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ABEM Emergency Medicine Form 168 Exam
ACTUAL QUESTIONS AND ANSWERS LATEST
UPDATE THIS YEAR
ABEM Emergency Medicine Form 168 Exam –
ABEM Emergency Medicine Initial Certification Exam (Form 168), including the ABEM EM Model
Content Outline covering adult and pediatric emergency medicine, trauma, medical and surgical
emergencies, toxicology, environmental emergencies, and emergency medical services . Each question is
written in the ABEM format: positively phrased, single-best-answer, with selective distractors. No “all of
the following except” or “A and B” formatting is used .
Exam Coverage Summary (Point Form)
Based on ABEM’s EM Model Content Outline and the EMS Core Content :
• Adult Medical Emergencies (45-50%) : Cardiovascular, respiratory, gastrointestinal,
neurological, endocrine/metabolic, hematologic, infectious diseases, renal/urologic,
rheumatologic, allergic/immunologic
• Pediatric Emergencies (10-15%) : Neonatal, respiratory distress, fever/infections, seizures,
trauma, toxicology, child abuse
• Trauma (10-15%) : Blunt and penetrating trauma, head/spine injuries,
thoracic/abdominal/pelvic trauma, burns, shock
• Surgical & Procedural (5-10%) : Acute abdomen, vascular emergencies, wound management,
airway procedures, resuscitation
• Toxicology & Environmental (5-10%) : Overdose, poisoning, envenomations, heat/cold illness,
drowning, electrical/lightning injuries
• EMS & Disaster Medicine (5-10%) : Prehospital care, medical oversight, triage, mass casualty
incidents, disaster response
• Psychiatric & Behavioral (3-5%) : Suicidal patient, agitation, depression, psychosis, substance
use disorders
• Eye, ENT, Dental (3-5%) : Ophthalmologic emergencies, ENT infections/injuries, dental trauma
• Ob/Gyn (2-4%) : Ectopic pregnancy, miscarriage, labor/delivery complications, sexual assault
• Ethics & Legal (1-2%) : Informed consent, capacity, advance directives, EMTALA
1. A 55-year-old man presents with sudden onset tearing chest pain radiating to his back. His blood
pressure is 140/90 in the right arm and 110/70 in the left arm. A chest radiograph shows a widened
mediastinum. Which is the most appropriate next imaging study?
A) CT angiography of the chest
, Page 2 of 177
B) Echocardiography
C) Magnetic resonance angiography
D) Transesophageal echocardiography
Answer: A
Rationale: CT angiography is the initial imaging modality of choice for suspected aortic dissection in
hemodynamically stable patients due to its speed, availability, and high sensitivity/specificity . Aortic
dissection classically presents with tearing chest pain, blood pressure differential between arms, and
widened mediastinum on chest x-ray.
2. A 32-year-old woman with no prior psychiatric history is brought in by her husband for acute onset
confusion and agitation over the past 12 hours. Her temperature is 38.9°C (102°F), heart rate 122 bpm,
blood pressure 148/92 mmHg. On examination, she has mydriasis, dry mucous membranes, and flushed
skin. She is mumbling incoherently. Which medication is most likely responsible?
A) Sertraline
, Page 3 of 177
B) Bupropion
C) Diphenhydramine
D) Lamotrigine
Answer: C
Rationale: Diphenhydramine (an anticholinergic) causes anticholinergic toxidrome: fever, tachycardia,
mydriasis, dry skin, urinary retention, and delirium. The classic mnemonic is “hot as a hare, blind as a
bat, dry as a bone, red as a beet, mad as a hatter.”
3. A 45-year-old man with a history of alcohol use disorder presents with acute onset epigastric pain
radiating to the back, accompanied by nausea and vomiting. His serum lipase is 1,200 U/L. A CT scan
shows pancreatic necrosis. Which is the most appropriate next step in management?
A) Early enteral nutrition via nasojejunal tube
B) Intravenous antibiotics
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C) Surgical debridement
D) Total parenteral nutrition
Answer: A
Rationale: Early enteral nutrition improves outcomes in acute pancreatitis and reduces infectious
complications compared to parenteral nutrition. Antibiotics are not indicated for sterile necrosis.
Surgery is reserved for infected necrosis.
4. A 6-month-old infant is brought to the emergency department with fever, irritability, and poor
feeding for 2 days. On examination, the infant is lethargic with a bulging fontanelle. Which is the most
appropriate diagnostic test?
A) Computed tomography of the head
B) Lumbar puncture
C) Magnetic resonance imaging of the brain
ABEM Emergency Medicine Form 168 Exam
ACTUAL QUESTIONS AND ANSWERS LATEST
UPDATE THIS YEAR
ABEM Emergency Medicine Form 168 Exam –
ABEM Emergency Medicine Initial Certification Exam (Form 168), including the ABEM EM Model
Content Outline covering adult and pediatric emergency medicine, trauma, medical and surgical
emergencies, toxicology, environmental emergencies, and emergency medical services . Each question is
written in the ABEM format: positively phrased, single-best-answer, with selective distractors. No “all of
the following except” or “A and B” formatting is used .
Exam Coverage Summary (Point Form)
Based on ABEM’s EM Model Content Outline and the EMS Core Content :
• Adult Medical Emergencies (45-50%) : Cardiovascular, respiratory, gastrointestinal,
neurological, endocrine/metabolic, hematologic, infectious diseases, renal/urologic,
rheumatologic, allergic/immunologic
• Pediatric Emergencies (10-15%) : Neonatal, respiratory distress, fever/infections, seizures,
trauma, toxicology, child abuse
• Trauma (10-15%) : Blunt and penetrating trauma, head/spine injuries,
thoracic/abdominal/pelvic trauma, burns, shock
• Surgical & Procedural (5-10%) : Acute abdomen, vascular emergencies, wound management,
airway procedures, resuscitation
• Toxicology & Environmental (5-10%) : Overdose, poisoning, envenomations, heat/cold illness,
drowning, electrical/lightning injuries
• EMS & Disaster Medicine (5-10%) : Prehospital care, medical oversight, triage, mass casualty
incidents, disaster response
• Psychiatric & Behavioral (3-5%) : Suicidal patient, agitation, depression, psychosis, substance
use disorders
• Eye, ENT, Dental (3-5%) : Ophthalmologic emergencies, ENT infections/injuries, dental trauma
• Ob/Gyn (2-4%) : Ectopic pregnancy, miscarriage, labor/delivery complications, sexual assault
• Ethics & Legal (1-2%) : Informed consent, capacity, advance directives, EMTALA
1. A 55-year-old man presents with sudden onset tearing chest pain radiating to his back. His blood
pressure is 140/90 in the right arm and 110/70 in the left arm. A chest radiograph shows a widened
mediastinum. Which is the most appropriate next imaging study?
A) CT angiography of the chest
, Page 2 of 177
B) Echocardiography
C) Magnetic resonance angiography
D) Transesophageal echocardiography
Answer: A
Rationale: CT angiography is the initial imaging modality of choice for suspected aortic dissection in
hemodynamically stable patients due to its speed, availability, and high sensitivity/specificity . Aortic
dissection classically presents with tearing chest pain, blood pressure differential between arms, and
widened mediastinum on chest x-ray.
2. A 32-year-old woman with no prior psychiatric history is brought in by her husband for acute onset
confusion and agitation over the past 12 hours. Her temperature is 38.9°C (102°F), heart rate 122 bpm,
blood pressure 148/92 mmHg. On examination, she has mydriasis, dry mucous membranes, and flushed
skin. She is mumbling incoherently. Which medication is most likely responsible?
A) Sertraline
, Page 3 of 177
B) Bupropion
C) Diphenhydramine
D) Lamotrigine
Answer: C
Rationale: Diphenhydramine (an anticholinergic) causes anticholinergic toxidrome: fever, tachycardia,
mydriasis, dry skin, urinary retention, and delirium. The classic mnemonic is “hot as a hare, blind as a
bat, dry as a bone, red as a beet, mad as a hatter.”
3. A 45-year-old man with a history of alcohol use disorder presents with acute onset epigastric pain
radiating to the back, accompanied by nausea and vomiting. His serum lipase is 1,200 U/L. A CT scan
shows pancreatic necrosis. Which is the most appropriate next step in management?
A) Early enteral nutrition via nasojejunal tube
B) Intravenous antibiotics
, Page 4 of 177
C) Surgical debridement
D) Total parenteral nutrition
Answer: A
Rationale: Early enteral nutrition improves outcomes in acute pancreatitis and reduces infectious
complications compared to parenteral nutrition. Antibiotics are not indicated for sterile necrosis.
Surgery is reserved for infected necrosis.
4. A 6-month-old infant is brought to the emergency department with fever, irritability, and poor
feeding for 2 days. On examination, the infant is lethargic with a bulging fontanelle. Which is the most
appropriate diagnostic test?
A) Computed tomography of the head
B) Lumbar puncture
C) Magnetic resonance imaging of the brain
