1
MCGRAW-HILL EMERGENCY MEDICINE
EXAM 2026/2027 | BOARD REVIEW | 100
VERIFIED Q&A | DETAILED RATIONALES |
PASS GUARANTEED – A+ GRADED
SECTION 1: CARDIOVASCULAR EMERGENCIES - Questions 1-15
Q1: Acute Myocardial Infarction – STEMI Criteria
The student is reviewing cardiovascular emergencies. Which ECG finding is diagnostic of an ST-
elevation myocardial infarction (STEMI) in the absence of left ventricular hypertrophy or bundle
branch block?
A. ST depression in two contiguous leads
B. ST elevation ≥1 mm in two contiguous limb leads
C. T wave inversion in three contiguous leads
D. New-onset atrial fibrillation
Correct Answer: B
Rationale: STEMI is diagnosed by ST elevation ≥1 mm in two or more contiguous limb leads or ≥2
mm in two or more contiguous precordial leads (V1-V3) in men, or ≥1.5 mm in women. ST
depression suggests ischemia or non-STEMI. T wave inversion is nonspecific. New-onset AF is not
diagnostic of STEMI. [100% CORRECT]
Q2: Cardiac Arrest – Defibrillation
The student is reviewing cardiac arrest management. A patient in ventricular fibrillation (VF) cardiac
arrest has just arrived. What is the most appropriate initial intervention?
A. Epinephrine 1 mg IV push
B. Amiodarone 300 mg IV push
C. Immediate defibrillation
D. Endotracheal intubation
Correct Answer: C
Rationale: For VF or pulseless VT, immediate defibrillation is the definitive treatment. Epinephrine
and amiodarone are given after initial defibrillation attempts. Intubation should not delay
defibrillation. [100% CORRECT]
Q3: Aortic Dissection – Clinical Presentation
,2
The student is reviewing aortic emergencies. A 65-year-old male with a history of hypertension
presents with sudden, severe, tearing chest pain radiating to the back. Blood pressure is 180/100
mmHg in the right arm and 140/80 mmHg in the left arm. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with sudden, severe, tearing pain radiating to the
back, often with a pulse deficit or blood pressure differential between arms. Hypertension is a major
risk factor. [100% CORRECT]
Q4: Hypertensive Emergency – Treatment
The student is reviewing hypertensive emergencies. A patient presents with a blood pressure of
220/130 mmHg and evidence of acute end-organ damage (papilledema, chest pain, dyspnea). What
is the goal for blood pressure reduction in the first hour?
A. Reduce to normal within 30 minutes
B. Reduce mean arterial pressure by 10-20%
C. Reduce systolic to <120 mmHg
D. No reduction needed
Correct Answer: B
Rationale: In hypertensive emergency, the goal is to reduce mean arterial pressure by 10-20% in the
first hour, then gradually over 24-48 hours, to avoid organ hypoperfusion. [100% CORRECT]
Q5: Pulmonary Embolism – Diagnosis
The student is reviewing pulmonary embolism. A 45-year-old female presents with sudden-onset
dyspnea, pleuritic chest pain, and tachycardia after a long flight. What is the most appropriate initial
diagnostic test?
A. D-dimer
B. Chest X-ray
C. CT pulmonary angiography
D. Ventilation-perfusion scan
Correct Answer: C
Rationale: CT pulmonary angiography is the diagnostic test of choice for hemodynamically stable
patients with suspected PE. D-dimer is useful for ruling out PE in low-risk patients. V/Q scan is
reserved for those with contrast allergy or renal failure. [100% CORRECT]
Q6: Acute Decompensated Heart Failure – Treatment
,3
The student is reviewing heart failure. A patient presents with acute dyspnea, orthopnea, and
bilateral crackles. Blood pressure is 160/90 mmHg. What is the most appropriate initial treatment?
A. IV fluids
B. IV furosemide
C. IV metoprolol
D. IV diltiazem
Correct Answer: B
Rationale: Acute decompensated heart failure with volume overload is treated with IV loop diuretics
(e.g., furosemide) to reduce preload. Beta-blockers and calcium channel blockers are
contraindicated in acute decompensation. [100% CORRECT]
Q7: Unstable Angina – Definition
The student is reviewing acute coronary syndromes. Unstable angina is characterized by all of the
following EXCEPT:
A. Angina at rest
B. New-onset angina
C. Angina lasting >20 minutes
D. Angina relieved by rest
Correct Answer: D
Rationale: Unstable angina is defined as angina at rest, new-onset severe angina, or crescendo
angina. It is not relieved by rest or nitroglycerin. Angina relieved by rest is stable angina. [100%
CORRECT]
Q8: Supraventricular Tachycardia – Management
The student is reviewing arrhythmias. A patient presents with a regular narrow-complex tachycardia
at a rate of 180 bpm. The patient is hemodynamically stable. What is the most appropriate initial
intervention?
A. Synchronized cardioversion
B. Vagal maneuvers
C. Adenosine 6 mg IV push
D. Amiodarone 150 mg IV
Correct Answer: B
Rationale: For stable SVT, vagal maneuvers are the first-line intervention. If unsuccessful, adenosine
is given. Synchronized cardioversion is reserved for unstable patients. [100% CORRECT]
Q9: Bradycardia – Indications for Pacing
The student is reviewing bradyarrhythmias. Which of the following is an indication for
transcutaneous pacing?
, 4
A. Heart rate <60 bpm with no symptoms
B. Complete heart block with hypotension
C. Sinus bradycardia in a well-conditioned athlete
D. First-degree AV block
Correct Answer: B
Rationale: Transcutaneous pacing is indicated for symptomatic bradycardia, including complete
heart block with hemodynamic instability (hypotension, altered mental status, chest pain, or acute
heart failure). [100% CORRECT]
Q10: Cardiac Tamponade – Beck's Triad
The student is reviewing pericardial emergencies. Beck's triad, associated with cardiac tamponade,
consists of:
A. Hypotension, muffled heart sounds, and jugular venous distension
B. Hypertension, clear heart sounds, and flat neck veins
C. Tachycardia, pericardial friction rub, and fever
D. Bradycardia, hypertension, and respiratory depression
Correct Answer: A
Rationale: Beck's triad for cardiac tamponade includes hypotension, muffled heart sounds, and
jugular venous distension. [100% CORRECT]
Q11: Endocarditis – Empiric Treatment
The student is reviewing infectious endocarditis. A patient with a history of IV drug use presents with
fever, new murmur, and Janeway lesions. Blood cultures are pending. What is the most appropriate
empiric antibiotic regimen?
A. Vancomycin + gentamicin
B. Ampicillin + gentamicin
C. Ceftriaxone
D. Azithromycin
Correct Answer: A
Rationale: Empiric treatment for suspected infective endocarditis, especially in IV drug users, should
cover Staphylococcus aureus (including MRSA) and streptococci. Vancomycin + gentamicin is
appropriate. [100% CORRECT]
Q12: Acute Pericarditis – ECG Findings
The student is reviewing pericarditis. Which ECG finding is most characteristic of acute pericarditis?
A. Diffuse ST elevation with PR depression
B. Localized ST elevation in two contiguous leads
MCGRAW-HILL EMERGENCY MEDICINE
EXAM 2026/2027 | BOARD REVIEW | 100
VERIFIED Q&A | DETAILED RATIONALES |
PASS GUARANTEED – A+ GRADED
SECTION 1: CARDIOVASCULAR EMERGENCIES - Questions 1-15
Q1: Acute Myocardial Infarction – STEMI Criteria
The student is reviewing cardiovascular emergencies. Which ECG finding is diagnostic of an ST-
elevation myocardial infarction (STEMI) in the absence of left ventricular hypertrophy or bundle
branch block?
A. ST depression in two contiguous leads
B. ST elevation ≥1 mm in two contiguous limb leads
C. T wave inversion in three contiguous leads
D. New-onset atrial fibrillation
Correct Answer: B
Rationale: STEMI is diagnosed by ST elevation ≥1 mm in two or more contiguous limb leads or ≥2
mm in two or more contiguous precordial leads (V1-V3) in men, or ≥1.5 mm in women. ST
depression suggests ischemia or non-STEMI. T wave inversion is nonspecific. New-onset AF is not
diagnostic of STEMI. [100% CORRECT]
Q2: Cardiac Arrest – Defibrillation
The student is reviewing cardiac arrest management. A patient in ventricular fibrillation (VF) cardiac
arrest has just arrived. What is the most appropriate initial intervention?
A. Epinephrine 1 mg IV push
B. Amiodarone 300 mg IV push
C. Immediate defibrillation
D. Endotracheal intubation
Correct Answer: C
Rationale: For VF or pulseless VT, immediate defibrillation is the definitive treatment. Epinephrine
and amiodarone are given after initial defibrillation attempts. Intubation should not delay
defibrillation. [100% CORRECT]
Q3: Aortic Dissection – Clinical Presentation
,2
The student is reviewing aortic emergencies. A 65-year-old male with a history of hypertension
presents with sudden, severe, tearing chest pain radiating to the back. Blood pressure is 180/100
mmHg in the right arm and 140/80 mmHg in the left arm. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
Correct Answer: C
Rationale: Aortic dissection classically presents with sudden, severe, tearing pain radiating to the
back, often with a pulse deficit or blood pressure differential between arms. Hypertension is a major
risk factor. [100% CORRECT]
Q4: Hypertensive Emergency – Treatment
The student is reviewing hypertensive emergencies. A patient presents with a blood pressure of
220/130 mmHg and evidence of acute end-organ damage (papilledema, chest pain, dyspnea). What
is the goal for blood pressure reduction in the first hour?
A. Reduce to normal within 30 minutes
B. Reduce mean arterial pressure by 10-20%
C. Reduce systolic to <120 mmHg
D. No reduction needed
Correct Answer: B
Rationale: In hypertensive emergency, the goal is to reduce mean arterial pressure by 10-20% in the
first hour, then gradually over 24-48 hours, to avoid organ hypoperfusion. [100% CORRECT]
Q5: Pulmonary Embolism – Diagnosis
The student is reviewing pulmonary embolism. A 45-year-old female presents with sudden-onset
dyspnea, pleuritic chest pain, and tachycardia after a long flight. What is the most appropriate initial
diagnostic test?
A. D-dimer
B. Chest X-ray
C. CT pulmonary angiography
D. Ventilation-perfusion scan
Correct Answer: C
Rationale: CT pulmonary angiography is the diagnostic test of choice for hemodynamically stable
patients with suspected PE. D-dimer is useful for ruling out PE in low-risk patients. V/Q scan is
reserved for those with contrast allergy or renal failure. [100% CORRECT]
Q6: Acute Decompensated Heart Failure – Treatment
,3
The student is reviewing heart failure. A patient presents with acute dyspnea, orthopnea, and
bilateral crackles. Blood pressure is 160/90 mmHg. What is the most appropriate initial treatment?
A. IV fluids
B. IV furosemide
C. IV metoprolol
D. IV diltiazem
Correct Answer: B
Rationale: Acute decompensated heart failure with volume overload is treated with IV loop diuretics
(e.g., furosemide) to reduce preload. Beta-blockers and calcium channel blockers are
contraindicated in acute decompensation. [100% CORRECT]
Q7: Unstable Angina – Definition
The student is reviewing acute coronary syndromes. Unstable angina is characterized by all of the
following EXCEPT:
A. Angina at rest
B. New-onset angina
C. Angina lasting >20 minutes
D. Angina relieved by rest
Correct Answer: D
Rationale: Unstable angina is defined as angina at rest, new-onset severe angina, or crescendo
angina. It is not relieved by rest or nitroglycerin. Angina relieved by rest is stable angina. [100%
CORRECT]
Q8: Supraventricular Tachycardia – Management
The student is reviewing arrhythmias. A patient presents with a regular narrow-complex tachycardia
at a rate of 180 bpm. The patient is hemodynamically stable. What is the most appropriate initial
intervention?
A. Synchronized cardioversion
B. Vagal maneuvers
C. Adenosine 6 mg IV push
D. Amiodarone 150 mg IV
Correct Answer: B
Rationale: For stable SVT, vagal maneuvers are the first-line intervention. If unsuccessful, adenosine
is given. Synchronized cardioversion is reserved for unstable patients. [100% CORRECT]
Q9: Bradycardia – Indications for Pacing
The student is reviewing bradyarrhythmias. Which of the following is an indication for
transcutaneous pacing?
, 4
A. Heart rate <60 bpm with no symptoms
B. Complete heart block with hypotension
C. Sinus bradycardia in a well-conditioned athlete
D. First-degree AV block
Correct Answer: B
Rationale: Transcutaneous pacing is indicated for symptomatic bradycardia, including complete
heart block with hemodynamic instability (hypotension, altered mental status, chest pain, or acute
heart failure). [100% CORRECT]
Q10: Cardiac Tamponade – Beck's Triad
The student is reviewing pericardial emergencies. Beck's triad, associated with cardiac tamponade,
consists of:
A. Hypotension, muffled heart sounds, and jugular venous distension
B. Hypertension, clear heart sounds, and flat neck veins
C. Tachycardia, pericardial friction rub, and fever
D. Bradycardia, hypertension, and respiratory depression
Correct Answer: A
Rationale: Beck's triad for cardiac tamponade includes hypotension, muffled heart sounds, and
jugular venous distension. [100% CORRECT]
Q11: Endocarditis – Empiric Treatment
The student is reviewing infectious endocarditis. A patient with a history of IV drug use presents with
fever, new murmur, and Janeway lesions. Blood cultures are pending. What is the most appropriate
empiric antibiotic regimen?
A. Vancomycin + gentamicin
B. Ampicillin + gentamicin
C. Ceftriaxone
D. Azithromycin
Correct Answer: A
Rationale: Empiric treatment for suspected infective endocarditis, especially in IV drug users, should
cover Staphylococcus aureus (including MRSA) and streptococci. Vancomycin + gentamicin is
appropriate. [100% CORRECT]
Q12: Acute Pericarditis – ECG Findings
The student is reviewing pericarditis. Which ECG finding is most characteristic of acute pericarditis?
A. Diffuse ST elevation with PR depression
B. Localized ST elevation in two contiguous leads
