Emergency Medicine Prometric exam questions with answers

1. Question 1Resuscitation, Shock and Airway Managementmedium

   A 35-year-old man with anaphylaxis after a wasp sting has received two appropriately dosed intramuscular injections of epinephrine 5 minutes apart, high-flow oxygen and 2 L of crystalloid. He still has wheeze and a blood pressure of 78/40 mmHg. What is the most appropriate next step?

   1. AIntravenous chlorphenamine and hydrocortisone, then reassess in 30 minutes
   2. BNebulised salbutamol and observation for a biphasic reaction
   3. CAn intravenous epinephrine infusion with critical care support
   4. DIntravenous glucagon as the next vasoactive agent
   Show answer and explanation▾

   Answer: C. An intravenous epinephrine infusion with critical care support

   Persisting respiratory or cardiovascular compromise despite two doses of intramuscular epinephrine defines refractory anaphylaxis, and current guidance recommends a low-dose intravenous epinephrine infusion with critical care involvement, continuing intramuscular doses until it is running. Antihistamines and corticosteroids do not treat shock or bronchospasm and must never delay epinephrine. Glucagon is mainly considered for refractory anaphylaxis in patients taking beta-blockers.

2. Question 2Trauma, EMS, Prehospital and Disaster Medicineeasy

   Four alert patients (GCS 15) with stable vital signs present after trauma with neck pain. Using the Canadian C-spine rule, which patient requires cervical spine imaging on the basis of a high-risk factor?

   1. AA 70-year-old who fell from standing height
   2. BA 32-year-old after a simple rear-end collision who has been walking
   3. CA 45-year-old whose neck pain began several hours after the injury
   4. DA 25-year-old sitting up in the department with no midline tenderness
   Show answer and explanation▾

   Answer: A. A 70-year-old who fell from standing height

   The Canadian C-spine rule identifies age 65 years or more, a dangerous mechanism and paraesthesias in the extremities as high-risk factors that mandate imaging regardless of other findings. A simple rear-end collision, ambulation at any time, sitting in the department, delayed onset of neck pain and absence of midline tenderness are low-risk factors that allow safe assessment of neck rotation. Patients with a low-risk factor who can actively rotate the neck 45 degrees left and right need no imaging.

3. Question 3Trauma, EMS, Prehospital and Disaster Medicinemedium

   At a bus crash you apply START triage. An adult cannot walk, is breathing at 24/min, has a palpable radial pulse with capillary refill under 2 seconds, but cannot follow simple commands. Which triage category should be assigned?

   1. AMinor (green)
   2. BDelayed (yellow)
   3. CExpectant or deceased (black)
   4. DImmediate (red)
   Show answer and explanation▾

   Answer: D. Immediate (red)

   In START, non-ambulatory patients are assessed by respiration, perfusion and mental status: respiratory rate over 30/min, absent radial pulse or capillary refill over 2 seconds, or inability to follow simple commands each places the patient in the immediate category. This patient breathes adequately with good perfusion, but altered mental status alone makes them immediate rather than delayed. The black category applies to patients not breathing after airway repositioning.

4. Question 4Cardiovascular and Respiratory Emergencieshard

   A 24-year-old man has palpitations. Blood pressure is 118/76 mmHg and he is alert. The ECG shows an irregularly irregular, broad complex tachycardia at up to 260/min with varying QRS morphology and width. A previous ECG showed a short PR interval and delta waves. Which is the most appropriate drug treatment?

   1. AIntravenous amiodarone
   2. BIntravenous procainamide
   3. CIntravenous diltiazem
   4. DIntravenous adenosine
   Show answer and explanation▾

   Answer: B. Intravenous procainamide

   This is pre-excited atrial fibrillation in Wolff-Parkinson-White syndrome. AV nodal blockade with adenosine, calcium channel blockers, beta-blockers or digoxin can increase conduction down the accessory pathway and precipitate ventricular fibrillation, and current AF guidelines also list intravenous amiodarone as potentially harmful in this setting. In a stable patient, intravenous procainamide or ibutilide slows accessory pathway conduction, and synchronised cardioversion is used if the patient becomes unstable.

5. Question 5Cardiovascular and Respiratory Emergencieseasy

   A 63-year-old man with inferior ST elevation becomes hypotensive (BP 74/40 mmHg) after one sublingual nitroglycerin tablet. Lung fields are clear and jugular venous pressure is raised. Right-sided leads show 1.5 mm ST elevation in V4R. While primary PCI is arranged, what is the most appropriate immediate treatment?

   1. AAn intravenous crystalloid bolus
   2. BIntravenous furosemide 40 mg
   3. CA further dose of nitroglycerin
   4. DIntravenous metoprolol 5 mg
   Show answer and explanation▾

   Answer: A. An intravenous crystalloid bolus

   ST elevation in V4R with hypotension, clear lungs and raised JVP indicates right ventricular infarction, which is preload-dependent, so nitrates and diuretics can cause profound hypotension. Cautious intravenous fluid boluses are first-line, with inotropic support if hypotension persists, alongside urgent reperfusion. Beta-blockers are contraindicated in hypotension and cardiogenic shock.

6. Question 6Toxicology and Environmental Emergencieshard

   A 30-year-old man with known G6PD deficiency took an overdose of dapsone and presents confused and cyanosed with SpO2 85% that does not improve with high-flow oxygen. Arterial PaO2 is 38 kPa (285 mmHg), the blood is chocolate-brown and co-oximetry shows methaemoglobin of 45%. He is hypotensive. Which is the most appropriate treatment?

   1. AMethylene blue 1 mg/kg intravenously
   2. BHydroxocobalamin 5 g intravenously
   3. CExchange transfusion
   4. DIntravenous sodium thiosulfate
   Show answer and explanation▾

   Answer: C. Exchange transfusion

   Methylene blue needs NADPH generated through G6PD to reduce methaemoglobin, so it is ineffective in G6PD deficiency and can cause haemolysis. In severe, symptomatic methaemoglobinaemia with haemodynamic compromise in such a patient, exchange transfusion (or hyperbaric oxygen where available) is the most appropriate rescue therapy, with ascorbic acid as an adjunct. Hydroxocobalamin and sodium thiosulfate are cyanide antidotes and do not reduce methaemoglobin.

7. Question 7Toxicology and Environmental Emergencieseasy

   A 22-year-old soldier collapses during a summer march. He is confused, with a rectal temperature of 41.6 degrees C and BP 104/60 mmHg. His airway is protected. Which is the most effective initial cooling method?

   1. AIntravenous paracetamol and cooled intravenous fluids
   2. BRemoving clothing and fanning in a shaded area
   3. CIce packs to the axillae and groins only
   4. DImmersion of the trunk and limbs in cold or iced water
   Show answer and explanation▾

   Answer: D. Immersion of the trunk and limbs in cold or iced water

   Cold-water immersion produces the fastest cooling rate in exertional heat stroke and is associated with very low mortality when started promptly, aiming to reach about 39 degrees C within 30 minutes. Fanning and ice packs to the groins and axillae are useful adjuncts when immersion is unavailable, but cool much more slowly. Antipyretics are ineffective because the hypothalamic set point is not raised.

8. Question 8Pediatric Emergenciesmedium

   A 15-day-old term infant has a rectal temperature of 38.4 degrees C. She is feeding well and appears well, with no focus of infection on examination. Following the 2021 AAP guideline for well-appearing febrile infants, which is the most appropriate management?

   1. AUrinalysis and blood culture, with discharge if inflammatory markers are normal
   2. BBlood, urine and cerebrospinal fluid cultures, parenteral antibiotics and admission
   3. CUrine culture only, with clinical review in 24 hours
   4. DAdmission for observation without investigations unless she deteriorates
   Show answer and explanation▾

   Answer: B. Blood, urine and cerebrospinal fluid cultures, parenteral antibiotics and admission

   For well-appearing febrile infants aged 8 to 21 days, the guideline recommends urinalysis, blood culture and lumbar puncture, parenteral antibiotics and hospital admission, because inflammatory markers cannot reliably exclude invasive bacterial infection at this age. Using inflammatory markers to guide lumbar puncture and possible discharge applies to infants aged 22 days and older. Withholding investigations risks missing bacteraemia or meningitis.

9. Question 9Orthopedic and Musculoskeletal Emergencieseasy

   A 38-year-old man presents after a generalised tonic-clonic seizure with right shoulder pain. The arm is held adducted and internally rotated, and he cannot externally rotate it. The AP radiograph shows a symmetrical, rounded humeral head resembling a light bulb. What is the most appropriate next imaging?

   1. AAxillary or scapular Y view of the shoulder
   2. BUltrasound of the rotator cuff
   3. CRepeat AP view in external rotation
   4. DMRI of the shoulder
   Show answer and explanation▾

   Answer: A. Axillary or scapular Y view of the shoulder

   Seizures are a classic cause of posterior shoulder dislocation, which is easily missed on a single AP view where the internally rotated humeral head has a light bulb appearance. An axillary or scapular Y view shows the posterior position of the humeral head and is needed to confirm the diagnosis, with CT if views are inadequate or a reverse Hill-Sachs lesion is suspected. An externally rotated view cannot be obtained because the dislocation blocks rotation, and MRI is not first-line.

10. Question 10Neurologic and Psychiatric Emergenciesmedium

    A 48-year-old woman taking sertraline was started on tramadol 2 days ago. She is agitated and diaphoretic, with temperature 38.4 degrees C, heart rate 124/min, dilated pupils, diarrhoea and hyperreflexia. Which examination finding most strongly supports serotonin toxicity rather than neuroleptic malignant syndrome?

    1. AGeneralised lead-pipe rigidity
    2. BRaised creatine kinase
    3. CFever above 38 degrees C
    4. DInducible ankle clonus
    Show answer and explanation▾

    Answer: D. Inducible ankle clonus

    Inducible or spontaneous clonus, together with hyperreflexia and rapid onset after a serotonergic drug, is central to the Hunter criteria for serotonin toxicity. Neuroleptic malignant syndrome develops over days after dopamine antagonists, with bradyreflexia and severe lead-pipe rigidity. Fever and a raised creatine kinase occur in both conditions and do not discriminate; management includes stopping serotonergic drugs, benzodiazepines and, if needed, cyproheptadine.

11. Question 11Gastrointestinal and Abdominal Emergenciesmedium

    An 82-year-old nursing home resident with chronic constipation has 2 days of abdominal distension and absolute constipation. He is stable, with a non-tender abdomen and normal lactate. CT shows a hugely dilated sigmoid loop with a whirl sign of the mesentery and no free gas or pneumatosis. What is the most appropriate initial management?

    1. AWater-soluble contrast enema and observation
    2. BFlexible endoscopic detorsion and decompression with a rectal tube
    3. CEmergency Hartmann procedure
    4. DColonic stent placement across the twist
    Show answer and explanation▾

    Answer: B. Flexible endoscopic detorsion and decompression with a rectal tube

    In sigmoid volvulus without peritonitis, perforation or ischaemia, endoscopic detorsion with flexible sigmoidoscopy and a decompression tube is first-line and allows assessment of mucosal viability. Because recurrence is common, elective sigmoid resection during the same admission is considered in fit patients. Emergency surgery is reserved for peritonitis, perforation, gangrenous mucosa or failed endoscopic reduction, and stenting has no role in volvulus.

12. Question 12Obstetric and Gynecologic Emergencieshard

    A 33-year-old woman at 32 weeks' gestation has a cardiac arrest in the emergency department. High-quality CPR with manual left uterine displacement and advanced life support have been under way for 4 minutes without return of spontaneous circulation. The obstetric team is present. Which is the most appropriate action?

    1. AContinue resuscitation during transfer to the operating theatre for delivery
    2. BContinue CPR for 20 minutes before considering delivery
    3. CPerform resuscitative hysterotomy immediately in the resuscitation bay
    4. DPause CPR to obtain an ultrasound of fetal heart activity
    Show answer and explanation▾

    Answer: C. Perform resuscitative hysterotomy immediately in the resuscitation bay

    When the uterus is at or above the umbilicus (about 20 weeks or more) and there is no ROSC after about 4 minutes, resuscitative hysterotomy should be performed at the site of arrest, aiming for delivery by around 5 minutes, primarily to relieve aortocaval compression and improve maternal resuscitation. Transfer to theatre and prolonged CPR before delivery waste critical time and worsen maternal and fetal outcomes. Interrupting CPR for fetal assessment is not indicated.

13. Question 13Endocrine, Metabolic, Electrolyte, Renal and Genitourinary Emergenciesmedium

    A 26-year-old woman collapses after a marathon and has a generalised seizure. Serum sodium is 118 mmol/L. She is now drowsy and vomiting. Which is the most appropriate immediate treatment?

    1. AA bolus of 100 to 150 mL of 3% hypertonic saline, repeated if needed
    2. BFluid restriction to 800 mL per day
    3. CIntravenous 0.9% sodium chloride 1 L over 1 hour
    4. DOral tolvaptan 15 mg
    Show answer and explanation▾

    Answer: A. A bolus of 100 to 150 mL of 3% hypertonic saline, repeated if needed

    Exercise-associated hyponatraemia with seizures or severe symptoms needs prompt hypertonic saline, typically a 100 to 150 mL bolus of 3% saline over 10 to 20 minutes, repeated up to two further times until symptoms improve, aiming for an initial rise of about 4 to 6 mmol/L. Fluid restriction is too slow for life-threatening cerebral oedema, and isotonic saline may not raise the sodium adequately. Sodium must then be monitored closely to avoid overcorrection.

14. Question 14Hematologic and Oncologic Emergenciesmedium

    A 34-year-old woman has confusion, petechiae and fever. Haemoglobin is 78 g/L and platelets 12 x 10^9/L, with numerous schistocytes on the blood film, raised LDH, normal coagulation and creatinine 130 micromol/L. Which is the most appropriate immediate management?

    1. APlatelet transfusion to a count above 50 x 10^9/L
    2. BIntravenous immunoglobulin alone
    3. CFresh frozen plasma infusion and outpatient review
    4. DUrgent plasma exchange with corticosteroids
    Show answer and explanation▾

    Answer: D. Urgent plasma exchange with corticosteroids

    Microangiopathic haemolytic anaemia with severe thrombocytopenia, neurological features and normal coagulation strongly suggests thrombotic thrombocytopenic purpura, which is often fatal without urgent plasma exchange; corticosteroids, rituximab and caplacizumab are added for immune TTP, and treatment should start on clinical suspicion before ADAMTS13 results. Platelet transfusion is avoided unless there is life-threatening bleeding because it may worsen thrombosis. Plasma infusion is only a temporising measure if exchange is delayed.

15. Question 15Infectious Disease, HEENT, Ophthalmology, Dermatology and Palliative/End-of-Life Carehard

    A 45-year-old man has fever, headache and neck stiffness for 12 hours, and a new left hemiparesis. CT scanning will take about 40 minutes to arrange. Which sequence of management is most appropriate?

    1. ACT head, then lumbar puncture, then antibiotics and dexamethasone
    2. BBlood cultures, then dexamethasone and empirical antibiotics, then CT head
    3. CLumbar puncture immediately, then antibiotics, then CT head
    4. DEmpirical antibiotics only after CT shows no contraindication to lumbar puncture
    Show answer and explanation▾

    Answer: B. Blood cultures, then dexamethasone and empirical antibiotics, then CT head

    When lumbar puncture must be delayed for imaging because of focal neurology, blood cultures should be taken and dexamethasone with empirical antibiotics given immediately, before the CT, because delay in antibiotics increases mortality in bacterial meningitis. Lumbar puncture before imaging is unsafe with a focal deficit because of the risk of herniation. Waiting for CT before giving antibiotics is a common and dangerous error.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.