100+ Free ABPS Emergency Medicine (BCEM) Practice Questions

Resuscitation & Cardiac Arrest (ACLS)

AHA 2025 ACLS algorithms, high-quality CPR (rate 100-120/min, depth 5-6 cm, full recoil), shockable vs non-shockable rhythms, defibrillation (biphasic 120-200 J), epinephrine 1 mg q3-5 min, amiodarone 300 mg for refractory VF/pVT, Hs and Ts reversible causes, post-ROSC care with targeted temperature management 32-36°C (TTM2), waveform capnography to confirm intubation and assess perfusion, ECMO/ECPR for refractory arrest.

Shock & Trauma

ATLS 10th edition primary/secondary survey, hemorrhagic shock classes, damage-control resuscitation with 1:1:1 plasma:platelets:pRBCs (PROPPR), TXA 1 g within 3 hours (CRASH-2), shock index (HR/SBP >0.9 = high risk), tension pneumothorax needle decompression (4th-5th ICS anterior axillary line), Parkland formula for burns (4 mL × kg × %TBSA), warfarin reversal with 4F-PCC + vitamin K, andexanet alfa for Factor Xa inhibitor reversal, idarucizumab for dabigatran, ruptured AAA with permissive hypotension.

Cardiovascular Emergencies

STEMI recognition (door-to-balloon ≤90 min, door-to-needle ≤30 min if fibrinolysis), inferior MI with RV infarction (avoid nitrates), unstable narrow-complex tachycardia (synchronized cardioversion 120-200 J), SVT with adenosine 6→12 mg, atrial fibrillation rate vs rhythm control, hyperkalemia ECG progression and calcium gluconate first, aortic dissection with BP differential and widened mediastinum, cardiac tamponade (Beck's triad, electrical alternans, pericardiocentesis), bedside echo for tamponade and PE.

Respiratory Emergencies

Acute severe asthma (continuous albuterol/ipratropium, IV/PO steroids, IV magnesium), silent chest as warning of impending failure, COPD exacerbation with BiPAP for hypercapnic failure, PE risk stratification (Wells, PERC, CTPA, V/Q if contrast contraindicated), thrombolysis for massive PE, ARDS lung-protective ventilation (TV 4-6 mL/kg PBW, plateau ≤30, permissive hypercapnia), SCAPE/acute pulmonary edema with NIPPV + high-dose IV nitroglycerin + diuresis, sickle cell acute chest syndrome with exchange transfusion.

Neurologic Emergencies

Acute ischemic stroke with IV alteplase within 4.5 hours, mechanical thrombectomy up to 24 hours for LVO with favorable imaging (DAWN/DEFUSE-3), status epilepticus first-line benzodiazepines (lorazepam 4 mg IV, midazolam 10 mg IM — RAMPART), ESETT second-line equivalence (levetiracetam/fosphenytoin/valproate), thunderclap headache and SAH workup with CT then LP, bacterial meningitis with antibiotics within 30 minutes plus dexamethasone, epidural vs subdural hematoma on CT, TBI ICP management with target PaCO2 35-40, hypoglycemia and altered mental status.

GI/Abdominal & Renal Emergencies

Acute appendicitis with Alvarado score and CT (US in pediatric/pregnant), mesenteric ischemia with pain out of proportion and pneumatosis intestinalis, upper GI bleeding with restrictive transfusion threshold Hgb 7, variceal bleeding with octreotide + ceftriaxone + endoscopy, acute pancreatitis with BISAP severity scoring and aggressive LR, DKA management (fluids first, insulin only if K ≥3.3, dextrose when glucose ≤200), AKI etiology (prerenal vs ATN vs postrenal), testicular torsion with emergent detorsion within 6 hours, rhabdomyolysis with aggressive crystalloid.

Toxicology

Cholinergic toxidrome (SLUDGE/BBB) and atropine + pralidoxime, acetaminophen toxicity with NAC and Rumack-Matthew nomogram, TCA overdose with sodium bicarbonate for QRS widening, opioid overdose with titrated naloxone, methanol/ethylene glycol with fomepizole + dialysis, osmolar gap, salicylate toxicity with bicarb and dialysis, beta-blocker/calcium-channel-blocker overdose with calcium, glucagon, high-dose insulin euglycemia, intralipid emulsion as rescue, digoxin toxicity with Fab fragments, cyanide with hydroxocobalamin, CO with HBOT criteria.

Pediatric Emergencies (PALS)

PALS algorithms, weight-based dosing (epinephrine 0.01 mg/kg of 1:10,000 IV/IO, defib 2→4 J/kg), croup with racemic epinephrine and dexamethasone, epiglottitis (rare post-Hib) with airway preparation, intussusception with currant jelly stool and air enema reduction, pyloric stenosis with non-bilious vomiting and pyloromyotomy, pediatric sepsis fluid resuscitation 10-20 mL/kg boluses with reassessment, NAT/non-accidental trauma red flags, foreign body management, button battery emergency.

OB/GYN Emergencies

Ectopic pregnancy and discriminatory zone (β-hCG 1500-2000 transvaginal), methotrexate vs surgical management, placental abruption with painful bleeding and rigid uterus, placenta previa with painless bleeding, eclampsia with magnesium sulfate 4-6 g IV load then 1-2 g/hr (Magpie trial superior to phenytoin), severe preeclampsia BP control (labetalol, hydralazine), shoulder dystocia HELPERR with McRoberts and suprapubic pressure (never fundal), postpartum hemorrhage 4 Ts with oxytocin/methergine/Hemabate/misoprostol, Bakri balloon.

Environmental Emergencies

Heat stroke with rapid cold-water immersion (cooling rate 0.15-0.25°C/min), severe hypothermia with modified ACLS (defer drugs/shocks until >30°C, 'not dead until warm and dead'), drowning, decompression illness and HBOT, lightning injuries, anaphylaxis with IM epinephrine 0.3-0.5 mg first-line, snake envenomation with CroFab/Anavip antivenom (no tourniquet/incision/suction), animal/human bites with augmentin, rabies and tetanus prophylaxis, frostbite with rapid rewarming.

Infectious Disease & Sepsis

Sepsis-3 definitions and qSOFA/SOFA, Surviving Sepsis Hour-1 bundle (lactate, cultures, broad-spectrum antibiotics within 1 hour, 30 mL/kg crystalloid, vasopressors), norepinephrine first-line, bacterial meningitis empiric ceftriaxone + vancomycin (+ ampicillin if >50 or immunocompromised) + dexamethasone, meningococcemia with petechial rash and droplet isolation, necrotizing fasciitis with surgical debridement and vancomycin + pip-tazo + clindamycin, toxic shock syndrome, HIV PEP within 72 hours, tetanus prophylaxis decision tree.

Procedural Skills

Rapid sequence intubation (RSI) 7 Ps with preoxygenation, induction agent choice (etomidate vs ketamine for septic shock), succinylcholine vs rocuronium, waveform capnography for tube confirmation (gold standard), central venous access with ultrasound guidance (IJ vs subclavian vs femoral), tube thoracostomy in safe triangle (4th-5th ICS anterior to midaxillary line), lumbar puncture indications and CT-before-LP criteria, cricothyroidotomy as rescue airway, chemical sedation with ketamine/midazolam/droperidol for excited delirium.

EM Point-of-Care Ultrasound

FAST exam four windows (pericardial, RUQ Morison's pouch, LUQ perisplenic, suprapubic), eFAST adds bilateral lung views for pneumothorax, RUSH protocol (Pump/Tank/Pipes) for undifferentiated shock, B-lines indicating interstitial fluid/pulmonary edema, A-lines and absent lung sliding for pneumothorax, bedside echo for RV strain in PE (McConnell's sign), cardiac standstill in arrest, AAA screening, IVC collapsibility for volume responsiveness, gallbladder/biliary, DVT compression.