100+ Free Arab Board EM Final Written Practice Questions

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Sample Arab Board EM Final Written Practice Questions

Try these sample questions to test your Arab Board EM Final Written exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 58-year-old man achieves return of spontaneous circulation (ROSC) after a 20-minute resuscitation for out-of-hospital ventricular fibrillation arrest. He remains comatose (GCS 3) with a blood pressure of 115/70 mmHg. According to current post-cardiac arrest care guidelines, what is the recommended targeted temperature management (TTM) strategy?

A.Select and actively maintain a constant target temperature between 32°C and 36°C for at least 24 hours, strictly preventing fever

B.Induce rapid deep hypothermia to a target temperature of 28°C to 30°C for 72 hours

C.Allow permissive hyperthermia up to 39°C to enhance enzymatic recovery and immune function

D.Maintain active warming to 38.5°C to optimize peripheral perfusion and metabolic rate

Explanation: Post-cardiac arrest guidelines recommend targeted temperature management (TTM) for comatose adult patients with ROSC, maintaining a constant target between 32°C and 36°C for at least 24 hours and strictly avoiding fever (>37.7°C) for at least 72 hours. Active temperature control prevents secondary neuronal injury from hyperthermia and reduces cerebral metabolic demand. Permissive fever and deep hypothermia (<30°C) are harmful.

2A 24-year-old woman with severe diabetic ketoacidosis (pH 6.88, pCO2 12 mmHg, HCO3 2 mEq/L, blood glucose 620 mg/dL) develops acute respiratory fatigue and requires emergency endotracheal intubation. Which physiological consideration is most critical during rapid sequence intubation (RSI) in this patient?

A.Minimize the duration of apnea and set mechanical ventilation to match her severe compensatory hyperventilation

B.Administer high-dose opioids to blunt the sympathetic response and deliberately induce hypoventilation

C.Set the post-intubation ventilator to standard resting minute ventilation (tidal volume 6 mL/kg, rate 12/min)

D.Administer sodium bicarbonate bolus after induction to eliminate the need for hyperventilation

Explanation: Patients with severe metabolic acidosis rely on extreme compensatory respiratory alkalosis (Kussmaul breathing) to survive. Even a brief period of apnea during RSI or inadequate post-intubation minute ventilation causes rapid acute PaCO2 elevation, leading to catastrophic systemic acidemia, cardiovascular collapse, and cardiac arrest. The ventilator must be programmed to provide very high minute ventilation to match pre-intubation spontaneous hyperventilation.

3During resuscitation of a 62-year-old man in out-of-hospital cardiac arrest, ventricular fibrillation persists despite four standard anterolateral defibrillation shocks at maximal energy, 3 mg of epinephrine, and 450 mg of amiodarone. Which strategy has demonstrated increased termination of refractory ventricular fibrillation?

A.Dual sequential external defibrillation (DSED) or vector change (VC) defibrillation

B.Immediate administration of intravenous calcium chloride and magnesium sulfate

C.Doubling the dose of intravenous epinephrine to 2 mg every 2 minutes

D.Switching from biphasic defibrillation to high-energy monophasic defibrillation

Explanation: The DOSE VF trial demonstrated that for refractory ventricular fibrillation (VF persisting after three standard shocks), vector change (VC) defibrillation (switching pads to anteroposterior) and double sequential external defibrillation (DSED) significantly increase termination of VF and survival to hospital discharge compared to standard shocks. DSED alters the myocardial electrical vectors and reduces transthoracic impedance.

4A 48-year-old marathon runner collapses with sudden cardiac arrest during a road race. Bystander CPR is initiated within 1 minute, and the first arriving EMS team documents ventricular fibrillation. After 25 minutes of high-quality ACLS in the field with ongoing refractory VF, the team considers extracorporeal cardiopulmonary resuscitation (E-CPR). Which set of clinical characteristics represents ideal candidate criteria for emergency veno-arterial ECMO cannulation?

A.Witnessed arrest, immediate bystander CPR, initial shockable rhythm, age under 65, and estimated cannulation within 60 minutes of collapse

B.Unwitnessed arrest, unknown downtime, initial asystole, and severe end-stage renal disease

C.Witnessed arrest with severe pre-existing severe dementia and metastatic lung cancer

D.Arrest duration exceeding 90 minutes with severe fixed dilated pupils and core temperature 38°C

Explanation: Extracorporeal cardiopulmonary resuscitation (E-CPR) protocols select patients with high likelihood of reversible pathology and minimal ischemic brain injury. Ideal criteria include witnessed collapse, immediate high-quality bystander CPR, initial shockable rhythm (VF/pVT), young or physiological age (<65 years), absence of devastating comorbidities, and total ischemic time to ECMO flow under 60 minutes.

5During closed-chest cardiopulmonary resuscitation for an intubated patient in pulseless electrical activity (PEA), the end-tidal carbon dioxide (ETCO2) tracing suddenly and sustainedly rises from 14 mmHg to 42 mmHg without any change in chest compression technique. What is the most appropriate immediate action?

A.Check for a central pulse and assess for return of spontaneous circulation (ROSC)

B.Administer an immediate 1 mg bolus of intravenous epinephrine

C.Increase chest compression rate to 140 compressions per minute

D.Extubate the patient because this indicates esophageal misplaced intubation

Explanation: A sudden, sustained increase in end-tidal CO2 (typically rising to >=35-40 mmHg) during active CPR is the earliest and most reliable physiological marker of return of spontaneous circulation (ROSC). It reflects the sudden restoration of endogenous cardiac output and pulmonary perfusion, delivering accumulated tissue CO2 to the lungs. The resuscitator should immediately pause compressions to palpate a central pulse.

6A 52-year-old woman with known severe idiopathic pulmonary arterial hypertension presents in severe respiratory distress from viral pneumonia. Her blood pressure is 80/50 mmHg, heart rate is 118 bpm, and room air SpO2 is 78%. She requires emergency tracheal intubation. Which induction strategy best preserves right ventricular (RV) hemodynamics and prevents acute RV decompensation?

A.Preload preservation, initiation of an inotrope/vasopressor (norepinephrine/epinephrine) prior to induction, and avoiding hypoxia/hypercarbia and high intrathoracic pressures

B.Aggressive fluid boluses of 4 liters normal saline followed by high-dose propofol induction and high PEEP ventilation

C.Rapid high-dose thiopental induction with prolonged apnea to facilitate direct laryngoscopy

D.High-dose ketamine monotherapy without supplemental vasopressors and high-rate bag-valve-mask hyperventilation

Explanation: Patients with severe pulmonary hypertension and acute RV failure are at extreme risk of cardiovascular collapse during intubation. Induction agents cause systemic vasodilation, while positive pressure ventilation increases RV afterload and decreases venous return. Resuscitation before intubation with early vasopressors (norepinephrine to maintain RV coronary perfusion) and gentle ventilation avoiding hypoxia and hypercarbia (potent pulmonary vasoconstrictors) are essential.

7A 45-year-old male trauma patient with extensive midface fractures and severe oropharyngeal hemorrhage cannot be intubated after two attempts by an experienced emergency physician. Insertion of a supraglottic airway device fails, and bag-valve-mask ventilation produces no chest rise with an SpO2 dropping to 62%. What is the most appropriate next step?

A.Perform an immediate scalpel-finger-bougie surgical cricothyroidotomy

B.Attempt awake blind nasotracheal intubation with a small endotracheal tube

C.Administer additional neuromuscular blockade and repeat video laryngoscopy

D.Request an urgent in-hospital anesthesiology consultation while continuing bag-mask attempts

Explanation: This patient is in a 'Can't Intubate, Can't Oxygenate' (CICO) failed airway emergency. In a CICO scenario, immediate emergency front-of-neck access (FONA) via a scalpel-finger-bougie surgical cricothyroidotomy is life-saving and mandatory. Delays to attempt further non-surgical methods lead to irreversible hypoxic brain injury and death.

8A 4-year-old child is brought to the emergency department in pulseless cardiac arrest following submersion in a swimming pool. Which pathophysiological difference between pediatric and adult cardiac arrest dictates the resuscitation priority?

A.Pediatric arrests are predominantly asphyxial/hypoxic in origin, making early effective ventilation and oxygenation crucial alongside compressions

B.Pediatric arrests are primarily caused by coronary thrombosis, requiring immediate defibrillation before ventilation

C.Pediatric myocardium has higher compliance and cannot generate cardiac output from external chest compressions

D.Children have higher glycogen stores and do not require epinephrine or chest compressions

Explanation: Unlike adults, whose cardiac arrests are most often primary cardiac/arrhythmic events (e.g., VF from ischemic heart disease), pediatric arrests are overwhelmingly secondary to progressive hypoxia, respiratory failure, or shock (asphyxial arrest). Therefore, high-quality chest compressions combined with immediate, effective ventilation (CAB or ABC with priority on oxygen delivery) are essential for pediatric resuscitation.

9A 32-year-old woman at 34 weeks gestation collapses in sudden cardiac arrest in the emergency department. Resuscitative efforts including CPR, defibrillation, and epinephrine are initiated immediately. At minute 4 of resuscitation, there is no ROSC. In addition to manual left uterine displacement, what intervention should be performed immediately?

A.Perform emergency perimortem cesarean delivery (resuscitative hysterotomy) at the bedside

B.Place the patient in a full 90-degree left lateral decubitus position and stop compressions

C.Administer 100 g of intravenous magnesium sulfate and high-dose oxytocin bolus

D.Transfer the patient to the main operating room suite for emergency delivery

Explanation: In maternal cardiac arrest beyond 20-24 weeks gestation (fundus at or above the umbilicus), aortocaval compression by the gravid uterus severely reduces venous return and limits the efficacy of chest compressions. If ROSC is not achieved within 4 minutes of arrest, immediate bedside resuscitative hysterotomy (perimortem cesarean section) should be initiated and completed by minute 5. This relieves inferior vena cava compression, significantly improving maternal resuscitation success and fetal survival.

10A 65-year-old man achieves ROSC following cardiac arrest due to an acute anterior STEMI. He is mechanically ventilated. Arterial blood gas on 100% FiO2 reveals pH 7.34, PaCO2 42 mmHg, and PaO2 340 mmHg with an SpO2 of 100%. What is the most appropriate adjustment to his oxygen therapy?

A.Titrate FiO2 downward to target an arterial oxygen saturation (SpO2) of 92% to 98% (or PaO2 80-100 mmHg)

B.Maintain FiO2 at 100% to maximize myocardial oxygen delivery and prevent tissue hypoxia

C.Increase positive end-expiratory pressure (PEEP) to 20 cmH2O to enhance oxygen diffusion

D.Add nitric oxide to improve pulmonary capillary microvascular recruitment

Explanation: Hyperoxia following resuscitation from cardiac arrest induces intense coronary and cerebral vasoconstriction and generates reactive oxygen species (free radicals), exacerbating reperfusion injury and worsening neurological outcomes. Guidelines strongly recommend titrating supplemental oxygen immediately following ROSC to maintain an SpO2 between 92% and 98% (or normoxia with PaO2 80-100 mmHg), avoiding both hypoxia and hyperoxia.

About the Arab Board EM Final Written Exam

The Arab Board Emergency Medicine Final Written Examination is the culminating cognitive assessment required for board certification by the Arab Board of Health Specializations (ABHS). Spanning all essential domains of modern emergency practice, this examination tests senior residents and specialist candidates on high-stakes clinical decision-making, complex resuscitation, trauma management, critical care, pediatric emergencies, toxicology, diagnostic modalities including bedside ultrasound, and system-level operations.

Assessment

A comprehensive final exit written examination of multiple-choice single-best-answer questions assessing advanced clinical emergency medicine decision-making, resuscitation, trauma, acute subspecialties, and prehospital/administrative systems.

Time Limit

Approximately 3 hours

Passing Score

60%. The ABHS examination-affairs decisions fix the pass mark at 60% for the primary written, final written and clinical/oral examinations across every scientific council; recent council guidebooks add that the mark is confirmed by criterion-referenced standard setting (Angoff/Hofstee) under the Arab Board bylaws.

Exam Fee

Set by ABHS and national councils (Arab Board of Health Specializations (ABHS) - Scientific Council of Emergency Medicine)

Arab Board EM Final Written Exam Content Outline

14%

Resuscitation and Advanced Airway

Physiologically difficult airway management, rapid sequence intubation (RSI) pharmacotherapy, refractory ventricular arrhythmias, post-resuscitation hemodynamic and neurological optimization, and extracorporeal cardiopulmonary resuscitation (E-CPR).

14%

Cardiovascular Emergencies

Hyperacute coronary syndromes, STEMI equivalents (de Winter, Wellens, Sgarbossa criteria), cardiogenic shock classification and vasopressor selection, aortic dissection and rupture, acute decompensated heart failure, and complex channelopathies.

14%

Trauma, Orthopedics, and Burns

Balanced massive transfusion, viscoelastic hemostatic assays (TEG/ROTEM), resuscitative endovascular balloon occlusion of the aorta (REBOA), emergency thoracotomy, severe traumatic brain injury, pelvic binders, and extensive thermal injury.

12%

Pediatric Emergency Medicine

Pediatric septic shock guidelines, neonatal resuscitation program (NRP) algorithms, pediatric status epilepticus, acute upper airway obstruction (croup, bacterial tracheitis), congenital heart disease emergencies, and pediatric trauma resuscitation.

12%

Toxicology and Environmental Emergencies

Toxicologic mechanisms, toxic alcohol management, calcium channel blocker and beta-blocker overdose interventions (high-dose insulin, lipid emulsion), regional snake/scorpion envenomations, severe exertional heat stroke, and hypothermia rewarming protocols.

10%

Neurology, Stroke, and Critical Care

Thrombolysis and endovascular thrombectomy inclusion/exclusion criteria, blood pressure targets in intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage grading and management, status epilepticus escalations, and acute neuromuscular weakness.

10%

Infectious Diseases, Sepsis, and Critical Care

Sepsis-3 definitions, Surviving Sepsis Campaign bundle execution, septic shock in special populations (neutropenic fever, transplant recipients), severe soft tissue infections (necrotizing fasciitis), and central nervous system infections.

Emergency Ultrasound, Diagnostics, and Procedures

Point-of-care ultrasound (POCUS) diagnostic accuracy in undifferentiated shock (RUSH exam), advanced lung ultrasound in acute dyspnea (BLUE protocol), focused vascular ultrasound for DVT, and critical emergency procedures.

Administrative, Disaster, and Prehospital Systems

Emergency department crowding, throughput optimization, disaster triage systems (START/SALT), prehospital protocol adherence, medical ethics, patient autonomy, and error disclosure in emergency care.

How to Pass the Arab Board EM Final Written Exam

What You Need to Know

Passing score: 60%. The ABHS examination-affairs decisions fix the pass mark at 60% for the primary written, final written and clinical/oral examinations across every scientific council; recent council guidebooks add that the mark is confirmed by criterion-referenced standard setting (Angoff/Hofstee) under the Arab Board bylaws.
Assessment: A comprehensive final exit written examination of multiple-choice single-best-answer questions assessing advanced clinical emergency medicine decision-making, resuscitation, trauma, acute subspecialties, and prehospital/administrative systems.
Time limit: Approximately 3 hours
Exam fee: Set by ABHS and national councils

Keys to Passing

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

Arab Board EM Final Written Study Tips from Top Performers

1Focus extensively on high-yield scenario questions involving physiologically difficult airways, shock-refractory arrhythmias, and hemodynamically unstable trauma patients where sequential decision-making is critical.

2Review evidence-based guidelines including the 2026/current Surviving Sepsis Campaign recommendations, AHA/ERC ACLS guidelines, ATLS 10th/11th edition principles, and acute stroke thrombectomy trial criteria.

3Practice interpreting emergency point-of-care ultrasound findings (RUSH protocol, BLUE protocol), 12-lead ECGs with subtle ischemia equivalents (Wellens, de Winter, posterior MI), and toxicologic toxidromes with specific antidote regimens.

Frequently Asked Questions

What is the format of the Arab Board Emergency Medicine Final Written Examination?

The examination is typically delivered as a single-best-answer multiple-choice question (MCQ) format consisting of approximately 150 questions across one or two examination papers, lasting about 3 hours in total.

What is the passing standard for the ABHS EM Final Written Exam?

While the exact pass mark is determined through standard-setting methods by the Scientific Council of Emergency Medicine for each examination cohort, candidates generally aim for a benchmark of 60% or higher.

What eligibility requirements must be met before taking the Final Written Exam?

Candidates must have successfully completed the required years of accredited residency training in emergency medicine under an ABHS-recognized training center and passed the Part 1 examination as well as all in-training evaluation requirements.

How does the Final Written Examination differ from the Part 1 Written Exam?

Part 1 focuses heavily on core foundational knowledge, basic sciences, and standard clinical algorithms. The Final Written Exam emphasizes advanced clinical decision-making, nuanced diagnostic reasoning, multimodal critical care interventions, trauma resuscitation, toxicology, bedside ultrasonography, and administrative systems.

100+ Free Arab Board EM Final Written Practice Questions

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