments (Correct answer)
The supraspinatus and infraspinatus tendons
The sternoclavicular ligament complex

Correct answer: Both the acromioclavicular and coracoclavicular ligaments

Grade III AC separation involves complete disruption of both the AC and coracoclavicular (conoid and trapezoid) ligaments, allowing complete clavicular elevation.

Question 62: What is the first action in suspected sepsis?

Steroids
Painkillers
Antibiotics (Correct answer)
Oxygen only

Correct answer: Antibiotics

Sepsis is a life-threatening condition caused by the body's overwhelming response to an infection, leading to organ dysfunction. Administering broad-spectrum antibiotics as quickly as possible is critical in suspected sepsis to target the underlying infection and prevent its progression. Early antibiotic therapy significantly improves patient outcomes and survival rates.

Question 63: A patient develops diffuse muscle pain, dark urine, and AKI after a severe rattlesnake envenomation. Which complication is most directly responsible for the renal injury?

Hypotension-related ischemia
Disseminated intravascular coagulation
Myoglobinuria from venom-induced rhabdomyolysis (Correct answer)
Direct nephrotoxin in venom

Correct answer: Myoglobinuria from venom-induced rhabdomyolysis

Crotalid venom causes myonecrosis and rhabdomyolysis; the resulting myoglobinuria precipitates in renal tubules and causes acute tubular necrosis.

Question 64: What is used for insecticide poisoning?

Insulin
Atropine (Correct answer)
Lidocaine
Naloxone

Correct answer: Atropine

Organophosphate insecticide poisoning causes overstimulation of the parasympathetic nervous system due to inhibition of acetylcholinesterase. Atropine is the primary antidote, acting as a competitive antagonist at muscarinic acetylcholine receptors. It helps reverse life-threatening symptoms like bradycardia, bronchospasm, and excessive secretions.

Question 65: A 28-year-old asthmatic presents with severe wheezing, cannot speak in full sentences, HR 128, and SpO2 88%. After initial bronchodilators, what adjunct treatment is MOST appropriate?

Ipratropium nebulization only
IV aminophylline
Systemic corticosteroids (Correct answer)
Immediate intubation

Correct answer: Systemic corticosteroids

Systemic corticosteroids (IV methylprednisolone or oral prednisone) reduce airway inflammation and decrease length of stay in severe asthma exacerbations.

Question 66: A 45-year-old new mother presents with radial-sided wrist pain at the base of the thumb that worsens with gripping and pinching. Finkelstein test reproduces her pain. What is the diagnosis?

Occult scaphoid fracture
First carpometacarpal joint osteoarthritis
De Quervain's tenosynovitis (Correct answer)
Carpal tunnel syndrome

Correct answer: De Quervain's tenosynovitis

De Quervain's tenosynovitis is inflammation of the APL and EPB tendons in the first dorsal compartment; Finkelstein's test (thumb in fist with ulnar deviation) is the diagnostic maneuver.

Question 67: Which of the following is the MOST appropriate management of severe hypothermia (core temp 25°C) with ventricular fibrillation refractory to three defibrillation attempts?

Initiate extracorporeal membrane oxygenation (ECMO) rewarming
Perform urgent cardiopulmonary bypass in the ED
Continue CPR and withhold further shocks until rewarmed to ≥30°C (Correct answer)
Administer amiodarone 300 mg IV and shock every 2 minutes

Correct answer: Continue CPR and withhold further shocks until rewarmed to ≥30°C

In severe hypothermia, pharmacologic and electrical therapies are largely ineffective below 30°C; CPR should be maintained and rewarming prioritized before repeating defibrillation.

Question 68: A 50-year-old presents with acute onset severe headache after intercourse. CT and LP are negative for subarachnoid hemorrhage. What is the most likely diagnosis?

Primary thunderclap headache / coital cephalgia (Correct answer)
Basilar migraine
Cerebral venous sinus thrombosis
Cluster headache

Correct answer: Primary thunderclap headache / coital cephalgia

Primary thunderclap headache (coital or exertional cephalgia) can mimic SAH and must be a diagnosis of exclusion after negative workup.

Question 69: In cardiac tamponade, Beck's triad includes hypotension, muffled heart sounds, and:

Pulsus alternans
Jugular venous distension (Correct answer)
Tracheal deviation
Bradycardia

Correct answer: Jugular venous distension

Beck's triad consists of hypotension, muffled heart sounds, and jugular venous distension (JVD) due to impaired cardiac filling.

Question 70: What documentation is MOST critical to maintain for safety compliance in the American Board of Emergency Medicine field?

Client marketing preferences
Annual revenue reports
Employee vacation schedules
Incident reports, training records, and inspection logs (Correct answer)

Correct answer: Incident reports, training records, and inspection logs

Incident reports, training records, and inspection logs are essential safety documentation. They demonstrate compliance with safety regulations, track training completion, and provide evidence of systematic hazard management.

Question 71: Which finding during FAST examination suggests cardiac tamponade?

Pericardial effusion with diastolic right heart collapse (Correct answer)
Right ventricular dilation
Aortic root dilation
Hypokinetic left ventricle

Correct answer: Pericardial effusion with diastolic right heart collapse

Pericardial effusion with diastolic collapse of the right ventricle on FAST indicates tamponade physiology.

Question 72: A neonate is born with a heart rate of 50 bpm and no spontaneous respirations after 30 seconds of PPV. What is the next step?

Start chest compressions and continue PPV (Correct answer)
IV epinephrine immediately
Intubate only
Continue PPV alone

Correct answer: Start chest compressions and continue PPV

Chest compressions are initiated when HR remains below 60 bpm despite 30 seconds of adequate PPV in neonatal resuscitation.

Question 73: What PPE is essential in infection control?

Thermometer
Cap only
Shoes
Gloves and mask (Correct answer)

Correct answer: Gloves and mask

Gloves and masks are essential components of Personal Protective Equipment (PPE) for infection control. Gloves protect healthcare workers from direct contact with blood, body fluids, and contaminated surfaces, while masks prevent the inhalation of airborne pathogens and the spread of respiratory droplets. Together, they form a crucial barrier against transmission.

Question 74: Which foundational principle is MOST important for success in the American Board of Emergency Medicine profession?

Specializing in only one narrow area of practice
Maximizing financial returns on every engagement
Commitment to continuous learning, ethical practice, and quality outcomes (Correct answer)
Maintaining the minimum requirements for certification

Correct answer: Commitment to continuous learning, ethical practice, and quality outcomes

Question 75: What is suicide risk factor?

History of attempt (Correct answer)
Good grades
No insurance
Sibling illness

Correct answer: History of attempt

A history of previous suicide attempts is one of the strongest predictors and highest risk factors for future suicide. Individuals who have attempted suicide before are at a significantly increased risk of making another attempt, underscoring the importance of recognizing this history and providing ongoing support and intervention.

Question 76: Which rhythm requires defibrillation?

Ventricular fibrillation (Correct answer)
Asystole
Sinus rhythm
Bradycardia

Correct answer: Ventricular fibrillation

Ventricular fibrillation (VF) is a chaotic electrical activity in the ventricles that prevents the heart from pumping blood effectively, leading to cardiac arrest. Defibrillation, which delivers an electrical shock, is the definitive treatment for VF because it aims to reset the heart's electrical activity, allowing a normal rhythm to resume. Asystole, a flatline rhythm, indicates no electrical activity and does not respond to defibrillation.

Question 77: A patient presents after a tonic-clonic seizure. Which finding on history or exam would most urgently warrant a CT head before lumbar puncture?

New focal neurological deficit with GCS 12 (Correct answer)
Post-ictal drowsiness resolving over 20 minutes
Known seizure disorder with breakthrough seizure
Single provoked seizure after alcohol binge

Correct answer: New focal neurological deficit with GCS 12

New focal neurological deficits after seizure may indicate an intracranial mass or hemorrhage; CT must precede LP to rule out herniation risk.

Question 78: What is priority in head trauma?

Feed patient
Draw labs
Spine and GCS (Correct answer)
Check pulse

Correct answer: Spine and GCS

In head trauma, ensuring cervical spine immobilization is paramount to prevent further neurological injury, as concurrent spinal cord injury is common. Assessing the Glasgow Coma Scale (GCS) is crucial for evaluating the patient's level of consciousness and neurological status, which guides immediate management and helps monitor changes over time. These are critical components of the primary survey in trauma.

Question 79: How is heat stroke treated?

Cool and hydrate (Correct answer)
Hot packs
Antibiotics
Steroids

Correct answer: Cool and hydrate

Heat stroke is a severe, life-threatening condition caused by the body overheating, often due to prolonged exposure to high temperatures or physical exertion in the heat. The primary treatment involves rapid cooling of the body, such as with ice packs or cool water immersion, and rehydration to lower core body temperature and restore fluid balance.

Question 80: Which tool is used to stop external bleeding?

Tourniquet (Correct answer)
Bandage
Stethoscope
IV catheter

Correct answer: Tourniquet

A tourniquet is a life-saving device specifically designed to apply circumferential pressure to a limb, thereby occluding arterial blood flow. This extreme pressure is highly effective in stopping severe, life-threatening external bleeding that cannot be controlled by direct pressure alone. While bandages cover wounds, a tourniquet actively stops the hemorrhage.

Question 81: A motorcyclist is brought in after a high-speed crash with a GCS of 8, bilateral femur fractures, and BP 80/50. After two large-bore IVs and 2L crystalloid, BP remains 85/55. What is the priority?

Activate massive transfusion protocol and FAST exam (Correct answer)
Pelvic binder application only
Foley catheter insertion
CT scan of head and abdomen

Correct answer: Activate massive transfusion protocol and FAST exam

Persistent hypotension after initial resuscitation warrants MTP activation and bedside FAST to identify hemorrhage source.

Question 82: A child presents with fever, refusal to bear weight, and a painful hip held in flexion and external rotation. Which finding best distinguishes septic arthritis from transient synovitis?

WBC > 12,000 and fever > 38.5°C (Correct answer)
Duration of symptoms
ESR > 40 mm/hr alone
Age of the patient

Correct answer: WBC > 12,000 and fever > 38.5°C

The Kocher criteria (fever >38.5°C, WBC >12,000, ESR >40, non-weight-bearing) help differentiate septic arthritis from transient synovitis.

Question 83: A 10-year-old presents with acute onset severe scrotal pain for 2 hours. What is the priority management?

Ultrasound then urology consult
Immediate surgical exploration (Correct answer)
Doppler ultrasound only
Analgesics and observation

Correct answer: Immediate surgical exploration

Testicular torsion requires immediate surgical exploration; time to detorsion directly determines testicular salvage rates.

Question 84: An 18-month-old presents with a femur fracture with a history inconsistent with the injury. What is the most appropriate next step?

Non-accidental trauma workup and child protective services notification (Correct answer)
Genetic workup for osteogenesis imperfecta
Discharge with orthopedics follow-up
Bone density scan

Correct answer: Non-accidental trauma workup and child protective services notification

A femur fracture in a pre-ambulatory child with an inconsistent history is highly concerning for non-accidental trauma and mandates a full workup and CPS notification.

Question 85: A patient sustains a closed mid-shaft femur fracture after a motor vehicle collision. Approximately how much blood can accumulate in the thigh from this injury?

2500-3000 mL
250-500 mL
1000-1500 mL (Correct answer)
500-750 mL

Correct answer: 1000-1500 mL

A closed femur fracture can cause 1,000-1,500 mL of blood loss into the thigh, enough to precipitate hemorrhagic shock even without external bleeding.

Question 86: A patient sustains a crush injury to the left thigh. Six hours later he develops severe calf pain with passive stretch, tense compartments, and paresthesias. Compartment pressure is 38 mmHg and diastolic BP is 65 mmHg. What is the threshold for fasciotomy?

Compartment pressure > 30 mmHg absolute
Compartment pressure > 40 mmHg absolute
Delta pressure (diastolic BP - compartment pressure) < 30 mmHg (Correct answer)
Clinical signs alone regardless of pressure

Correct answer: Delta pressure (diastolic BP - compartment pressure) < 30 mmHg

Fasciotomy is indicated when the delta pressure (diastolic BP minus compartment pressure) falls below 30 mmHg.

Question 87: Which feature best differentiates Todd's paralysis from an acute ischemic stroke in a patient with post-ictal focal weakness?

Presence of headache
Elevated blood pressure
Gradual resolution of weakness over minutes to hours (Correct answer)
Abnormal CT head

Correct answer: Gradual resolution of weakness over minutes to hours

Todd's paralysis (post-ictal paresis) typically resolves within minutes to hours after a seizure, whereas stroke deficits are persistent.

Question 88: A 16-year-old female presents with lower abdominal pain, fever, and cervical motion tenderness. What is the most likely diagnosis?

Appendicitis
Ovarian torsion
Ruptured ectopic pregnancy
Pelvic inflammatory disease (Correct answer)

Correct answer: Pelvic inflammatory disease

The classic triad of lower abdominal pain, adnexal tenderness, and cervical motion tenderness in a sexually active female indicates PID.

Question 89: Which type of shock is expected in a patient with blunt cardiac injury causing right ventricular failure after sternal fracture?

Hemorrhagic
Distributive
Obstructive
Cardiogenic (Correct answer)

Correct answer: Cardiogenic

Blunt cardiac injury causing RV dysfunction produces cardiogenic shock due to impaired myocardial pump function.

Question 90: A patient presents with a serum glucose of 40 mg/dL and confusion. The patient is unable to swallow safely. What is the correct treatment?

IM glucagon only if no IV access
Dextrose 50% (D50) IV push (Correct answer)
Subcutaneous insulin
Orange juice PO

Correct answer: Dextrose 50% (D50) IV push

IV D50 is the fastest and most reliable treatment for symptomatic hypoglycemia when the patient cannot safely swallow.

Question 91: What is the correct placement site for an intraosseous (IO) needle in an adult trauma patient when IV access is unavailable?

Distal radius
Greater trochanter of femur
Proximal tibia 2 cm below tibial tuberosity medially (Correct answer)
Calcaneus

Correct answer: Proximal tibia 2 cm below tibial tuberosity medially

The proximal tibia 2 cm below and medial to the tibial tuberosity is the preferred IO site in adults.

Question 92: A 3-year-old presents with refusal to use his right arm after being lifted by his hands. The arm hangs with the elbow slightly flexed and forearm pronated. X-rays are normal. What is the most appropriate management?

Orthopedic consultation for casting
Hyperpronation or supination-flexion reduction technique (Correct answer)
Splint in posterior long-arm splint and obtain MRI
IV sedation with closed reduction under fluoroscopy

Correct answer: Hyperpronation or supination-flexion reduction technique

Nursemaid's elbow (radial head subluxation) is successfully reduced at the bedside using hyperpronation or supination-flexion without anesthesia.

Question 93: What is the purpose of chest decompression?

Control heart rate
Drain abscess
Relieve pneumothorax (Correct answer)
Remove clot

Correct answer: Relieve pneumothorax

Chest decompression, often performed via needle decompression or chest tube insertion, is an emergency procedure to relieve a tension pneumothorax. In this life-threatening condition, air accumulates in the pleural space, collapsing the lung and putting pressure on the heart and great vessels. Decompression releases this trapped air, restoring lung function and cardiovascular stability.

Question 94: Which statement BEST describes the relationship between American Board of Emergency Medicine certification requirements and industry evolution?

Changes only occur when government mandates new requirements
Requirements evolve periodically to reflect advances in knowledge, technology, and practice standards (Correct answer)
Requirements become less stringent over time
Certification requirements never change once established

Correct answer: Requirements evolve periodically to reflect advances in knowledge, technology, and practice standards

Certification requirements evolve to keep pace with advances in professional knowledge, technological developments, and changes in practice standards. This ensures that certified professionals remain current and competent in a changing professional landscape.

Question 95: During a difficult airway attempt, the patient becomes apneic and you cannot intubate or ventilate. What is the definitive rescue procedure?

Surgical cricothyrotomy (Correct answer)
Nasopharyngeal airway
Transtracheal jet ventilation
LMA insertion

Correct answer: Surgical cricothyrotomy

Surgical cricothyrotomy is the definitive rescue airway in the cannot-intubate-cannot-oxygenate scenario.

Question 96: A patient has a shotgun wound to the right chest with sucking chest wound. After occlusive dressing placement the patient acutely deteriorates. What is the most likely cause?

Hemothorax
Pulmonary contusion
Air embolism
Tension pneumothorax from occluded dressing (Correct answer)

Correct answer: Tension pneumothorax from occluded dressing

A fully occlusive dressing on an open pneumothorax can convert it to a tension pneumothorax if air cannot escape.

Question 97: A patient is found unconscious with empty bottles of amitriptyline and alcohol. ECG shows a QRS of 140 ms and right axis deviation of the terminal 40 ms. What is the most appropriate initial treatment?

Magnesium sulfate 2 g IV
Overdrive pacing
Physostigmine 2 mg IV
Sodium bicarbonate 1–2 mEq/kg IV bolus (Correct answer)

Correct answer: Sodium bicarbonate 1–2 mEq/kg IV bolus

Sodium bicarbonate narrows the QRS in tricyclic antidepressant overdose by increasing serum sodium and alkalinizing the blood, reversing sodium channel blockade.

Question 98: How does the ABEM body of knowledge relate to daily professional practice?

It provides the foundational framework that guides decision-making and standard practices (Correct answer)
It is theoretical and has limited practical application
It only applies during certification exams
It is relevant only for academic research

Correct answer: It provides the foundational framework that guides decision-making and standard practices

Question 99: What is a symptom of carbon monoxide poisoning?

Fever
Rash
Headache and confusion (Correct answer)
Cough

Correct answer: Headache and confusion

Carbon monoxide (CO) is a colorless, odorless gas that binds to hemoglobin more readily than oxygen, leading to cellular hypoxia. Common symptoms of CO poisoning, often mistaken for flu, include headache, dizziness, nausea, and confusion. Severe poisoning can lead to loss of consciousness, seizures, and death due to oxygen deprivation to vital organs.

Question 100: A ABEM professional discovers a conflict of interest in a current assignment. What is the MOST ethical course of action?

Handle it privately without informing stakeholders
Disclose the conflict immediately and recuse if necessary (Correct answer)
Continue the assignment but document the conflict later
Ignore it if no one else has noticed

Correct answer: Disclose the conflict immediately and recuse if necessary

Question 101: Which of the following is the MOST reliable antidote for methanol poisoning in the emergency setting when fomepizole is unavailable?

Pyridoxine IV
N-acetylcysteine
Sodium bicarbonate bolus
Ethanol IV infusion (Correct answer)

Correct answer: Ethanol IV infusion

Ethanol competitively inhibits alcohol dehydrogenase and prevents conversion of methanol to its toxic metabolite formic acid when fomepizole is unavailable.

Question 102: A pregnant patient at 36 weeks presents with painless vaginal bleeding. Ultrasound shows placenta covering the cervical os. What is the diagnosis?

Placental abruption
Vasa previa
Placenta previa (Correct answer)
Uterine rupture

Correct answer: Placenta previa

Placenta previa is characterized by painless vaginal bleeding with the placenta overlying the cervical os on ultrasound.

Question 103: Why give aspirin in MI?

Reduces clotting (Correct answer)
Lowers temperature
For pain only
Decreases sugar

Correct answer: Reduces clotting

Aspirin is given in cases of myocardial infarction (MI) because it is an antiplatelet agent. It works by inhibiting platelet aggregation, which helps to prevent the formation of new blood clots and reduces the growth of existing clots in the coronary arteries. This action is crucial in limiting heart muscle damage during a heart attack.

Question 104: What is the purpose of cervical spine immobilization?

Reduce pain
Monitor BP
Lower stress
Prevent spine injury (Correct answer)

Correct answer: Prevent spine injury

Cervical spine immobilization is crucial in trauma to stabilize the neck and prevent movement of potentially fractured or damaged vertebrae. This stabilization minimizes the risk of further injury to the spinal cord, which could lead to permanent neurological deficits. It's a prophylactic measure to protect the delicate spinal cord from secondary damage.

Question 105: A 40-year-old male with HIV presents with progressive dyspnea and dry cough. CXR shows bilateral interstitial infiltrates. LDH is markedly elevated. The most likely diagnosis is:

Pulmonary Kaposi's sarcoma
Community-acquired pneumonia
Pneumocystis jirovecii pneumonia (PCP) (Correct answer)
Tuberculosis

Correct answer: Pneumocystis jirovecii pneumonia (PCP)

PCP is the most common opportunistic lung infection in HIV patients with low CD4 counts and classically presents with bilateral interstitial infiltrates and elevated LDH.

Question 106: In damage control resuscitation, what ratio of packed red blood cells to fresh frozen plasma to platelets is recommended?

2:1:0
4:1:1
1:1:1 (Correct answer)
6:4:1

Correct answer: 1:1:1

A 1:1:1 ratio of pRBC:FFP:platelets approximates whole blood and is the standard for damage control resuscitation.

Question 107: A 7-year-old presents with a 3-day history of periorbital swelling, fever, and proptosis with painful eye movement. What is the most concerning diagnosis?

Dacryocystitis
Allergic reaction
Periorbital (preseptal) cellulitis
Orbital cellulitis (Correct answer)

Correct answer: Orbital cellulitis

Proptosis and painful eye movement in a febrile child indicate orbital (postseptal) cellulitis, which can spread intracranially and requires urgent CT and IV antibiotics.

Question 108: After a house fire, a victim presents with confusion, cherry-red skin, and carboxyhemoglobin of 28%. What is the half-life of COHb with 100% normobaric oxygen?

~30 minutes
~5 hours
~60–90 minutes (Correct answer)
~4–5 hours without oxygen treatment

Correct answer: ~60–90 minutes

100% normobaric oxygen reduces the carboxyhemoglobin half-life from ~5 hours on room air to approximately 60–90 minutes.

Question 109: Which lab helps confirm infection?

Creatinine
WBC count (Correct answer)
Platelets
Glucose

Correct answer: WBC count

A White Blood Cell (WBC) count, also known as a leukocyte count, is a common laboratory test used to help identify and monitor infections. An elevated WBC count (leukocytosis) often indicates that the body's immune system is actively fighting an infection, as it produces more white blood cells to combat pathogens.

Question 110: Which risk management approach is MOST effective for ABEM professionals when evaluating potential workplace hazards?

Proactive hazard identification and assessment (Correct answer)
Reactive analysis after incidents occur
Relying solely on historical accident data
Delegating all safety decisions to management

Correct answer: Proactive hazard identification and assessment

Proactive hazard identification and assessment allows professionals to identify and mitigate risks before incidents occur, which is far more effective than reactive approaches that only address problems after they happen.

Question 111: A patient with acute STEMI develops cardiogenic shock. After PCI, which medication should be AVOIDED as it may worsen outcomes in this setting?

Intra-aortic balloon pump support
Heparin
Aspirin
High-dose vasopressors as primary treatment without PCI (Correct answer)

Correct answer: High-dose vasopressors as primary treatment without PCI

High-dose vasopressors increase afterload and myocardial oxygen demand; early revascularization with PCI is the priority in cardiogenic shock from STEMI.

Question 112: Which arrhythmia is MOST commonly associated with Wolff-Parkinson-White syndrome presenting as a wide-complex tachycardia?

Ventricular tachycardia
Atrial flutter with 2:1 block
Atrial fibrillation with accessory pathway conduction (Correct answer)
Junctional tachycardia

Correct answer: Atrial fibrillation with accessory pathway conduction

Atrial fibrillation conducting rapidly down an accessory pathway in WPW produces a wide, irregular, potentially life-threatening tachycardia.

Question 113: What is the PRIMARY purpose of obtaining ABEM certification in American Board of Emergency Medicine?

To demonstrate verified competency and adherence to professional standards (Correct answer)
To satisfy a personal achievement goal
To guarantee employment in the field
To bypass educational requirements

Correct answer: To demonstrate verified competency and adherence to professional standards

Question 114: A pregnant patient at 32 weeks presents with severe headache, BP 168/110, and 3+ proteinuria. What is the diagnosis?

Chronic hypertension
Gestational hypertension
Severe preeclampsia (Correct answer)
HELLP syndrome

Correct answer: Severe preeclampsia

Severe preeclampsia is defined by BP ≥160/110 with proteinuria or other severe features after 20 weeks gestation.

Question 115: Which clinical sign differentiates obstructive shock from distributive shock?

Cool, clamped extremities with elevated JVP (Correct answer)
Tachycardia
Widened pulse pressure
Hypotension

Correct answer: Cool, clamped extremities with elevated JVP

Obstructive shock (e.g., PE, tamponade, tension pneumothorax) presents with elevated JVP and cool extremities due to mechanical obstruction impeding cardiac output.

Question 116: During central venous line placement in a trauma patient, which complication is identified by worsening hypoxia, hypotension, and distended neck veins after line insertion?

Iatrogenic tension pneumothorax (Correct answer)
Line sepsis
Air embolism
Catheter-associated DVT

Correct answer: Iatrogenic tension pneumothorax

Pneumothorax complicating subclavian or internal jugular CVC placement can tension if the patient is on positive pressure ventilation.

Question 117: A 70-year-old diabetic male presents with 2 hours of vague epigastric discomfort and diaphoresis. ECG shows new ST elevation in leads II, III, and aVF. The culprit artery is most likely:

Left main coronary
Left anterior descending
Left circumflex
Right coronary artery (Correct answer)

Correct answer: Right coronary artery

ST elevation in inferior leads II, III, and aVF indicates inferior STEMI, most commonly caused by right coronary artery (RCA) occlusion.

Question 118: What is the MOST effective way for new ABEM professionals to build competency in their field?

Learning entirely through trial and error
Focusing solely on the most advanced topics
Combining formal education, mentored practice, and ongoing professional development (Correct answer)
Studying certification materials exclusively

Correct answer: Combining formal education, mentored practice, and ongoing professional development

Question 119: A patient presents with sudden severe 'tearing' back pain, pulsatile abdominal mass, and hypotension. What is the immediate priority?

Aortic ultrasound only
IV fluids to normalize BP
Emergent vascular surgery consultation and operative repair (Correct answer)
CT angiography to confirm

Correct answer: Emergent vascular surgery consultation and operative repair

A ruptured AAA with hemodynamic instability requires immediate operative intervention; delaying for imaging is associated with mortality.

Question 120: What is the first step in managing a cardiac arrest?

Initiate CPR (Correct answer)
Apply cold packs
Administer glucose
Call family

Correct answer: Initiate CPR

In managing a cardiac arrest, the immediate priority is to restore circulation and oxygenation to the brain and other vital organs. Initiating cardiopulmonary resuscitation (CPR) without delay is the critical first step, as it provides artificial circulation and breathing until advanced medical help arrives or a defibrillator can be used. Early CPR significantly improves the chances of survival and neurological outcomes.

Question 121: In a patient with suspected tension pneumothorax, what is the IMMEDIATE management?

Obtain chest X-ray first
Needle decompression at 2nd ICS midclavicular line (Correct answer)
Chest CT scan
Intubate and ventilate

Correct answer: Needle decompression at 2nd ICS midclavicular line

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression without waiting for imaging to prevent cardiac arrest.

Question 122: What is psychosis?

Low BP
Delusions or hallucinations (Correct answer)
Nausea
Muscle cramps

Correct answer: Delusions or hallucinations

Psychosis is a severe mental disorder characterized by a loss of contact with reality. Its hallmark symptoms include delusions (fixed, false beliefs not amenable to change in light of conflicting evidence) and hallucinations (perceiving things that are not actually present, such as hearing voices or seeing things). These symptoms indicate a significant disruption in thought processes and perception.

Question 123: A 7-year-old falls from the monkey bars and has distal radius pain. X-ray shows cortical buckling on one side without a complete fracture line. What is the most appropriate treatment?

Posterior long-arm splint for 3-4 weeks without reduction (Correct answer)
Closed reduction under sedation followed by casting
Short arm cast for 8 weeks
Open reduction and internal fixation

Correct answer: Posterior long-arm splint for 3-4 weeks without reduction

Torus (buckle) fractures are inherently stable due to the intact periosteum and cortex on one side; splinting for 3-4 weeks without reduction is sufficient.

Question 124: What to check before intubation?

Call nurse
Check tools (Correct answer)
Start IV
Give pain meds

Correct answer: Check tools

Before intubation, it is critical to perform a thorough 'check tools' or 'check equipment' step to ensure all necessary equipment is present, functional, and correctly sized. This includes verifying the laryngoscope blade and light, endotracheal tube, stylet, suction, and ventilation device. This preparation prevents delays and complications during the procedure, which can be life-threatening.

Question 125: A 25-year-old jams her finger and cannot actively extend the distal interphalangeal (DIP) joint; there is a slight flexion deformity. X-ray shows no bony avulsion. What is the correct diagnosis and treatment?

Swan neck deformity; hand therapy referral
Mallet finger; continuous DIP extension splinting for 6-8 weeks (Correct answer)
Boutonniere deformity; PIP extension splinting
Jersey finger; urgent surgical tendon repair

Correct answer: Mallet finger; continuous DIP extension splinting for 6-8 weeks

Mallet finger results from disruption of the terminal extensor tendon at the DIP joint and is treated with uninterrupted DIP extension splinting for 6-8 weeks.

Question 126: Which landmark is used for needle decompression of tension pneumothorax using the 4th or 5th intercostal space approach?

Mid-clavicular line
Mid-axillary line (Correct answer)
Posterior axillary line
Anterior axillary line

Correct answer: Mid-axillary line

The mid-axillary line at the 4th–5th ICS is the preferred alternate site, especially in obese patients where MCL decompression may fail.

Question 127: How to treat status epilepticus?

Lorazepam (Correct answer)
Insulin
Epinephrine
Digoxin

Correct answer: Lorazepam

Status epilepticus is a medical emergency characterized by prolonged or recurrent seizures without full recovery of consciousness between episodes. Benzodiazepines, such as lorazepam, are the first-line treatment because they act rapidly to suppress seizure activity by enhancing the effect of GABA, an inhibitory neurotransmitter in the brain.

Question 128: An 80-year-old woman presents with groin pain and inability to bear weight after a fall. Her leg is slightly shortened and externally rotated but plain X-rays are negative. What is the best next imaging step?

MRI of the hip (Correct answer)
CT scan of the pelvis
Technetium bone scan
Discharge with analgesics and follow-up in 1 week

Correct answer: MRI of the hip

MRI is the preferred modality for occult hip fractures when plain radiographs are negative but clinical suspicion is high, offering high sensitivity and no radiation.

Question 129: What distinguishes a American Board of Emergency Medicine certified professional from a non-certified practitioner?

Certification validates competency through standardized assessment against established benchmarks (Correct answer)
Certified professionals always have more years of experience
There is no meaningful difference in competency
Certified professionals exclusively work in larger organizations

Correct answer: Certification validates competency through standardized assessment against established benchmarks

Certification provides objective validation of competency through standardized assessment. While non-certified practitioners may be skilled, certification offers verified evidence that a professional meets established benchmarks for knowledge and performance.

Question 130: A patient with history of alcohol use presents with hematemesis. EGD shows actively bleeding esophageal varices. Which medication should be administered immediately?

Octreotide IV infusion (Correct answer)
Beta-blockers
PPI infusion only
IV vasopressin alone

Correct answer: Octreotide IV infusion

Octreotide reduces portal hypertension by inhibiting vasodilatory peptides, and is given as a continuous infusion in acute variceal bleeding.

Question 131: A patient with HIV and CD4 count of 60/µL presents with headache, fever, and altered mentation. India ink stain of the CSF is positive. What is the first-line induction therapy?

Micafungin IV
Amphotericin B deoxycholate + flucytosine (Correct answer)
Fluconazole 400 mg PO daily
Voriconazole IV

Correct answer: Amphotericin B deoxycholate + flucytosine

Cryptococcal meningitis induction therapy requires amphotericin B plus flucytosine for at least 2 weeks to achieve fungal clearance before consolidation with fluconazole.

Question 132: A 22-year-old is brought in with hyperthermia of 41.2°C, muscle rigidity, diaphoresis, and clonus after starting linezolid while taking sertraline. Which intervention is MOST important to reduce mortality?

Cyproheptadine 12 mg PO
Lorazepam 2 mg IV and active cooling (Correct answer)
Dantrolene 2.5 mg/kg IV
Bromocriptine 2.5 mg PO

Correct answer: Lorazepam 2 mg IV and active cooling

Serotonin syndrome treatment prioritizes benzodiazepines for neuromuscular agitation plus aggressive cooling; cyproheptadine is adjunctive but oral delivery is slower.

Question 133: Which ECG finding in a patient with digoxin toxicity is MOST specific for toxicity rather than therapeutic effect?

Scooped ST depression
QT shortening
Bidirectional ventricular tachycardia (Correct answer)
PR prolongation

Correct answer: Bidirectional ventricular tachycardia

Bidirectional ventricular tachycardia is highly specific for digoxin (and aconitine) toxicity and is not a therapeutic ECG change.

Question 134: A patient with a history of kidney stones presents with colicky flank pain radiating to the groin, hematuria, and nausea. CT shows a 7 mm ureteral stone. What is the appropriate management?

Foley catheter and observation
Extracorporeal shock wave lithotripsy in ED
Pain control, hydration, alpha-blocker, and urology follow-up (Correct answer)
Immediate urologic intervention

Correct answer: Pain control, hydration, alpha-blocker, and urology follow-up

Stones 5–10 mm have a moderate chance of spontaneous passage; alpha-blockers (e.g., tamsulosin) plus analgesia and urology follow-up is appropriate.

Question 135: A 25-year-old develops severe forearm pain after a closed forearm fracture. The pain is disproportionate to injury and worsens with passive finger extension. Compartment pressure measures 35 mmHg with a diastolic BP of 60 mmHg. What is the next step?

Emergency fasciotomy (Correct answer)
Elevate the extremity and reassess in 2 hours
Ice, analgesics, and close monitoring
IV antibiotics and repeat pressure measurement

Correct answer: Emergency fasciotomy

Compartment syndrome is confirmed when pressures are within 30 mmHg of diastolic BP; emergency fasciotomy is the definitive and only treatment.

Question 136: A 6-week-old male presents with projectile non-bilious vomiting after feeding. What is the most likely diagnosis?

Volvulus
Intussusception
GERD
Pyloric stenosis (Correct answer)

Correct answer: Pyloric stenosis

Pyloric stenosis classically presents in 2–8 week old males with projectile, non-bilious vomiting and a palpable olive-shaped mass.

Question 137: What distinguishes a American Board of Emergency Medicine certified professional from a non-certified practitioner?

Certified professionals always have more years of experience
There is no meaningful difference in competency
Certified professionals exclusively work in larger organizations
Certification validates competency through standardized assessment against established benchmarks (Correct answer)

Correct answer: Certification validates competency through standardized assessment against established benchmarks

Question 138: Which statement BEST describes the relationship between American Board of Emergency Medicine certification requirements and industry evolution?

Requirements become less stringent over time
Changes only occur when government mandates new requirements
Certification requirements never change once established
Requirements evolve periodically to reflect advances in knowledge, technology, and practice standards (Correct answer)

Correct answer: Requirements evolve periodically to reflect advances in knowledge, technology, and practice standards

Question 139: What documentation is MOST critical to maintain for safety compliance in the American Board of Emergency Medicine field?

Annual revenue reports
Client marketing preferences
Employee vacation schedules
Incident reports, training records, and inspection logs (Correct answer)

Correct answer: Incident reports, training records, and inspection logs

Question 140: A 45-year-old with known alcoholism presents after a seizure. He last drank 48 hours ago. His blood alcohol level is 0. What is the MOST appropriate next step?

Order CT head with contrast
Administer lorazepam and thiamine (Correct answer)
Start propofol infusion
Load with phenytoin IV

Correct answer: Administer lorazepam and thiamine

Alcohol withdrawal seizures are best treated with benzodiazepines; thiamine must be given prior to or concurrently with glucose to prevent precipitating Wernicke encephalopathy.

Question 141: What is the MOST important reason for American Board of Emergency Medicine professionals to maintain continuing education?

To accumulate credentials for personal prestige
To stay current with evolving standards, practices, and regulations (Correct answer)
To satisfy employer preferences
To increase billing rates

Correct answer: To stay current with evolving standards, practices, and regulations

Continuing education ensures professionals remain current with evolving industry standards, best practices, and regulatory requirements. This directly impacts the quality of service provided and maintains public trust in the profession.

Question 142: A patient presents with right lower quadrant pain, fever, and elevated WBC. CT confirms acute appendicitis without perforation. What is the standard management?

Colonoscopy to confirm
Appendectomy with IV antibiotics (Correct answer)
Observation only
Antibiotics alone and discharge

Correct answer: Appendectomy with IV antibiotics

Acute uncomplicated appendicitis is treated with surgical appendectomy; IV antibiotics are given perioperatively.

Question 143: A previously healthy 30-year-old male presents with sudden pleuritic chest pain and dyspnea after lifting weights. CXR shows a 25% pneumothorax on the right. He is hemodynamically stable. Management is:

Supplemental O2 and discharge with follow-up
Large-bore chest tube (28-32 Fr)
Observation only without oxygen
Needle aspiration or small-bore chest tube (Correct answer)

Correct answer: Needle aspiration or small-bore chest tube

A symptomatic primary spontaneous pneumothorax >15-20% in a stable patient is treated with needle aspiration or small-bore chest tube placement.

Question 144: Which feature most reliably distinguishes hypertensive encephalopathy from hypertensive urgency without end-organ damage?

Elevated serum creatinine
Presence of papilledema, encephalopathy, or focal neurological deficits (Correct answer)
Presence of severe headache
Blood pressure level above 220/120 mmHg

Correct answer: Presence of papilledema, encephalopathy, or focal neurological deficits

Hypertensive emergency is defined by end-organ damage (encephalopathy, papilledema, focal deficits, AKI, heart failure) rather than a specific blood pressure threshold.

Question 145: A 68-year-old man presents with sudden-onset vertigo, ipsilateral facial numbness, contralateral body numbness, hoarseness, and dysphagia. What is the most likely diagnosis?

Cerebellar hemorrhage
Wallenberg syndrome (lateral medullary syndrome) (Correct answer)
Basilar artery occlusion
Central pontine myelinolysis

Correct answer: Wallenberg syndrome (lateral medullary syndrome)

Wallenberg syndrome results from posterior inferior cerebellar artery (PICA) occlusion causing lateral medullary infarction with crossed sensory deficits and cranial nerve findings.

Question 146: How are airborne diseases prevented?

Open windows
Wash hands only
Drink fluids
N95 and isolation (Correct answer)

Correct answer: N95 and isolation

Airborne diseases, such as tuberculosis or measles, are spread through tiny particles that remain suspended in the air. Prevention requires specialized measures like placing infected patients in airborne isolation rooms with negative pressure and healthcare workers wearing N95 respirators. These respirators filter out at least 95% of airborne particles, providing superior protection.

Question 147: A patient presents with descending flaccid paralysis, dry mouth, diplopia, and ptosis after eating home-canned green beans. Autonomic function is preserved. Which toxin mechanism is responsible?

Irreversible inhibition of acetylcholinesterase at the neuromuscular junction
Inhibition of glycine release in the spinal cord
Blockade of presynaptic acetylcholine release at the neuromuscular junction (Correct answer)
Competitive antagonism of nicotinic receptors

Correct answer: Blockade of presynaptic acetylcholine release at the neuromuscular junction

Botulinum toxin cleaves SNARE proteins, blocking presynaptic acetylcholine vesicle release at the neuromuscular junction, causing flaccid paralysis.

Question 148: In American Board of Emergency Medicine practice, what is the FIRST step when a safety hazard is identified in the workplace?

Document it for the next safety audit
Continue working and report at end of shift
Immediately secure the area and report the hazard (Correct answer)
Wait for a supervisor to notice the issue

Correct answer: Immediately secure the area and report the hazard

When a safety hazard is identified, the immediate priority is to secure the area to prevent injury and report the hazard through proper channels. Delaying action increases the risk of incidents.

Question 149: When a ABEM professional faces pressure to compromise professional standards, the BEST response is to:

Comply to maintain workplace relationships
Immediately resign from the position
Ignore the pressure and continue without reporting
Document the pressure and uphold professional standards (Correct answer)

Correct answer: Document the pressure and uphold professional standards

Question 150: Which scenario represents a violation of the American Board of Emergency Medicine code of professional conduct?

Seeking continuing education beyond minimum requirements
Reporting safety concerns to regulatory authorities
Misrepresenting qualifications or certification status (Correct answer)
Declining work outside one's area of competence

Correct answer: Misrepresenting qualifications or certification status

Misrepresenting qualifications or certification status is a serious violation of professional conduct. It undermines public trust and can lead to harm when unqualified individuals perform specialized work.

Question 151: What is pulmonary embolism symptom?

Nausea
Sudden dyspnea (Correct answer)
Sore throat
Rash

Correct answer: Sudden dyspnea

Pulmonary embolism (PE) occurs when a blood clot blocks an artery in the lungs, leading to impaired blood flow and oxygen exchange. Sudden onset of dyspnea (shortness of breath) is a classic and often the most prominent symptom of PE, as the body struggles to get enough oxygen. This symptom, especially when acute and unexplained, warrants immediate investigation for PE.

Question 152: What condition follows prolonged cold exposure?

Shock
Dehydration
Hypothermia (Correct answer)
Hyperglycemia

Correct answer: Hypothermia

Hypothermia is a dangerous drop in body temperature, typically below 95°F (35°C), caused by prolonged exposure to cold environments. When the body loses heat faster than it can produce it, vital systems begin to shut down, leading to symptoms like shivering, confusion, and eventually loss of consciousness and cardiac arrest if not treated.

Question 153: A patient presents with bradycardia, hypotension, and hyperkalemia after ingesting a large quantity of sustained-release verapamil. Which antidote provides the most direct physiologic benefit?

Lipid emulsion therapy
Glucagon IV
Calcium gluconate IV
High-dose insulin with dextrose (Correct answer)

Correct answer: High-dose insulin with dextrose

High-dose insulin euglycemic therapy (HIET) improves myocardial carbohydrate metabolism and is the mainstay treatment for severe calcium channel blocker overdose.

Question 154: Which medication is first-line for controlling severe hypertension in eclampsia?

Hydralazine
Nifedipine
ACE inhibitors
Labetalol IV (Correct answer)

Correct answer: Labetalol IV

IV labetalol is a first-line agent for acute severe hypertension in pregnancy due to its safety profile and rapid onset.

Question 155: A 65-year-old smoker with known COPD presents in respiratory failure. ABG shows pH 7.22, PaCO2 78, PaO2 52. The MOST appropriate initial ventilatory support is:

High-flow nasal cannula at 60 L/min
Immediate orotracheal intubation
Simple face mask at 10 L/min
Non-invasive positive pressure ventilation (BiPAP) (Correct answer)

Correct answer: Non-invasive positive pressure ventilation (BiPAP)

BiPAP is the preferred initial ventilatory support for COPD exacerbation with hypercapnic respiratory failure as it reduces intubation rates and mortality.

Question 156: A patient presents with severe epigastric pain, fever, and jaundice. RUQ ultrasound shows CBD dilation and stones. What is the diagnosis?

Cholecystitis
Biliary colic only
Hepatitis
Ascending cholangitis (Charcot's triad) (Correct answer)

Correct answer: Ascending cholangitis (Charcot's triad)

Charcot's triad (fever, jaundice, RUQ pain) represents ascending cholangitis — a surgical emergency requiring antibiotics and biliary decompression.

Question 157: What is the mechanism by which PEEP (positive end-expiratory pressure) improves oxygenation in ARDS?

Increases FiO2 delivery
Reduces pulmonary vascular resistance
Increases cardiac output
Recruits collapsed alveoli and prevents derecruitment (Correct answer)

Correct answer: Recruits collapsed alveoli and prevents derecruitment

PEEP keeps alveoli open at end-expiration, recruits previously collapsed lung units, and improves ventilation-perfusion matching in ARDS.

Question 158: An 18-year-old male presents with his third episode of sudden bilateral leg weakness with preserved consciousness, triggered by emotional laughter. EEG is normal during an episode. What is the most likely diagnosis?

Absence seizure disorder
Cataplexy associated with narcolepsy (Correct answer)
Conversion disorder
Transient ischemic attack

Correct answer: Cataplexy associated with narcolepsy

Cataplexy is characterized by sudden bilateral muscle weakness triggered by strong emotions (especially laughter), associated with narcolepsy, with preserved consciousness and normal EEG.

Question 159: A patient with a gunshot wound through-and-through to the neck presents with subcutaneous emphysema and hemoptysis. Which structure is most likely injured?

Carotid artery
Trachea or larynx (Correct answer)
Esophagus
Jugular vein

Correct answer: Trachea or larynx

Subcutaneous emphysema and hemoptysis following penetrating neck trauma indicate airway (tracheal or laryngeal) injury.

Question 160: A patient with end-stage renal disease presents with peaked T-waves, widening QRS, and a sine-wave pattern on ECG. The MOST immediately life-saving treatment is:

Calcium gluconate IV (Correct answer)
Kayexalate PO
Sodium bicarbonate IV
Insulin + glucose IV

Correct answer: Calcium gluconate IV

Calcium gluconate immediately stabilizes the cardiac membrane in severe hyperkalemia, buying time while other measures to lower potassium are implemented.

Question 161: Which statement BEST describes the relationship between American Board of Emergency Medicine certification requirements and industry evolution?

Changes only occur when government mandates new requirements
Requirements evolve periodically to reflect advances in knowledge, technology, and practice standards (Correct answer)
Certification requirements never change once established
Requirements become less stringent over time

Correct answer: Requirements evolve periodically to reflect advances in knowledge, technology, and practice standards

Question 162: In American Board of Emergency Medicine, what is the PRIMARY purpose of conducting regular safety drills and exercises?

To evaluate employee performance reviews
To satisfy insurance requirements only
To ensure personnel can respond effectively in emergencies (Correct answer)
To reduce daily workload

Correct answer: To ensure personnel can respond effectively in emergencies

Question 163: A 55-year-old man with hypertension presents with acute pulmonary edema. His BP is 220/130 mmHg. Which vasodilator acts primarily as a venodilator to rapidly reduce preload?

Nicardipine
Nitroglycerin (Correct answer)
Hydralazine
Labetalol

Correct answer: Nitroglycerin

Nitroglycerin at low doses acts primarily as a venodilator, rapidly reducing preload and relieving acute pulmonary congestion.

Question 164: A 30-year-old falls on an outstretched hand and has anatomical snuffbox tenderness. Initial X-rays are negative. What is the most appropriate management?

Thumb spica splint with MRI or repeat X-ray in 1-2 weeks (Correct answer)
Apply cast for 6 weeks without further imaging
CT scan of the wrist immediately
Discharge with wrist splint and routine follow-up in 2 weeks

Correct answer: Thumb spica splint with MRI or repeat X-ray in 1-2 weeks

Anatomical snuffbox tenderness after a FOOSH injury warrants presumptive treatment for occult scaphoid fracture with thumb spica splinting and early MRI or repeat X-ray due to avascular necrosis risk.

Question 165: A patient taking metformin presents with lactic acidosis, pH 7.05, lactate 12, and acute renal failure. What is the most effective treatment?

Sodium bicarbonate infusion
IV saline and observation
Activated charcoal
Hemodialysis (Correct answer)

Correct answer: Hemodialysis

Hemodialysis is the definitive treatment for severe metformin-associated lactic acidosis as it removes metformin and corrects acidosis.

Question 166: Which statement BEST describes the relationship between American Board of Emergency Medicine certification requirements and industry evolution?

Requirements evolve periodically to reflect advances in knowledge, technology, and practice standards (Correct answer)
Requirements become less stringent over time
Changes only occur when government mandates new requirements
Certification requirements never change once established

Correct answer: Requirements evolve periodically to reflect advances in knowledge, technology, and practice standards

Question 167: A 4-year-old presents with moderate respiratory distress and wheezing. SpO2 is 91%. What is the immediate treatment for acute asthma exacerbation?

Heliox as first-line
IV corticosteroids only
Magnesium sulfate immediately
Albuterol via nebulizer and supplemental oxygen (Correct answer)

Correct answer: Albuterol via nebulizer and supplemental oxygen

Inhaled albuterol (bronchodilator) plus supplemental oxygen is the cornerstone initial treatment of acute pediatric asthma exacerbations.

Question 168: A 38-year-old female presents with episodic severe unilateral headache with nausea, photophobia, and a preceding visual aura of a scintillating scotoma. Which medication is most appropriate for acute treatment of a moderate-to-severe attack?

Acetaminophen 1000 mg PO
Sumatriptan 6 mg SC (Correct answer)
Metoprolol 50 mg PO
Verapamil 80 mg PO

Correct answer: Sumatriptan 6 mg SC

Triptans (serotonin 5-HT1B/1D agonists) are first-line for moderate-to-severe migraine attacks; sumatriptan SC has the fastest onset.

Question 169: Which foundational principle is MOST important for success in the American Board of Emergency Medicine profession?

Specializing in only one narrow area of practice
Maximizing financial returns on every engagement
Commitment to continuous learning, ethical practice, and quality outcomes (Correct answer)
Maintaining the minimum requirements for certification

Correct answer: Commitment to continuous learning, ethical practice, and quality outcomes

Question 170: A patient presents in wide-complex tachycardia at 180 bpm, is hemodynamically stable. The rhythm is regular and the QRS morphology is LBBB pattern. The SAFEST initial pharmacologic treatment is:

Verapamil
Adenosine
Metoprolol
Procainamide (Correct answer)

Correct answer: Procainamide

Procainamide is the preferred agent for stable wide-complex tachycardia of uncertain origin; verapamil and other AV nodal blockers can cause deterioration in VT.

Question 171: What distinguishes a American Board of Emergency Medicine certified professional from a non-certified practitioner?

Certification validates competency through standardized assessment against established benchmarks (Correct answer)
Certified professionals exclusively work in larger organizations
Certified professionals always have more years of experience
There is no meaningful difference in competency

Correct answer: Certification validates competency through standardized assessment against established benchmarks

Question 172: A 32-year-old sustains a foot injury in a motor vehicle accident. Weight-bearing X-ray reveals a fracture at the base of the second metatarsal with widening between the first and second metatarsals. What injury does this represent?

Dancer's fracture (spiral fifth metatarsal)
Navicular stress fracture
Jones fracture of the fifth metatarsal
Lisfranc tarsometatarsal fracture-dislocation (Correct answer)

Correct answer: Lisfranc tarsometatarsal fracture-dislocation

A fracture at the second metatarsal base is pathognomonic for Lisfranc injury; the second metatarsal base is the keystone of the tarsometatarsal joint complex.

Question 173: A patient with known myasthenia gravis presents with worsening dyspnea and inability to swallow after starting ciprofloxacin for a UTI. What is the most likely explanation?

Fluoroquinolone-induced myasthenic crisis (Correct answer)
Autonomic neuropathy
Aspiration pneumonia
Cholinergic crisis from pyridostigmine overdose

Correct answer: Fluoroquinolone-induced myasthenic crisis

Fluoroquinolones, aminoglycosides, and other antibiotics can worsen neuromuscular junction blockade and precipitate myasthenic crisis.

Question 174: A patient with a gunshot wound to the right upper quadrant has a BP of 90/60 despite 2L NS. FAST shows free fluid in Morison's pouch. What is the next step?

IR embolization
Emergent operative laparotomy (Correct answer)
CT abdomen with contrast
Repeat FAST in 15 minutes

Correct answer: Emergent operative laparotomy

Hemodynamically unstable penetrating abdominal trauma with positive FAST requires emergent surgical intervention.

Question 175: Which type of aortic dissection (Stanford classification) requires immediate surgical intervention?

Both Type A and B equally
Type A dissections involving the ascending aorta (Correct answer)
Type B dissections only
Neither; all dissections are managed medically first

Correct answer: Type A dissections involving the ascending aorta

Stanford Type A dissections involve the ascending aorta and require emergent surgery due to risk of cardiac tamponade, coronary occlusion, and stroke.

Question 176: A 28-year-old male twists his ankle and has tenderness over the lateral malleolus but can bear weight in the ED. According to the Ottawa Ankle Rules, which finding independently mandates an X-ray?

Inability to bear weight both immediately after injury and in the ED (Correct answer)
Mild swelling over the lateral ankle
Pain with passive inversion of the foot
Lateral malleolus tenderness alone

Correct answer: Inability to bear weight both immediately after injury and in the ED

Ottawa Ankle Rules require X-ray if there is bony tenderness at specific malleolar zones OR inability to bear weight (4 steps) both immediately after injury and in the ED.

Question 177: When conducting a risk assessment for ABEM operations, which factor should receive the HIGHEST priority?

Cost of implementing safety measures
Time required for safety training
Convenience for daily operations
Probability and severity of potential harm (Correct answer)

Correct answer: Probability and severity of potential harm

The probability and severity of potential harm are the primary factors in risk assessment. While cost and convenience are considerations, they should never override the assessment of how likely an incident is and how severe its consequences could be.

Question 178: Which of the following ECG findings is MOST specific for right heart strain in pulmonary embolism?

Diffuse ST elevation
Left bundle branch block
ST depression in V1-V4
S1Q3T3 pattern (Correct answer)

Correct answer: S1Q3T3 pattern

The S1Q3T3 pattern (S wave in lead I, Q wave and T-wave inversion in lead III) is the classic but not sensitive ECG finding in PE suggesting right heart strain.

Question 179: In American Board of Emergency Medicine practice, what is the FIRST step when a safety hazard is identified in the workplace?

Wait for a supervisor to notice the issue
Immediately secure the area and report the hazard (Correct answer)
Continue working and report at end of shift
Document it for the next safety audit

Correct answer: Immediately secure the area and report the hazard

When a safety hazard is identified, the immediate priority is to secure the area to prevent injury and report the hazard through proper channels. Delaying action increases the risk of incidents.

Question 180: A 19-year-old presents with sudden-onset psychosis, orofacial dyskinesias, autonomic instability, and decreased consciousness following a viral illness. Which antibody is most likely responsible?

Anti-Hu antibody
Anti-NMDA receptor antibody (Correct answer)
Anti-MOG antibody
Anti-voltage-gated calcium channel antibody

Correct answer: Anti-NMDA receptor antibody

Anti-NMDA receptor encephalitis presents with psychiatric symptoms, movement disorders, autonomic dysfunction, and decreased consciousness, often following herpes encephalitis or in young women with ovarian teratoma.

Question 181: A 40-year-old squash player hears a 'pop' and feels as if he was kicked in the back of his leg. He cannot plantar flex against resistance. Which test confirms the diagnosis?

Tinel sign at the heel
Thompson test (calf squeeze test) (Correct answer)
Peroneal provocation test
Anterior drawer test of the ankle

Correct answer: Thompson test (calf squeeze test)

A positive Thompson test — absence of plantar flexion when the calf is squeezed with the patient prone — confirms complete Achilles tendon rupture.

Question 182: A patient with known cirrhosis presents with confusion and asterixis. Ammonia level is elevated. What is the first-line treatment for hepatic encephalopathy?

Hemodialysis
Lactulose and rifaximin (Correct answer)
IV neomycin
Protein restriction only

Correct answer: Lactulose and rifaximin

Lactulose reduces ammonia absorption from the gut, and rifaximin reduces ammonia-producing gut bacteria; both are first-line for hepatic encephalopathy.

Question 183: A patient presents with oliguria, BUN 80, creatinine 6.2 (baseline 1.0), and no urine output for 12 hours. Bladder scan shows 600 mL. What is the next step?

Start hemodialysis
Foley catheter placement (Correct answer)
IV furosemide
Nephrology consult first

Correct answer: Foley catheter placement

Post-renal AKI from bladder outlet obstruction requires immediate Foley catheterization to relieve the obstruction.

Question 184: What needle size is typically used for trauma IV access?

30 gauge
10 gauge
14-16 gauge (Correct answer)
22 gauge

Correct answer: 14-16 gauge

In trauma, rapid fluid resuscitation and blood product administration are often critical. Larger bore IV catheters, specifically 14-16 gauge, are preferred because their wider lumen allows for a much faster flow rate of fluids and blood compared to smaller gauges. This enables efficient volume replacement to combat hypovolemic shock.

Question 185: What is the PRIMARY purpose of obtaining ABEM certification in American Board of Emergency Medicine?

To guarantee employment in the field
To demonstrate verified competency and adherence to professional standards (Correct answer)
To bypass educational requirements
To satisfy a personal achievement goal

Correct answer: To demonstrate verified competency and adherence to professional standards

Question 186: What is the PRIMARY ethical obligation of a certified American Board of Emergency Medicine professional regarding confidential information?

Share it with colleagues who might benefit
Use it to advance career opportunities
Discuss it informally during professional networking
Protect it from unauthorized disclosure at all times (Correct answer)

Correct answer: Protect it from unauthorized disclosure at all times

Confidentiality is a fundamental ethical obligation. Certified professionals must protect confidential information from unauthorized disclosure, regardless of circumstances. Breach of confidentiality can result in loss of certification and legal liability.

Question 187: What is the MOST effective way for new ABEM professionals to build competency in their field?

Learning entirely through trial and error
Focusing solely on the most advanced topics
Studying certification materials exclusively
Combining formal education, mentored practice, and ongoing professional development (Correct answer)

Correct answer: Combining formal education, mentored practice, and ongoing professional development

Question 188: What is the most common cause of preventable death in penetrating extremity trauma?

Compressible hemorrhage (Correct answer)
Nerve injury
Compartment syndrome
Infection

Correct answer: Compressible hemorrhage

Compressible extremity hemorrhage is the leading preventable cause of death in combat and civilian penetrating trauma.

Question 189: A 3-year-old presents with sudden-onset choking and unilateral decreased breath sounds. What is the most likely diagnosis?

Foreign body aspiration (Correct answer)
Bronchiolitis
Pneumothorax
Asthma exacerbation

Correct answer: Foreign body aspiration

Sudden choking with unilateral decreased breath sounds in a toddler is foreign body aspiration until proven otherwise.

Question 190: In a trauma patient with a suspected thoracic aortic injury after deceleration, which initial imaging study is most appropriate?

Pulmonary arteriography
Transthoracic echocardiogram
MRI thorax
Plain chest X-ray followed by CT angiography of the chest (Correct answer)

Correct answer: Plain chest X-ray followed by CT angiography of the chest

CXR serves as the initial screen; CT angiography is the definitive study for blunt thoracic aortic injury.

Question 191: Which of the following correctly characterizes the Rumack-Matthew nomogram used in acetaminophen toxicity?

It predicts hepatotoxicity risk based on serum level plotted against time post-ingestion (Correct answer)
It applies to all acetaminophen exposures regardless of time of ingestion
It is valid for extended-release acetaminophen formulations
It is used to determine NAC dosing duration

Correct answer: It predicts hepatotoxicity risk based on serum level plotted against time post-ingestion

The Rumack-Matthew nomogram plots serum acetaminophen concentration against hours post-acute ingestion to predict risk of hepatotoxicity and guide NAC treatment.

Question 192: A patient presents with calcium of 14.2 mg/dL, confusion, polyuria, and constipation. What is the first-line treatment for hypercalcemic crisis?

IV normal saline hydration (Correct answer)
Calcitonin before fluids
Bisphosphonates IV immediately
Furosemide as first step

Correct answer: IV normal saline hydration

Aggressive IV normal saline rehydration is the cornerstone first step in treating hypercalcemic crisis, increasing renal calcium excretion.

Question 193: A patient presents with a Gustilo type IIIB open tibia fracture with significant soft tissue loss. After hemorrhage control and wound assessment, what is the highest priority in the ED?

Splinting and outpatient orthopedic follow-up within 24 hours
Immediate IV antibiotics and urgent surgical debridement in the OR (Correct answer)
ORIF in the ED procedure room
Wound irrigation with saline followed by primary closure in the ED

Correct answer: Immediate IV antibiotics and urgent surgical debridement in the OR

Open fractures require immediate IV antibiotics (cephalosporin plus aminoglycoside for type III) and urgent operative debridement to prevent osteomyelitis and sepsis.

Question 194: What is the MOST effective way for new ABEM professionals to build competency in their field?

Combining formal education, mentored practice, and ongoing professional development (Correct answer)
Studying certification materials exclusively
Learning entirely through trial and error
Focusing solely on the most advanced topics

Correct answer: Combining formal education, mentored practice, and ongoing professional development

Question 195: Which of the following presentations is MOST consistent with black widow spider envenomation rather than brown recluse envenomation?

Painless local erythema with central eschar formation
Local urticaria and angioedema within 30 minutes of the bite
Expanding necrotic wound with blue-gray halo at the bite site
Diffuse muscle cramping, diaphoresis, and severe abdominal rigidity (Correct answer)

Correct answer: Diffuse muscle cramping, diaphoresis, and severe abdominal rigidity

Latrodectus (black widow) venom causes alpha-latrotoxin-induced neurotransmitter release, producing the classic latrodectism: painful muscle cramping, diaphoresis, and autonomic instability.

Question 196: What is a sign of shock?

Hypotension and tachycardia (Correct answer)
Hyperthermia
Bradycardia
Rashes

Correct answer: Hypotension and tachycardia

Shock is a life-threatening condition characterized by inadequate tissue perfusion, meaning the body's cells aren't getting enough oxygen and nutrients. Hypotension (low blood pressure) occurs as the circulatory system fails to maintain adequate pressure, while tachycardia (rapid heart rate) is a compensatory mechanism as the heart tries to pump more blood to vital organs.

Question 197: A patient with known COPD presents with acute exacerbation. SpO2 is 82%. What is the target oxygen saturation range for this patient?

88-92% (Correct answer)
80-85%
94-98%
98-100%

Correct answer: 88-92%

In COPD patients with chronic hypercapnia, target SpO2 is 88-92% to avoid suppressing the hypoxic drive and worsening hypercapnia.

Question 198: What indicates respiratory distress?

Cyanosis and effort (Correct answer)
Itching
Dry mouth
Sneezing

Correct answer: Cyanosis and effort

Respiratory distress is characterized by visible signs that indicate difficulty breathing and inadequate oxygenation. Cyanosis, a bluish discoloration of the skin or mucous membranes, signifies low oxygen levels, while increased effort (e.g., nasal flaring, retractions, accessory muscle use) shows the body struggling to breathe. These are critical indicators requiring immediate medical attention.

Question 199: A patient presents with altered mental status, tachycardia, fever, and a thyroid-stimulating hormone near zero with T4 markedly elevated. What is the diagnosis?

Subacute thyroiditis
Thyroid storm (Correct answer)
Sick euthyroid syndrome
Myxedema coma

Correct answer: Thyroid storm

Thyroid storm is a life-threatening hypermetabolic emergency characterized by hyperthermia, tachycardia, altered mental status, and extremely low TSH.

Question 200: A patient presents with ascending flaccid paralysis, areflexia, and respiratory insufficiency 10 days after a gastroenteritis illness. CSF shows elevated protein with normal glucose and no pleocytosis. What is the most appropriate emergency intervention?

Intubation and mechanical ventilation if FVC < 20 mL/kg (Correct answer)
Thiamine 100 mg IV and glucose
Plasmapheresis or IVIG
High-dose methylprednisolone IV

Correct answer: Intubation and mechanical ventilation if FVC < 20 mL/kg

In Guillain-Barré syndrome, the most critical emergency intervention is airway management; intubation is indicated when FVC falls below 20 mL/kg or the patient cannot complete a sentence.

Question 201: Which personal protective equipment (PPE) principle applies to ALL ABEM certified professionals regardless of their specific role?

PPE must be properly fitted, maintained, and replaced as needed (Correct answer)
PPE is only necessary during formal inspections
Any PPE will provide adequate protection
PPE is optional if experienced in the field

Correct answer: PPE must be properly fitted, maintained, and replaced as needed

Regardless of experience level or specific role, PPE must be properly fitted to the individual, regularly maintained in good condition, and replaced when worn or damaged. Improperly fitted or degraded PPE can provide a false sense of security.

Question 202: Why reassess after interventions?

Increase workload
Check policy
Avoid documentation
Monitor effectiveness (Correct answer)

Correct answer: Monitor effectiveness

Reassessment after medical interventions is a fundamental principle of patient care. It allows healthcare providers to determine if the treatment administered is having the desired effect and if the patient's condition is improving, worsening, or remaining stable. This continuous monitoring guides further management decisions and ensures optimal patient outcomes.

Question 203: A 62-year-old female presents with acute dyspnea, pleuritic chest pain, and leg swelling after a 10-hour flight. D-dimer is elevated. The MOST appropriate next step is:

V/Q scan
Lower extremity venous duplex only
CT pulmonary angiography (Correct answer)
Empiric anticoagulation and discharge

Correct answer: CT pulmonary angiography

CT pulmonary angiography (CTPA) is the gold standard imaging study for diagnosing pulmonary embolism in patients with intermediate-to-high clinical probability.

Question 204: A 40-year-old presents with sudden unilateral vision loss, described as a 'shade coming down' over the eye that resolved in 10 minutes. What is this phenomenon called and what does it indicate?

Retinal detachment — requires immediate ophthalmology referral
Amaurosis fugax — indicates carotid artery disease (Correct answer)
Central retinal artery occlusion — requires tPA
Ocular migraine — indicates cortical spreading depression

Correct answer: Amaurosis fugax — indicates carotid artery disease

Amaurosis fugax (transient monocular blindness) is caused by emboli from ipsilateral carotid stenosis temporarily occluding retinal blood flow.

Question 205: A child ingests iron tablets and presents 6 hours later with vomiting, abdominal pain, and bloody diarrhea. Which laboratory finding best indicates systemic iron toxicity?

Leukocytosis > 15,000/µL
Serum iron level > 350 µg/dL
Anion gap metabolic acidosis (Correct answer)
Hyperglycemia

Correct answer: Anion gap metabolic acidosis

An anion gap metabolic acidosis reflects mitochondrial dysfunction from free radical damage and is a marker of systemic iron toxicity requiring deferoxamine.

Question 206: A trauma patient develops paradoxical chest wall movement involving multiple ribs bilaterally after a crush injury. What is the primary concern?

Flail chest with underlying pulmonary contusion (Correct answer)
Pneumothorax
Diaphragmatic rupture
Aortic dissection

Correct answer: Flail chest with underlying pulmonary contusion

Paradoxical chest wall movement indicates flail chest, and the underlying pulmonary contusion is the primary driver of respiratory failure.

Question 207: A patient presents with respiratory failure, miosis, bradycardia, and excessive secretions after a farmworker exposure. What is the appropriate initial dose of atropine?

0.04 mg/kg IM as a single dose
2–4 mg IV, repeat every 5–10 min until secretions dry (Correct answer)
0.5 mg IV, titrate slowly
10 mg IV single bolus

Correct answer: 2–4 mg IV, repeat every 5–10 min until secretions dry

Organophosphate poisoning requires aggressive atropinization starting at 2–4 mg IV titrated to drying of secretions, which is the clinical endpoint.

Question 208: What is the first step in trauma assessment?

Measure glucose
Check temperature
Obtain history
Primary survey (Correct answer)

Correct answer: Primary survey

In trauma assessment, the primary survey is the crucial first step, focusing on identifying and immediately treating life-threatening injuries. It follows the ABCDE mnemonic (Airway, Breathing, Circulation, Disability, Exposure) to systematically assess and manage critical issues, ensuring the patient's immediate survival before proceeding to a more detailed secondary assessment.

Question 209: A 5-year-old presents after a seizure lasting 4 minutes that has now stopped. Temperature is 39.2°C. What is the most appropriate management?

EEG immediately
Reassurance and antipyretics for a simple febrile seizure (Correct answer)
Admit for 24-hour observation
Lumbar puncture in all cases

Correct answer: Reassurance and antipyretics for a simple febrile seizure

A simple febrile seizure (single, brief, generalized) in a child 6 months–5 years requires reassurance and treatment of the fever.

Question 210: A 28-year-old presents with acute psychosis, severe agitation, hyperthermia, rigidity, and elevated CK after starting haloperidol 3 days ago. What is the most likely diagnosis?

Serotonin syndrome
Malignant hyperthermia
Anticholinergic toxicity
Neuroleptic malignant syndrome (Correct answer)

Correct answer: Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) presents with hyperthermia, lead-pipe rigidity, altered mental status, and autonomic instability following antipsychotic use.

Question 211: During a resuscitative thoracotomy for penetrating cardiac trauma, you find a laceration to the right ventricle. Which maneuver is most appropriate to control bleeding?

Pulmonary artery clamping
Aortic cross-clamp only
Finger occlusion followed by stapling or suture repair (Correct answer)
Pericardial patch

Correct answer: Finger occlusion followed by stapling or suture repair

Finger occlusion of the ventricular laceration followed by suture or staple repair is the standard initial control technique.

Question 212: A patient on warfarin presents with an INR of 9.8 and active intracranial hemorrhage. Which is the FASTEST and most appropriate reversal strategy?

Vitamin K 10 mg IV alone
4-factor prothrombin complex concentrate (4F-PCC) (Correct answer)
Recombinant factor VIIa
Fresh frozen plasma 4 units

Correct answer: 4-factor prothrombin complex concentrate (4F-PCC)

4-factor PCC reverses warfarin-related INR within minutes, contains all vitamin K-dependent factors, requires small volume, and is superior to FFP for emergent reversal.

Question 213: Which ECG finding during SVT suggests the rhythm is atrial flutter rather than AVNRT?

No visible P waves
Regular narrow QRS complexes
Retrograde P waves immediately after QRS
Sawtooth flutter waves at 300 bpm in leads II, III, aVF (Correct answer)

Correct answer: Sawtooth flutter waves at 300 bpm in leads II, III, aVF

Atrial flutter characteristically shows sawtooth flutter waves at approximately 300 bpm (atrial rate) in inferior leads, often with 2:1 AV conduction giving a ventricular rate of 150 bpm.

Question 214: Which risk management approach is MOST effective for ABEM professionals when evaluating potential workplace hazards?

Relying solely on historical accident data
Reactive analysis after incidents occur
Delegating all safety decisions to management
Proactive hazard identification and assessment (Correct answer)

Correct answer: Proactive hazard identification and assessment

Question 215: Which scenario represents a violation of the American Board of Emergency Medicine code of professional conduct?

Reporting safety concerns to regulatory authorities
Seeking continuing education beyond minimum requirements
Declining work outside one's area of competence
Misrepresenting qualifications or certification status (Correct answer)

Correct answer: Misrepresenting qualifications or certification status

Question 216: Which of the following is the preferred initial airway management in a patient with suspected C-spine injury and a GCS of 6?

Orotracheal RSI with inline stabilization (Correct answer)
Awake fiberoptic intubation
Surgical cricothyrotomy
Nasotracheal intubation

Correct answer: Orotracheal RSI with inline stabilization

RSI with manual inline cervical stabilization is the standard approach for airway management in trauma patients with suspected C-spine injury.

Question 217: A patient is found in pulseless electrical activity (PEA). Which of the H's and T's should be considered FIRST given a history of massive hemorrhage?

Hydrogen ion excess
Hypothermia
Thrombosis (PE)
Hypovolemia (Correct answer)

Correct answer: Hypovolemia

Hypovolemia from hemorrhage is the most immediately reversible cause of PEA and should be addressed with rapid volume resuscitation.

Question 218: A restrained driver sustains a lap-belt abdominal bruise pattern. Which injury triad is classically associated with this mechanism?

Liver laceration, spleen rupture, bladder injury
Aortic transection, hemothorax, rib fractures
Sternal fracture, cardiac contusion, aortic injury
Chance fracture, hollow viscus injury, mesenteric tear (Correct answer)

Correct answer: Chance fracture, hollow viscus injury, mesenteric tear

The lap-belt complex includes Chance fracture (flexion-distraction lumbar), bowel/mesenteric injury from compression against the spine.

Question 219: A 30-year-old presents with acute onset of severe agitation, hyperthermia (40.5°C), diaphoresis, myoclonus, and hyperreflexia after starting a new medication. Which drug combination most likely caused this?

Haloperidol and benztropine
Clonazepam and alcohol
Tramadol and sertraline (Correct answer)
Amitriptyline alone

Correct answer: Tramadol and sertraline

Serotonin syndrome is caused by excess serotonergic activity, classically from combining opioids with serotonin activity (tramadol) and SSRIs.

Question 220: Which of the following is the MOST common cause of massive hemoptysis requiring emergency intervention?

Pulmonary embolism
Bronchiectasis (Correct answer)
Goodpasture syndrome
Bronchogenic carcinoma

Correct answer: Bronchiectasis

Bronchiectasis is the most common cause of massive hemoptysis due to hypertrophied bronchial arteries and recurrent infections.

Question 221: What distinguishes a American Board of Emergency Medicine certified professional from a non-certified practitioner?

There is no meaningful difference in competency
Certified professionals exclusively work in larger organizations
Certified professionals always have more years of experience
Certification validates competency through standardized assessment against established benchmarks (Correct answer)

Correct answer: Certification validates competency through standardized assessment against established benchmarks

Question 222: What is a seizure?

Brain activity (Correct answer)
Heart spasm
Muscle fatigue
Low oxygen

Correct answer: Brain activity

A seizure is fundamentally a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. It is caused by uncontrolled electrical discharges in the brain, which can manifest in various ways, including altered consciousness, involuntary movements, or sensory disturbances.

Question 223: What is the PRIMARY ethical obligation of a certified American Board of Emergency Medicine professional regarding confidential information?

Protect it from unauthorized disclosure at all times (Correct answer)
Use it to advance career opportunities
Discuss it informally during professional networking
Share it with colleagues who might benefit

Correct answer: Protect it from unauthorized disclosure at all times

Question 224: A 60-year-old woman presents with painless diplopia, ptosis, and a dilated pupil. She has a known posterior communicating artery aneurysm. What is the most urgent next step?

Administer IV methylprednisolone
Emergent neurosurgical or interventional neuroradiology consultation (Correct answer)
MRI orbits with contrast
Prescribe eye patch and outpatient follow-up

Correct answer: Emergent neurosurgical or interventional neuroradiology consultation

Third nerve palsy with pupil involvement from a PComm aneurysm represents a surgical emergency due to risk of rupture and subarachnoid hemorrhage.

Question 225: What is the antidote for opioid overdose?

Digoxin
Naloxone (Correct answer)
Atropine
Epinephrine

Correct answer: Naloxone

Naloxone is a specific opioid antagonist that rapidly reverses the effects of opioid overdose. It works by binding to opioid receptors in the brain, displacing opioids and blocking their effects, particularly respiratory depression. This can quickly restore normal breathing and consciousness in someone experiencing an opioid overdose.

Question 226: What is the MOST important reason for American Board of Emergency Medicine professionals to maintain continuing education?

To stay current with evolving standards, practices, and regulations (Correct answer)
To satisfy employer preferences
To accumulate credentials for personal prestige
To increase billing rates

Correct answer: To stay current with evolving standards, practices, and regulations

Question 227: A 2-year-old presents with inspiratory stridor and a barking cough. Which intervention is first-line for moderate croup?

Nebulized epinephrine
Heliox therapy
Racemic epinephrine only
Dexamethasone 0.6 mg/kg IM/PO (Correct answer)

Correct answer: Dexamethasone 0.6 mg/kg IM/PO

Dexamethasone (0.6 mg/kg) is the first-line treatment for moderate croup, reducing airway edema and decreasing return visits.

Question 228: A 22-year-old sustains an anterior shoulder dislocation during a tackle. Which neurovascular structure is most commonly injured in this dislocation?

Musculocutaneous nerve
Radial nerve
Axillary nerve (Correct answer)
Brachial artery

Correct answer: Axillary nerve

The axillary nerve wraps around the surgical neck of the humerus and is the most commonly injured nerve in anterior shoulder dislocations, causing deltoid weakness and lateral shoulder numbness.

Question 229: Which maneuver is used to confirm proper endotracheal tube placement in a trauma patient immediately after intubation?

Chest X-ray alone
Waveform capnography combined with clinical assessment (Correct answer)
Pulse oximetry
Bilateral breath sounds alone

Correct answer: Waveform capnography combined with clinical assessment

Continuous waveform capnography is the gold standard for confirming ETT placement, especially during trauma resuscitation.

Question 230: A patient with ulcerative colitis presents with >10 bloody stools per day, fever, tachycardia, and Hgb of 8. What is the first management step in the ED?

Oral mesalamine
IV corticosteroids and GI consultation (Correct answer)
Colonoscopy immediately
Oral prednisone and discharge

Correct answer: IV corticosteroids and GI consultation

Severe ulcerative colitis requires hospitalization, IV corticosteroids, and urgent GI consultation to prevent toxic megacolon.

Question 231: A 35-year-old with HIV presents with headache, fever, and altered mental status. CSF shows lymphocytic pleocytosis and India ink staining is positive. What is the treatment?

Dexamethasone plus ceftriaxone
Amphotericin B plus flucytosine (Correct answer)
Trimethoprim-sulfamethoxazole
IV acyclovir

Correct answer: Amphotericin B plus flucytosine

Cryptococcal meningitis in HIV patients is treated with amphotericin B plus flucytosine for induction therapy.

Question 232: What is the recommended initial fluid bolus for hypotensive trauma patients according to damage control resuscitation principles?

1–2L crystalloid then reassess
2L lactated Ringer's followed by 2L NS
3L normal saline
Immediate blood product transfusion with limited crystalloid (Correct answer)

Correct answer: Immediate blood product transfusion with limited crystalloid

Damage control resuscitation prioritizes early blood products over crystalloid to prevent dilutional coagulopathy and hypothermia.

Question 233: Which trauma score assesses severity?

BMI
GCS (Correct answer)
APGAR
ABG

Correct answer: GCS

The Glasgow Coma Scale (GCS) is a widely used neurological scale that provides an objective and reliable way to assess a patient's conscious state, particularly after a head injury or in other trauma. It evaluates eye opening, verbal response, and motor response, with a lower score indicating greater severity of brain injury and overall trauma.

Question 234: A patient presents with septic shock from suspected gram-negative bacteremia. Which of the following represents the BEST evidence-based initial fluid resuscitation target in the first 3 hours per surviving sepsis guidelines?

Vasopressors first without fluid bolus
Colloid 20 mL/kg to minimize fluid overload
30 mL/kg of crystalloid IV, then reassess (Correct answer)
1 L boluses until MAP > 65 mmHg, maximum 4 L

Correct answer: 30 mL/kg of crystalloid IV, then reassess

The Surviving Sepsis Campaign recommends at least 30 mL/kg of IV crystalloid within the first 3 hours of sepsis-induced hypoperfusion recognition.

Question 235: Which personal protective equipment (PPE) principle applies to ALL ABEM certified professionals regardless of their specific role?

PPE must be properly fitted, maintained, and replaced as needed (Correct answer)
PPE is optional if experienced in the field
Any PPE will provide adequate protection
PPE is only necessary during formal inspections

Correct answer: PPE must be properly fitted, maintained, and replaced as needed

Question 236: A 50-year-old male develops acute onset dyspnea and hypoxia 3 days after an MI. Echocardiogram shows a new VSD. Which finding would you expect on physical exam?

Loud systolic murmur at the left sternal border (Correct answer)
Diastolic murmur at the apex
Pericardial friction rub
Continuous machine-like murmur

Correct answer: Loud systolic murmur at the left sternal border

Post-MI ventricular septal defect causes a harsh holosystolic murmur heard best at the left lower sternal border due to left-to-right shunting.

Question 237: A 68-year-old woman presents with acute decompensated heart failure and severe dyspnea. Despite diuretics and nitroglycerin, she remains hypoxic with SpO2 86%. The BEST next step is:

Increase the dose of furosemide
Apply CPAP via non-invasive ventilation (Correct answer)
Administer IV morphine 4mg
Start dobutamine infusion

Correct answer: Apply CPAP via non-invasive ventilation

CPAP reduces work of breathing, improves oxygenation, and decreases preload in acute cardiogenic pulmonary edema, reducing intubation rates.

Question 238: A 75-year-old female on digoxin presents with nausea, yellow-green visual halos, and bradycardia with a junctional rhythm on ECG. Digoxin toxicity is suspected. The MOST important electrolyte to check and correct is:

Potassium (Correct answer)
Sodium
Phosphate
Calcium

Correct answer: Potassium

Hypokalemia potentiates digoxin toxicity by competing with digoxin for the same Na+/K+ ATPase binding site; correcting potassium is essential.

Question 239: A patient with blunt chest trauma has absent breath sounds on the left and tracheal deviation to the right. BP is 70/40 mmHg. What is the immediate next step?

Chest tube insertion
Intubation
Needle decompression at left 2nd ICS MCL (Correct answer)
Chest X-ray

Correct answer: Needle decompression at left 2nd ICS MCL

Tension pneumothorax causing hemodynamic instability requires immediate needle decompression before imaging.

Question 240: When conducting a risk assessment for ABEM operations, which factor should receive the HIGHEST priority?

Time required for safety training
Cost of implementing safety measures
Probability and severity of potential harm (Correct answer)
Convenience for daily operations

Correct answer: Probability and severity of potential harm

Question 241: A 32-year-old presents with visual disturbances, bilateral internuclear ophthalmoplegia, and an episode of transverse myelitis 6 months ago. MRI shows periventricular white matter lesions. What is the most likely diagnosis?

Anti-NMDA receptor encephalitis
CNS vasculitis
Neurosarcoidosis
Multiple sclerosis (Correct answer)

Correct answer: Multiple sclerosis

Multiple sclerosis presents with relapsing-remitting neurological episodes, periventricular demyelinating lesions, and internuclear ophthalmoplegia due to MLF involvement.

Question 242: Which of the following is a reliable clinical feature distinguishing heat stroke from severe heat exhaustion?

Central nervous system dysfunction (Correct answer)
Core temperature > 40°C
Hypotension
Diaphoresis

Correct answer: Central nervous system dysfunction

CNS dysfunction (altered mentation, seizures, coma) is the defining feature of heat stroke and differentiates it from heat exhaustion, where cognition remains intact.

Question 243: A comatose patient has pinpoint pupils, bradycardia, and respiratory depression after being found with empty prescription bottles. What is the antidote?

Flumazenil 0.2 mg IV
N-acetylcysteine IV
Physostigmine 1–2 mg IV slow push
Naloxone 0.4–2 mg IV (Correct answer)

Correct answer: Naloxone 0.4–2 mg IV

The opioid toxidrome (CNS depression, miosis, respiratory depression) is reversed with naloxone, an opioid receptor antagonist.

Question 244: A patient presents with midepigastric pain radiating to the back, nausea, and elevated lipase 3× the upper limit of normal. What is the cornerstone of initial management?

IV fluid resuscitation and NPO (Correct answer)
Nasogastric tube decompression
Immediate ERCP
Urgent cholecystectomy

Correct answer: IV fluid resuscitation and NPO

Aggressive IV fluid resuscitation and bowel rest are the mainstays of initial acute pancreatitis management.

Question 245: A 55-year-old presents with severe low back pain radiating bilaterally to both legs, new urinary retention, and decreased rectal sphincter tone. What is the most appropriate next step?

NSAIDs, physical therapy referral, and reassurance
Urgent MRI of the lumbar spine and neurosurgical consultation (Correct answer)
Epidural steroid injection for nerve root decompression
Lumbar X-ray and discharge with muscle relaxants and follow-up

Correct answer: Urgent MRI of the lumbar spine and neurosurgical consultation

Cauda equina syndrome is a surgical emergency; urgent MRI is required to identify the compressive lesion and emergent neurosurgical decompression must not be delayed.

Question 246: How does the ABEM body of knowledge relate to daily professional practice?

It is theoretical and has limited practical application
It provides the foundational framework that guides decision-making and standard practices (Correct answer)
It only applies during certification exams
It is relevant only for academic research

Correct answer: It provides the foundational framework that guides decision-making and standard practices

Question 247: A 25-year-old woman presents with ascending weakness starting in the legs over 3 days, areflexia, and mild autonomic instability. CSF shows albuminocytologic dissociation. What is the priority concern?

Urinary retention
Aspiration pneumonia
Imminent respiratory failure (Correct answer)
Cardiac arrhythmia

Correct answer: Imminent respiratory failure

In Guillain-Barré syndrome, respiratory muscle involvement causing respiratory failure is the most immediately life-threatening complication requiring serial FVC monitoring.

Question 248: A 35-year-old found after lying on a hard surface for 10 hours presents with diffuse muscle pain, dark urine, and creatinine of 3.1 mg/dL. Urine dipstick is 3+ blood with no RBCs on microscopy. What is the most critical initial treatment?

Aggressive IV fluid resuscitation with isotonic normal saline (Correct answer)
Furosemide 40 mg IV to promote forced diuresis
Urgent hemodialysis initiation
Sodium bicarbonate IV bolus to alkalinize urine

Correct answer: Aggressive IV fluid resuscitation with isotonic normal saline

Aggressive isotonic saline resuscitation targeting urine output of 200-300 mL/hr is the cornerstone of rhabdomyolysis management to prevent myoglobin-induced acute tubular necrosis.

Question 249: A 72-year-old nursing home patient presents with gradual cognitive decline, urinary incontinence, and a wide-based magnetic gait. CT shows enlarged ventricles disproportionate to cortical atrophy. What condition should be ruled out?

Creutzfeldt-Jakob disease
Multi-infarct dementia
Alzheimer dementia
Normal pressure hydrocephalus (Correct answer)

Correct answer: Normal pressure hydrocephalus

Normal pressure hydrocephalus presents with the classic triad of gait apraxia, urinary incontinence, and dementia, and is potentially reversible with VP shunting.

Question 250: What confirms pneumothorax?

Chest x-ray (Correct answer)
Blood sugar
EKG
Ultrasound

Correct answer: Chest x-ray

A pneumothorax, or collapsed lung, occurs when air leaks into the space between the lung and chest wall, causing the lung to partially or fully collapse. A chest x-ray is the primary diagnostic imaging tool used to confirm a pneumothorax, as it clearly visualizes the presence of air in the pleural space and the collapsed lung tissue.

Question 251: A trauma patient with a suspected diaphragmatic rupture is intubated. Which finding on chest X-ray is most specific?

Mediastinal shift
Elevated hemidiaphragm
Left lower lobe atelectasis
Nasogastric tube coiled in left chest (Correct answer)

Correct answer: Nasogastric tube coiled in left chest

A nasogastric tube visible in the left chest cavity is pathognomonic for left-sided diaphragmatic rupture with gastric herniation.

Question 252: A patient presents with confusion, serum sodium of 118 mEq/L, and euvolemia. What is the safest correction rate for chronic hyponatremia?

Correct as fast as possible
Correct to 130 within 4 hours
No more than 8–10 mEq/L in 24 hours (Correct answer)
Give 3% saline at rapid rate

Correct answer: No more than 8–10 mEq/L in 24 hours

Overcorrecting chronic hyponatremia faster than 8–10 mEq/L per 24 hours risks osmotic demyelination syndrome (central pontine myelinolysis).

Question 253: What is the PRIMARY purpose of obtaining ABEM certification in American Board of Emergency Medicine?

To demonstrate verified competency and adherence to professional standards (Correct answer)
To satisfy a personal achievement goal
To bypass educational requirements
To guarantee employment in the field

Correct answer: To demonstrate verified competency and adherence to professional standards

ABEM Qualifying Examination (QE)

This exam is the initial certification examination for physicians seeking board certification in Emergency Medicine, assessing broad knowledge of the specialty.

300

Questions

480 min

Time Limit

70%

To Pass

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