10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The EM exam has 305 questions and runs 6 hours 20 minutes.
These 10 free EM questions are organized by exam domain, so you can see how each part of the Emergency Medicine blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Signs, Symptoms and Presentations 10% of exam
Question 1
A 78-year-old woman cannot find a comfortable position because of diffuse abdominal pain that began suddenly two hours ago. Her abdomen is soft, with only mild periumbilical tenderness and no guarding. She has atrial fibrillation and is not anticoagulated because of a previous gastrointestinal bleed. Blood pressure is 138/76 mm Hg, lactate is 1.4 mmol/L, and creatinine is 2.2 mg/dL, increased from 1.1 mg/dL one month earlier. Which diagnostic study should be obtained now?
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Correct answer: A - CT angiography of the abdomen and pelvis
Domain 2: Abdominal & Gastrointestinal Disorders 7% of exam
Question 2
Palpitations began abruptly 25 minutes ago in a 32-year-old man. His ECG shows an irregular tachycardia at 190-240/min, with QRS complexes that vary in width and morphology. An ECG from a previous visit shows a short PR interval and a slurred initial QRS upstroke. He is alert, has no chest discomfort or pulmonary edema, and has a blood pressure of 126/78 mm Hg. If pharmacologic conversion is selected, which IV treatment is appropriate?
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Correct answer: D - Procainamide given as an IV infusion
Domain 4: Cutaneous Disorders 3% of exam
Question 3
Vomiting and poor intake have kept a 43-year-old woman with type 2 diabetes from eating for two days. She takes empagliflozin and metformin. After initial isotonic fluid replacement, laboratory results show glucose 184 mg/dL, beta-hydroxybutyrate 5.8 mmol/L, bicarbonate 11 mmol/L, venous pH 7.23, potassium 4.2 mmol/L, and lactate 1.2 mmol/L. She remains alert but tachypneic. Which treatment should accompany continued fluid replacement?
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Correct answer: B - IV regular insulin with concurrent dextrose
Domain 5: Endocrine, Metabolic & Nutritional Disorders 5% of exam
Question 4
A 70-kg adult arrives three hours after a thermal burn, having received 1,000 mL of lactated Ringer's solution. The entire anterior trunk and all surfaces of the right arm are moist, blistered, and painful. The entire posterior trunk is red, dry, and briskly blanching, without blisters; the remaining skin is uninjured. Using the adult rule of nines, the burn team selects an initial 24-hour estimate of 2 mL/kg per percent burned, with half delivered during the first eight hours after injury. Which starting infusion rate for the next five hours best fits this plan, before further titration to urine output and perfusion?
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Correct answer: A - 180 mL/hour
Domain 7: Head, Ear, Eye, Nose & Throat Disorders 4% of exam
Question 5
The laboratory calls about a platelet count of 14,000/microliter in a 39-year-old woman with new bruising and intermittent confusion. Hemoglobin is 8.3 g/dL, LDH is markedly elevated, haptoglobin is undetectable, and the smear contains numerous schistocytes. Creatinine is 1.2 mg/dL; PT, aPTT, and fibrinogen are normal. She is not pregnant and has no active bleeding. An ADAMTS13 sample has been collected, but the result will take two days. What should begin before that result returns?
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Correct answer: C - Urgent plasma exchange plus corticosteroids
Domain 10: Systemic Infectious Disorders 7% of exam
Question 6
Ninety minutes after a witnessed onset of speech difficulty, a previously independent 61-year-old woman has an NIH Stroke Scale score of 3: two points for aphasia and one for right facial weakness. She follows commands and moves all four limbs normally, but cannot communicate basic needs. Blood pressure is 168/92 mm Hg and glucose is 108 mg/dL. Noncontrast head CT shows no hemorrhage; CT angiography shows no large-vessel occlusion. She has no contraindication to thrombolysis. Which acute management approach is indicated?
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Correct answer: C - Administer intravenous thrombolysis
Domain 11: Musculoskeletal Disorders (Non-traumatic) 3% of exam
Question 7
Six days after delivery, a woman presents with severe hypertension and a generalized seizure. She receives IV magnesium sulfate followed by a maintenance infusion. Over the next several hours, urine output falls to 10 mL/hour. She then becomes somnolent, her respiratory rate falls to 6/min, and patellar reflexes are absent. The infusion is stopped and assisted ventilation is begun. Which medication most directly reverses the suspected cause of this deterioration?
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Correct answer: A - Calcium gluconate, 1 g IV
Domain 12: Nervous System Disorders 6% of exam
Question 8
A man brought in after expressing suicidal thoughts while drinking initially had slurred speech and an alcohol concentration of 280 mg/dL. After observation, he is attentive, speaks clearly, walks steadily, and can explain his circumstances and the consequences of his choices. His alcohol concentration remains 150 mg/dL. He now denies suicidal intent, but no comprehensive suicide assessment has been completed. What is the appropriate approach at this point?
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Correct answer: D - Proceed with a comprehensive suicide risk assessment now
Domain 14: Psychobehavioral Disorders 2% of exam
Question 9
A highly sensitive D-dimer assay returns at 590 ng/mL FEU in a 68-year-old outpatient being evaluated for mild pleuritic chest pain. The laboratory flags results above 500 ng/mL FEU. His pretest probability of pulmonary embolism is low, heart rate is 84/min, oxygen saturation is 98% on room air, and there are no signs of deep venous thrombosis. He is not taking anticoagulants. Using an age-adjusted D-dimer strategy, how should the pulmonary embolism evaluation proceed?
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Correct answer: B - End the pulmonary embolism evaluation without additional testing
Domain 16: Thoracic-Respiratory Disorders 7% of exam
Question 10
Four hours after a witnessed trip and fall, a 76-year-old man taking apixaban for atrial fibrillation feels ready to go home. He struck his forehead and briefly felt dazed. Head CT shows no hemorrhage or fracture, his neurologic examination is at baseline, and a mild headache has resolved. There is no vomiting, other significant injury, or separate reason for admission. His wife can remain with him and understands return precautions. Which disposition is supported by these findings?
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Correct answer: D - Discharge with head-injury precautions and reliable home observation