NEWEST EMERGENCY MEDICINE
CERTIFICATION EXAM FOR THE
AMERICAN BOARD OF EMERGENCY
MEDICINE (ABMS) | Q&A WITH
RATIONALES
1. A 55-year-old patient presents with sudden-onset,
severe, tearing chest pain radiating to the back.
Blood pressure is 100/60 mmHg in the right arm and
80/50 mmHg in the left arm. The most likely diagnosis
is:
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct answer: C
Rationale: Aortic dissection presents with tearing
chest pain radiating to the back and pulse deficits
(blood pressure differential between arms).
2. The most common cause of atraumatic chest pain
in patients presenting to the emergency department
is:
,A) Acute coronary syndrome (ACS)
B) Pulmonary embolism
C) Musculoskeletal chest pain
D) Pericarditis
Correct answer: C
Rationale: Musculoskeletal chest pain
(costochondritis, chest wall strain) is the most
common cause of chest pain in the ED after cardiac
causes are excluded.
3. A 65-year-old patient with a history of hypertension
presents with substernal chest pressure radiating to
the jaw, diaphoresis, and nausea. The ECG shows ST-
segment elevation in leads V1-V4. The initial
management is:
A) Aspirin 324 mg, nitroglycerin, morphine, and
immediate percutaneous coronary intervention (PCI)
or thrombolytics
B) Heparin alone
C) Oral anticoagulation
D) Beta-blocker only
Correct answer: A
,Rationale: Acute STEMI requires aspirin, anti-
ischemic therapy, and emergent reperfusion (PCI
preferred within 90 minutes or thrombolytics).
4. The most specific cardiac biomarker for acute
myocardial infarction is:
A) Creatine kinase-MB (CK-MB)
B) Troponin I or T
C) Myoglobin
D) Lactate dehydrogenase (LDH)
Correct answer: B
Rationale: Cardiac troponins are the most sensitive
and specific biomarkers for myocardial necrosis.
5. A 30-year-old patient presents with acute onset of
pleuritic chest pain, dyspnea, and tachycardia. The
patient is an oral contraceptive user. The most likely
diagnosis is:
A) Pneumothorax
B) Acute pericarditis
C) Pulmonary embolism (PE)
D) Musculoskeletal pain
Correct answer: C
, Rationale: Oral contraceptive use is a risk factor for
venous thromboembolism; symptoms of PE include
pleuritic chest pain, dyspnea, and tachycardia.
6. A patient with a suspected pulmonary embolism
has a Wells score of 6. The next appropriate
diagnostic test is:
A) D-dimer
B) CT pulmonary angiography (CTPA)
C) Ventilation-perfusion (V/Q) scan
D) Chest X-ray
Correct answer: B
Rationale: High pretest probability (Wells >4)
warrants immediate CTPA; D-dimer is for
low/intermediate probability.
7. The most common ECG finding in acute
pericarditis is:
A) ST-segment elevation with concave (upward)
morphology in multiple leads, often with PR
depression
B) ST-segment depression
C) Pathologic Q waves
CERTIFICATION EXAM FOR THE
AMERICAN BOARD OF EMERGENCY
MEDICINE (ABMS) | Q&A WITH
RATIONALES
1. A 55-year-old patient presents with sudden-onset,
severe, tearing chest pain radiating to the back.
Blood pressure is 100/60 mmHg in the right arm and
80/50 mmHg in the left arm. The most likely diagnosis
is:
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct answer: C
Rationale: Aortic dissection presents with tearing
chest pain radiating to the back and pulse deficits
(blood pressure differential between arms).
2. The most common cause of atraumatic chest pain
in patients presenting to the emergency department
is:
,A) Acute coronary syndrome (ACS)
B) Pulmonary embolism
C) Musculoskeletal chest pain
D) Pericarditis
Correct answer: C
Rationale: Musculoskeletal chest pain
(costochondritis, chest wall strain) is the most
common cause of chest pain in the ED after cardiac
causes are excluded.
3. A 65-year-old patient with a history of hypertension
presents with substernal chest pressure radiating to
the jaw, diaphoresis, and nausea. The ECG shows ST-
segment elevation in leads V1-V4. The initial
management is:
A) Aspirin 324 mg, nitroglycerin, morphine, and
immediate percutaneous coronary intervention (PCI)
or thrombolytics
B) Heparin alone
C) Oral anticoagulation
D) Beta-blocker only
Correct answer: A
,Rationale: Acute STEMI requires aspirin, anti-
ischemic therapy, and emergent reperfusion (PCI
preferred within 90 minutes or thrombolytics).
4. The most specific cardiac biomarker for acute
myocardial infarction is:
A) Creatine kinase-MB (CK-MB)
B) Troponin I or T
C) Myoglobin
D) Lactate dehydrogenase (LDH)
Correct answer: B
Rationale: Cardiac troponins are the most sensitive
and specific biomarkers for myocardial necrosis.
5. A 30-year-old patient presents with acute onset of
pleuritic chest pain, dyspnea, and tachycardia. The
patient is an oral contraceptive user. The most likely
diagnosis is:
A) Pneumothorax
B) Acute pericarditis
C) Pulmonary embolism (PE)
D) Musculoskeletal pain
Correct answer: C
, Rationale: Oral contraceptive use is a risk factor for
venous thromboembolism; symptoms of PE include
pleuritic chest pain, dyspnea, and tachycardia.
6. A patient with a suspected pulmonary embolism
has a Wells score of 6. The next appropriate
diagnostic test is:
A) D-dimer
B) CT pulmonary angiography (CTPA)
C) Ventilation-perfusion (V/Q) scan
D) Chest X-ray
Correct answer: B
Rationale: High pretest probability (Wells >4)
warrants immediate CTPA; D-dimer is for
low/intermediate probability.
7. The most common ECG finding in acute
pericarditis is:
A) ST-segment elevation with concave (upward)
morphology in multiple leads, often with PR
depression
B) ST-segment depression
C) Pathologic Q waves
