ACE YOUR SCRIBEAMERICA EMERGENCY
MEDICINE FINAL EXAM 2026| PROVEN
STUDY TIPS AND STRATEGIES TO MASTER
EMERGENCY MEDICINE CONCEPTS AND
SUCCEED WITH CONFIDENCE
1. You have reached the “4-10-2-8” documentation required for a
Level 5 chart. What may be some reasons your doctor would not
receive full reimbursement?
A. Critical care was not documented
B. Quality measures were performed but not documented
C. Missing pertinent MDM
D. Missing justification for testing, medications, or treatment
E. All of the above
Correct Answer: All of the above
Rationale:
Level 5 reimbursement depends not only on complexity but on complete
documentation. Failure to document critical care time, quality measures, or medical
decision making reduces billable justification. Payers require clear reasoning for
diagnostics and treatment choices. Even excellent care cannot be reimbursed without
proper documentation.
2. When you see a widened mediastinum on chest X-ray, which
diagnosis should be considered?
,A. Mitral stenosis
B. Aortic aneurysm
C. Aortic stenosis
D. Pulmonary arterial hypertension
E. Congestive heart failure
Correct Answer: Aortic aneurysm
Rationale:
A widened mediastinum is a classic red-flag finding for thoracic aortic pathology.
Aortic aneurysm or dissection must be ruled out emergently due to high mortality risk.
Other conditions listed do not typically cause mediastinal widening. Prompt CT
angiography is often required.
3. A 13-year-old male with a distal radial fracture is discharged
home. Which elements must be included in the disposition note?
A. Time of discharge only
B. Follow-up instructions only
C. Mental capacity and condition only
D. Follow-up, return precautions, condition at discharge, mental capacity,
and timing
Correct Answer: Follow-up, return precautions, condition at discharge,
mental capacity, and timing
Rationale:
Disposition notes must clearly establish patient safety at discharge. Follow-up timing,
return precautions, and mental status protect both patient and provider. These
elements demonstrate that discharge was appropriate and understood. Missing any
can increase medicolegal risk.
,4. A patient presents with “worst headache of life,” vomiting,
photophobia, nuchal rigidity, seizures, and bloody CSF. What type
of CVA is suspected?
A. Hemorrhagic
B. Thrombotic
C. Embolic
Correct Answer: Hemorrhagic
Rationale:
This presentation strongly suggests subarachnoid hemorrhage. Sudden severe
headache, meningeal signs, and bloody CSF are hallmark features. Thrombotic and
embolic strokes typically cause focal deficits rather than meningeal irritation.
Immediate imaging is critical.
5. What does GERD stand for?
A. Gastrointestinal esophageal reflux disease
B. Gastric esophageal reflux disease
C. Gastric esophageal reflux disorder
D. Gastroesophageal reflux disease
Correct Answer: Gastroesophageal reflux disease
Rationale:
GERD refers to chronic reflux of gastric contents into the esophagus. The term
“gastroesophageal” correctly describes the anatomical structures involved. Incorrect
options misuse anatomical terminology. Precise language is critical in medical
documentation.
6. What is the significance of a history of breast cancer when
determining Level 5 billing?
, A. Only affects outpatient billing
B. Indicates increased complexity that may justify Level 5 billing
C. Is irrelevant
D. Simplifies billing
Correct Answer: Indicates increased complexity that may justify Level 5
billing
Rationale:
A history of cancer increases diagnostic complexity due to recurrence risk, metastasis,
and treatment effects. Emergency providers must consider broader differentials. This
complexity supports higher MDM levels. Proper documentation is essential.
7. A patient presents with chest pain and has a history of CAD and
hypertension. Where should this history be documented?
A. Social history
B. ROS
C. HPI
D. Family history
Correct Answer: HPI
Rationale:
Past medical history directly relevant to the chief complaint belongs in the HPI. CAD
and hypertension significantly impact chest pain evaluation. This placement supports
medical decision making. ROS is symptom-focused, not historical.
8. What does G, P, A stand for in obstetric history?
A. General, Primary, Abortion
B. Gestation, Pregnancy, Abortion
C. Gestational, Parental, Abortion
D. Gravida, Para, Abortus
MEDICINE FINAL EXAM 2026| PROVEN
STUDY TIPS AND STRATEGIES TO MASTER
EMERGENCY MEDICINE CONCEPTS AND
SUCCEED WITH CONFIDENCE
1. You have reached the “4-10-2-8” documentation required for a
Level 5 chart. What may be some reasons your doctor would not
receive full reimbursement?
A. Critical care was not documented
B. Quality measures were performed but not documented
C. Missing pertinent MDM
D. Missing justification for testing, medications, or treatment
E. All of the above
Correct Answer: All of the above
Rationale:
Level 5 reimbursement depends not only on complexity but on complete
documentation. Failure to document critical care time, quality measures, or medical
decision making reduces billable justification. Payers require clear reasoning for
diagnostics and treatment choices. Even excellent care cannot be reimbursed without
proper documentation.
2. When you see a widened mediastinum on chest X-ray, which
diagnosis should be considered?
,A. Mitral stenosis
B. Aortic aneurysm
C. Aortic stenosis
D. Pulmonary arterial hypertension
E. Congestive heart failure
Correct Answer: Aortic aneurysm
Rationale:
A widened mediastinum is a classic red-flag finding for thoracic aortic pathology.
Aortic aneurysm or dissection must be ruled out emergently due to high mortality risk.
Other conditions listed do not typically cause mediastinal widening. Prompt CT
angiography is often required.
3. A 13-year-old male with a distal radial fracture is discharged
home. Which elements must be included in the disposition note?
A. Time of discharge only
B. Follow-up instructions only
C. Mental capacity and condition only
D. Follow-up, return precautions, condition at discharge, mental capacity,
and timing
Correct Answer: Follow-up, return precautions, condition at discharge,
mental capacity, and timing
Rationale:
Disposition notes must clearly establish patient safety at discharge. Follow-up timing,
return precautions, and mental status protect both patient and provider. These
elements demonstrate that discharge was appropriate and understood. Missing any
can increase medicolegal risk.
,4. A patient presents with “worst headache of life,” vomiting,
photophobia, nuchal rigidity, seizures, and bloody CSF. What type
of CVA is suspected?
A. Hemorrhagic
B. Thrombotic
C. Embolic
Correct Answer: Hemorrhagic
Rationale:
This presentation strongly suggests subarachnoid hemorrhage. Sudden severe
headache, meningeal signs, and bloody CSF are hallmark features. Thrombotic and
embolic strokes typically cause focal deficits rather than meningeal irritation.
Immediate imaging is critical.
5. What does GERD stand for?
A. Gastrointestinal esophageal reflux disease
B. Gastric esophageal reflux disease
C. Gastric esophageal reflux disorder
D. Gastroesophageal reflux disease
Correct Answer: Gastroesophageal reflux disease
Rationale:
GERD refers to chronic reflux of gastric contents into the esophagus. The term
“gastroesophageal” correctly describes the anatomical structures involved. Incorrect
options misuse anatomical terminology. Precise language is critical in medical
documentation.
6. What is the significance of a history of breast cancer when
determining Level 5 billing?
, A. Only affects outpatient billing
B. Indicates increased complexity that may justify Level 5 billing
C. Is irrelevant
D. Simplifies billing
Correct Answer: Indicates increased complexity that may justify Level 5
billing
Rationale:
A history of cancer increases diagnostic complexity due to recurrence risk, metastasis,
and treatment effects. Emergency providers must consider broader differentials. This
complexity supports higher MDM levels. Proper documentation is essential.
7. A patient presents with chest pain and has a history of CAD and
hypertension. Where should this history be documented?
A. Social history
B. ROS
C. HPI
D. Family history
Correct Answer: HPI
Rationale:
Past medical history directly relevant to the chief complaint belongs in the HPI. CAD
and hypertension significantly impact chest pain evaluation. This placement supports
medical decision making. ROS is symptom-focused, not historical.
8. What does G, P, A stand for in obstetric history?
A. General, Primary, Abortion
B. Gestation, Pregnancy, Abortion
C. Gestational, Parental, Abortion
D. Gravida, Para, Abortus
