1|Page
ABEM Emergency Medicine Qualifying (Initial
Certification) Exam ACTUAL VERIFIED EXAM
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES.pdf
A 66-year-old man with a history of HTN and diabetes
mellitus, type 2, presents to the emergency department
with complaints of palpitations for over 2 weeks,
tachypnea, and chest pain. He denies history of CAD,
stroke, TIA, or congestive heart failure. He is afebrile, with
vital signs as follows: BP 145/98, HR 138, and RR 22. His
EKG is shown (Figure 1). Troponins are negative X 3.
Which of the following choices is the most appropriate
next diagnostic study for this patient?
A Transthoracic echocardiogram
B Cardiac catheterization
C Nuclear stress test
D Holter monitor
E Event recorder - Answer-*The Correct Answer is: A
Choice A, transthoracic echocardiogram, is correct, as it
can demonstrate the presence of valvular heart disease.
The presence of valvular heart disease can change the
recommendations for embolism prophylaxis.* Choice B,
,2|Page
cardiac catheterization, is useful in patients suspected to
have unstable angina, or who have sustained a
myocardial infarction. Choice C, nuclear stress test, is
useful in patients suspected to have angina pectoris, and
may be a useful diagnostic study in this patient with
cardiac risk factors (once the issue of atrial fibrillation has
been treated). Choices D and E would be useful tests if
the EKG had not established a diagnosis for this patient,
with the Holter monitor indicated in patients experiencing
symptoms on a daily basis, and the event recorder
indicated in patients demonstrating more sporadic
symptoms.
What absolute tissue pressure generally is used as a
guideline for diagnosing compartment syndrome?
A 10 mm Hg
B 20 mm Hg
C 30 mm Hg
D 40 mm Hg
E 50 mm Hg - Answer-*The Correct Answer is: C
Many trauma surgery services use an absolute tissue
pressure of approximately 30 mm Hg as the threshold for
diagnosing compartment syndrome.* Based on the entire
clinical picture, patients with numbers in that range or
,3|Page
higher will likely require surgical decompression with a
fasciotomy, while lower numbers will probably be managed
with a more conservative approach.
A 6-year-old female presents to the emergency
department with left wrist pain after falling off the monkey
bars at the school playground. Imaging of the left upper
extremity shows the following fracture pattern:
Which type of Salter-Harris Classification is observed?
A Type I
B Type II
C Type III
D Type IV
E Type V - Answer-*The Correct Answer is: A
A Salter-Harris Type I (A) involves the entire epiphysis.*
Type II (B) is the entire epiphysis along with a portion of
the metaphysis,
Type III (C) involves a portion of the epiphysis only,
Type IV (D) involves a portion of the epiphysis along with a
portion of the metaphysis, and
, 4|Page
Type V (E) is a compression injury of the epiphyseal plate
(nothing is "broken off").
A 70-year-old woman who was found barely responsive at
home by her daughter is brought to the emergency
department. Evaluation reveals that she is in a
hyperglycemic hyperosmolar state with a severe fluid
deficit. Treatment is initiated with vigorous saline
rehydration and a continuous infusion of insulin. At what
point should her glucose be added to her treatment?
A when her condition becomes stable
B when her urine output reaches 50 mL/hour
C when her blood glucose reaches 250 mg/dL
D if she develops hypokalemia
E if she begins to spill ketones in her urine - Answer-*The
Correct Answer is: C
In hyperglycemic hyperosmolar states, the serum glucose
rapidly corrects with fluid administration alone. However,
with vigorous rehydration, glucose may fall precipitously
and lead to severe hypoglycemia. To avoid this, glucose
should be added to water, half-normal, or normal saline as
soon as the patient's blood glucose is less than or equal to
250mg/dL. She should continue to receive insulin IV until
she is stabilized* (A) when it can be switched to
ABEM Emergency Medicine Qualifying (Initial
Certification) Exam ACTUAL VERIFIED EXAM
QUESTIONS AND VERIFIED ANSWERS WITH
RATIONALES.pdf
A 66-year-old man with a history of HTN and diabetes
mellitus, type 2, presents to the emergency department
with complaints of palpitations for over 2 weeks,
tachypnea, and chest pain. He denies history of CAD,
stroke, TIA, or congestive heart failure. He is afebrile, with
vital signs as follows: BP 145/98, HR 138, and RR 22. His
EKG is shown (Figure 1). Troponins are negative X 3.
Which of the following choices is the most appropriate
next diagnostic study for this patient?
A Transthoracic echocardiogram
B Cardiac catheterization
C Nuclear stress test
D Holter monitor
E Event recorder - Answer-*The Correct Answer is: A
Choice A, transthoracic echocardiogram, is correct, as it
can demonstrate the presence of valvular heart disease.
The presence of valvular heart disease can change the
recommendations for embolism prophylaxis.* Choice B,
,2|Page
cardiac catheterization, is useful in patients suspected to
have unstable angina, or who have sustained a
myocardial infarction. Choice C, nuclear stress test, is
useful in patients suspected to have angina pectoris, and
may be a useful diagnostic study in this patient with
cardiac risk factors (once the issue of atrial fibrillation has
been treated). Choices D and E would be useful tests if
the EKG had not established a diagnosis for this patient,
with the Holter monitor indicated in patients experiencing
symptoms on a daily basis, and the event recorder
indicated in patients demonstrating more sporadic
symptoms.
What absolute tissue pressure generally is used as a
guideline for diagnosing compartment syndrome?
A 10 mm Hg
B 20 mm Hg
C 30 mm Hg
D 40 mm Hg
E 50 mm Hg - Answer-*The Correct Answer is: C
Many trauma surgery services use an absolute tissue
pressure of approximately 30 mm Hg as the threshold for
diagnosing compartment syndrome.* Based on the entire
clinical picture, patients with numbers in that range or
,3|Page
higher will likely require surgical decompression with a
fasciotomy, while lower numbers will probably be managed
with a more conservative approach.
A 6-year-old female presents to the emergency
department with left wrist pain after falling off the monkey
bars at the school playground. Imaging of the left upper
extremity shows the following fracture pattern:
Which type of Salter-Harris Classification is observed?
A Type I
B Type II
C Type III
D Type IV
E Type V - Answer-*The Correct Answer is: A
A Salter-Harris Type I (A) involves the entire epiphysis.*
Type II (B) is the entire epiphysis along with a portion of
the metaphysis,
Type III (C) involves a portion of the epiphysis only,
Type IV (D) involves a portion of the epiphysis along with a
portion of the metaphysis, and
, 4|Page
Type V (E) is a compression injury of the epiphyseal plate
(nothing is "broken off").
A 70-year-old woman who was found barely responsive at
home by her daughter is brought to the emergency
department. Evaluation reveals that she is in a
hyperglycemic hyperosmolar state with a severe fluid
deficit. Treatment is initiated with vigorous saline
rehydration and a continuous infusion of insulin. At what
point should her glucose be added to her treatment?
A when her condition becomes stable
B when her urine output reaches 50 mL/hour
C when her blood glucose reaches 250 mg/dL
D if she develops hypokalemia
E if she begins to spill ketones in her urine - Answer-*The
Correct Answer is: C
In hyperglycemic hyperosmolar states, the serum glucose
rapidly corrects with fluid administration alone. However,
with vigorous rehydration, glucose may fall precipitously
and lead to severe hypoglycemia. To avoid this, glucose
should be added to water, half-normal, or normal saline as
soon as the patient's blood glucose is less than or equal to
250mg/dL. She should continue to receive insulin IV until
she is stabilized* (A) when it can be switched to
