MCGRAW-HILL EMERGENCY MEDICINE EXAM
REVIEW (TINTINALLI'S) 2026/2027 | COMPLETE
300 QUESTIONS & VERIFIED ANSWERS |
ALREADY GRADED A+
McGRAW-HILL EMERGENCY MEDICINE EXAM REVIEW (TINTINALLI'S) 2026/2027
OVERVIEW
This exam review is based on Tintinalli's Emergency Medicine — the gold standard
reference for emergency medicine practice and board preparation. It covers the full
spectrum of emergency medicine including cardiovascular emergencies, respiratory
distress, toxicology, trauma, pediatrics, neurology, infectious disease,
obstetrics/gynecology, and procedural skills. This 300-question set is designed to
reinforce clinical reasoning, diagnostic accuracy, and evidence-based management at
the level expected of emergency medicine practitioners and board candidates. Each
question includes five options (A–E), the CORRECT ANSWER with highlighting, and a
RATIONALE to reinforce learning.
INSTRUCTIONS
• 5 options per question (A to E)
• CORRECT ANSWER is highlighted
• RATIONALE follows each CORRECT ANSWER
• Questions progress from foundational to advanced clinical scenarios
SECTION 1: CARDIOVASCULAR EMERGENCIES
Question 1
A 58-year-old male presents with crushing substernal chest pain radiating to the left arm
for 45 minutes. ECG shows ST elevation in leads II, III, and aVF. Which artery is most
likely occluded?
A. Left anterior descending artery
, B. Left circumflex artery
C. Left main coronary artery
D. Right coronary artery
E. Diagonal branch artery
CORRECT ANSWER: D. Right coronary artery
RATIONALE: ST elevation in leads II, III, and aVF indicates an inferior wall MI.
The right coronary artery (RCA) supplies the inferior wall of the left ventricle in most
patients. RCA occlusion is the most common cause of inferior STEMI.
Question 2
A 65-year-old woman presents with sudden onset severe tearing chest pain radiating to
the back. BP is 180/100 in the right arm and 150/85 in the left arm. CXR shows widened
mediastinum. What is the most appropriate next step?
A. Administer thrombolytics immediately
B. Perform immediate PCI
C. CT angiography of the chest
D. Echocardiogram at bedside
E. Start heparin infusion
CORRECT ANSWER: C. CT angiography of the chest
RATIONALE: The presentation is classic for aortic dissection — tearing pain, BP
differential between arms, and widened mediastinum. CT angiography is the gold
standard for diagnosis. Thrombolytics and heparin are contraindicated in aortic
dissection.
Question 3
A patient presents with palpitations. ECG shows a regular narrow complex tachycardia
at 160 bpm with no visible P waves. Vagal maneuvers fail. What is the first-line
pharmacologic treatment?
A. Amiodarone IV
, B. Metoprolol IV
C. Diltiazem IV
D. Adenosine 6 mg IV rapid push
E. Digoxin IV
CORRECT ANSWER: D. Adenosine 6 mg IV rapid push
RATIONALE: The rhythm is consistent with SVT (AVNRT or AVRT). Adenosine is
the first-line drug for stable SVT, administered as a rapid IV push followed by a saline
flush. It transiently blocks the AV node, terminating reentrant tachycardias.
Question 4
A 70-year-old man is brought in unresponsive. ECG shows ventricular fibrillation. What
is the immediate priority?
A. Intubate the patient
B. Administer epinephrine 1 mg IV
C. Administer amiodarone 300 mg IV
D. Start high-quality CPR and call for help
E. Defibrillate with 200J biphasic immediately
CORRECT ANSWER: E. Defibrillate with 200J biphasic immediately
RATIONALE: For ventricular fibrillation, early defibrillation is the single most
important intervention. CPR should be initiated if a defibrillator is not immediately
available, but defibrillation takes priority as soon as the device is ready. Every minute
without defibrillation reduces survival by approximately 10%.
Question 5
A patient has a BP of 80/50, HR 120, JVD, muffled heart sounds, and pulsus paradoxus.
What is the most likely diagnosis?
A. Tension pneumothorax
B. Massive pulmonary embolism
C. Acute MI with cardiogenic shock
, D. Cardiac tamponade
E. Severe aortic stenosis
CORRECT ANSWER: D. Cardiac tamponade
RATIONALE: Beck's triad — hypotension, JVD, and muffled heart sounds — is
classic for cardiac tamponade. Pulsus paradoxus (>10 mmHg drop in BP with
inspiration) further supports this. Emergency pericardiocentesis is the treatment.
Question 6
A 55-year-old diabetic male presents with fatigue, nausea, and mild epigastric
discomfort. ECG shows new ST elevation in V1–V4. What is the diagnosis?
A. Inferior STEMI
B. Anterior STEMI
C. Peptic ulcer disease
D. NSTEMI
E. Aortic dissection
CORRECT ANSWER: B. Anterior STEMI
RATIONALE: ST elevation in V1–V4 indicates anterior wall STEMI, typically due to
LAD occlusion. Diabetic patients often present atypically (no classic chest pain), with GI
symptoms or fatigue. ECG is critical in this group.
Question 7
Which of the following best describes first-degree AV block on ECG?
A. Progressively lengthening PR interval until a beat is dropped
B. Fixed PR interval with randomly dropped beats
C. Complete dissociation between P waves and QRS
D. Prolonged PR interval (>200 ms) with every P wave conducting
E. Wide QRS with no preceding P wave
REVIEW (TINTINALLI'S) 2026/2027 | COMPLETE
300 QUESTIONS & VERIFIED ANSWERS |
ALREADY GRADED A+
McGRAW-HILL EMERGENCY MEDICINE EXAM REVIEW (TINTINALLI'S) 2026/2027
OVERVIEW
This exam review is based on Tintinalli's Emergency Medicine — the gold standard
reference for emergency medicine practice and board preparation. It covers the full
spectrum of emergency medicine including cardiovascular emergencies, respiratory
distress, toxicology, trauma, pediatrics, neurology, infectious disease,
obstetrics/gynecology, and procedural skills. This 300-question set is designed to
reinforce clinical reasoning, diagnostic accuracy, and evidence-based management at
the level expected of emergency medicine practitioners and board candidates. Each
question includes five options (A–E), the CORRECT ANSWER with highlighting, and a
RATIONALE to reinforce learning.
INSTRUCTIONS
• 5 options per question (A to E)
• CORRECT ANSWER is highlighted
• RATIONALE follows each CORRECT ANSWER
• Questions progress from foundational to advanced clinical scenarios
SECTION 1: CARDIOVASCULAR EMERGENCIES
Question 1
A 58-year-old male presents with crushing substernal chest pain radiating to the left arm
for 45 minutes. ECG shows ST elevation in leads II, III, and aVF. Which artery is most
likely occluded?
A. Left anterior descending artery
, B. Left circumflex artery
C. Left main coronary artery
D. Right coronary artery
E. Diagonal branch artery
CORRECT ANSWER: D. Right coronary artery
RATIONALE: ST elevation in leads II, III, and aVF indicates an inferior wall MI.
The right coronary artery (RCA) supplies the inferior wall of the left ventricle in most
patients. RCA occlusion is the most common cause of inferior STEMI.
Question 2
A 65-year-old woman presents with sudden onset severe tearing chest pain radiating to
the back. BP is 180/100 in the right arm and 150/85 in the left arm. CXR shows widened
mediastinum. What is the most appropriate next step?
A. Administer thrombolytics immediately
B. Perform immediate PCI
C. CT angiography of the chest
D. Echocardiogram at bedside
E. Start heparin infusion
CORRECT ANSWER: C. CT angiography of the chest
RATIONALE: The presentation is classic for aortic dissection — tearing pain, BP
differential between arms, and widened mediastinum. CT angiography is the gold
standard for diagnosis. Thrombolytics and heparin are contraindicated in aortic
dissection.
Question 3
A patient presents with palpitations. ECG shows a regular narrow complex tachycardia
at 160 bpm with no visible P waves. Vagal maneuvers fail. What is the first-line
pharmacologic treatment?
A. Amiodarone IV
, B. Metoprolol IV
C. Diltiazem IV
D. Adenosine 6 mg IV rapid push
E. Digoxin IV
CORRECT ANSWER: D. Adenosine 6 mg IV rapid push
RATIONALE: The rhythm is consistent with SVT (AVNRT or AVRT). Adenosine is
the first-line drug for stable SVT, administered as a rapid IV push followed by a saline
flush. It transiently blocks the AV node, terminating reentrant tachycardias.
Question 4
A 70-year-old man is brought in unresponsive. ECG shows ventricular fibrillation. What
is the immediate priority?
A. Intubate the patient
B. Administer epinephrine 1 mg IV
C. Administer amiodarone 300 mg IV
D. Start high-quality CPR and call for help
E. Defibrillate with 200J biphasic immediately
CORRECT ANSWER: E. Defibrillate with 200J biphasic immediately
RATIONALE: For ventricular fibrillation, early defibrillation is the single most
important intervention. CPR should be initiated if a defibrillator is not immediately
available, but defibrillation takes priority as soon as the device is ready. Every minute
without defibrillation reduces survival by approximately 10%.
Question 5
A patient has a BP of 80/50, HR 120, JVD, muffled heart sounds, and pulsus paradoxus.
What is the most likely diagnosis?
A. Tension pneumothorax
B. Massive pulmonary embolism
C. Acute MI with cardiogenic shock
, D. Cardiac tamponade
E. Severe aortic stenosis
CORRECT ANSWER: D. Cardiac tamponade
RATIONALE: Beck's triad — hypotension, JVD, and muffled heart sounds — is
classic for cardiac tamponade. Pulsus paradoxus (>10 mmHg drop in BP with
inspiration) further supports this. Emergency pericardiocentesis is the treatment.
Question 6
A 55-year-old diabetic male presents with fatigue, nausea, and mild epigastric
discomfort. ECG shows new ST elevation in V1–V4. What is the diagnosis?
A. Inferior STEMI
B. Anterior STEMI
C. Peptic ulcer disease
D. NSTEMI
E. Aortic dissection
CORRECT ANSWER: B. Anterior STEMI
RATIONALE: ST elevation in V1–V4 indicates anterior wall STEMI, typically due to
LAD occlusion. Diabetic patients often present atypically (no classic chest pain), with GI
symptoms or fatigue. ECG is critical in this group.
Question 7
Which of the following best describes first-degree AV block on ECG?
A. Progressively lengthening PR interval until a beat is dropped
B. Fixed PR interval with randomly dropped beats
C. Complete dissociation between P waves and QRS
D. Prolonged PR interval (>200 ms) with every P wave conducting
E. Wide QRS with no preceding P wave
