Iraqi Board Emergency Medicine common mistakes
Iraqi Board Emergency Medicine · Understand the traps and how to avoid them.
Committing to a single diagnosis and management plan in a resuscitative scenario without first stating a structured primary survey (A-B-C-D-E) and the immediate life threats identified at each step.
Candidates pattern-match the vignette's headline feature (e.g., hypotension, chest pain) and jump straight to the 'answer' therapy, skipping the prioritisation framework the Iraqi Board examiners are explicitly testing through the resuscitation stem.
What to do instead
Before answering, write down A-B-C-D-E on your scratch paper and assign one finding per letter from the stem. State the single most immediate threat and its intervention first, then the secondary plan. Practise 20 stems with a hard rule: no diagnosis is named until all five letters have an entry.
Applying adult vital-sign thresholds and adult drug doses to paediatric stems, and failing to calculate weight-based doses and fluid boluses explicitly.
Most revision material is adult-oriented, and candidates under time pressure default to remembered adult numbers rather than recalculating for age and weight; the exam deliberately uses infants and toddlers to test this.
What to do instead
Memorise and rehearse age-banded normal ranges (heart rate, respiratory rate, systolic BP) and the standard 10-20 mL/kg bolus and 4-10 mL/kg maintenance rules. On every paediatric question, write the estimated weight and the calculated dose in the margin before selecting an option.
Reading an ECG stem as a single-lead diagnosis and missing the rate, rhythm, axis, intervals and ST-T analysis sequence, then choosing a treatment that treats a rhythm but not the patient's stability.
Candidates recognise a pattern (e.g., wide-complex tachycardia) and answer the antiarrhythmic rather than first deciding stable versus unstable, which determines whether synchronised cardioversion is the correct answer.
What to do instead
Use a fixed ECG routine: rate, rhythm, axis, P-QRS-T intervals, ST segments, then 'is the patient stable?' If unstable, the answer is electricity, not drugs. Drill 30 ECGs where the same rhythm appears in stable and unstable versions and note how the answer changes.
Describing a trauma patient's management without stating the mechanism, the time-critical decision (e.g., operating theatre versus CT), and the endpoints of resuscitation, instead listing every possible investigation.
Candidates equate thoroughness with correctness and produce unfocused lists; Iraqi Board trauma questions reward the correct sequence and timing of interventions, especially in a resource-limited setting where CT availability is itself a decision point.
What to do instead
Answer trauma stems in a fixed format: mechanism and physiology, immediate life threats found, the next time-critical action within the first hour, and the endpoint (haemorrhage control, permissive hypotension targets, transfusion ratio). Explicitly justify why an investigation would delay definitive care.
Giving a single antidote or decontamination step as the complete answer to a toxicology stem, omitting risk assessment, observation period, and the criteria for discharge or escalation.
Toxicology is taught as a list of antidotes, so candidates retrieve the antidote name and stop, missing that the exam often asks about the safe observation window or the decision to treat an asymptomatic patient.
What to do instead
Structure every toxicology answer as: agent and dose, toxidrome, risk stratification (dose, time since ingestion, co-ingestants), specific antidote with indication and endpoint, supportive care, observation duration, and disposition criteria. Learn the observation periods for paracetamol, salicylate, iron, opioids and organophosphates specifically.
Treating a suspected septic or obstetric patient's workup as complete once cultures and antibiotics are ordered, without stating the fluid strategy, source control, vasopressor threshold and time targets.
Candidates compartmentalise 'sepsis' as a microbiology question and 'obstetric emergency' as an obstetrics question, so they omit the haemodynamic and time-critical bundle elements that the integrated stems are designed to test.
What to do instead
For every sepsis or obstetric emergency stem, write the hour-1 bundle explicitly: cultures before antibiotics, broad-spectrum antibiotics within the stated time, 30 mL/kg crystalloid with reassessment, lactate, source control, and the MAP threshold for vasopressors. In pregnancy, add left lateral tilt, magnesium sulphate criteria for eclampsia, and the decision for delivery.
Answering an airway or procedure question with the name of the technique but not the confirmation method, the failed-attempt plan, or the anatomical landmarks and contraindications.
Candidates memorise procedure names and indications but not the safety steps, and the exam frequently asks 'what next' after a failed first attempt or how to confirm placement.
What to do instead
For each core procedure (intubation, surgical cricothyrotomy, chest drain, central line, lumbar puncture, ultrasound-guided cannulation), rehearse a three-part script: landmarks and contraindications, step sequence with confirmation of success, and the escalation plan after failure. State confirmation methods explicitly (waveform capnography, ultrasound, aspiration of air/fluid).
Interpreting a point-of-care ultrasound finding in isolation without integrating it into the clinical question, the pre-test probability, and the limitations of the study.
Candidates treat ultrasound as an image-recognition test and answer the visual finding, missing that the exam asks whether the finding changes management and what a negative or indeterminate study means.
What to do instead
Frame every ultrasound answer around the clinical question (e.g., pericardial effusion in hypotension), the expected finding, the confirmatory or alternative view, and the action if the study is negative or non-diagnostic. State the pre-test probability and the plan for an inconclusive scan.
Managing an electrolyte or endocrine crisis by naming the correction fluid but omitting the rate of correction, the monitoring interval, and the complication of over-correction.
Candidates recall the direction of correction (e.g., hypertonic saline for hyponatraemia) but not the safe rate, so they choose an option that is qualitatively right but dangerously fast or slow.
What to do instead
For sodium, potassium, calcium and glucose emergencies, memorise the target rate of change, the maximum safe correction per 24 hours, the monitoring frequency, and the specific over-correction complication (osmotic demyelination, cerebral oedema, arrhythmia, rebound hypoglycaemia). Write the numbers next to every answer option and eliminate those outside safe limits.
Answering ethics, disaster and administration stems with generic principles ('do what is best for the patient') rather than applying the specific framework, triage category, or legal duty that the scenario requires.
These domains feel like common sense, so candidates do not revise them, and they miss that the exam tests concrete constructs such as capacity assessment, consent in an emergency, resource allocation under surge, and declaration and notification duties.
What to do instead
Learn the named frameworks and apply them explicitly: capacity assessment (understanding, retention, communication, weighing), best-interests decision-making, mass-casualty triage categories with their physiological criteria, and the sequence of hospital disaster response. Practise writing the framework name and its criteria into each answer.