Arab Board Emergency Medicine Clinical Exam common mistakes
Arab Board Emergency Medicine Clinical Exam · Understand the traps and how to avoid them.
Begins the scenario by taking a full history and ordering investigations before stating a structured ABCDE primary survey, immediate life threats, or team roles.
Candidates default to clerking habits and race toward a diagnosis; examiners score explicit primary-survey actions, and unspoken actions are treated as not done.
What to do instead
Open with a clear declaration: 'This is a resuscitation; I will assess ABCDE, call for help, attach monitoring, and obtain IV access.' Verbalize each positive and negative finding, delegate tasks by name, and reassess after every intervention.
Anchors on the first working diagnosis, such as sepsis, and does not reassess perfusion, urine output, mentation, or lactate, or state when to escalate to a senior or ICU.
Candidates treat the diagnostic label rather than the physiology, and under time pressure they omit dynamic reassessment and escalation triggers.
What to do instead
State a time-bound reassessment plan including vital signs, capillary refill, mentation, urine output, and lactate. Define explicit escalation criteria, and verbalize fluid and vasopressor strategy with endpoints.
Moves to imaging or a secondary survey before completing the primary survey, and omits log-roll, pelvic binder, or cervical spine immobilization when indicated.
The search for injuries overtakes treatment of immediate threats, and time pressure leads to skipped trauma sequences.
What to do instead
Verbalize the order: primary survey and immediate adjuncts first, then secondary survey with log-roll. State cervical spine control, pelvic binder use, and hemorrhage control before transport to CT.
Calculates Parkland fluid but does not subtract time elapsed since the burn or titrate to urine output, and misses soot, hoarseness, stridor, or enclosed-space exposure as inhalational injury signs.
Formula memorization replaces dynamic application, and subtle airway findings are overlooked in a noisy resuscitation.
What to do instead
State the formula, subtract elapsed time, and titrate to urine output of 0.5–1 mL/kg/h in adults. Explicitly examine for inhalational injury signs and arrange early airway assessment if present.
Delays ECG or aspirin in suspected ACS because the presentation is atypical, and does not ask about true allergy, active bleeding, anticoagulation, or aortic dissection risk.
Pattern recognition based on textbook presentations and fear of causing harm lead to hesitation and incomplete contraindication checks.
What to do instead
State: 'ECG within 10 minutes and aspirin 300 mg chewed unless true allergy or active bleeding.' Ask about recent GI bleed, anticoagulation, and dissection risk before any thrombolysis decision.
Continues non-invasive ventilation or high-flow oxygen in a deteriorating patient without defining intubation criteria, and calls an ABG 'compensated' without checking whether PaCO2 and pH fit the expected compensation.
Reluctance to commit to airway intervention and rote ABG interpretation lead to delayed escalation and incorrect acid-base labels.
What to do instead
State objective failure criteria: exhaustion, worsening gas exchange, reduced consciousness, or hemodynamic instability. Set a reassessment time and interpret ABG stepwise using compensation formulas.
Assumes stroke before checking capillary glucose and exact last-known-well time, and omits the thrombolysis contraindication checklist and blood pressure thresholds.
Time pressure and anchoring on focal neurological deficit cause candidates to skip reversible mimics and eligibility criteria.
What to do instead
Verbalize glucose, CT, NIHSS, last-known-well time, blood pressure limits, and absolute contraindications before recommending thrombolysis or thrombectomy.
Fails to calculate anion gap or osmolar gap in overdose, does not obtain a 12-lead ECG and co-oximetry, and gives an antidote without confirming the indication and dose.
Toxicology cases feel unfamiliar, so candidates jump to 'call poison center' without a systematic toxidrome assessment or gap calculation.
What to do instead
Use a toxidrome-based approach with vital signs, calculate gaps, obtain ECG and paracetamol/salicylate levels, and state the antidote indication and weight-based dose before administration.
Uses adult drug doses or equipment sizes in a child and does not calculate weight-based fluid and drug doses aloud.
Adult emergency medicine habits persist, and anxiety about calculations leads to omissions under observation.
What to do instead
State an estimated weight using a length-based tape or age formula, calculate every dose aloud with units, select length-based equipment, and ask for a second clinician check.
Evaluates abdominal pain, syncope, or vaginal bleeding in a reproductive-age woman without a pregnancy test or consideration of ectopic pregnancy.
Candidates anchor on gastrointestinal or urinary diagnoses and forget to ask about last menstrual period or sexual history.
What to do instead
State that every woman of reproductive age with abdominal pain or syncope gets a urine or serum hCG. If positive, perform bedside ultrasound and involve obstetrics early.