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100+ Free AOBEM Emergency Medicine Practice Questions

Pass your AOBEM Emergency Medicine Primary Certifying Examination exam on the first try — instant access, no signup required.

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Question 1
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A patient with sudden severe flank pain radiating to the groin and hematuria likely has which condition?

A
B
C
D
to track
2026 Statistics

Key Facts: AOBEM Emergency Medicine Exam

300 MCQs

Total Written Exam Questions

AOBEM Written Exam outline

6 hours

Total Testing Time (Six 60-min Sections)

AOBEM

Remote

Online Remote-Proctored Delivery

AOBEM 2026

~$210/yr

OCC/CORE Annual Fee

AOBEM CORE

~80-90%

First-Attempt Pass Rate (historical)

AOBEM published rates

300-500 hrs

Typical Study Time

EM residency graduates

AOBEM certification is one of two pathways (with ABEM) for emergency physicians in the US, and the AOA pathway preserves recognition of osteopathic principles and OMM in EM practice. The Written Exam consists of 300 single-best-answer MCQs across six 60-minute sections delivered via remote proctored testing, with first-attempt pass rates historically ~80-90%. After passing the Written, candidates complete the Oral/Clinical Exam, and ongoing certification is maintained via the CORE annual online exam plus the OCC framework (~$210/yr).

Sample AOBEM Emergency Medicine Practice Questions

Try these sample questions to test your AOBEM Emergency Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 62-year-old man presents with crushing substernal chest pain for 45 minutes. ECG shows 3 mm ST elevation in leads II, III, and aVF with reciprocal ST depression in I and aVL. What is the most appropriate next step?
A.Activate the cardiac catheterization lab for primary PCI
B.Administer IV nitroglycerin and observe for 30 minutes
C.Obtain a stat CT pulmonary angiogram
D.Begin fibrinolytic therapy with tenecteplase immediately
Explanation: This is an inferior STEMI. The standard of care is primary PCI with a door-to-balloon time of 90 minutes or less. Fibrinolytics are reserved for cases when PCI cannot be performed within 120 minutes of first medical contact.
2A patient in cardiac arrest has a rhythm of pulseless ventricular tachycardia. After two cycles of CPR and defibrillation, which medication should be administered next?
A.Atropine 1 mg IV
B.Epinephrine 1 mg IV
C.Adenosine 6 mg IV
D.Magnesium 2 g IV
Explanation: Per ACLS, epinephrine 1 mg IV/IO is given every 3-5 minutes during cardiac arrest. In a shockable rhythm, epinephrine is administered after the second defibrillation.
3A 24-year-old presents with intentional overdose of an unknown medication. ECG reveals QRS duration of 130 ms with a terminal R wave in aVR. What is the most appropriate treatment?
A.Activated charcoal alone
B.IV sodium bicarbonate
C.IV calcium gluconate
D.Hemodialysis
Explanation: Wide QRS with a terminal R in aVR is classic for tricyclic antidepressant overdose causing sodium channel blockade. IV sodium bicarbonate (1-2 mEq/kg bolus) narrows the QRS by overcoming the blockade and alkalinizing serum.
4A 30-year-old presents 4 hours after ingesting 25 acetaminophen 500 mg tablets. Serum acetaminophen level at 4 hours is 180 mcg/mL. What is the most appropriate management?
A.Discharge with reassurance
B.N-acetylcysteine
C.Gastric lavage and observation
D.Hemodialysis
Explanation: On the Rumack-Matthew nomogram, 180 mcg/mL at 4 hours is above the treatment line. N-acetylcysteine should be started promptly to replenish glutathione and prevent hepatotoxicity, ideally within 8 hours of ingestion.
5A 65-year-old woman presents with sudden-onset right-sided weakness and aphasia that began 90 minutes ago. NIHSS is 12 and head CT shows no hemorrhage. BP is 175/95. What is the next step?
A.IV alteplase (tPA)
B.Aspirin 325 mg PO
C.Heparin drip
D.Lower BP to <140/90 before any therapy
Explanation: Within the 4.5-hour window from last known well, IV alteplase is indicated for acute ischemic stroke after ruling out hemorrhage and confirming no major contraindications. BP <185/110 is acceptable for tPA candidates.
6A 5-week-old male presents with non-bilious projectile vomiting and an olive-shaped mass in the epigastrium. Labs show hypochloremic, hypokalemic metabolic alkalosis. What is the most likely diagnosis?
A.Intussusception
B.Pyloric stenosis
C.Malrotation with volvulus
D.Necrotizing enterocolitis
Explanation: Hypertrophic pyloric stenosis classically presents in 3-6 week-old boys with projectile non-bilious vomiting, palpable olive-shaped pyloric mass, and hypochloremic hypokalemic metabolic alkalosis. Ultrasound is the diagnostic test of choice.
7A 27-year-old G3P2 at 8 weeks gestation by LMP presents with right lower quadrant pain and vaginal spotting. Beta-hCG is 4,500 mIU/mL and transvaginal ultrasound shows an empty uterus with a complex right adnexal mass. What is the most likely diagnosis?
A.Threatened abortion
B.Ectopic pregnancy
C.Ovarian torsion
D.Heterotopic pregnancy
Explanation: With beta-hCG above the discriminatory zone (1,500-2,000 mIU/mL transvaginal) and no intrauterine gestational sac plus an adnexal mass, ectopic pregnancy is most likely. Management may be methotrexate (if stable and meets criteria) or surgical.
8A 40-year-old construction worker presents with a 70% TBSA partial-thickness burn from a building fire. He weighs 80 kg. Using the Parkland formula, what is the total fluid for the first 24 hours?
A.11,200 mL lactated Ringer's
B.22,400 mL lactated Ringer's
C.5,600 mL normal saline
D.16,800 mL D5W
Explanation: Parkland: 4 mL x kg x %TBSA = 4 x 80 x 70 = 22,400 mL of lactated Ringer's, given half over the first 8 hours and the other half over the next 16 hours, titrated to urine output ~0.5 mL/kg/h.
9A 35-year-old hiker is brought in unresponsive after being submerged in a frozen lake. Core temperature is 26 C (78.8 F) and there is no pulse. What is the most appropriate management?
A.Pronounce death; CPR is futile
B.Continue CPR and rewarm aggressively before terminating resuscitation
C.External pacing only
D.Bolus epinephrine every 3 minutes regardless of rhythm
Explanation: In severe hypothermia, the dictum 'not dead until warm and dead' applies. Continue CPR and active rewarming (ECMO, warmed lavage) until core temperature reaches at least 32-35 C before considering termination.
10A 28-year-old man is found unresponsive at a party. He has pinpoint pupils, RR 6, and decreased mental status. After bag-valve-mask ventilation, what is the most appropriate next medication?
A.Flumazenil 0.2 mg IV
B.Naloxone 0.4 mg IV
C.Glucagon 1 mg IM
D.Thiamine 100 mg IV
Explanation: The opioid toxidrome is miosis, respiratory depression, and decreased mental status. Naloxone 0.4-2 mg IV/IM/IN is the antidote and can be titrated to restore respirations.

About the AOBEM Emergency Medicine Exam

The AOBEM Emergency Medicine Primary Certifying Examination is the written component of AOA board certification in Emergency Medicine. It tests core EM knowledge across resuscitation and critical care, cardiovascular and neurologic emergencies, trauma, toxicology, pediatric and obstetric emergencies, environmental and musculoskeletal complaints, ED procedures and ultrasound, EMS, administration, and osteopathic principles applied to the ED. The written exam is delivered remotely once per year as 300 single-best-answer MCQs in six 50-item sections.

Questions

100 scored questions

Time Limit

6 hours testing (six 60-minute sections of 50 MCQs)

Passing Score

Criterion-referenced scaled standard set by AOBEM (typical AOA scale ~500/800; pass/fail reported)

Exam Fee

Application + exam fees per AOBEM fee schedule (American Osteopathic Board of Emergency Medicine (AOBEM))

AOBEM Emergency Medicine Exam Content Outline

20%

Resuscitation and Critical Care

ACLS algorithms (V-fib/pulseless VT, asystole/PEA, post-arrest TTM 32-36 C), RSI (etomidate, ketamine, rocuronium, succinylcholine cautions in hyperkalemia), difficult airway, sepsis bundle (lactate, cultures, broad-spectrum antibiotics within 1 h, 30 mL/kg crystalloid), septic vs cardiogenic vs hypovolemic shock, mechanical ventilation initial settings (lung-protective 6 mL/kg PBW).

15%

Cardiovascular Emergencies

STEMI (door-to-balloon <=90 min, fibrinolytics if PCI >120 min), NSTEMI/UA risk stratification (HEART score), arrhythmia management (adenosine 6-12-12 for SVT, synchronized cardioversion for unstable AF/flutter/SVT/VT with pulse), aortic dissection (Stanford A surgical, B medical with esmolol then nicardipine), hypertensive emergency, syncope (San Francisco rule), acute HF.

10%

Trauma

ATLS primary/secondary survey, hemorrhagic shock classes I-IV, massive transfusion 1:1:1 ratio, TXA within 3 hours, FAST/eFAST, Glasgow Coma Scale, NEXUS/Canadian C-spine rules, head injury (CT head rules), pelvic binder, tension pneumothorax (clinical diagnosis, decompression), burns (Parkland 4 mL x kg x %TBSA).

10%

Toxicology

Acetaminophen (Rumack-Matthew nomogram, NAC), salicylates (alkalinization, hemodialysis criteria), TCA (sodium bicarbonate for QRS >100 ms), beta-blocker/CCB (glucagon, high-dose insulin euglycemia), digoxin (Digibind), opioid (naloxone), benzodiazepine withdrawal, sympathomimetic toxidrome, anticholinergic toxidrome, methanol/ethylene glycol (fomepizole, dialysis), carbon monoxide (hyperbaric O2 criteria).

10%

Pediatric Emergencies

Pediatric Assessment Triangle, fever in neonate <=28 d (full sepsis workup, empiric antibiotics), bronchiolitis (supportive care), croup (dexamethasone, racemic epi), pediatric asthma, intussusception (currant jelly stool, air enema), pyloric stenosis (olive mass, hypochloremic metabolic alkalosis), Kawasaki disease, child abuse (sentinel injuries), neonatal congenital heart lesion (prostaglandin E1).

10%

OB/GYN and Neurologic Emergencies

Ectopic pregnancy (beta-hCG discriminatory zone, methotrexate vs surgery), pre-eclampsia/eclampsia (magnesium sulfate, BP control labetalol/hydralazine), postpartum hemorrhage (4 T's - tone/trauma/tissue/thrombin), stroke (tPA 0-4.5 h, thrombectomy 6-24 h with imaging), status epilepticus (benzo first then levetiracetam/fosphenytoin), SAH (CT then LP if negative, xanthochromia), bacterial meningitis (empiric antibiotics + dexamethasone).

10%

Environmental and Musculoskeletal

Heat stroke (active cooling to <39 C), severe hypothermia (rewarming, prolonged CPR until warm), drowning (no spine stabilization unless trauma), electrical/lightning injury, snakebite (CroFab), marine envenomation, decompression illness (hyperbaric O2), high-altitude pulmonary/cerebral edema (descent, dexamethasone, acetazolamide), compartment syndrome (delta pressure <30 mmHg, fasciotomy).

5%

Osteopathic Principles & OMM in ED

Rib raising for sympathetic balance in asthma/COPD, suboccipital release for tension headache, lumbar HVLA/muscle energy for acute LBP, treatment of somatic dysfunction in costochondritis, Chapman's reflex points, viscerosomatic reflexes guiding ED differential.

10%

Procedures, EMS, and Administration

Central line (subclavian/IJ/femoral), procedural sedation (ketamine, propofol, etomidate), point-of-care ultrasound (RUSH, FAST, lung, DVT), EMS systems and medical direction, disaster triage (START algorithm), medicolegal (EMTALA, informed consent, capacity), quality/safety, ED throughput.

How to Pass the AOBEM Emergency Medicine Exam

What You Need to Know

  • Passing score: Criterion-referenced scaled standard set by AOBEM (typical AOA scale ~500/800; pass/fail reported)
  • Exam length: 100 questions
  • Time limit: 6 hours testing (six 60-minute sections of 50 MCQs)
  • Exam fee: Application + exam fees per AOBEM fee schedule

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

AOBEM Emergency Medicine Study Tips from Top Performers

1Drill toxicology antidote pairs daily: acetaminophen-NAC, TCA-sodium bicarb, beta-blocker/CCB-glucagon/HIE, digoxin-Digibind, opioid-naloxone, methanol/ethylene glycol-fomepizole, organophosphate-atropine + pralidoxime, iron-deferoxamine, isoniazid-pyridoxine, lead-EDTA/DMSA, methemoglobinemia-methylene blue, sympathomimetic-benzodiazepines.
2Memorize pediatric red flags: fever in neonate <=28 d gets full sepsis workup and empiric antibiotics (ampicillin + gentamicin or cefotaxime), pyloric stenosis (hypochloremic hypokalemic metabolic alkalosis, olive mass), intussusception (currant jelly stool, target sign), Kawasaki diagnostic criteria, Wong-Baker pain scale, weight-based dosing in mg/kg.
3Master ECG/STEMI equivalents - posterior MI (V1-V2 reciprocal, confirm V7-V9), de Winter T waves, Wellens type A/B, Sgarbossa criteria in LBBB, hyperkalemia progression (peaked T - QRS widening - sine wave), Brugada type 1 coved ST, WPW delta, torsades vs polymorphic VT.
4For trauma, internalize ATLS reflexes: airway-cervical spine, breathing (tension PTX clinical), circulation (massive transfusion 1:1:1, TXA within 3 h), disability (GCS), exposure. Know NEXUS criteria, Canadian C-spine, Canadian head CT, Ottawa ankle/knee rules, and FAST view sequence (RUQ, LUQ, pelvis, subxiphoid).
5Practice OMM in ED scenarios: rib raising for sympathetic balance in asthma exacerbation, suboccipital release for tension-type headache, muscle energy/HVLA for acute somatic dysfunction in mechanical LBP, lymphatic pump techniques in pneumonia, Chapman's reflex points (e.g., anterior 2nd intercostal space - bronchi). Know contraindications such as Down syndrome cervical HVLA and acute fracture/instability.
6Time yourself on remote-proctored mock sections: 50 questions in 60 minutes (~1.2 min/question). Identify pacing breakdowns and practice the optional 10-minute between-section breaks so you simulate the real 6-section, 6-hour rhythm.

Frequently Asked Questions

Who is eligible for the AOBEM Emergency Medicine Primary Certifying Examination?

Candidates must be DO graduates (or MDs with approved equivalency) who have completed an ACGME-accredited Emergency Medicine residency (formerly an AOA-approved EM residency). An unrestricted US medical license, AOA membership where required, and a program director attestation of clinical competence are all required. Candidates must apply through AOBEM and pay applicable application and exam fees.

How is the AOBEM Written Exam structured?

The Written Exam is delivered annually via a remote proctored online platform. It consists of 300 single-best-answer multiple-choice questions divided into six 50-item sections, each with a 60-minute time limit. Candidates may take an optional 10-minute break after each section and an optional 40-minute lunch break after section 3. After passing the Written, candidates complete an Oral/Clinical Exam for full certification.

What does the AOBEM Written Exam cost?

AOBEM publishes its current fee schedule on the Applications and Payment page. Candidates submit application and exam fees per the fee schedule in effect at the time of registration. Continuous certification through the CORE annual online exam is included in the AOA Osteopathic Continuous Certification (OCC) annual fee, which is approximately $210 per year (AOBEM 2026).

What topics are tested on the AOBEM Written Exam?

The blueprint covers resuscitation and critical care, cardiovascular and neurologic emergencies, trauma, toxicology, pediatric and obstetric/gynecologic emergencies, environmental and musculoskeletal complaints, ED procedures and ultrasound, EMS, administration and medicolegal/ethics, and the application of osteopathic principles and OMM to acute presentations in the emergency department.

How long should I study for the AOBEM Written Exam?

Most EM residency graduates report 300-500 hours of dedicated study over 4-8 months. A typical plan allocates ~20% to resuscitation/critical care, ~15% to cardiovascular, ~10% each to trauma, toxicology, pediatrics, OB/neuro, and environmental, ~10% to procedures/EMS/administration, and ~5% to osteopathic principles and OMM in the ED.

What is the pass rate for the AOBEM Written Exam?

AOBEM publishes annual pass-rate statistics on its certification site. First-attempt pass rates for US-trained EM residency graduates have historically ranged about 80-90%, with retakers performing lower. Completing a structured EM board review (Rosh, Hippo, EM:RAP), drilling toxicology antidotes, and timing question-set practice correlates with success.

How is osteopathic content (OMM) tested on the AOBEM exam?

Approximately 5% of items address osteopathic principles and OMM applied in the ED - common scenarios include rib raising for respiratory complaints, suboccipital release for tension-type headache, muscle energy or HVLA for acute mechanical low back pain, and recognition of Chapman's reflex points and viscerosomatic reflexes. Candidates should know indications, contraindications, and basic technique principles.

What is CORE and how does AOBEM continuous certification work?

AOBEM has replaced the traditional 10-year recertification exam with the Continuous Osteopathic Recertification Examination (CORE), an annual online open-book exam taken from home. CORE is included within the AOA Osteopathic Continuous Certification (OCC) framework. Diplomates pay an annual OCC fee (~$210 in 2026) and complete CORE plus other OCC components (CME, practice performance, professionalism) to maintain certification.