Page 1 of 99
ABEM Emergency Medicine Qualifying (Initial Certification)
Exam ACTUAL EXAM QUESTIONS AND VERIFIED ANSWERS
WITH RATIONALES JUST RELEASED
ABEM Emergency Medicine Qualifying (Initial Certification) Exam by providing a set of scenario-based,
exam-relevant multiple-choice questions. I’ve prioritized the style and content you’d see on the real
exam, including the distinctive "dense triangle" and "empty delta" signs for cerebral venous thrombosis
mentioned in your search and aligned with the ABEM Content Outline .
Q1. A patient presents with a severe headache for 4 days. Cross-sectional brain imaging demonstrates
a dense triangle in the superior sagittal sinus. Which of the following is a predisposing factor to the
diagnosis associated with this finding?
A) Alcohol use
B) End-stage kidney disease
C) Male sex
D) Pregnancy
Answer: D
Findings are consistent with cerebral venous thrombosis (CVT). The "dense triangle" sign (noncontrast
CT) or "empty delta" sign (contrast CT/MRV) indicates thrombus in the superior sagittal sinus. CVT is
, Page 2 of 99
associated with pregnancy, postpartum, OCP use, hypercoagulable states, and adjacent infections .
Pregnancy is a known risk factor.
Q2. A 55-year-old man with hypertension presents with sudden onset of the "worst headache of his
life" that reached maximum intensity within seconds. Neurologic exam is nonfocal. Which diagnosis is
most likely?
A) Migraine with aura
B) Subarachnoid hemorrhage
C) Tension-type headache
D) Cluster headache
Answer: B
The classic "thunderclap" headache (peak intensity within seconds to one minute) is highly concerning for
subarachnoid hemorrhage until proven otherwise, typically from a ruptured aneurysm. Noncontrast head
CT is the initial study.
Q3. A 40-year-old woman presents with altered mental status. CT angiogram of the head
demonstrates an "empty delta sign." What is the most appropriate initial treatment?
A) Intravenous tPA
, Page 3 of 99
B) Endovascular thrombectomy
C) Anticoagulation with heparin
D) Platelet transfusion
Answer: C
The "empty delta sign" indicates cerebral venous thrombosis. Unfractionated heparin or low-molecular-
weight heparin is the standard initial treatment for CVT, even in the presence of hemorrhagic venous
infarcts, as it prevents thrombus propagation .
Q4. A patient with seizures and a known brain tumor presents with worsening headache. What is the
most common cause of thrombotic occlusion of the intracranial venous sinuses in this setting?
A) Bacterial meningitis
B) Direct tumor compression
C) Hyperviscosity syndrome
D) Hyperhomocysteinemia
Answer: B
Cerebral venous thrombosis is often caused by venous outflow compression from adjacent tumors,
, Page 4 of 99
abscesses, or postoperative changes. Malignancy is a well-known risk factor for CVT due to mechanical
obstruction or hypercoagulability .
Q5. You are treating a 32-year-old woman with cerebral venous thrombosis confirmed by MRV. She is
currently 32 weeks pregnant. What is the most appropriate anticoagulation strategy?
A) Warfarin titrated to INR 2-3
B) Unfractionated heparin or LMWH
C) Aspirin 325 mg daily
D) No anticoagulation due to pregnancy
Answer: B
Because warfarin crosses the placenta and is teratogenic, heparin (UFH or LMWH) is the preferred
anticoagulant during pregnancy. It does not cross the placenta and is safe for the fetus. Pregnancy itself
is a risk factor for CVT .
Q6. A 65-year-old with a history of atrial fibrillation presents with acute aphasia and right-sided
weakness. Her INR is 1.2. What is the most likely mechanism of her symptoms?
A) Embolic occlusion of the left middle cerebral artery
B) Thrombotic occlusion of the superior sagittal sinus
ABEM Emergency Medicine Qualifying (Initial Certification)
Exam ACTUAL EXAM QUESTIONS AND VERIFIED ANSWERS
WITH RATIONALES JUST RELEASED
ABEM Emergency Medicine Qualifying (Initial Certification) Exam by providing a set of scenario-based,
exam-relevant multiple-choice questions. I’ve prioritized the style and content you’d see on the real
exam, including the distinctive "dense triangle" and "empty delta" signs for cerebral venous thrombosis
mentioned in your search and aligned with the ABEM Content Outline .
Q1. A patient presents with a severe headache for 4 days. Cross-sectional brain imaging demonstrates
a dense triangle in the superior sagittal sinus. Which of the following is a predisposing factor to the
diagnosis associated with this finding?
A) Alcohol use
B) End-stage kidney disease
C) Male sex
D) Pregnancy
Answer: D
Findings are consistent with cerebral venous thrombosis (CVT). The "dense triangle" sign (noncontrast
CT) or "empty delta" sign (contrast CT/MRV) indicates thrombus in the superior sagittal sinus. CVT is
, Page 2 of 99
associated with pregnancy, postpartum, OCP use, hypercoagulable states, and adjacent infections .
Pregnancy is a known risk factor.
Q2. A 55-year-old man with hypertension presents with sudden onset of the "worst headache of his
life" that reached maximum intensity within seconds. Neurologic exam is nonfocal. Which diagnosis is
most likely?
A) Migraine with aura
B) Subarachnoid hemorrhage
C) Tension-type headache
D) Cluster headache
Answer: B
The classic "thunderclap" headache (peak intensity within seconds to one minute) is highly concerning for
subarachnoid hemorrhage until proven otherwise, typically from a ruptured aneurysm. Noncontrast head
CT is the initial study.
Q3. A 40-year-old woman presents with altered mental status. CT angiogram of the head
demonstrates an "empty delta sign." What is the most appropriate initial treatment?
A) Intravenous tPA
, Page 3 of 99
B) Endovascular thrombectomy
C) Anticoagulation with heparin
D) Platelet transfusion
Answer: C
The "empty delta sign" indicates cerebral venous thrombosis. Unfractionated heparin or low-molecular-
weight heparin is the standard initial treatment for CVT, even in the presence of hemorrhagic venous
infarcts, as it prevents thrombus propagation .
Q4. A patient with seizures and a known brain tumor presents with worsening headache. What is the
most common cause of thrombotic occlusion of the intracranial venous sinuses in this setting?
A) Bacterial meningitis
B) Direct tumor compression
C) Hyperviscosity syndrome
D) Hyperhomocysteinemia
Answer: B
Cerebral venous thrombosis is often caused by venous outflow compression from adjacent tumors,
, Page 4 of 99
abscesses, or postoperative changes. Malignancy is a well-known risk factor for CVT due to mechanical
obstruction or hypercoagulability .
Q5. You are treating a 32-year-old woman with cerebral venous thrombosis confirmed by MRV. She is
currently 32 weeks pregnant. What is the most appropriate anticoagulation strategy?
A) Warfarin titrated to INR 2-3
B) Unfractionated heparin or LMWH
C) Aspirin 325 mg daily
D) No anticoagulation due to pregnancy
Answer: B
Because warfarin crosses the placenta and is teratogenic, heparin (UFH or LMWH) is the preferred
anticoagulant during pregnancy. It does not cross the placenta and is safe for the fetus. Pregnancy itself
is a risk factor for CVT .
Q6. A 65-year-old with a history of atrial fibrillation presents with acute aphasia and right-sided
weakness. Her INR is 1.2. What is the most likely mechanism of her symptoms?
A) Embolic occlusion of the left middle cerebral artery
B) Thrombotic occlusion of the superior sagittal sinus
