1
MCGRAW-HILL EMERGENCY MEDICINE
PRACTICE EXAM 2026/2027 | BOARD REVIEW
| 75 VERIFIED Q&A | DETAILED RATIONALES |
PASS GUARANTEED – A+ GRADED
SECTION 1: CARDIOVASCULAR EMERGENCIES - Questions 1-15
Q1: Atrial Fibrillation with Rapid Ventricular Response – Treatment
The student is reviewing tachyarrhythmias. A hemodynamically stable patient presents with atrial
fibrillation and a ventricular rate of 150 bpm. What is the most appropriate initial treatment?
A. Immediate synchronized cardioversion
B. IV diltiazem
C. IV adenosine
D. IV amiodarone
Correct Answer: B
Rationale: For stable atrial fibrillation with rapid ventricular response, rate control with IV diltiazem
or a beta-blocker is first-line. Synchronized cardioversion is reserved for unstable patients.
Adenosine is for SVT, not AFib. Amiodarone is used for rhythm control in specific situations but is not
first-line for rate control. [100% CORRECT]
Q2: Ventricular Tachycardia with Pulse – Treatment
The student is reviewing wide-complex tachycardia. A patient has monomorphic ventricular
tachycardia with a palpable pulse and is hemodynamically stable. What is the most appropriate
treatment?
A. Synchronized cardioversion
B. IV amiodarone
C. IV adenosine
D. IV digoxin
Correct Answer: B
Rationale: Stable monomorphic VT is treated with IV amiodarone (or procainamide, sotalol).
Synchronized cardioversion is for unstable VT. Adenosine is for regular narrow-complex SVT, not VT.
Digoxin is not used for acute VT. [100% CORRECT]
Q3: Asystole – Management
,2
The student is reviewing cardiac arrest. A patient is in asystole on the monitor. What is the most
appropriate initial intervention?
A. Defibrillation
B. High-quality CPR and epinephrine
C. Synchronized cardioversion
D. Atropine
Correct Answer: B
Rationale: Asystole is not a shockable rhythm. Treatment is high-quality CPR and IV epinephrine.
Defibrillation and cardioversion are not indicated. Atropine is no longer recommended for asystole.
[100% CORRECT]
Q4: Pulseless Electrical Activity – Causes
The student is reviewing PEA. Which of the following is a reversible cause of pulseless electrical
activity (PEA)?
A. Hypovolemia
B. Hypoxia
C. Hypothermia
D. All of the above
Correct Answer: D
Rationale: The Hs and Ts of PEA include hypovolemia, hypoxia, hydrogen ion (acidosis),
hypo/hyperkalemia, hypothermia, toxins, tamponade, tension pneumothorax, thrombosis (coronary
or pulmonary), and trauma. [100% CORRECT]
Q5: Acute Coronary Syndrome – Aspirin
The student is reviewing ACS. A patient with suspected acute coronary syndrome has no allergy to
aspirin. What is the recommended aspirin dose?
A. 81 mg PO
B. 162 mg PO
C. 325 mg PO (chewed)
D. 650 mg PO
Correct Answer: C
Rationale: For suspected ACS, aspirin 162-325 mg should be chewed immediately to inhibit platelet
aggregation. Chewing accelerates absorption. [100% CORRECT]
Q6: STEMI – Reperfusion Strategy
The student is reviewing STEMI. A patient presents with STEMI at a hospital without PCI capability.
The nearest PCI center is 90 minutes away. What is the preferred reperfusion strategy?
, 3
A. Fibrinolysis
B. Transfer for PCI
C. Conservative management
D. CABG
Correct Answer: B
Rationale: If PCI can be performed within 120 minutes of first medical contact, transfer for PCI is
preferred. If not, fibrinolysis should be given within 30 minutes. [100% CORRECT]
Q7: Aortic Stenosis – Syncope
The student is reviewing valvular emergencies. An elderly patient presents with exertional syncope.
Which valvular lesion is most likely?
A. Aortic stenosis
B. Mitral stenosis
C. Aortic regurgitation
D. Mitral regurgitation
Correct Answer: A
Rationale: Aortic stenosis classically presents with the triad of angina, syncope, and heart failure.
Exertional syncope is a common presentation. [100% CORRECT]
Q8: Pericardial Tamponade – Treatment
The student is reviewing pericardial emergencies. A patient with cardiac tamponade is hypotensive.
What is the definitive treatment?
A. IV fluids
B. Pericardiocentesis
C. Pericardial window
D. Both B and C
Correct Answer: D
Rationale: Definitive treatment of cardiac tamponade is drainage of pericardial fluid via
pericardiocentesis or surgical pericardial window. IV fluids are temporizing. [100% CORRECT]
Q9: Hypertensive Urgency vs. Emergency
The student is reviewing hypertension. A patient has a blood pressure of 200/120 mmHg with no
evidence of end-organ damage. What is this condition?
A. Hypertensive emergency
B. Hypertensive urgency
C. Normal blood pressure
D. Hypertensive crisis
MCGRAW-HILL EMERGENCY MEDICINE
PRACTICE EXAM 2026/2027 | BOARD REVIEW
| 75 VERIFIED Q&A | DETAILED RATIONALES |
PASS GUARANTEED – A+ GRADED
SECTION 1: CARDIOVASCULAR EMERGENCIES - Questions 1-15
Q1: Atrial Fibrillation with Rapid Ventricular Response – Treatment
The student is reviewing tachyarrhythmias. A hemodynamically stable patient presents with atrial
fibrillation and a ventricular rate of 150 bpm. What is the most appropriate initial treatment?
A. Immediate synchronized cardioversion
B. IV diltiazem
C. IV adenosine
D. IV amiodarone
Correct Answer: B
Rationale: For stable atrial fibrillation with rapid ventricular response, rate control with IV diltiazem
or a beta-blocker is first-line. Synchronized cardioversion is reserved for unstable patients.
Adenosine is for SVT, not AFib. Amiodarone is used for rhythm control in specific situations but is not
first-line for rate control. [100% CORRECT]
Q2: Ventricular Tachycardia with Pulse – Treatment
The student is reviewing wide-complex tachycardia. A patient has monomorphic ventricular
tachycardia with a palpable pulse and is hemodynamically stable. What is the most appropriate
treatment?
A. Synchronized cardioversion
B. IV amiodarone
C. IV adenosine
D. IV digoxin
Correct Answer: B
Rationale: Stable monomorphic VT is treated with IV amiodarone (or procainamide, sotalol).
Synchronized cardioversion is for unstable VT. Adenosine is for regular narrow-complex SVT, not VT.
Digoxin is not used for acute VT. [100% CORRECT]
Q3: Asystole – Management
,2
The student is reviewing cardiac arrest. A patient is in asystole on the monitor. What is the most
appropriate initial intervention?
A. Defibrillation
B. High-quality CPR and epinephrine
C. Synchronized cardioversion
D. Atropine
Correct Answer: B
Rationale: Asystole is not a shockable rhythm. Treatment is high-quality CPR and IV epinephrine.
Defibrillation and cardioversion are not indicated. Atropine is no longer recommended for asystole.
[100% CORRECT]
Q4: Pulseless Electrical Activity – Causes
The student is reviewing PEA. Which of the following is a reversible cause of pulseless electrical
activity (PEA)?
A. Hypovolemia
B. Hypoxia
C. Hypothermia
D. All of the above
Correct Answer: D
Rationale: The Hs and Ts of PEA include hypovolemia, hypoxia, hydrogen ion (acidosis),
hypo/hyperkalemia, hypothermia, toxins, tamponade, tension pneumothorax, thrombosis (coronary
or pulmonary), and trauma. [100% CORRECT]
Q5: Acute Coronary Syndrome – Aspirin
The student is reviewing ACS. A patient with suspected acute coronary syndrome has no allergy to
aspirin. What is the recommended aspirin dose?
A. 81 mg PO
B. 162 mg PO
C. 325 mg PO (chewed)
D. 650 mg PO
Correct Answer: C
Rationale: For suspected ACS, aspirin 162-325 mg should be chewed immediately to inhibit platelet
aggregation. Chewing accelerates absorption. [100% CORRECT]
Q6: STEMI – Reperfusion Strategy
The student is reviewing STEMI. A patient presents with STEMI at a hospital without PCI capability.
The nearest PCI center is 90 minutes away. What is the preferred reperfusion strategy?
, 3
A. Fibrinolysis
B. Transfer for PCI
C. Conservative management
D. CABG
Correct Answer: B
Rationale: If PCI can be performed within 120 minutes of first medical contact, transfer for PCI is
preferred. If not, fibrinolysis should be given within 30 minutes. [100% CORRECT]
Q7: Aortic Stenosis – Syncope
The student is reviewing valvular emergencies. An elderly patient presents with exertional syncope.
Which valvular lesion is most likely?
A. Aortic stenosis
B. Mitral stenosis
C. Aortic regurgitation
D. Mitral regurgitation
Correct Answer: A
Rationale: Aortic stenosis classically presents with the triad of angina, syncope, and heart failure.
Exertional syncope is a common presentation. [100% CORRECT]
Q8: Pericardial Tamponade – Treatment
The student is reviewing pericardial emergencies. A patient with cardiac tamponade is hypotensive.
What is the definitive treatment?
A. IV fluids
B. Pericardiocentesis
C. Pericardial window
D. Both B and C
Correct Answer: D
Rationale: Definitive treatment of cardiac tamponade is drainage of pericardial fluid via
pericardiocentesis or surgical pericardial window. IV fluids are temporizing. [100% CORRECT]
Q9: Hypertensive Urgency vs. Emergency
The student is reviewing hypertension. A patient has a blood pressure of 200/120 mmHg with no
evidence of end-organ damage. What is this condition?
A. Hypertensive emergency
B. Hypertensive urgency
C. Normal blood pressure
D. Hypertensive crisis
