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AOBEM Emergency Medicine study materials
AOBEM Emergency Medicine study resources

AOBEM Emergency Medicine practice questions

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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

A 28-year-old man presents with sudden-onset unilateral scrotal pain that began 2 hours ago. The testis is high-riding with an absent cremasteric reflex. Which is the most appropriate immediate management?

  1. Emergent urologic consultation for surgical exploration Correct answer.
  2. NSAIDs and outpatient follow-up in 48 hours
  3. Scrotal elevation and empiric antibiotics for epididymitis
  4. Urgent ultrasound before any intervention

Explanation

Testicular torsion is a time-dependent surgical emergency; salvage rates decline sharply after roughly 6 hours of ischemia. When the clinical picture is convincing, detorsion should not be delayed for imaging. Immediate surgical exploration with orchiopexy is the standard of care.

Question 2Emergency Medicine

Which finding most strongly suggests a diagnosis of acute aortic dissection on chest radiograph?

  1. Kerley B lines
  2. Air bronchograms
  3. Widened mediastinum Correct answer.
  4. Cephalization of pulmonary vessels

Explanation

A widened mediastinum (or abnormal aortic contour) is the classic plain-film finding in aortic dissection, though the radiograph is normal in a substantial minority. Kerley lines and cephalization reflect pulmonary edema, and air bronchograms reflect alveolar consolidation.

Question 3Emergency Medicine

A 62-year-old woman with a history of hypertension presents with sudden tearing chest pain radiating to the back. Which medication should be given first to reduce aortic wall stress while awaiting definitive imaging?

  1. Sublingual nitroglycerin
  2. Intravenous calcium chloride
  3. Intravenous furosemide
  4. Intravenous beta-blocker Correct answer.

Explanation

Beta-blockade is the cornerstone of initial therapy for suspected aortic dissection because it lowers heart rate and dP/dt, reducing shear stress on the aortic wall. Vasodilators should be added only after rate control to avoid reflex tachycardia.

Question 4Emergency Medicine

A 24-year-old woman presents with a severe unilateral headache with ipsilateral ptosis, miosis, and lacrimation, occurring several times per day. Which is the most likely diagnosis?

  1. Tension-type headache
  2. Migraine with aura
  3. Giant cell arteritis
  4. Cluster headache Correct answer.

Explanation

Cluster headache produces severe periorbital pain with ipsilateral autonomic features (ptosis, miosis, lacrimation, rhinorrhea) and occurs in clusters of short attacks. Migraine typically has photophobia and nausea without prominent autonomic signs, and GCA occurs in older adults.

Question 5Emergency Medicine

A 55-year-old man presents with a painful, swollen leg. Which finding on history most increases the pretest probability of deep vein thrombosis?

  1. Chronic stable claudication
  2. Recent long-haul air travel Correct answer.
  3. Bilateral leg swelling
  4. Presence of varicose veins

Explanation

Immobilization, including prolonged air travel, is a recognized risk factor for venous thromboembolism and increases pretest probability. Bilateral swelling argues against unilateral DVT, and chronic claudication reflects arterial disease.

Question 6Emergency Medicine

A 70-year-old man with a history of atrial fibrillation presents with sudden painless loss of vision in one eye. Fundoscopy reveals a pale retina with a cherry-red spot at the macula. Which is the most appropriate immediate management?

  1. Oral acetazolamide and discharge
  2. Topical beta-blocker drops and same-day follow-up
  3. Emergent ophthalmology consultation for central retinal artery occlusion Correct answer.
  4. Reassurance and outpatient optometry referral

Explanation

Central retinal artery occlusion is an ocular emergency with a narrow window for intervention; emergent ophthalmology consultation is warranted. The cherry-red spot reflects retinal ischemia with a spared fovea.

Question 7Emergency Medicine

Which is the most common cause of acute pancreatitis in the United States?

  1. Alcohol use
  2. Gallstones Correct answer.
  3. Hypertriglyceridemia
  4. Hypercalcemia

Explanation

Gallstones and alcohol are the two leading causes of acute pancreatitis, with gallstones being the most common overall in the United States. Hypertriglyceridemia and hypercalcemia are less common causes.

Question 8Emergency Medicine

A 45-year-old man presents with severe epigastric pain radiating to the back, and CT confirms acute pancreatitis. Which finding best predicts severe disease?

  1. Epigastric tenderness on palpation
  2. Serum lipase three times the upper limit of normal
  3. Persistent organ failure lasting more than 48 hours Correct answer.
  4. Presence of nausea and vomiting

Explanation

Severity in acute pancreatitis is defined by persistent organ failure lasting more than 48 hours, per the revised Atlanta classification. Lipase elevation, tenderness, and vomiting are common but do not define severity.

Question 9Emergency Medicine

A 30-year-old woman presents with a first seizure. Which electrolyte abnormality most commonly precipitates seizures in the emergency department?

  1. Hyperchloremia
  2. Hyponatremia Correct answer.
  3. Hyperkalemia
  4. Hyperphosphatemia

Explanation

Severe hyponatremia is a common and correctable cause of new-onset seizures in the emergency department. Hyperkalemia primarily causes cardiac dysrhythmias, and phosphate and chloride disturbances rarely cause seizures.

Question 10Emergency Medicine

A 22-year-old man is brought in after a witnessed generalized tonic-clonic seizure lasting 3 minutes that has now stopped. He is postictal. Which is the most appropriate next step?

  1. Lumbar puncture before imaging
  2. Administration of a second-line antiepileptic before any evaluation
  3. Immediate intubation for airway protection
  4. Observation with reassessment and evaluation for provoking causes Correct answer.

Explanation

A single self-limited seizure with a postictal state is managed with observation, reassessment, and evaluation for provoking causes such as hypoglycemia, electrolyte disturbance, or structural lesions. Intubation is reserved for airway compromise, and lumbar puncture requires prior imaging when focal deficits are present.

Question 11Emergency Medicine

A 65-year-old man presents with fever, productive cough, and a chest radiograph showing right lower lobe consolidation. Which clinical tool best estimates his risk of mortality to guide disposition?

  1. Wells score
  2. CURB-65 score Correct answer.
  3. Glasgow Coma Scale
  4. CHA2DS2-VASc score

Explanation

The CURB-65 score (confusion, urea, respiratory rate, blood pressure, age ≥65) stratifies pneumonia severity and mortality risk to guide disposition. The Wells score estimates DVT/PE probability, and the CHA2DS2-VASc estimates stroke risk in atrial fibrillation.

Question 12Emergency Medicine

A 40-year-old woman presents with dyspnea and pleuritic chest pain 10 days after a long-haul flight. Which finding on CT pulmonary angiography confirms a pulmonary embolism?

  1. Intraluminal filling defect in a pulmonary artery Correct answer.
  2. Ground-glass opacities in the upper lobes
  3. Mediastinal lymphadenopathy
  4. Bilateral pleural effusions

Explanation

The diagnostic finding of pulmonary embolism on CT angiography is an intraluminal filling defect within a pulmonary artery. Ground-glass opacities and effusions are nonspecific, and lymphadenopathy suggests other processes.

Question 13Emergency Medicine

A 58-year-old man with a history of heart failure presents with acute dyspnea and bilateral crackles. Which initial intervention is most appropriate for acute decompensated heart failure with volume overload?

  1. Intravenous beta-agonist infusion
  2. Rapid bolus of 2 liters of normal saline
  3. Intravenous furosemide with noninvasive positive pressure ventilation if distress is severe Correct answer.
  4. Immediate cardioversion

Explanation

Acute decompensated heart failure with volume overload is treated with diuretics, and noninvasive positive pressure ventilation reduces work of breathing in severe distress. Fluid boluses and beta-agonists can worsen pulmonary edema.

Question 14Emergency Medicine

A 68-year-old woman presents with sudden-onset palpitations and lightheadedness. ECG reveals a narrow-complex tachycardia at 180 bpm with a blood pressure of 78/40. Which is the most appropriate initial intervention?

  1. Vagal maneuvers alone
  2. Synchronized cardioversion Correct answer.
  3. Oral metoprolol
  4. Adenosine 6 mg IV push

Explanation

An unstable narrow-complex tachycardia with hypotension requires immediate synchronized cardioversion. Adenosine and vagal maneuvers are appropriate for stable patients, and oral beta-blockers are too slow for an unstable patient.

Question 15Emergency Medicine

A 72-year-old man presents with syncope. ECG shows a PR interval of 0.28 seconds with a 2:1 atrioventricular block and a ventricular rate of 40. Which is the most appropriate management?

  1. Transcutaneous pacing while preparing for transvenous pacing Correct answer.
  2. Sublingual nitroglycerin
  3. Observation with serial ECGs
  4. Oral digoxin

Explanation

High-grade (Mobitz II or advanced) AV block with bradycardia and syncope is an indication for pacing. Transcutaneous pacing should be initiated while arrangements are made for transvenous pacing. Observation and rate-slowing drugs are inappropriate.

Question 16Emergency Medicine

A 25-year-old man presents with anaphylaxis after a bee sting, with hypotension and urticaria. Which is the first-line medication?

  1. Oral prednisone
  2. Intramuscular epinephrine Correct answer.
  3. Intravenous diphenhydramine
  4. Nebulized albuterol

Explanation

Intramuscular epinephrine is the first-line treatment for anaphylaxis, addressing hypotension, bronchospasm, and mast cell mediator release. Antihistamines and corticosteroids are adjuncts only.

Question 17Emergency Medicine

A 35-year-old woman presents with a diffuse rash, hypotension, and a history of a new antibiotic started 2 days ago. Which finding best supports the diagnosis of anaphylaxis over septic shock?

  1. Elevated lactate
  2. Positive blood cultures
  3. Fever and leukocytosis
  4. Sudden onset within minutes of exposure with urticaria and bronchospasm Correct answer.

Explanation

Anaphylaxis is characterized by rapid onset after exposure with mucocutaneous findings and bronchospasm or hypotension. Fever, leukocytosis, lactate, and positive cultures are features of sepsis.

Question 18Emergency Medicine

A 48-year-old man presents with a deep laceration to the palm from a kitchen knife. Which is the most important next step before wound closure?

  1. Apply a pressure dressing and discharge
  2. Assess for tendon and nerve function Correct answer.
  3. Administer oral antibiotics
  4. Irrigate with hydrogen peroxide

Explanation

Before closure, a thorough neurovascular and tendon examination is essential to identify injuries that require operative repair. Hydrogen peroxide is tissue-toxic, and antibiotics do not substitute for a proper examination.

Question 19Emergency Medicine

A 60-year-old woman presents with a deep partial-thickness burn to 20% of her total body surface area. Which is the most appropriate initial fluid resuscitation strategy?

  1. Lactated Ringer's using the Parkland formula, with half in the first 8 hours from time of injury Correct answer.
  2. Normal saline at a fixed 100 mL/hr
  3. Colloid infusion as the primary fluid
  4. No fluids until a burn center accepts transfer

Explanation

Burn resuscitation uses the Parkland formula (4 mL × kg × %TBSA of lactated Ringer's), with half given in the first 8 hours from the time of injury and the remainder over the next 16 hours. Crystalloid is preferred, and delaying fluids worsens outcomes.

Question 20Emergency Medicine

A 3-year-old child is brought in with drooling, stridor, and a muffled voice. He is sitting forward and appears toxic. Which is the most appropriate initial action?

  1. Administer nebulized racemic epinephrine and discharge
  2. Obtain a lateral neck radiograph before any intervention
  3. Inspect the posterior pharynx with a tongue blade
  4. Keep the child calm in a position of comfort and prepare for controlled airway management Correct answer.

Explanation

The presentation suggests epiglottitis, a pediatric airway emergency. The child should be kept calm, and airway management should occur in a controlled setting with anesthesia and ENT available. Agitating the child or inspecting the pharynx can precipitate complete airway obstruction.

Question 21Emergency Medicine

A 19-year-old woman presents with a positive pregnancy test and lower abdominal pain with vaginal bleeding. Which finding most strongly suggests a ruptured ectopic pregnancy?

  1. Rebound tenderness with hypotension and a positive FAST Correct answer.
  2. A closed cervix with a small amount of spotting
  3. Mild unilateral cramping with stable vital signs
  4. A quantitative hCG of 1,200 mIU/mL

Explanation

Ruptured ectopic pregnancy presents with peritoneal signs and hemorrhagic shock, and a positive FAST indicates hemoperitoneum. Mild cramping, a closed cervix, and a single hCG value do not indicate rupture.

Question 22Emergency Medicine

A 30-year-old man presents with a swollen, erythematous, tender leg with a well-demarcated border. Which is the most appropriate initial treatment for cellulitis without systemic toxicity?

  1. Surgical debridement
  2. Oral antibiotics covering streptococci and staphylococci Correct answer.
  3. Observation without antibiotics
  4. Intravenous vancomycin for all patients

Explanation

Uncomplicated cellulitis without systemic toxicity is treated with oral antibiotics covering streptococci and staphylococci. Vancomycin is reserved for severe infection or MRSA risk, and debridement is for necrotizing infection.

Question 23Emergency Medicine

A 55-year-old man presents with a painful, swollen calf and a Wells score indicating high probability for DVT. Which is the most appropriate next step?

  1. Empiric anticoagulation and discharge
  2. Immediate CT venography
  3. Duplex ultrasonography of the lower extremity Correct answer.
  4. D-dimer testing to exclude DVT

Explanation

With a high pretest probability, duplex ultrasonography is the appropriate next step; D-dimer is not useful for exclusion in high-probability patients. Anticoagulation may be started while awaiting imaging but discharge without confirmation is inappropriate.

Question 24Emergency Medicine

A 70-year-old man presents with a severe headache and jaw claudication. Which laboratory test best supports the diagnosis of giant cell arteritis?

  1. Procalcitonin
  2. Erythrocyte sedimentation rate Correct answer.
  3. Serum lipase
  4. Troponin

Explanation

Giant cell arteritis is an inflammatory vasculitis associated with a markedly elevated erythrocyte sedimentation rate (and CRP). Lipase, troponin, and procalcitonin do not support this diagnosis.

Question 25Emergency Medicine

A 45-year-old man presents with a severe headache and a history of a prior subarachnoid hemorrhage. Which is the most appropriate initial diagnostic study for suspected subarachnoid hemorrhage presenting within 6 hours of onset?

  1. MRI of the brain
  2. Noncontrast head CT Correct answer.
  3. Carotid duplex ultrasound
  4. Lumbar puncture immediately

Explanation

Noncontrast head CT is highly sensitive for subarachnoid hemorrhage within the first 6 hours and is the initial study of choice. Lumbar puncture is reserved for cases with a negative CT and ongoing suspicion.

Question 26Emergency Medicine

A 24-year-old man is brought to the emergency department after a high-speed motorcycle crash. He is anxious and diaphoretic. Vital signs: heart rate 130/min, blood pressure 80/50 mm Hg, respiratory rate 28/min, oxygen saturation 92% on room air. He has distended neck veins, muffled heart sounds, and clear lung fields. Which is the most likely diagnosis?

  1. Tension pneumothorax
  2. Massive hemothorax
  3. Cardiac tamponade Correct answer.
  4. Aortic dissection

Explanation

Beck triad (hypotension, distended neck veins, muffled heart sounds) in blunt chest trauma suggests cardiac tamponade. Clear lung fields help distinguish it from tension pneumothorax, which typically has absent breath sounds and tracheal deviation.

Question 27Emergency Medicine

A 32-year-old woman presents with a 3-day history of dysuria, frequency, and suprapubic discomfort. She is afebrile with normal vital signs. Urinalysis shows positive leukocyte esterase and nitrites. Which is the most appropriate initial management?

  1. Oral nitrofurantoin Correct answer.
  2. Intravenous ceftriaxone
  3. Observation without antibiotics
  4. Oral ciprofloxacin

Explanation

Uncomplicated cystitis in a healthy nonpregnant woman is typically treated with a short course of oral antibiotics such as nitrofurantoin. Intravenous antibiotics are reserved for pyelonephritis or systemic symptoms.

Question 28Emergency Medicine

A 58-year-old man with a history of alcohol use disorder presents with confusion and ataxia. He has horizontal nystagmus and ophthalmoplegia. Which is the most likely diagnosis?

  1. Korsakoff syndrome
  2. Delirium tremens
  3. Wernicke encephalopathy Correct answer.
  4. Hepatic encephalopathy

Explanation

Wernicke encephalopathy is characterized by the triad of encephalopathy, ataxia, and ophthalmoplegia, often due to thiamine deficiency in alcohol use disorder. Immediate thiamine administration is required to prevent progression to Korsakoff syndrome.

Question 29Emergency Medicine

A 6-year-old child is brought in with a barking cough and inspiratory stridor that worsens at night. He is afebrile and has a hoarse voice. Which is the most appropriate initial treatment?

  1. Nebulized albuterol
  2. Nebulized epinephrine
  3. Intravenous antibiotics
  4. Oral dexamethasone Correct answer.

Explanation

Croup (laryngotracheobronchitis) is a viral infection causing subglottic edema. Mild to moderate croup is treated with a single dose of oral dexamethasone to reduce airway edema.

Question 30Emergency Medicine

A 45-year-old woman presents with sudden-onset severe headache described as 'the worst headache of my life.' She is alert and oriented. Noncontrast head CT is negative. Which is the most appropriate next step?

  1. Observation and discharge
  2. Intravenous antibiotics
  3. Lumbar puncture Correct answer.
  4. Magnetic resonance imaging of the brain

Explanation

Subarachnoid hemorrhage can be missed on noncontrast CT, especially after 6 hours from symptom onset. A lumbar puncture to assess for xanthochromia is the next step when CT is negative and clinical suspicion remains high.

Question 31Emergency Medicine

A 70-year-old man presents with palpitations and lightheadedness. ECG shows a wide-complex tachycardia at 180/min. He is diaphoretic and has a blood pressure of 85/50 mm Hg. Which is the most appropriate immediate management?

  1. Oral metoprolol
  2. Intravenous adenosine
  3. Intravenous amiodarone
  4. Synchronized cardioversion Correct answer.

Explanation

Unstable wide-complex tachycardia requires immediate synchronized cardioversion. Adenosine is used for stable narrow-complex tachycardia and is not recommended for wide-complex tachycardia.

Question 32Emergency Medicine

A 28-year-old man presents with a deep laceration to the forearm after a fall. He has no active bleeding, and the wound is clean. He received a tetanus booster 3 years ago. Which is the most appropriate tetanus prophylaxis?

  1. No tetanus prophylaxis needed Correct answer.
  2. Tetanus immune globulin
  3. Both toxoid and immune globulin
  4. Tetanus toxoid booster

Explanation

A tetanus booster is recommended every 10 years, or 5 years for high-risk wounds. Since the patient had a booster 3 years ago and the wound is not high-risk, no additional prophylaxis is needed.

Question 33Emergency Medicine

A 55-year-old man with a history of hypertension presents with sudden-onset tearing chest pain radiating to the back. Blood pressure is 180/100 mm Hg in the right arm and 140/80 mm Hg in the left arm. Which is the most appropriate initial diagnostic study?

  1. CT angiography of the aorta Correct answer.
  2. Chest radiograph
  3. Troponin level
  4. Electrocardiogram

Explanation

The presentation suggests aortic dissection, and CT angiography is the diagnostic study of choice. It visualizes the intimal flap and extent of dissection.

Question 34Emergency Medicine

A 3-year-old boy is brought in with a 2-day history of fever, sore throat, and refusal to eat. He is drooling and has a muffled voice. He is sitting upright and leaning forward. Which is the most appropriate next step in management?

  1. Prepare for emergent airway management in the operating room Correct answer.
  2. Oral amoxicillin
  3. Immediate endotracheal intubation
  4. Lateral neck radiograph

Explanation

The presentation is classic for epiglottitis, a medical emergency. The airway should be secured in a controlled setting, typically the operating room, with anesthesia and ENT present.

Question 35Emergency Medicine

A 62-year-old woman presents with generalized weakness and confusion. She takes furosemide for heart failure. ECG shows a prolonged QT interval and flattened T waves. Which electrolyte abnormality is most likely?

  1. Hyperkalemia
  2. Hypokalemia Correct answer.
  3. Hypermagnesemia
  4. Hypocalcemia

Explanation

Hypokalemia causes flattened T waves, prominent U waves, and QT prolongation. Loop diuretics like furosemide increase potassium excretion.

Question 36Emergency Medicine

A 19-year-old man presents with a deep cut to the palm from a broken bottle. He has no allergies. Which is the most appropriate wound irrigation solution?

  1. Chlorhexidine
  2. Povidone-iodine
  3. Hydrogen peroxide
  4. Normal saline Correct answer.

Explanation

Normal saline is the preferred irrigation solution for wound cleansing because it is isotonic and does not impair healing. Antiseptics like povidone-iodine and hydrogen peroxide can be cytotoxic.

Question 37Emergency Medicine

A 28-year-old woman presents with a positive pregnancy test and severe lower abdominal pain. She is hypotensive and has rebound tenderness. Which is the most appropriate immediate management?

  1. Diagnostic laparoscopy after stabilization
  2. Outpatient quantitative hCG testing
  3. Oral methotrexate
  4. Intravenous fluids and emergent surgical consultation Correct answer.

Explanation

The presentation suggests ruptured ectopic pregnancy with hemorrhagic shock. Immediate resuscitation with IV fluids and emergent surgical consultation for laparotomy is required.

Question 38Emergency Medicine

A 40-year-old man presents with a painful, swollen right calf after a long car ride. He has no chest pain or dyspnea. Which is the most appropriate initial diagnostic test?

  1. Contrast venography
  2. D-dimer
  3. Duplex ultrasonography Correct answer.
  4. CT pulmonary angiography

Explanation

Duplex ultrasonography is the diagnostic test of choice for suspected lower extremity deep vein thrombosis. D-dimer is useful only in low-risk patients to rule out DVT.

Question 39Emergency Medicine

A 70-year-old woman presents with severe headache, jaw claudication, and blurred vision. Erythrocyte sedimentation rate is 85 mm/h. Which is the most appropriate immediate treatment?

  1. Subcutaneous sumatriptan
  2. Oral prednisone
  3. Intravenous methylprednisolone Correct answer.
  4. High-dose aspirin

Explanation

The presentation is consistent with giant cell arteritis, and high-dose intravenous corticosteroids should be started immediately to prevent vision loss. Oral steroids may be used if vision is not threatened.

Question 40Emergency Medicine

A 30-year-old man presents with sudden-onset unilateral scrotal pain and swelling. He has no urinary symptoms. Which is the most appropriate immediate action?

  1. Scrotal ultrasound
  2. Antibiotics for epididymitis
  3. NSAIDs and scrotal support
  4. Urgent urology consultation for detorsion Correct answer.

Explanation

Testicular torsion is a surgical emergency requiring immediate detorsion to salvage the testicle. Ultrasound should not delay surgical consultation if clinical suspicion is high.

Question 41Emergency Medicine

A 65-year-old man with a history of COPD presents with increased sputum purulence and dyspnea. He is afebrile with an oxygen saturation of 88% on room air. Which is the most appropriate initial oxygen therapy?

  1. Noninvasive positive pressure ventilation
  2. High-flow oxygen to maintain saturation above 94%
  3. Intubation and mechanical ventilation
  4. Titrate oxygen to maintain saturation between 88% and 92% Correct answer.

Explanation

In COPD, target oxygen saturation is 88–92% to avoid worsening hypercapnia. High-flow oxygen can suppress respiratory drive.

Question 42Emergency Medicine

A 52-year-old woman presents with a 2-day history of severe left lower quadrant pain, fever, and chills. CT shows diverticulitis with a small abscess. She is hemodynamically stable. Which is the most appropriate management?

  1. Oral antibiotics and outpatient follow-up
  2. Immediate surgery
  3. Percutaneous drainage
  4. Intravenous antibiotics and observation Correct answer.

Explanation

Uncomplicated diverticulitis with a small abscess in a stable patient is managed with intravenous antibiotics and observation. Surgery is reserved for complications like perforation or failure to improve.

Question 43Emergency Medicine

A 24-year-old woman presents with a 2-day history of severe throbbing headache, nausea, and photophobia. She has had similar episodes in the past. Neurologic examination is normal. Which is the most appropriate abortive therapy?

  1. Oral sumatriptan Correct answer.
  2. Oral propranolol
  3. Intravenous ceftriaxone
  4. Oral amitriptyline

Explanation

Triptans are first-line abortive therapy for moderate to severe migraine. Propranolol and amitriptyline are used for prophylaxis, not acute treatment.

Question 44Emergency Medicine

A 68-year-old man presents with sudden-onset painless loss of vision in his right eye. Fundoscopy shows a pale retina with a cherry-red spot at the macula. Which is the most likely diagnosis?

  1. Central retinal artery occlusion Correct answer.
  2. Vitreous hemorrhage
  3. Retinal detachment
  4. Central retinal vein occlusion

Explanation

Central retinal artery occlusion presents with sudden painless monocular vision loss and a pale retina with a cherry-red spot. It is an ophthalmologic emergency.

Question 45Emergency Medicine

A 35-year-old man presents with a 3-day history of fever, chills, and right flank pain. He has costovertebral angle tenderness. Urinalysis shows pyuria and bacteriuria. Which is the most appropriate initial management?

  1. Intravenous ceftriaxone and admission Correct answer.
  2. Oral nitrofurantoin
  3. Oral ciprofloxacin
  4. Observation and analgesia

Explanation

The presentation is consistent with pyelonephritis. Intravenous antibiotics and admission are indicated for systemic symptoms and flank pain.

Question 46Emergency Medicine

A 45-year-old woman presents with a 1-day history of severe pain and swelling of the right index finger. She has a history of diabetes. Examination shows a tense, erythematous finger with a small puncture wound. Which is the most appropriate next step?

  1. Soaking in warm water
  2. Splinting and NSAIDs
  3. Oral antibiotics and elevation
  4. Incision and drainage Correct answer.

Explanation

The presentation suggests a felon or deep space infection of the finger. Incision and drainage are required for decompression and source control.

Question 47Emergency Medicine

A 50-year-old man presents with a 2-day history of progressive weakness and areflexia after a diarrheal illness. He has difficulty swallowing and is short of breath. Which is the most appropriate immediate management?

  1. Endotracheal intubation and mechanical ventilation Correct answer.
  2. Intravenous immunoglobulin
  3. Oral prednisone
  4. Plasmapheresis

Explanation

The presentation is consistent with Guillain-Barré syndrome. Respiratory failure is a major complication, and intubation is indicated for impending respiratory failure.

Question 48Emergency Medicine

A 22-year-old woman presents with a 2-day history of dysuria and vaginal discharge. She is afebrile. Pelvic examination shows a purulent cervical discharge and cervical motion tenderness. Which is the most appropriate treatment?

  1. Oral azithromycin
  2. Oral fluconazole
  3. Intravenous ceftriaxone and oral azithromycin Correct answer.
  4. Oral metronidazole

Explanation

The presentation suggests pelvic inflammatory disease, which is often polymicrobial. Recommended treatment includes ceftriaxone plus azithromycin to cover gonorrhea and chlamydia.

Question 49Emergency Medicine

A 60-year-old man presents with a 3-day history of progressive dyspnea and a nonproductive cough. He recently started amiodarone for atrial fibrillation. Chest radiograph shows bilateral interstitial infiltrates. Which is the most likely cause?

  1. Community-acquired pneumonia
  2. Heart failure exacerbation
  3. Pulmonary embolism
  4. Amiodarone pulmonary toxicity Correct answer.

Explanation

Amiodarone can cause pulmonary toxicity, presenting with dyspnea, cough, and interstitial infiltrates. It is an important adverse effect to recognize.

Question 50Emergency Medicine

A 30-year-old man presents with a 1-hour history of severe, constant testicular pain that started after lifting a heavy box. He has no urinary symptoms. Examination shows a tender, swollen scrotum with an absent cremasteric reflex. Which is the most appropriate next step?

  1. Antibiotics for epididymitis
  2. NSAIDs and scrotal elevation
  3. Scrotal ultrasound
  4. Emergent urology consultation Correct answer.

Explanation

Testicular torsion is a surgical emergency. The absent cremasteric reflex and acute onset suggest torsion, requiring immediate urology consultation for detorsion.