Emergency Med NBME EXAM
QUESTIONS WITH CORRECT
SOLUTIONS||100% GUARANTEED
PASS||UPDATED 2026/2027
SYLLABUS||<<RECENT VERSION>>
48 yo female - 9 hrs after bitten on R.forearm by another woman during bar
altercation
no PMHx, no meds
vitals stable
PE: 1 cm avulsion inj to R.forearm
most app mgnt of this pt's wound? - ANSWER ✓ irrigation and antibiotic therapy
mgnt of bite wounds: left open to be healed by secondary intention
> exception: mammalian bites to face can be sutured if < 24 hrs
surg exploration and massive irrigation
leave open and give amox-clav
f/u: Td appropriately
77 yo female - 4 hrs of pain in L.leg after falling
> unable to bear weight
no PMHx, no meds
vitals stable
PE: LLE held in ext rot and 1 in shorter than RLE
most likely dx? - ANSWER ✓ fracture of the femoral neck
PE demonstrates this type of fx - ext rot and leg shorter than the other
other options don't make sense for vignette:
> pelvic fx would be seen in high-velocity accident
> this ain't knee dislocation or fx of tibial plateau
23 yo male - 45 min after bitten by rattlesnake on L.hand
no PMHx, no meds, NKDA
98.6 F
114/min
23/min
134/76 mmHg
,POx: 98% RA
PE: swelling, discoloration, severe tenderness of L.hand
ED: CroFab (Crotalidae Polyvalent Immune Fab) antivenin is administered
> 15 min later: pt obtunded, flushed; 100.4F; 138/min; 35/min; 75/34 mmHg; POx:
85% RA
most likely dx? - ANSWER ✓ anaphylaxis
homeboy having an allergic rxn to the antivenin
vasomotor shock
> circulatory collapse occurs in flushed, "pink and warm" pts
> low CVP
> tx: vasopressors, IVF
acute serum sickness: rxn to proteins in antiserum derived from a non-human
animal source, occurring 5-10 days after exposure
57 yo male - 2 hrs of prog HA, confusion, nausea, dizziness
> fishing on small boat when symptoms began
> operating outboard motor continuously for latter part of the day
> caught several fish
> ate tuna sandwiches and beer
PMHx: HTN (HCTZ), low back pain (oxy w/ acet)
ED: confused, orientedx1
vitals stable
PE: gucci
CBC, CMP: WNL
most app tx? - ANSWER ✓ hyperbaric oxygen therapy
homeboy has CO poisoning (from working w/ the motor)
this is given when CO >25, loss of consciousness, mac less than 7.1, chest pain,
abnormal ECG
station wagon effect:
> traveling at slow speeds or idling in the water can cause CO to build up in a
boat's cabin, cockpit, bridge, and aft deck, or in an open area
> wind from the aft section of the boat can inc this buildup of CO
> back drafting can cause CO to build up inside the cabin, cockpit, and bridge
when a boat is operated at a high bow angle, is improperly or heavily loaded, or
has an opening that draws in exhaust
23 yo female - 3 days of severe LL abd pain, foul-smelling vag d/c
SHx: sex active w/ multiple partners, uses condoms inconsistently; LMP - 2 wks
ago
, 101.3F
110/min
14/min
110/85 mmHg
PE: abd - tenderness to palp in LLQ; pelvic - cervical motion tenderness and
L.adnexal tenderness; foul-smelling white d/c
urine preg test: neg
most likely to confirm dx? - ANSWER ✓ pelvic ultrasonography
homegirl most likely has PID
chronic PID - bugs created ascending infxn +/- abscess
> chronic abd pain and pelvic mass
> cervical motion tenderness and adnexal tenderness
> fever
tx: amp-gen and metro; abscess can be drained; if peritonitis present - ex lap
feel like if there's ever anything going on w/ females in the pelvic region - you
should just get a transvaginal/pelvic US
73 yo female - lethargic and minimally responsive 30 min
> resident of SNF
> 3 days of vomiting
> no urine for past 24 hrs
> 3 wks ago: hospitalized for PNA
PMHx: renal insuff, T2DM, CHF, dementia
meds: furosemide, metformin, memantine
95.7F
82/min, reg
25/min
90/43 mmHg
POx: 93% RA
PE: skin cool/clammy; crackles at lung bases; abd - soft, mild/diffuse tenderness to
lap; mod pitting edema of lower ext; able to move all 4 ext but doesn't cooperate
w/ neuro exam
labs: bG 78
ECG: peaked T waves, sine waves ???
most app pharmacotherapy? - ANSWER ✓ calcium gluconate
ECG shows severe hyperK
> starting to develop sine waves (aka she's heading to torsades)
has been vomiting and oliguric > inc K
need to protect the heart bc K disturbances can cause arrhythmias
QUESTIONS WITH CORRECT
SOLUTIONS||100% GUARANTEED
PASS||UPDATED 2026/2027
SYLLABUS||<<RECENT VERSION>>
48 yo female - 9 hrs after bitten on R.forearm by another woman during bar
altercation
no PMHx, no meds
vitals stable
PE: 1 cm avulsion inj to R.forearm
most app mgnt of this pt's wound? - ANSWER ✓ irrigation and antibiotic therapy
mgnt of bite wounds: left open to be healed by secondary intention
> exception: mammalian bites to face can be sutured if < 24 hrs
surg exploration and massive irrigation
leave open and give amox-clav
f/u: Td appropriately
77 yo female - 4 hrs of pain in L.leg after falling
> unable to bear weight
no PMHx, no meds
vitals stable
PE: LLE held in ext rot and 1 in shorter than RLE
most likely dx? - ANSWER ✓ fracture of the femoral neck
PE demonstrates this type of fx - ext rot and leg shorter than the other
other options don't make sense for vignette:
> pelvic fx would be seen in high-velocity accident
> this ain't knee dislocation or fx of tibial plateau
23 yo male - 45 min after bitten by rattlesnake on L.hand
no PMHx, no meds, NKDA
98.6 F
114/min
23/min
134/76 mmHg
,POx: 98% RA
PE: swelling, discoloration, severe tenderness of L.hand
ED: CroFab (Crotalidae Polyvalent Immune Fab) antivenin is administered
> 15 min later: pt obtunded, flushed; 100.4F; 138/min; 35/min; 75/34 mmHg; POx:
85% RA
most likely dx? - ANSWER ✓ anaphylaxis
homeboy having an allergic rxn to the antivenin
vasomotor shock
> circulatory collapse occurs in flushed, "pink and warm" pts
> low CVP
> tx: vasopressors, IVF
acute serum sickness: rxn to proteins in antiserum derived from a non-human
animal source, occurring 5-10 days after exposure
57 yo male - 2 hrs of prog HA, confusion, nausea, dizziness
> fishing on small boat when symptoms began
> operating outboard motor continuously for latter part of the day
> caught several fish
> ate tuna sandwiches and beer
PMHx: HTN (HCTZ), low back pain (oxy w/ acet)
ED: confused, orientedx1
vitals stable
PE: gucci
CBC, CMP: WNL
most app tx? - ANSWER ✓ hyperbaric oxygen therapy
homeboy has CO poisoning (from working w/ the motor)
this is given when CO >25, loss of consciousness, mac less than 7.1, chest pain,
abnormal ECG
station wagon effect:
> traveling at slow speeds or idling in the water can cause CO to build up in a
boat's cabin, cockpit, bridge, and aft deck, or in an open area
> wind from the aft section of the boat can inc this buildup of CO
> back drafting can cause CO to build up inside the cabin, cockpit, and bridge
when a boat is operated at a high bow angle, is improperly or heavily loaded, or
has an opening that draws in exhaust
23 yo female - 3 days of severe LL abd pain, foul-smelling vag d/c
SHx: sex active w/ multiple partners, uses condoms inconsistently; LMP - 2 wks
ago
, 101.3F
110/min
14/min
110/85 mmHg
PE: abd - tenderness to palp in LLQ; pelvic - cervical motion tenderness and
L.adnexal tenderness; foul-smelling white d/c
urine preg test: neg
most likely to confirm dx? - ANSWER ✓ pelvic ultrasonography
homegirl most likely has PID
chronic PID - bugs created ascending infxn +/- abscess
> chronic abd pain and pelvic mass
> cervical motion tenderness and adnexal tenderness
> fever
tx: amp-gen and metro; abscess can be drained; if peritonitis present - ex lap
feel like if there's ever anything going on w/ females in the pelvic region - you
should just get a transvaginal/pelvic US
73 yo female - lethargic and minimally responsive 30 min
> resident of SNF
> 3 days of vomiting
> no urine for past 24 hrs
> 3 wks ago: hospitalized for PNA
PMHx: renal insuff, T2DM, CHF, dementia
meds: furosemide, metformin, memantine
95.7F
82/min, reg
25/min
90/43 mmHg
POx: 93% RA
PE: skin cool/clammy; crackles at lung bases; abd - soft, mild/diffuse tenderness to
lap; mod pitting edema of lower ext; able to move all 4 ext but doesn't cooperate
w/ neuro exam
labs: bG 78
ECG: peaked T waves, sine waves ???
most app pharmacotherapy? - ANSWER ✓ calcium gluconate
ECG shows severe hyperK
> starting to develop sine waves (aka she's heading to torsades)
has been vomiting and oliguric > inc K
need to protect the heart bc K disturbances can cause arrhythmias
