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McGraW- HILL EMERGENCY MEDICINE EXAM 2026-2027
BANK QUESTIONS WITH DETAILED VERIFIED ANSWERS
EXAM QUESTIONS WILL COME FROM HERE (100%
CORRECT ANSWERS A+ GRADED
1. A 25-year-old man is brought to the ED after a high-speed motor
vehicle collision. He is intubated for a GCS of 6. His blood pressure is
80/40 mm Hg, heart rate 130/min. Breath sounds are absent on the
left. The most immediate next step is:
A. CT scan of the chest
B. Needle decompression of the left chest
C. Diagnostic peritoneal lavage
D. Focused Abdominal Sonography for Trauma (FAST)
Answer: B. The absence of breath sounds in a hypotensive trauma
patient indicates tension pneumothorax until proven otherwise.
Immediate needle decompression is life-saving and takes precedence
over imaging.
2. A 70-year-old woman with a history of atrial fibrillation on warfarin
presents with acute onset of severe left flank pain. Urinalysis shows 10-
20 RBCs/HPF. Contrast-enhanced CT reveals a wedge-shaped, non-
enhancing area in the left kidney. What is the most likely diagnosis?
A. Acute pyelonephritis
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B. Renal cell carcinoma
C. Renal infarct
D. Nephrolithiasis
Answer: C. A wedge-shaped perfusion defect in the kidney with acute
flank pain and hematuria in a patient with atrial fibrillation suggests a
thromboembolic renal infarct.
3. A 4-year-old child presents with a sudden onset of "barking" cough,
stridor, and respiratory distress that started at night. She has a low-
grade fever of 38.1°C (100.6°F). A neck X-ray shows a steeple sign. What
is the most common etiology?
A. Haemophilus influenzae type B
B. Parainfluenza virus
C. Respiratory syncytial virus
D. Foreign body aspiration
Answer: B. The clinical presentation and steeple sign are classic for
croup (laryngotracheobronchitis), most commonly caused by
parainfluenza virus type 1.
4. A 55-year-old male with chest pain has the following ECG: ST
elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
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D. Left main
Answer: C. Inferior wall ST-elevation myocardial infarction (STEMI) is
most often due to occlusion of the right coronary artery in 80% of
cases; the left circumflex supplies the remainder.
5. A patient presents with a severe headache described as "the worst of
my life," with associated nausea and photophobia. The initial non-
contrast CT head is normal. What is the next best step?
A. MRI of the brain
B. Lumbar puncture
C. CT angiogram of the head
D. Transcranial Doppler
Answer: B. A normal non-contrast CT does not exclude subarachnoid
hemorrhage. Lumbar puncture is required to look for xanthochromia or
red blood cells.
6. An 80-year-old nursing home patient presents with confusion, foul-
smelling urine, and a fever. She is hypotensive with a blood pressure of
85/50 mmHg. Appropriate initial management includes all of the
following EXCEPT:
A. Intravenous fluids
B. Blood cultures
C. Immediate Foley catheter insertion
D. Broad-spectrum antibiotics
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Answer: C. Immediate catheter insertion is not required. The diagnosis
of a UTI in a patient with a chronic catheter requires changing the
catheter, not just inserting a new one; culture should be taken from the
new catheter.
7. What is the antidote for a patient who presents with respiratory
depression and pinpoint pupils following a heroin overdose?
A. Flumazenil
B. N-acetylcysteine
C. Naloxone
D. Atropine
Answer: C. The classic toxidrome of opioid overdose includes
respiratory depression, pinpoint pupils, and altered mental status.
Naloxone is a competitive opioid antagonist.
8. A 30-year-old G1P0 female at 32 weeks gestation presents with
vaginal bleeding and abdominal pain. The uterus is tender and firm on
palpation. What is the most likely diagnosis?
A. Placenta previa
B. Abruptio placentae
C. Preterm labor
D. Uterine rupture
Answer: B. Painful vaginal bleeding in the third trimester with a tender,
hypertonic uterus is classic for placental abruption. Placenta previa
typically presents with painless bleeding.
McGraW- HILL EMERGENCY MEDICINE EXAM 2026-2027
BANK QUESTIONS WITH DETAILED VERIFIED ANSWERS
EXAM QUESTIONS WILL COME FROM HERE (100%
CORRECT ANSWERS A+ GRADED
1. A 25-year-old man is brought to the ED after a high-speed motor
vehicle collision. He is intubated for a GCS of 6. His blood pressure is
80/40 mm Hg, heart rate 130/min. Breath sounds are absent on the
left. The most immediate next step is:
A. CT scan of the chest
B. Needle decompression of the left chest
C. Diagnostic peritoneal lavage
D. Focused Abdominal Sonography for Trauma (FAST)
Answer: B. The absence of breath sounds in a hypotensive trauma
patient indicates tension pneumothorax until proven otherwise.
Immediate needle decompression is life-saving and takes precedence
over imaging.
2. A 70-year-old woman with a history of atrial fibrillation on warfarin
presents with acute onset of severe left flank pain. Urinalysis shows 10-
20 RBCs/HPF. Contrast-enhanced CT reveals a wedge-shaped, non-
enhancing area in the left kidney. What is the most likely diagnosis?
A. Acute pyelonephritis
,2|Page
B. Renal cell carcinoma
C. Renal infarct
D. Nephrolithiasis
Answer: C. A wedge-shaped perfusion defect in the kidney with acute
flank pain and hematuria in a patient with atrial fibrillation suggests a
thromboembolic renal infarct.
3. A 4-year-old child presents with a sudden onset of "barking" cough,
stridor, and respiratory distress that started at night. She has a low-
grade fever of 38.1°C (100.6°F). A neck X-ray shows a steeple sign. What
is the most common etiology?
A. Haemophilus influenzae type B
B. Parainfluenza virus
C. Respiratory syncytial virus
D. Foreign body aspiration
Answer: B. The clinical presentation and steeple sign are classic for
croup (laryngotracheobronchitis), most commonly caused by
parainfluenza virus type 1.
4. A 55-year-old male with chest pain has the following ECG: ST
elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
,3|Page
D. Left main
Answer: C. Inferior wall ST-elevation myocardial infarction (STEMI) is
most often due to occlusion of the right coronary artery in 80% of
cases; the left circumflex supplies the remainder.
5. A patient presents with a severe headache described as "the worst of
my life," with associated nausea and photophobia. The initial non-
contrast CT head is normal. What is the next best step?
A. MRI of the brain
B. Lumbar puncture
C. CT angiogram of the head
D. Transcranial Doppler
Answer: B. A normal non-contrast CT does not exclude subarachnoid
hemorrhage. Lumbar puncture is required to look for xanthochromia or
red blood cells.
6. An 80-year-old nursing home patient presents with confusion, foul-
smelling urine, and a fever. She is hypotensive with a blood pressure of
85/50 mmHg. Appropriate initial management includes all of the
following EXCEPT:
A. Intravenous fluids
B. Blood cultures
C. Immediate Foley catheter insertion
D. Broad-spectrum antibiotics
, 4|Page
Answer: C. Immediate catheter insertion is not required. The diagnosis
of a UTI in a patient with a chronic catheter requires changing the
catheter, not just inserting a new one; culture should be taken from the
new catheter.
7. What is the antidote for a patient who presents with respiratory
depression and pinpoint pupils following a heroin overdose?
A. Flumazenil
B. N-acetylcysteine
C. Naloxone
D. Atropine
Answer: C. The classic toxidrome of opioid overdose includes
respiratory depression, pinpoint pupils, and altered mental status.
Naloxone is a competitive opioid antagonist.
8. A 30-year-old G1P0 female at 32 weeks gestation presents with
vaginal bleeding and abdominal pain. The uterus is tender and firm on
palpation. What is the most likely diagnosis?
A. Placenta previa
B. Abruptio placentae
C. Preterm labor
D. Uterine rupture
Answer: B. Painful vaginal bleeding in the third trimester with a tender,
hypertonic uterus is classic for placental abruption. Placenta previa
typically presents with painless bleeding.
