ABEM-AMERICAN BOARD OF EMERGENCY
MEDICINE QUALYFYING EXAM | ALL QUESTIONS
AND ANSWERS | A+ GRADED | COMPREHENSIVE
EXAM GUIDE 2026/2027
1. A 62-year-old man presents with crushing substernal chest pain that began 40 minutes
ago. His ECG demonstrates ST-segment elevation in leads II, III, and aVF. He is
hypotensive, has clear lungs, and has elevated jugular venous pressure. Which intervention
is most appropriate initially?
A. Intravenous furosemide
B. Sublingual nitroglycerin
C. Intravenous isotonic fluid administration
D. Immediate beta-blocker administration
Answer: C
Rationale: The inferior STEMI with hypotension, clear lungs, and elevated JVP strongly
suggests right ventricular infarction. Increasing preload with cautious intravenous isotonic
fluid is appropriate, whereas nitrates may worsen hypotension by reducing preload.
2. A 24-year-old woman presents with wheezing, respiratory distress, and difficulty
speaking in complete sentences. Her oxygen saturation is 89% on room air. Which
treatment should be administered promptly?
A. Nebulized short-acting beta-agonist
B. Oral leukotriene antagonist
C. Intravenous antibiotic
D. Chest physiotherapy
Answer: A
Rationale: Acute asthma exacerbation requires rapid bronchodilation. Inhaled or nebulized
short-acting beta-agonists are first-line therapy for significant bronchospasm.
3. A 70-year-old patient develops sudden aphasia and right-sided weakness 50 minutes
before arrival. CT head shows no hemorrhage. Which factor is most important when
determining eligibility for intravenous thrombolytic therapy?
A. Presence of hypertension alone
B. Exact time last known well
C. Current serum sodium concentration
D. History of migraine
Answer: B
,Rationale: Treatment eligibility for acute ischemic stroke is highly time dependent.
Establishing the exact last-known-well time is essential when determining whether the
patient is within the appropriate treatment window.
4. A patient with diabetic ketoacidosis has a serum potassium concentration of 2.8 mEq/L.
Which intervention should occur before starting an insulin infusion?
A. Administration of sodium bicarbonate
B. Administration of calcium gluconate
C. Immediate insulin bolus
D. Potassium replacement
Answer: D
Rationale: Insulin drives potassium intracellularly and can produce life-threatening
hypokalemia. When potassium is significantly low, potassium replacement should precede
insulin therapy.
5. A 35-year-old woman presents with severe unilateral lower abdominal pain and syncope.
Pregnancy testing is positive, and she is hypotensive. Which diagnosis should be presumed
until proven otherwise?
A. Ruptured ectopic pregnancy
B. Ovarian cyst
C. Pelvic inflammatory disease
D. Renal colic
Answer: A
Rationale: A pregnant patient with abdominal pain, syncope, and hemodynamic instability
has a ruptured ectopic pregnancy until proven otherwise. Immediate resuscitation and
surgical consultation are required.
6. A 58-year-old man with chronic kidney disease develops weakness. ECG demonstrates
peaked T waves and progressive QRS widening. Which medication is most important to
administer immediately to stabilize the myocardium?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Furosemide
D. Regular insulin alone
Answer: B
Rationale: Intravenous calcium stabilizes the cardiac membrane in severe hyperkalemia with
ECG abnormalities. It does not lower serum potassium but rapidly reduces the risk of
malignant arrhythmia.
,7. A 19-year-old patient is brought to the emergency department after ingesting an
unknown quantity of acetaminophen approximately 6 hours earlier. Which laboratory
value is essential for risk assessment?
A. Serum creatinine alone
B. Serum acetaminophen concentration
C. Serum amylase
D. Troponin concentration
Answer: B
Rationale: A timed serum acetaminophen concentration is interpreted using the appropriate
treatment nomogram to assess toxicity after an acute ingestion.
8. A patient with septic shock remains hypotensive after appropriate intravenous
crystalloid administration. Which vasopressor is generally preferred as the initial agent?
A. Dopamine
B. Phenylephrine
C. Norepinephrine
D. Epinephrine
Answer: C
Rationale: Norepinephrine is generally the first-line vasopressor for persistent hypotension in
septic shock after adequate fluid resuscitation.
9. A 45-year-old man develops sudden tearing chest pain radiating to the back. Blood
pressure is significantly higher in the right arm than the left. Which diagnosis is most
concerning?
A. Acute pericarditis
B. Aortic dissection
C. Pulmonary embolism
D. Esophageal reflux
Answer: B
Rationale: Abrupt tearing chest pain with pulse or blood-pressure asymmetry is highly
concerning for acute aortic dissection and requires urgent diagnostic evaluation and
management.
10. A 6-year-old child presents with barking cough, inspiratory stridor, and a hoarse voice.
He is sitting comfortably and has no drooling. Which treatment is appropriate for
moderate croup?
A. Dexamethasone
B. Amoxicillin
C. Diphenhydramine
D. Albuterol alone
, Answer: A
Rationale: Corticosteroids such as dexamethasone reduce upper-airway edema and are
indicated for croup across a range of severities.
11. A 72-year-old woman presents with confusion and dysuria. Her temperature is 39.2°C,
blood pressure is 84/48 mmHg, and lactate is elevated. Which management priority is most
appropriate?
A. Delay antibiotics until culture results return
B. Immediate sepsis-directed resuscitation and antibiotics
C. Oral hydration only
D. Discharge with outpatient antibiotics
Answer: B
Rationale: Hypotension, altered mental status, infection concern, and elevated lactate
indicate severe systemic illness requiring prompt resuscitation, cultures when feasible without
delaying therapy, and appropriate antibiotics.
12. A 28-year-old patient with palpitations has a regular narrow-complex tachycardia at
190 beats/min. Blood pressure is normal and the patient is alert. What is the appropriate
initial intervention?
A. Immediate synchronized cardioversion
B. Intravenous amiodarone
C. Vagal maneuvers
D. Defibrillation
Answer: C
Rationale: In a hemodynamically stable patient with regular narrow-complex
supraventricular tachycardia, vagal maneuvers are an appropriate initial treatment.
13. A 66-year-old man with atrial fibrillation becomes hypotensive and develops altered
mental status. Which treatment is indicated?
A. Oral anticoagulation alone
B. Synchronized cardioversion
C. Observation
D. Vagal maneuvers only
Answer: B
Rationale: Hemodynamic instability attributable to atrial fibrillation requires urgent
synchronized cardioversion rather than delayed pharmacologic management.
14. A patient is found unresponsive with pinpoint pupils and respiratory depression. Which
medication should be administered?
MEDICINE QUALYFYING EXAM | ALL QUESTIONS
AND ANSWERS | A+ GRADED | COMPREHENSIVE
EXAM GUIDE 2026/2027
1. A 62-year-old man presents with crushing substernal chest pain that began 40 minutes
ago. His ECG demonstrates ST-segment elevation in leads II, III, and aVF. He is
hypotensive, has clear lungs, and has elevated jugular venous pressure. Which intervention
is most appropriate initially?
A. Intravenous furosemide
B. Sublingual nitroglycerin
C. Intravenous isotonic fluid administration
D. Immediate beta-blocker administration
Answer: C
Rationale: The inferior STEMI with hypotension, clear lungs, and elevated JVP strongly
suggests right ventricular infarction. Increasing preload with cautious intravenous isotonic
fluid is appropriate, whereas nitrates may worsen hypotension by reducing preload.
2. A 24-year-old woman presents with wheezing, respiratory distress, and difficulty
speaking in complete sentences. Her oxygen saturation is 89% on room air. Which
treatment should be administered promptly?
A. Nebulized short-acting beta-agonist
B. Oral leukotriene antagonist
C. Intravenous antibiotic
D. Chest physiotherapy
Answer: A
Rationale: Acute asthma exacerbation requires rapid bronchodilation. Inhaled or nebulized
short-acting beta-agonists are first-line therapy for significant bronchospasm.
3. A 70-year-old patient develops sudden aphasia and right-sided weakness 50 minutes
before arrival. CT head shows no hemorrhage. Which factor is most important when
determining eligibility for intravenous thrombolytic therapy?
A. Presence of hypertension alone
B. Exact time last known well
C. Current serum sodium concentration
D. History of migraine
Answer: B
,Rationale: Treatment eligibility for acute ischemic stroke is highly time dependent.
Establishing the exact last-known-well time is essential when determining whether the
patient is within the appropriate treatment window.
4. A patient with diabetic ketoacidosis has a serum potassium concentration of 2.8 mEq/L.
Which intervention should occur before starting an insulin infusion?
A. Administration of sodium bicarbonate
B. Administration of calcium gluconate
C. Immediate insulin bolus
D. Potassium replacement
Answer: D
Rationale: Insulin drives potassium intracellularly and can produce life-threatening
hypokalemia. When potassium is significantly low, potassium replacement should precede
insulin therapy.
5. A 35-year-old woman presents with severe unilateral lower abdominal pain and syncope.
Pregnancy testing is positive, and she is hypotensive. Which diagnosis should be presumed
until proven otherwise?
A. Ruptured ectopic pregnancy
B. Ovarian cyst
C. Pelvic inflammatory disease
D. Renal colic
Answer: A
Rationale: A pregnant patient with abdominal pain, syncope, and hemodynamic instability
has a ruptured ectopic pregnancy until proven otherwise. Immediate resuscitation and
surgical consultation are required.
6. A 58-year-old man with chronic kidney disease develops weakness. ECG demonstrates
peaked T waves and progressive QRS widening. Which medication is most important to
administer immediately to stabilize the myocardium?
A. Sodium polystyrene sulfonate
B. Calcium gluconate
C. Furosemide
D. Regular insulin alone
Answer: B
Rationale: Intravenous calcium stabilizes the cardiac membrane in severe hyperkalemia with
ECG abnormalities. It does not lower serum potassium but rapidly reduces the risk of
malignant arrhythmia.
,7. A 19-year-old patient is brought to the emergency department after ingesting an
unknown quantity of acetaminophen approximately 6 hours earlier. Which laboratory
value is essential for risk assessment?
A. Serum creatinine alone
B. Serum acetaminophen concentration
C. Serum amylase
D. Troponin concentration
Answer: B
Rationale: A timed serum acetaminophen concentration is interpreted using the appropriate
treatment nomogram to assess toxicity after an acute ingestion.
8. A patient with septic shock remains hypotensive after appropriate intravenous
crystalloid administration. Which vasopressor is generally preferred as the initial agent?
A. Dopamine
B. Phenylephrine
C. Norepinephrine
D. Epinephrine
Answer: C
Rationale: Norepinephrine is generally the first-line vasopressor for persistent hypotension in
septic shock after adequate fluid resuscitation.
9. A 45-year-old man develops sudden tearing chest pain radiating to the back. Blood
pressure is significantly higher in the right arm than the left. Which diagnosis is most
concerning?
A. Acute pericarditis
B. Aortic dissection
C. Pulmonary embolism
D. Esophageal reflux
Answer: B
Rationale: Abrupt tearing chest pain with pulse or blood-pressure asymmetry is highly
concerning for acute aortic dissection and requires urgent diagnostic evaluation and
management.
10. A 6-year-old child presents with barking cough, inspiratory stridor, and a hoarse voice.
He is sitting comfortably and has no drooling. Which treatment is appropriate for
moderate croup?
A. Dexamethasone
B. Amoxicillin
C. Diphenhydramine
D. Albuterol alone
, Answer: A
Rationale: Corticosteroids such as dexamethasone reduce upper-airway edema and are
indicated for croup across a range of severities.
11. A 72-year-old woman presents with confusion and dysuria. Her temperature is 39.2°C,
blood pressure is 84/48 mmHg, and lactate is elevated. Which management priority is most
appropriate?
A. Delay antibiotics until culture results return
B. Immediate sepsis-directed resuscitation and antibiotics
C. Oral hydration only
D. Discharge with outpatient antibiotics
Answer: B
Rationale: Hypotension, altered mental status, infection concern, and elevated lactate
indicate severe systemic illness requiring prompt resuscitation, cultures when feasible without
delaying therapy, and appropriate antibiotics.
12. A 28-year-old patient with palpitations has a regular narrow-complex tachycardia at
190 beats/min. Blood pressure is normal and the patient is alert. What is the appropriate
initial intervention?
A. Immediate synchronized cardioversion
B. Intravenous amiodarone
C. Vagal maneuvers
D. Defibrillation
Answer: C
Rationale: In a hemodynamically stable patient with regular narrow-complex
supraventricular tachycardia, vagal maneuvers are an appropriate initial treatment.
13. A 66-year-old man with atrial fibrillation becomes hypotensive and develops altered
mental status. Which treatment is indicated?
A. Oral anticoagulation alone
B. Synchronized cardioversion
C. Observation
D. Vagal maneuvers only
Answer: B
Rationale: Hemodynamic instability attributable to atrial fibrillation requires urgent
synchronized cardioversion rather than delayed pharmacologic management.
14. A patient is found unresponsive with pinpoint pupils and respiratory depression. Which
medication should be administered?
