ITE EM Question and answers already
passed 2026
A healthy 40-year-old man on a hiking expedition at 14,000 ft elevation begins to develop vomiting and
lack of energy that progresses to altered mental status and ataxic gait. Due to his condition and the poor
weather, it is not possible to descend. Which of the following is the most appropriate treatment for this
patient?
A. Acetazolamide
B. Dexamethasone
C. Hypertonic saline infusion
D. Nifedipine - correct answer Dexamethasone
Which of the following moves the midsystolic click of mitral valve prolapse later into the systolic phase?
A Prone position
B Squatting
C Standing
D Valsalva maneuver - correct answer B. Squatting
Maneuvers that increase preload (such as squatting) or afterload (such as hand grip) move the click later
in systole.
Standing and Valsalva maneuver decrease preload, moving the click earlier in the systolic phase.
A 36-year old woman being treated for post-partum eclampsia with intravenous magnesium sulfate is
awaiting a bed in the intensive care unit. Nursing staff informs you that she is developing respiratory
depression. You stop the magnesium sulfate. Which of the following intravenous medications should be
given to the patient?
, A Calcium gluconate
B Oxytocin
C Potassium chloride
D Terbutalin - correct answer A. Calcium Gluconate
The antidote for magnesium sulfate toxicity is calcium gluconate, which should be administered
intravenously at a dose of 1.5-3 grams over 5 minutes.The first sign of magnesium sulfate toxicity is
hyporeflexia (loss of deep tendon reflexes) and occurs at serum concentrations between 7-10 mEq/L. At
serum concentrations > 10 mEq/L, patients can develop respiratory depression. Patients being treated
with high dose magnesium sulfate should be monitored closely for loss of deep tendon reflexes as this is
the first sign of toxicity.
A 27-year-old man presents to the emergency department with abdominal pain and bloody diarrhea. He
has presented to the emergency department previously for similar complaints. He states that he has
experienced these symptoms for the past week and has lost a significant amount of weight. His
temperature is 101°F (38.3°C), blood pressure is 107/68 mm Hg, and pulse is 110/min. Physical exam is
notable for guaiac-positive stools without grossly bloody stools and a painful oral ulcer. He has diffuse
abdominal pain, most notable in the right lower quadrant, but no guarding or rebound. Following
initiation of fluid resuscitation, which of the following is the best initial treatment for this patient?
A Budesonide
B Infliximab
C Mesalamine enema
D Metronidazole and ciprofloxacin - correct answer D. Metronidazole and cipro.
Crohn's disease typically presents with recurrent bouts of crampy abdominal pain and diarrhea. Patients
will often also experience fevers and weight loss. Because of the chronic nature of the disease, various
nutritional deficiencies including fat-soluble vitamin deficiencies (A, D, E, and K), vitamin B12 deficiency,
hypocalcemia (from vitamin D deficiency and excess oxalate absorption), and iron deficiency anemia are
also often present. Crohn's disease is typically anti-saccharomyces cerevisiae antibody positive, and the
diagnosis can be confirmed with barium studies and colonoscopy. The best initial step in management of
an acute exacerbation of Crohn's disease is hydration, electrolyte replacement, and administration of
passed 2026
A healthy 40-year-old man on a hiking expedition at 14,000 ft elevation begins to develop vomiting and
lack of energy that progresses to altered mental status and ataxic gait. Due to his condition and the poor
weather, it is not possible to descend. Which of the following is the most appropriate treatment for this
patient?
A. Acetazolamide
B. Dexamethasone
C. Hypertonic saline infusion
D. Nifedipine - correct answer Dexamethasone
Which of the following moves the midsystolic click of mitral valve prolapse later into the systolic phase?
A Prone position
B Squatting
C Standing
D Valsalva maneuver - correct answer B. Squatting
Maneuvers that increase preload (such as squatting) or afterload (such as hand grip) move the click later
in systole.
Standing and Valsalva maneuver decrease preload, moving the click earlier in the systolic phase.
A 36-year old woman being treated for post-partum eclampsia with intravenous magnesium sulfate is
awaiting a bed in the intensive care unit. Nursing staff informs you that she is developing respiratory
depression. You stop the magnesium sulfate. Which of the following intravenous medications should be
given to the patient?
, A Calcium gluconate
B Oxytocin
C Potassium chloride
D Terbutalin - correct answer A. Calcium Gluconate
The antidote for magnesium sulfate toxicity is calcium gluconate, which should be administered
intravenously at a dose of 1.5-3 grams over 5 minutes.The first sign of magnesium sulfate toxicity is
hyporeflexia (loss of deep tendon reflexes) and occurs at serum concentrations between 7-10 mEq/L. At
serum concentrations > 10 mEq/L, patients can develop respiratory depression. Patients being treated
with high dose magnesium sulfate should be monitored closely for loss of deep tendon reflexes as this is
the first sign of toxicity.
A 27-year-old man presents to the emergency department with abdominal pain and bloody diarrhea. He
has presented to the emergency department previously for similar complaints. He states that he has
experienced these symptoms for the past week and has lost a significant amount of weight. His
temperature is 101°F (38.3°C), blood pressure is 107/68 mm Hg, and pulse is 110/min. Physical exam is
notable for guaiac-positive stools without grossly bloody stools and a painful oral ulcer. He has diffuse
abdominal pain, most notable in the right lower quadrant, but no guarding or rebound. Following
initiation of fluid resuscitation, which of the following is the best initial treatment for this patient?
A Budesonide
B Infliximab
C Mesalamine enema
D Metronidazole and ciprofloxacin - correct answer D. Metronidazole and cipro.
Crohn's disease typically presents with recurrent bouts of crampy abdominal pain and diarrhea. Patients
will often also experience fevers and weight loss. Because of the chronic nature of the disease, various
nutritional deficiencies including fat-soluble vitamin deficiencies (A, D, E, and K), vitamin B12 deficiency,
hypocalcemia (from vitamin D deficiency and excess oxalate absorption), and iron deficiency anemia are
also often present. Crohn's disease is typically anti-saccharomyces cerevisiae antibody positive, and the
diagnosis can be confirmed with barium studies and colonoscopy. The best initial step in management of
an acute exacerbation of Crohn's disease is hydration, electrolyte replacement, and administration of
