Free Sample Emergency Medicine Questions, with Answers

See why TrueLearn is a trusted resource for thousands of medical students and residents. At TrueLearn, we understand that it’s all about the content. That’s why we have high-yield emergency medicine practice questions written and screened by high-performing physician authors that are updated on a regular basis to ensure our SmartBanks stay up-to-date with exam blueprint changes. Below are two free emergency medicine sample questions, with complete answers. One is from our ABEM ITE question bank and the second is from our ABEM Qualifying q-bank.

Free ABEM ITE Sample Question

A 20-year-old male presents after a head-on motor vehicle accident. He was a restrained driver. The patient is complaining of mild right flank pain. Vital signs are stable and the patient has a GCS of 15. A FAST exam is performed. Which of the following is the appropriate management of the patient?

A) Admit patient for serial abdominal examinations

B) Consult trauma for exploratory laparotomy

C) Discharge patient with close follow up with primary care physician

D) Order CT abdomen and pelvis with contrast and consult trauma surgery

Answer and Explanations

The patient presents after a motor vehicle accident and has evidence of an abdominal injury on FAST exam. The attached image reveals fluid in Morison’s pouch. In patients with stable vital signs and normal mentation, operative management can be delayed for a CT scan of the abdomen and pelvis with contrast to better evaluate the fluid seen on FAST exam. If the patient has unstable vital signs/altered mentation, the patient should undergo immediate exploratory laparotomy. If the patient had a negative FAST exam, the patient should still be admitted for serial abdominal exams as the patient’s clinical condition can change.

Did you get it right? The correct answer is: D

Answer A: Further testing should be performed in an otherwise stable patient with evidence of free fluid on FAST exam.

Answer B: The patient should be taken to the operating room immediately if the patient is unstable with evidence of free fluid on FAST exam.

Answer C: The patient has evidence of fluid in Morison’s pouch on FAST exam. The patient needs further testing with likely operative management.

Bottom Line: Stable patients with positive FAST exam should undergo CT imaging to further characterize injury.

For more information, see:

• Tintinalli Emergency Medicine, 7th edition. Chapter 260: Abdominal trauma.
• FAST exam. Tasia Audre
• Hommes M, Navasaria PH, Schipper IB, Krige JEJ, Kahn D, Nicol AJ. Management of blunt liver trauma in 134 severely injured patients. Injury: 46 (5): 837-842.
• Advanced Trauma Life Support, 9th edition. Abdominal and pelvic trauma.

Free ABS Qualifying Sample Question

An 87-year-old female presents from a long-term care facility after several hours of vomiting witnessed by the staff. She has multiple other comorbidities and is unable to provide history, but her examination is remarkable for abdominal distention, tympany, and a lack of auscultated bowel sounds. Vital signs include HR 108/min, respirations 24/min, blood pressure 160/78 and pulse oximetry 93% on room air. A lateral decubitus abdominal film is obtained as the patient is unable to stand due to contractures and is attached. What is the most likely historical feature leading to this patient’s diagnosis?

A) Constipation

B) History of atrial fibrillation

C) Hypertension

D) Recent antibiotic use

Answer and Explanations

The plain film shows the typical “coffee-bean” sign seen in a sigmoid volvulus. A history of constipation, neuropsychiatric illness, bedridden, or neurologic disease with paralysis are risk factors for development of this diagnosis, which can lead to a large bowel obstruction. Early in diagnosis, the patient can present with mild distension, nausea, and tympanic abdomen but late in the presentation they can have pain, severe distension and volvulus can even continue on to perforation due to high pressures causing the severe distension of the large bowel proximal to the volvulus point. The distension can also lead to an elevated diaphragm thus compromising respiration.

Did you get it right? The correct answer is: A

Answers B & C: These are both risk factors for the development of mesenteric ischemia, which presents with abdominal pain out of proportion to examination. It also presents in older patients with abdominal pain and bright red blood per rectum. Plain abdominal films are usually normal in these patients, but rarely can show pneumatosis intestinalis. Hypertension is also a risk factor for development of aortic aneurysms/dissection.

Answer D: Recent antibiotic use predisposes a patient for development of antibiotic-associated colitis or Clostridium difficile. Plain film imaging is typically negative. A CT scan may show evidence of thickened bowel wall, but the ultimate diagnosis of C. difficile is by identifying the toxin in a patient’s stool sample.

Bottom Line: Volvulus can be identified on plain radiography by the “coffee-bean” or “bent-tire” sign.

For more information, see:

• Sigmoid and Cecal Volvulus
• Image Credit