Iran Specialty Board - Emergency Medicine common mistakes
Iran Specialty Board - Emergency Medicine · Understand the traps and how to avoid them.
In shock questions, selecting a single normal vital sign (e.g., a normal blood pressure) as evidence that resuscitation is adequate, instead of integrating lactate, capillary refill, mentation, and urine output into the assessment.
Candidates memorize blood pressure thresholds as the definition of shock and treat hypotension as the trigger for action; the exam deliberately presents compensated shock with normal BP, so the familiar shortcut produces the wrong answer.
What to do instead
Before answering any shock item, explicitly classify the patient by perfusion markers rather than pressure alone, and rehearse the compensated-to-decompensated progression for each shock type so that normal BP is recognized as a warning sign, not reassurance.
Treating every wide-complex tachycardia as ventricular tachycardia and answering 'amiodarone or cardioversion' even when the stem describes a stable, regular, monomorphic rhythm with a known supraventricular history and prior response to adenosine.
Candidates learn the safety rule 'wide and irregular or unknown = VT' and overgeneralize it, losing the branch of the algorithm that permits vagal maneuvers or adenosine in stable, regular, monomorphic wide-complex tachycardia.
What to do instead
Answer in two steps: first decide stability (pulse, BP, ischemic chest pain, altered mentation), then decide regularity and monomorphism; only after that choose between synchronized cardioversion and pharmacologic/diagnostic maneuvers, and state the reason for each branch.
In trauma items, ordering computed tomography of the abdomen as the first diagnostic step in a hypotensive patient with a positive FAST examination, rather than proceeding to operative hemorrhage control.
Candidates conflate 'definitive diagnosis' with 'best next step' and are drawn to the most detailed imaging option; the exam tests disposition and time-critical decision-making, not diagnostic completeness.
What to do instead
For each trauma stem, ask 'what is the next action in the first five minutes?' and default to hemorrhage control (operative or angiographic) when the patient is unstable with a positive FAST; reserve CT for the hemodynamically stable or transiently responsive patient.
Managing a poisoned patient by naming the antidote before completing airway, breathing, and circulation, or giving an antidote that is contraindicated by the ingestion pattern (e.g., flumazenil in a mixed overdose with seizure history).
Antidote recall is the most rehearsed part of toxicology, so it dominates attention; candidates underweight the toxidrome, coingestants, and the risk of precipitating seizures or dysrhythmia.
What to do instead
Structure every toxicology answer as supportive care first, then decontamination eligibility, then antidote with its indication and contraindication; practice justifying why an antidote is withheld as often as why it is given.
Failing to give thrombolysis or thrombectomy consideration to a stroke patient who arrives outside the conventional window, or excluding a candidate because of a single borderline criterion instead of applying the current extended-window imaging-based criteria.
Candidates memorize fixed time cutoffs from older teaching and do not update to perfusion-imaging selection; the exam includes wake-up stroke and large-vessel occlusion scenarios that reward current criteria.
What to do instead
Build a one-page decision map distinguishing the standard window, the extended window with imaging selection, and contraindications, and practice stating the exact criterion that includes or excludes the patient rather than a bare time figure.
Choosing a high fraction of inspired oxygen or a specific ventilator mode as the answer for every hypoxemic respiratory failure item, without distinguishing the mechanism (shunt, ventilation-perfusion mismatch, hypoventilation, diffusion) described in the stem.
Candidates pattern-match 'hypoxia' to 'give oxygen and intubate' and skip the physiologic classification that determines whether oxygen, positive pressure, or ventilation is the correct intervention.
What to do instead
For each respiratory stem, name the mechanism first and predict the response to supplemental oxygen; then select the intervention that matches the mechanism, and review how positive end-expiratory pressure and recruitment behave differently in shunt versus mismatch.
Applying adult dosing, adult vital sign thresholds, or adult fluid bolus volumes to infants and children in resuscitation and sepsis items.
Adult resuscitation is rehearsed far more often, and candidates answer from the adult template under time pressure; weight-based dosing and age-specific thresholds are then misapplied.
What to do instead
Before answering any pediatric item, write the weight-based dose or the age-specific threshold explicitly, and drill the pediatric sepsis bundle, fluid bolus limits, and hypotension definitions by age band until they are automatic.
In obstetric emergencies, attributing third-trimester bleeding or shock to placental abruption alone and missing placenta previa, uterine rupture, or vasa previa, or performing a digital vaginal examination in a bleeding placenta previa.
Abruption is the most taught cause, so it crowds out the differential; candidates also forget that the pelvic examination itself is the harmful intervention in previa.
What to do instead
For third-trimester bleeding, list all causes with their discriminating features and state explicitly whether a vaginal examination is permitted; practice answering 'what must not be done' items as carefully as 'what should be done' items.
Describing ultrasound findings in words without committing to the clinical decision they change, or answering a procedural-skills item with the correct technique but the wrong sequence (e.g., confirming needle position before aspirating, or failing to identify the landmark that makes the approach safe).
Candidates treat ultrasound and procedures as factual recall and stop at image interpretation; the exam asks what the finding or step means for management and what happens next.
What to do instead
For every ultrasound or procedure item, answer in the form 'finding leads to decision', and rehearse each procedure as an ordered checklist with the indication, contraindication, landmark, confirmation step, and complication for each stage.
Answering disaster and emergency-medical-services items with the clinically best care for the individual patient rather than the triage category or system-level action the scenario requires, and misassigning mass-casualty triage colors.
Clinical training rewards individualized maximal care, so candidates default to it; disaster medicine instead rewards resource allocation and the correct triage category under scarcity.
What to do instead
Read disaster and EMS stems for the level of the question (patient, scene, system) and answer at that level; memorize one mass-casualty triage scheme completely, including the physiological cutoffs for each color, and practice justifying why a red-tagged patient may still be deprioritized.
Confusing the ethical or legal category in professionalism items, for example answering a consent question with a confidentiality principle, or treating an incapacitated patient's refusal as binding instead of activating surrogate or emergency exception pathways.
Candidates recognize the scenario but not the precise principle being tested, and the options are written so that several are true statements that do not answer the question asked.
What to do instead
Label each professionalism stem with its exact category (capacity, consent, confidentiality, mandatory reporting, duty to treat, futility) before reading the options, then eliminate any option that is true but belongs to a different category.
Accepting a study's conclusion at face value without checking whether the design supports it, or answering evidence-based-medicine items by preferring expert opinion or physiologic reasoning over higher-level evidence when both are offered.
Candidates read the abstract-style stem for the result and skip the methods sentence; under time pressure, plausibility feels safer than critical appraisal.
What to do instead
For each evidence item, identify design, comparator, outcome, and direction of effect before choosing, and rehearse the hierarchy of evidence plus the specific biases (selection, lead-time, spectrum, publication) that each design is prone to.
Skipping the calculation in quality-improvement and administration items (sensitivity, specificity, positive predictive value, number needed to treat, or run-chart interpretation) and choosing the option that sounds most reasonable.
Candidates avoid arithmetic under time pressure and trust qualitative judgment; these items are deliberately constructed so that the plausible answer differs from the computed one.
What to do instead
Reserve a fixed block of exam time for calculation items, write the formula and the numbers before looking at the options, and practice interpreting control charts and before-after quality data so the arithmetic is fast and reliable.