Emergency MedicineShelf Exam·quiz 8 questions · 11 min
Emergency Medicine: 8 High-Yield Board Practice Questions
Emergency medicine tests pattern recognition under pressure. The right answer requires knowing time-sensitive thresholds, diagnostic algorithms, and first-line interventions cold. These 8 questions cover the most frequently tested scenarios.
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Evidence-based · For exam prep, not medical advice
update Updated October 2026
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Built by surgery and anesthesiology residents·Written for USMLE Step 1
High-Yield Topics Covered
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Trauma primary survey (ATLS)
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Airway management and RSI
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STEMI and tPA time windows
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Septic shock management
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Toxicology antidotes
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Anaphylaxis treatment
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Ectopic pregnancy
Question 1 of 8Score: 0 / 0
Q1Thoracic Trauma
A trauma patient arrives after an MVC. Primary survey: airway intact, breath sounds absent on the left, trachea deviated to the right, HR 128, BP 78/50. Neck veins are distended. Most appropriate immediate intervention?
Explanation: Tension pneumothorax: absent breath sounds, tracheal deviation away from affected side, hemodynamic compromise, JVD. This is a clinical diagnosis — do NOT wait for X-ray. Treat immediately with needle decompression (2nd intercostal space, midclavicular line on the affected side) followed by chest tube. Seconds matter.
Q2Gynecologic Emergencies
A 28-year-old woman 7 weeks pregnant presents with sharp left lower quadrant pain and vaginal spotting. BP 92/60, HR 118. Urine hCG positive. Pelvic exam reveals left adnexal tenderness. Most appropriate next step?
Explanation: This patient is hemodynamically unstable with signs of ruptured ectopic pregnancy — hemorrhagic shock. Unstable ectopic = surgical emergency. Do NOT delay for ultrasound (appropriate in stable patients). Immediate OB consult for operative management. Methotrexate is used for stable, unruptured ectopic with specific criteria.
Q3Anaphylaxis
A patient presents with anaphylaxis after a bee sting: urticaria, angioedema, stridor, and BP 82/50. First-line treatment is:
Explanation: Epinephrine (1:1000, 0.3 mg IM) to the anterolateral thigh is the first-line and life-saving treatment for anaphylaxis. It reverses bronchospasm, prevents airway edema progression, and increases BP. Antihistamines and steroids are adjuncts — they do NOT save lives in acute anaphylaxis. Never give epinephrine IV in anaphylaxis unless in cardiac arrest.
Q4Toxicology
An 18-year-old is brought in after ingesting unknown pills. He is lethargic, HR 42, BP 86/50, RR 8. Pupils are normal. What class of toxin is most consistent with this presentation?
Explanation: Beta-blocker overdose: bradycardia + hypotension without miosis. Opioids would cause miosis and more prominent respiratory depression. TCA overdose causes QRS widening and arrhythmias. Stimulants cause tachycardia and hypertension. Treatment for beta-blocker OD: high-dose insulin + glucagon + calcium; IV lipid emulsion for severe cases.
Q5GI Emergencies
A patient with known cirrhosis presents to the ED vomiting blood. BP 88/52, HR 124. After 2 large-bore IVs, next step in management?
Explanation: Variceal bleeding in cirrhosis: initiate IV octreotide (reduces portal pressure), prophylactic IV ceftriaxone (SBP prevention — antibiotics reduce mortality in variceal bleeding), and urgent EGD for definitive band ligation/sclerotherapy. Resuscitate with pRBCs, aim Hgb 7–8. Avoid over-transfusion (increases portal pressure). TIPS if EGD fails.
Q6Toxicology Antidotes
A patient is brought in with suspected organophosphate toxicity after farm chemical exposure. He has bradycardia, bronchospasm, excessive secretions, urinary incontinence, and miosis. First-line antidote?
Explanation: Organophosphate toxicity (SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis; + bradycardia and bronchospasm) = cholinergic crisis from acetylcholinesterase inhibition. Antidotes: (1) Atropine (blocks muscarinic effects — give until secretions dry) + (2) Pralidoxime (2-PAM, reactivates acetylcholinesterase before it 'ages'). Give atropine first.
Q7Arrhythmia Management
A 55-year-old man presents with syncope. ECG shows alternating tall and short QRS complexes with a rate of 200 bpm and no clear P waves. He is conscious with BP 88/60. Most appropriate immediate management?
Explanation: Electrical alternans + rate 200 + hemodynamic instability suggests polymorphic VT or unstable SVT. For any unstable tachyarrhythmia with pulse: synchronized cardioversion. Defibrillation (unsynchronized) is for pulseless VFib/VTach. Adenosine is for stable narrow-complex SVT. Amiodarone is for stable WCT. Unstable = cardiovert first.
Q8CNS Infections
A patient presents with high fever, neck stiffness, photophobia, and petechial rash. LP is contraindicated due to suspected elevated ICP. The most appropriate immediate next step is:
Explanation: Bacterial meningitis: do NOT delay antibiotics for imaging or LP. If LP is clinically contraindicated (papilledema, focal neuro deficits, immunocompromise, new-onset seizure), obtain blood cultures, give antibiotics STAT (ceftriaxone + vancomycin + dexamethasone), then CT head, then LP. Antibiotic delay increases mortality — imaging should never delay treatment.
What is the most important thing to remember about tension pneumothorax?
Tension pneumothorax is a clinical diagnosis — treat before imaging. Waiting for X-ray is wrong in an unstable patient with the classic triad: absent breath sounds (ipsilateral), tracheal deviation (contralateral), and hemodynamic compromise (hypotension, tachycardia, JVD). Needle decompression saves the life; chest tube confirms and maintains decompression.
What are the key toxicology antidotes tested on boards?
How do you differentiate STEMI management from unstable angina/NSTEMI?
STEMI: ST elevation + biomarker rise → immediate revascularization (PCI <90 min door-to-balloon time, or thrombolytics if PCI unavailable within 120 min). NSTEMI: ST depression or T-wave changes + troponin rise → anticoagulation, dual antiplatelet therapy, risk-stratify → early invasive (PCI <24h for high-risk) or conservative. UA: symptoms + ECG changes but no troponin rise → medical management, risk stratify.
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