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ABPS Emergency Medicine (BCEM) study materials
ABPS Emergency Medicine (BCEM) study resources

ABPS Emergency Medicine (BCEM) practice questions

One question at a time. Build your ABPS Emergency Medicine (BCEM) understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

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Question 1Emergency Medicine - Written Examination (subject areas not enumerated in source)

A 24-year-old presents after a bee sting with diffuse urticaria, wheeze, and a blood pressure of 82/50 mmHg. After intramuscular epinephrine, which adjunct medication is most appropriate to give next for persistent hypotension?

  1. Intravenous diphenhydramine
  2. Nebulized albuterol
  3. Intravenous fluid bolus Correct answer.
  4. Oral prednisone

Explanation

Anaphylaxis with hypotension reflects distributive shock from vasodilation and capillary leak, so rapid volume resuscitation with an isotonic crystalloid bolus is the immediate adjunct after epinephrine. Epinephrine remains the first-line drug and reverses the underlying mediator release.

Question 2Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which finding best distinguishes a generalized tonic-clonic seizure from a syncopal episode?

  1. Postictal confusion lasting minutes Correct answer.
  2. Pallor before the event
  3. Brief myoclonic jerks
  4. Incontinence of urine

Explanation

A prolonged postictal state of confusion and drowsiness is characteristic of a true seizure, whereas recovery after syncope is typically rapid and complete. Motor activity and incontinence can occur in both.

Question 3Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with known atrial fibrillation presents with palpitations and a heart rate of 160/min. Which agent is most appropriate for rate control in a hemodynamically stable patient with preserved ejection fraction?

  1. Diltiazem Correct answer.
  2. Adenosine
  3. Atropine
  4. Procainamide

Explanation

Intravenous calcium channel blockers such as diltiazem slow AV nodal conduction and are first-line for rate control in stable atrial fibrillation with preserved ventricular function. Adenosine is used for narrow-complex tachycardias that depend on the AV node and would not durably control atrial fibrillation.

Question 4Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which of the following is the most sensitive initial test for suspected acute coronary syndrome in the emergency department?

  1. Creatine kinase-MB
  2. Lactate dehydrogenase
  3. Serial high-sensitivity troponin Correct answer.
  4. Myoglobin

Explanation

High-sensitivity cardiac troponin assays detect myocardial injury with high sensitivity and are the preferred biomarker for acute coronary syndrome, interpreted with serial sampling and clinical context. Older markers such as CK-MB and myoglobin have lower sensitivity and specificity.

Question 5Emergency Medicine - Written Examination (subject areas not enumerated in source)

A 68-year-old with a history of heart failure presents with acute dyspnea, bibasilar crackles, and an SpO2 of 86% on room air. Which initial intervention most directly improves oxygenation in acute cardiogenic pulmonary edema?

  1. Oral ACE inhibitor
  2. Intravenous furosemide alone
  3. Intravenous morphine
  4. Noninvasive positive-pressure ventilation Correct answer.

Explanation

Noninvasive positive-pressure ventilation recruits flooded alveoli and reduces work of breathing, rapidly improving oxygenation in acute cardiogenic pulmonary edema. Diuretics address volume overload but act more slowly and do not directly recruit alveoli.

Question 6Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which arterial blood gas pattern is most consistent with acute salicylate toxicity?

  1. Metabolic acidosis with respiratory alkalosis Correct answer.
  2. Metabolic alkalosis with respiratory acidosis
  3. Pure respiratory acidosis
  4. Pure metabolic alkalosis

Explanation

Salicylates directly stimulate the respiratory center causing hyperventilation and respiratory alkalosis, while uncoupling of oxidative phosphorylation produces a primary metabolic acidosis. The combined picture is a mixed metabolic acidosis with respiratory alkalosis.

Question 7Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with a suspected opioid overdose has a respiratory rate of 4/min and pinpoint pupils. Which medication should be administered?

  1. Naloxone Correct answer.
  2. N-acetylcysteine
  3. Flumazenil
  4. Physostigmine

Explanation

Naloxone is a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression. The triad of depressed mental status, respiratory depression, and miosis strongly suggests opioid toxicity.

Question 8Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient presents with severe abdominal pain, and imaging confirms a perforated viscus. Which initial management step is most appropriate in the emergency department?

  1. Immediate oral contrast study
  2. Discharge with analgesia
  3. Broad-spectrum antibiotics and surgical consultation Correct answer.
  4. Oral rehydration

Explanation

A perforated viscus is a surgical emergency requiring broad-spectrum antibiotics, intravenous fluids, and prompt surgical consultation. Delaying definitive management increases mortality from peritonitis and sepsis.

Question 9Emergency Medicine - Written Examination (subject areas not enumerated in source)

A 30-year-old woman has right lower quadrant pain, fever, and tenderness at McBurney's point. Which diagnosis is most likely?

  1. Diverticulitis
  2. Renal colic
  3. Acute appendicitis Correct answer.
  4. Acute cholecystitis

Explanation

Migration of pain to the right lower quadrant with focal tenderness at McBurney's point and fever is classic for acute appendicitis. Cholecystitis causes right upper quadrant pain, and diverticulitis typically affects the left lower quadrant.

Question 10Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which finding is most concerning for a ruptured ectopic pregnancy in a woman of childbearing age with abdominal pain?

  1. Nausea with a normal pelvic exam
  2. Low-grade fever with diarrhea
  3. Positive urine pregnancy test with adnexal tenderness and hypotension Correct answer.
  4. Mild unilateral pelvic discomfort with stable vitals

Explanation

A positive pregnancy test combined with adnexal tenderness and hemodynamic instability suggests a ruptured ectopic pregnancy with intraperitoneal hemorrhage, a life-threatening emergency. Immediate resuscitation and surgical consultation are required.

Question 11Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with a suspected open tibial fracture has active bleeding from the wound. What is the most appropriate first step to control hemorrhage?

  1. Irrigate the wound with saline
  2. Elevate the limb only
  3. Apply direct pressure with a sterile dressing Correct answer.
  4. Apply a tourniquet immediately

Explanation

Direct pressure with a sterile dressing is the initial step for controlling external hemorrhage from an extremity wound. Tourniquets are reserved for life-threatening bleeding not controlled by direct pressure.

Question 12Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which imaging study is the modality of choice for a hemodynamically stable patient with suspected acute ischemic stroke beyond the thrombolytic window?

  1. MRI with diffusion-weighted imaging Correct answer.
  2. Carotid ultrasound
  3. Noncontrast head CT
  4. Skull radiograph

Explanation

Diffusion-weighted MRI is the most sensitive modality for detecting acute ischemic stroke, particularly when the diagnosis is uncertain or beyond the thrombolytic window. Noncontrast CT is used to exclude hemorrhage before thrombolysis but is less sensitive for early ischemia.

Question 13Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with a severe asthma exacerbation has a silent chest on auscultation and rising PaCO2. What does this indicate?

  1. Improving airflow
  2. Resolution of bronchospasm
  3. Impending respiratory failure Correct answer.
  4. Mild exacerbation

Explanation

A silent chest with rising PaCO2 in severe asthma indicates critically reduced airflow and impending respiratory failure, requiring urgent escalation including possible intubation. Normalization of CO2 in a distressed asthmatic can be a warning sign rather than improvement.

Question 14Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient presents with a widened mediastinum on chest radiograph after high-speed deceleration trauma. Which diagnosis should be suspected?

  1. Pericardial tamponade
  2. Tension pneumothorax
  3. Aortic dissection or injury Correct answer.
  4. Pulmonary embolism

Explanation

A widened mediastinum after high-energy deceleration trauma raises concern for traumatic aortic injury, which requires urgent CT angiography. Tension pneumothorax and tamponade present with shock and specific exam findings rather than an isolated widened mediastinum.

Question 15Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which finding most strongly supports the diagnosis of tension pneumothorax in a hypotensive trauma patient?

  1. Tracheal deviation away from the affected side with absent breath sounds Correct answer.
  2. Subcutaneous emphysema alone
  3. Bibasilar crackles
  4. Friction rub

Explanation

Tension pneumothorax causes mediastinal shift with tracheal deviation away from the affected side, absent breath sounds, and hemodynamic compromise. It is a clinical diagnosis requiring immediate needle decompression.

Question 16Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with a suspected cervical spine injury should have which maneuver performed to open the airway during initial resuscitation?

  1. Jaw thrust Correct answer.
  2. Head tilt-chin lift
  3. Hyperextension of the neck
  4. Flexion of the neck

Explanation

The jaw-thrust maneuver opens the airway while minimizing movement of the cervical spine, making it preferred in suspected cervical injury. Head tilt-chin lift and neck hyperextension may worsen spinal injury.

Question 17Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which electrolyte abnormality is most likely in a patient with prolonged vomiting?

  1. Hypernatremic metabolic acidosis
  2. Hyperchloremic metabolic acidosis
  3. Hypochloremic metabolic alkalosis Correct answer.
  4. Hyperkalemia

Explanation

Prolonged vomiting causes loss of hydrogen and chloride ions, producing a hypochloremic metabolic alkalosis with hypokalemia. Volume depletion also triggers a paradoxical aciduria.

Question 18Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with diabetic ketoacidosis has a blood glucose of 480 mg/dL. Which is the most appropriate initial fluid for resuscitation?

  1. Hypertonic saline
  2. Dextrose-containing fluid immediately
  3. 0.9% normal saline Correct answer.
  4. 5% dextrose in water

Explanation

Isotonic crystalloid such as 0.9% normal saline is the initial fluid for volume resuscitation in DKA, followed by insulin and potassium replacement. Dextrose-containing fluids are added later when glucose falls.

Question 19Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient presents with severe hyperkalemia and ECG changes. Which intervention most rapidly stabilizes the myocardium?

  1. Sodium bicarbonate
  2. Oral potassium binder
  3. Insulin with glucose
  4. Intravenous calcium gluconate Correct answer.

Explanation

Intravenous calcium stabilizes the myocardial membrane and protects against arrhythmia without lowering serum potassium, acting within minutes. Insulin with glucose and other therapies shift or remove potassium but act more slowly.

Question 20Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which is the most appropriate initial management for a patient with suspected carbon monoxide poisoning and neurologic symptoms?

  1. Nitroglycerin
  2. Oral hydration
  3. High-flow supplemental oxygen Correct answer.
  4. Beta-blocker

Explanation

High-flow oxygen accelerates the dissociation of carboxyhemoglobin and is the mainstay of treatment for carbon monoxide poisoning. Hyperbaric oxygen may be considered for severe cases with neurologic involvement.

Question 21Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with suspected organophosphate poisoning presents with salivation, lacrimation, urination, diarrhea, and bradycardia. Which medication is most appropriate?

  1. Glucagon
  2. Naloxone
  3. Atropine Correct answer.
  4. Flumazenil

Explanation

Organophosphate poisoning causes a cholinergic syndrome from excess acetylcholine, and atropine blocks the muscarinic effects. Pralidoxime may be added to reactivate acetylcholinesterase.

Question 22Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which finding is most consistent with a diagnosis of acute compartment syndrome of the lower leg?

  1. Painless swelling of the calf
  2. Immediate loss of all sensation
  3. Diminished pulses as the earliest sign
  4. Pain out of proportion to injury that worsens with passive stretch Correct answer.

Explanation

Acute compartment syndrome presents with pain out of proportion to the injury and pain on passive stretch of the involved compartment, which is the most sensitive early sign. Pulselessness is typically a late finding.

Question 23Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with a severe head injury has a Glasgow Coma Scale score of 7. Which is the most appropriate airway management?

  1. Endotracheal intubation Correct answer.
  2. High-flow nasal cannula alone
  3. Observation with serial GCS checks
  4. Nasopharyngeal airway only

Explanation

A GCS of 8 or less indicates a need for definitive airway management with endotracheal intubation to protect the airway and control ventilation. Observation or nasal airways are inadequate for this level of consciousness.

Question 24Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which is the most appropriate initial treatment for a patient with symptomatic bradycardia and hypotension unresponsive to atropine?

  1. Diltiazem
  2. Transcutaneous pacing Correct answer.
  3. Amiodarone
  4. Adenosine

Explanation

Transcutaneous pacing is indicated for symptomatic bradycardia that does not respond to atropine, especially in high-degree AV block. Adenosine, diltiazem, and amiodarone would further slow conduction.

Question 25Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient presents with sudden painless loss of vision in one eye described as a curtain descending. Which diagnosis is most likely?

  1. Acute angle-closure glaucoma
  2. Retinal detachment Correct answer.
  3. Optic neuritis
  4. Central retinal artery occlusion

Explanation

A painless curtain-like visual field loss is classic for retinal detachment, which requires urgent ophthalmologic evaluation. Central retinal artery occlusion causes painless sudden blindness but not typically a curtain description.

Question 26Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient is brought in after a generalized tonic-clonic seizure that has now stopped. Which single measurement best guides immediate management decisions in the emergency department?

  1. Serum calcium
  2. Serum sodium
  3. Serum magnesium
  4. Serum glucose Correct answer.

Explanation

Hypoglycemia is a rapidly reversible cause of seizures and must be excluded immediately in any patient after a first or undifferentiated seizure. Point-of-care glucose is fast and changes management within minutes.

Question 27Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which clinical feature most reliably distinguishes an anaphylactic reaction from a vasovagal episode?

  1. Bradycardia
  2. History of fainting with needles
  3. Urticaria and angioedema Correct answer.
  4. Pallor and diaphoresis

Explanation

Anaphylaxis is an IgE-mediated process with mast cell mediator release producing skin and mucosal findings such as urticaria and angioedema. Vasovagal syncope produces bradycardia and pallor without these allergic features.

Question 28Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient is suspected of having acute bacterial meningitis. Which action should follow immediately after blood cultures are drawn?

  1. Wait for cerebrospinal fluid results
  2. Give oral corticosteroids and discharge
  3. Administer empiric antibiotics without delay Correct answer.
  4. Obtain magnetic resonance imaging of the brain

Explanation

Empiric antibiotics should be given as soon as possible because delay increases mortality in bacterial meningitis. Lumbar puncture and imaging should not delay antimicrobial therapy when the diagnosis is suspected.

Question 29Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which finding on physical examination is most typical of a patient with acute pericarditis?

  1. A holosystolic murmur at the apex
  2. Unilateral leg swelling
  3. A friction rub heard at the left lower sternal border Correct answer.
  4. Tracheal deviation away from the affected side

Explanation

Pericardial friction rub is the classic auscultatory sign of pericarditis and is best heard at the left lower sternal border. It is often intermittent and may be heard with the diaphragm.

Question 30Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient has a deep partial-thickness burn involving approximately 20% of the total body surface area. Which fluid strategy is appropriate for initial resuscitation?

  1. Hypertonic saline at a fixed rate for 24 hours
  2. Colloid infusion at twice the calculated crystalloid volume
  3. Crystalloid titrated to urine output using a weight-based formula Correct answer.
  4. No fluids until the burn is formally debrided

Explanation

Resuscitation for significant burns uses crystalloid calculated by a weight- and area-based formula, then titrated to adequate urine output. Over-resuscitation and under-resuscitation are both harmful, so titration is essential.

Question 31Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which historical feature is most suggestive of a transient ischemic attack rather than a seizure?

  1. Symptoms that are negative phenomena such as loss of function Correct answer.
  2. Aura of unusual smell before the event
  3. A postictal period of confusion
  4. Rhythmic jerking of one limb

Explanation

Transient ischemic attacks typically produce negative symptoms such as weakness, numbness, or loss of vision, reflecting loss of function. Seizures more often produce positive phenomena such as jerking or sensory distortion.

Question 32Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient presents with sudden severe headache described as the worst of life. Which test is most appropriate when the non-contrast head CT is normal but suspicion remains high?

  1. Carotid duplex ultrasonography
  2. Repeat non-contrast CT in 24 hours
  3. Electroencephalography
  4. Lumbar puncture for xanthochromia Correct answer.

Explanation

A normal CT does not fully exclude subarachnoid hemorrhage, especially if performed early or late. Lumbar puncture looking for xanthochromia is the next step when clinical suspicion is high.

Question 33Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient has a suspected acute upper gastrointestinal bleed with hemodynamic instability. Which is the most appropriate initial step?

  1. Resuscitation with intravenous fluids and blood products Correct answer.
  2. Elective endoscopy in one week
  3. Oral iron supplementation
  4. Immediate oral proton pump inhibitor and discharge

Explanation

Unstable gastrointestinal bleeding requires simultaneous resuscitation with crystalloid and blood products while arranging urgent endoscopy. Airway, breathing, and circulation take priority over diagnostic procedures.

Question 34Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with a known abdominal aortic aneurysm presents with sudden severe back pain and hypotension. Which finding most supports a ruptured aneurysm?

  1. A pulsatile abdominal mass with hemodynamic instability Correct answer.
  2. Diffuse abdominal tenderness without pulsation
  3. Bilious vomiting
  4. Rebound tenderness localized to the right lower quadrant

Explanation

A pulsatile abdominal mass with hypotension and back or abdominal pain is the classic triad of a leaking or ruptured abdominal aortic aneurysm. Immediate surgical consultation and resuscitation are required.

Question 35Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which finding best differentiates a simple febrile seizure from a complex febrile seizure?

  1. Temperature above 39 degrees Celsius
  2. Focal features or duration greater than 15 minutes Correct answer.
  3. History of recent immunization
  4. Age younger than 3 years

Explanation

Complex febrile seizures are defined by focal features, prolonged duration, or recurrence within 24 hours. Age, temperature, and immunization history do not define complexity.

Question 36Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient presents with a swollen, painful joint and a history of hemophilia. Which initial management is most appropriate?

  1. Nonsteroidal anti-inflammatory drugs alone
  2. Immediate intra-articular steroid injection
  3. Joint aspiration before factor replacement
  4. Factor replacement and joint rest Correct answer.

Explanation

Hemarthrosis in a hemophiliac requires prompt clotting factor replacement to stop bleeding, along with rest and analgesia. Invasive procedures should not precede factor correction.

Question 37Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient has a suspected scaphoid fracture with tenderness in the anatomic snuffbox but normal initial radiographs. Which management is most appropriate?

  1. Immediate open reduction and internal fixation
  2. Immobilization and repeat imaging or advanced imaging Correct answer.
  3. Reassurance and discharge without follow-up
  4. Range-of-motion exercises as tolerated

Explanation

Scaphoid fractures may be radiographically occult initially and risk nonunion and avascular necrosis. Immobilization with follow-up imaging or early MRI/CT protects against this complication.

Question 38Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which finding is most concerning for a posterior shoulder dislocation on a standard anteroposterior radiograph?

  1. Anterior displacement of the humeral head
  2. A lightbulb sign with internal rotation Correct answer.
  3. A superiorly displaced clavicle
  4. A widened acromioclavicular joint

Explanation

Posterior dislocations can be subtle on AP views and produce the lightbulb sign from fixed internal rotation. Additional axillary or scapular Y views improve detection.

Question 39Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with suspected acute otitis externa has severe pain with movement of the tragus. Which treatment is most appropriate in an otherwise healthy adult?

  1. Systemic corticosteroids alone
  2. Watchful waiting without treatment
  3. Topical antibiotic drops with an acidic agent Correct answer.
  4. Oral antibiotics alone

Explanation

Uncomplicated otitis externa is treated with topical antibiotic drops, often combined with an acidic or steroid component. Systemic antibiotics are reserved for severe or spreading infection.

Question 40Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient presents with a painful red eye, decreased vision, and a fixed mid-dilated pupil. Which diagnosis is most likely?

  1. Corneal abrasion
  2. Subconjunctival hemorrhage
  3. Acute angle-closure glaucoma Correct answer.
  4. Bacterial conjunctivitis

Explanation

Acute angle-closure glaucoma produces a painful red eye, decreased vision, a fixed mid-dilated pupil, and elevated intraocular pressure. It is an ophthalmologic emergency requiring immediate pressure-lowering therapy.

Question 41Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient is diagnosed with a corneal foreign body. Which step is essential before attempting removal?

  1. Application of a pressure patch
  2. Administration of oral antibiotics
  3. Eversion of the eyelid to inspect for additional foreign bodies Correct answer.
  4. Instillation of steroid drops

Explanation

Eyelid eversion is necessary to inspect the superior palpebral conjunctiva and fornix for additional or retained foreign bodies. Missing a foreign body risks infection and corneal damage.

Question 42Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient has a suspected ankle fracture and meets the Ottawa ankle rules. Which imaging is most appropriate?

  1. Computed tomography of the ankle
  2. Magnetic resonance imaging of the ankle
  3. Ultrasonography of the ankle
  4. Plain radiographs of the ankle Correct answer.

Explanation

Plain radiographs are the initial imaging modality for suspected ankle fracture when the Ottawa rules are positive. Advanced imaging is reserved for equivocal or complex cases.

Question 43Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient presents with a painful, swollen calf and a suspected deep vein thrombosis. Which test is most appropriate for initial diagnosis?

  1. D-dimer in all patients
  2. Magnetic resonance venography
  3. Duplex ultrasonography of the leg Correct answer.
  4. Contrast venography

Explanation

Duplex ultrasonography is the preferred initial test for suspected deep vein thrombosis because it is noninvasive and highly sensitive for proximal clots. D-dimer is useful only in low-risk patients to exclude the diagnosis.

Question 44Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which finding is most consistent with a diagnosis of acute mesenteric ischemia in a patient with severe abdominal pain?

  1. Rebound tenderness localized to the right lower quadrant
  2. Pain out of proportion to examination findings Correct answer.
  3. Marked elevation of serum amylase
  4. Bilious vomiting with distension

Explanation

Early mesenteric ischemia characteristically causes severe pain with a relatively benign abdominal examination. This mismatch should prompt urgent evaluation with imaging and surgical consultation.

Question 45Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with a known seizure disorder is brought in after a prolonged convulsion. Which finding is most consistent with a postictal state?

  1. Altered consciousness with gradual improvement Correct answer.
  2. Persistent focal neurologic deficit lasting days
  3. Hyperactive delirium with agitation
  4. Normal mental status immediately after the event

Explanation

The postictal state is characterized by altered consciousness and confusion that resolve gradually over minutes to hours. Persistent focal deficits lasting longer suggest stroke or another cause.

Question 46Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient in the emergency department has a blood pressure of 210/120 mm Hg with evidence of acute end-organ damage. Which management is most appropriate?

  1. Rapid normalization of blood pressure to normal within minutes
  2. Controlled blood pressure reduction with intravenous agents Correct answer.
  3. Observation without treatment
  4. Oral antihypertensive therapy and discharge

Explanation

Hypertensive emergency with end-organ damage requires controlled reduction of blood pressure using titratable intravenous agents to avoid hypoperfusion. Rapid normalization can precipitate ischemia.

Question 47Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with a suspected opioid overdose is being treated. Which complication should be anticipated after reversal with naloxone?

  1. Acute withdrawal with agitation and vomiting Correct answer.
  2. Severe hypertension unresponsive to treatment
  3. Persistent pinpoint pupils
  4. Worsening respiratory depression

Explanation

Naloxone reversal can precipitate acute opioid withdrawal with agitation, vomiting, and autonomic symptoms. Patients should be monitored because the naloxone half-life may be shorter than that of the opioid.

Question 48Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient presents with a severely swollen, painful knee after trauma. Which finding most suggests a hemarthrosis rather than a simple effusion?

  1. Rapid onset of swelling within hours of injury Correct answer.
  2. Gradual swelling over several days
  3. Warmth without tenderness
  4. Low-grade fever

Explanation

Hemarthrosis from intra-articular bleeding produces rapid swelling within hours, whereas a reactive effusion develops more gradually. Rapid tense swelling after trauma should prompt evaluation for fracture or ligamentous injury.

Question 49Emergency Medicine - Written Examination (subject areas not enumerated in source)

A patient with a suspected pelvic fracture is hypotensive. Which maneuver is most appropriate for initial stabilization?

  1. Application of a pelvic binder at the level of the greater trochanters Correct answer.
  2. Placement in the Trendelenburg position alone
  3. Manual compression of the abdomen
  4. Immediate log-rolling to inspect the back

Explanation

A pelvic binder applied at the level of the greater trochanters reduces pelvic volume and can limit hemorrhage in unstable pelvic fractures. Early binding is part of damage-control resuscitation.

Question 50Emergency Medicine - Written Examination (subject areas not enumerated in source)

Which finding most suggests that a patient with a headache has a benign cause rather than a secondary cause?

  1. Sudden onset reaching maximum intensity within seconds
  2. Symptoms that improve with over-the-counter analgesia and no red flags Correct answer.
  3. Headache associated with fever and neck stiffness
  4. New headache after age 50

Explanation

A primary headache syndrome is supported by response to simple analgesia and absence of red flags such as sudden onset, older age at onset, or systemic symptoms. Red flags should prompt further evaluation.