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 25-year-old female presents for confusion. Two days ago, she fractured her tibia and it was splinted. Since then, she has had slowly worsening shortness of breath and today she became confused. She has a temperature of 101°F and a petechial rash is present. Which of the following is true regarding her condition?
- A. A petechial rash typically on the hands and feet can be seen
- B. Prophylactic anticoagulation could have prevented this condition
- C. Splint removal and urgent fasciotomy is the treatment of choice
- D. The most common cause of death is ARDS
The Answer and Explanation
Did you get it right? The correct answer is: D
This patient is suffering from fat embolism syndrome, a complication of long bone fractures that becomes symptomatic one or two days after injury. Up to 2% of patients with isolated long bone fractures and up to 10% of patients with multiple fractures suffer from fat embolism syndrome. Early features of fat embolism syndrome include shortness of breath, respiratory distress, and hypoxemia. Confusion, fever, and a petechial rash, as seen in this patient, can also occur. Treatment is supportive. Despite adequate treatment, mortality is around 20% with the most common cause of death being ARDS.
Incorrect Answer Explanations
Answer A: The petechial rash seen in fat embolism syndrome is typically seen on the chest, and axilla. Not on the hands and feet.
Answer B: Although anticoagulation helps reduce the incidence of thrombotic pulmonary emboli, it would not reduce the likelihood of fat embolism syndrome.
Answer C: Although anticoagulation helps reduce the incidence of thrombotic pulmonary emboli, it would not reduce the likelihood of fat embolism syndrome.
Bottom Line
Compartment syndrome, which is more common following casting than splinting, would require an urgent fasciotomy.
For more information, see:
Rosen’s Emergency Medicine, 7th Edition, Chapter 46
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Free TrialFree ABEM Qualifying Sample Question
A 42-year-old male presents to your emergency department complaining of finger pain. While at his workshop as a carpenter, he accidentally struck his thumb with a hammer. Attached is an image of his injury. After examination of the patient, review of x-rays show no acute fracture and no lacerations or abrasions are found. What is the proper treatment of this condition?
- A. Discharge with precautions to return if worsening
- B. Heat an 18-gauge needle until red hot, then insert through nail to evacuate hematoma
- C. Insert a 25-gauge needle with 3cc syringe attached parallel to the nail at the hyponychium, then withdraw plunger to evacuate hematoma
- D. Using an electric cautery, melt a hole through the nail and evacuate the hematoma
The Answer and Explanation
Did you get it right? The correct answer is: D
The picture attached is consistent with a subungual hematoma. These are common hand injuries, especially in those individuals involved in manual work. They can be caused by blunt or sharp trauma to the fingers or toes. Bleeding consequently results from the vascular rich nail bed. The increased pressure into a confined space can cause significant discomfort, leading many to present to the hospital. If pain is not present, no subungual hematoma evacuation is necessary. For those with discomfort, a hematoma of at least 25% of the total nail area must be present for evacuation to take place. Also, the nail edges must be intact. Nail removal is not necessary to “search” for a nail bed laceration; literature shows that this does not improve outcomes.
There are multiple techniques for performing nail bed trephination. Electric cautery is an excellent choice for nail bed trephination. When activated, the cautery melts through the nail but does not damage the underlying nail bed (it cools on contact with the hematoma). Care should be taken with acrylic nails, however, as they may be flammable when contacted with the cautery. Other techniques include using an 18-gauge needle in a twisting motion at either a 45-60 or 90 degree angle. With this technique, once blood is visualized the practitioner must stop–further needle advancement could damage the nail bed. Paper clips are also noted to be useful in nail bed trephination but must be heated until red-hot to ensure sterility. In a similar technique, a punch biopsy has been reported to be effective. Anesthesia is usually unnecessary. Iodine can be applied to the nail prior to the procedure if desired and antibiotic ointment should be used after trephination is complete. The finger should then be dressed and kept dry for a period of 2 days. Most patients tolerate this procedure well and experience relief. Patient education should include wound care instructions and warnings that the nail may still fall off in the near future.
Incorrect Answer Explanations
Answer A: The size of this patient’s subungual hematoma and presence of pain warrant intervention.
Answer B: Using an 18-gauge needle is correct; however, heating is unnecessary as the needles are packaged with sterile technique.
Answer C: This technique is an accepted one, albeit with a smaller needle. An insulin syringe with an extra-fine 29-gauge needle can be inserted parallel to the nail with subsequent hematoma evacuation. Care should be taken to stay close to the nail surface, however. Angling toward the nail bed could injure the germinal matrix.
Bottom Line
Subungual hematomas require drainage when greater than 50% of the nail is involved and the patient experiences pain.
For more information, see:
Nailbed Injuries on Medscape
Subungual Hematoma Drainage on Medscape
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