Arab Board EM Part 1 common mistakes
Arab Board EM Part 1 · Understand the traps and how to avoid them.
Committing to a single diagnosis early in a resuscitation vignette and then selecting every subsequent answer that supports it, instead of pausing to build a ranked differential before answering the next item.
Exam stems are written to reward the candidate who recognises that the first plausible label (e.g. 'anxiety' or 'gastroenteritis') is often the distractor; early closure is a natural time-saving habit carried over from high-volume clinical work.
What to do instead
Before answering any management or next-step item, write a two-line differential with the single most dangerous alternative and check whether the proposed action would be safe if that alternative were true.
Choosing the most definitive or invasive intervention (intubation, thrombolysis, immediate surgery, central line) when the stem describes a patient who is stable or has not yet failed simpler measures.
Candidates conflate 'what ultimately happened' with 'what should happen next', and severe-sounding distractors feel safer than watchful waiting or a stepwise airway/breathing/circulation sequence.
What to do instead
Apply a strict next-step ladder: least invasive effective action that addresses the immediate threat, and only escalate after demonstrating failure of the prior step in the stem.
Mismanaging the airway-and-breathing sequence in respiratory stems by selecting oxygen delivery or ventilator settings without first classifying the physiology (hypoxaemic vs hypercapnic vs shunt) described by the numbers given.
Ventilator and oxygen questions look like recall items, so candidates answer from memory of settings rather than deriving the physiology from the PaO2, PaCO2, pH and clinical clues supplied.
What to do instead
For every respiratory item, first label the physiology in one sentence, then choose the intervention that corrects that specific physiology, and check the choice against the acid-base values given.
Treating a neurological stem as a single 'stroke or not stroke' question and ignoring the time window, glucose, anticoagulation status and blood pressure thresholds that determine the correct answer.
Thrombolysis and stroke pathways are memorised as a package, and candidates skip re-reading the specific eligibility variables embedded in the stem.
What to do instead
Use a fixed checklist on every neuro item: onset time, glucose, imaging findings, blood pressure, anticoagulant use, and contraindications; answer only after ticking each one against the stem.
Selecting a management step for gastrointestinal bleeding, jaundice or renal failure without first correcting volume status, electrolytes or acid-base derangement described in the vitals and labs.
Candidates focus on the organ-specific drama (endoscopy, dialysis, transfusion) and under-weight the resuscitation data deliberately placed in the stem.
What to do instead
Read the vitals and labs before the narrative; if a resuscitation or metabolic abnormality is present, the correct answer is almost always stabilisation before the definitive organ-specific intervention.
Missing occult or second injuries in trauma stems by answering the question asked about the obvious injury without scanning for the haemodynamic or mechanistic clues to a hidden one.
Trauma vignettes front-load the visible injury, and candidates answer the first question that comes to mind rather than the one the stem is setting up.
What to do instead
For every trauma item, state the mechanism and the haemodynamic trend in one line, then ask 'what else could this mechanism have injured?' before choosing.
Applying a remembered antidote or decontamination step without matching it to the toxidrome, time since exposure, and the specific agent named in the stem.
Toxicology is taught as antidote pairs, so candidates pattern-match the drug name to a memorised treatment and ignore dose, timing and contraindications.
What to do instead
Identify the toxidrome and the time course first, then select only the antidote or decontamination step whose indication and window match those two facts.
Using adult weight-based dosing, adult vital-sign thresholds or adult resuscitation algorithms on paediatric stems.
Adult emergency medicine dominates training exposure, and paediatric values are memorised less securely, so candidates default to familiar adult numbers under time pressure.
What to do instead
Flag every stem containing an age under 18 and consciously switch to weight-based dosing and age-specific thresholds before evaluating any option.
Answering obstetric items without first establishing maternal stability and gestational age, and choosing fetal-directed management when the mother is unstable.
Candidates fixate on the pregnancy as the emergency and invert the priority of maternal resuscitation before fetal assessment.
What to do instead
On every obstetric item, state maternal haemodynamic status and gestational age in one line, and choose maternal stabilisation first unless the stem shows a stable mother with a fetal-specific problem.
Overlooking the metabolic or haematological explanation for a presentation (e.g. attributing altered mentation or weakness to a primary neuro or cardiac cause) when the stem supplies glucose, sodium, calcium, thyroid or haemoglobin data.
Candidates anchor on the presenting symptom's organ system and treat the lab values as background rather than as the answer.
What to do instead
Before committing to any diagnosis, scan every abnormal value in the stem and ask whether it alone explains the presentation; if it does, that is the answer.
Choosing an antibiotic regimen from memory without applying the source, severity, and local resistance or sepsis-bundle timing described in the stem.
Antibiotic recall is strong but context-dependent, and candidates select the 'best drug' rather than the drug matched to the site, severity and timing given.
What to do instead
For each infection item, state source, severity and time-to-antibiotics from the stem, then select the regimen that matches all three.
Interpreting an ultrasound finding or describing a procedure step without anchoring it to the clinical question and the operator's own limitations described in the stem.
Ultrasound items reward image-pattern recall, so candidates name the finding and stop, neglecting the clinical integration and the fallback plan that the options test.
What to do instead
For each ultrasound or procedure item, state the clinical question the study is answering and the next step if the study is indeterminate or the operator is inexperienced.
Answering administration, ethics and evidence-based medicine items with a personal or idealistic preference rather than the principle or study-design rule the item is testing.
These items feel like opinion questions, so candidates answer from values or local custom instead of naming the governing principle or the hierarchy of evidence.
What to do instead
For each such item, name the principle being tested (e.g. capacity, beneficence, sensitivity versus specificity, intention-to-treat) in one line before selecting the option that instantiates it.