Free Practice Questions for Iran Specialty Board - Emergency Medicine

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Key Facts: Iran Specialty Board - Emergency Medicine Exam

150

Total multiple-choice questions on the written national specialty board examination

Sanjesh Pezeshki National Specialty Board Regulations

70%

Written stage qualifying threshold (105 / 150) required to advance to the clinical OSCE

Council for Medical and Specialized Education, MOHME

210 min

Total time limit for the written examination (4 hours; ~95 seconds per question)

National Center for Health Assessment Administration Guidelines

Negative marking: incorrect answers receive 0 points without deducting marks

Secretariat for Medical and Specialized Education Examination Rules

2 Stages

Two-phase examination: National Written MCQ stage followed by multi-station clinical OSCE/simulation

Iranian Board of Emergency Medicine Official Curriculum

The Iranian Specialty Board in Emergency Medicine (آزمون دانشنامه تخصصی طب اورژانس) is the definitive terminal certification exam for emergency physicians in Iran. Administered annually by Sanjesh Pezeshki, it features a 152-question, 240-minute written MCQ exam requiring a 70% score (105/150) with no negative marking to qualify for the practical OSCE and simulation assessment.

Sample Iran Specialty Board - Emergency Medicine Practice Questions

Try these sample questions to review concepts for the Iran Specialty Board - Emergency Medicine exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 56-year-old man collapses in the emergency department waiting room. The monitor displays ventricular fibrillation. A 200 J biphasic defibrillation shock is delivered. What is the immediate next step in management?

A.Resume chest compressions immediately for 2 minutes without pausing for rhythm or pulse check

B.Perform an immediate pulse and rhythm check to assess conversion

C.Administer amiodarone 300 mg intravenous push immediately

D.Deliver a second consecutive 200 J biphasic shock

Explanation: Current advanced cardiac life support guidelines dictate that chest compressions must be resumed immediately following defibrillation without pausing for a rhythm or pulse check. Post-shock myocardial stunning is common, and immediate rhythm or pulse checks waste crucial perfusion time during the vulnerable early post-shock period. Pulse and rhythm assessments are deferred until completing the full 2-minute CPR cycle.

2A 62-year-old woman achieves return of spontaneous circulation (ROSC) following out-of-hospital cardiac arrest due to ventricular tachycardia. She remains comatose with a Glasgow Coma Scale score of 4. What is the recommended targeted temperature management (TTM) strategy?

A.Permit active hyperthermia up to 38.5°C to preserve enzymatic metabolic activity

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

C.Rapidly cool the patient to 28°C to induce deep cerebral metabolic suppression

D.Induce hypothermia for exactly 6 hours followed by rapid rewarming at 1.5°C per hour

Explanation: Post-cardiac arrest guidelines recommend targeted temperature management selecting and maintaining a constant temperature between 32°C and 36°C for at least 24 hours in comatose post-cardiac arrest patients, with active fever prevention (maintaining temperature below 37.5°C) for at least 72 hours. Controlled normothermia or mild hypothermia provides neuroprotection by blunting reperfusion injury, apoptosis, and free radical generation.

3A 50-year-old trauma victim with severe hemorrhagic shock (blood pressure 72/40 mmHg, heart rate 138 beats/min) requires urgent endotracheal intubation for acute respiratory failure. Which induction agent is preferred for rapid sequence intubation (RSI) due to its hemodynamic stability?

A.Propofol 2 mg/kg intravenous push

B.Thiopental 4 mg/kg intravenous push

C.Etomidate 0.15 to 0.3 mg/kg intravenous push

D.Midazolam 0.3 mg/kg intravenous push

Explanation: Etomidate is the induction agent of choice in critically unstable and hypotensive patients because it produces negligible myocardial depression and preserves peripheral vascular tone. While ketamine is also widely used, its sympathetic stimulation may fail if endogenous catecholamines are depleted, whereas propofol and thiopental trigger profound systemic vasodilation and severe cardiovascular collapse.

4A 45-year-old intubated patient with severe acute respiratory distress syndrome (ARDS) secondary to aspiration pneumonia is receiving mechanical ventilation. Which parameter combination aligns with established lung-protective mechanical ventilation principles?

A.Tidal volume of 10 to 12 mL/kg actual body weight with zero end-expiratory pressure

B.Tidal volume of 8 to 10 mL/kg actual body weight and plateau pressure targeting 40 cmH2O

C.Tidal volume of 6 mL/kg actual body weight with plateau pressure limit of 35 cmH2O

D.Tidal volume of 4 to 6 mL/kg predicted body weight with plateau pressure kept below 30 cmH2O

Explanation: The ARDSNet lung-protective ventilation protocol requires low tidal volumes of 4 to 8 mL/kg of predicted body weight (PBW, calculated from sex and height, never actual weight) and maintaining end-inspiratory plateau pressure below 30 cmH2O. This strategy prevents ventilator-induced lung injury (volutrauma and barotrauma) while titrating positive end-expiratory pressure (PEEP) to avoid atelectotrauma.

5During an emergency airway management scenario in a morbidly obese trauma patient, direct laryngoscopy and video laryngoscopy fail. Bag-valve-mask ventilation and a second-generation supraglottic airway device fail to achieve adequate chest rise or oxygenation (SpO2 drops to 68%). What is the definitive immediate next action?

A.Perform an immediate emergency surgical cricothyroidotomy

B.Attempt awake flexible fiberoptic intubation

C.Administer additional intravenous rocuronium and re-attempt video laryngoscopy

D.Place a nasopharyngeal airway and continue positive-pressure bag-valve ventilation

Explanation: This patient is in a 'cannot intubate, cannot oxygenate' (CICO) failed airway crisis. Once endotracheal intubation, supraglottic airway rescue, and bag-valve-mask ventilation have all failed, immediate surgical access via scalpel-bougie-tube cricothyroidotomy is mandatory to prevent anoxic brain injury and death.

6A 68-year-old male presents with severe septic shock from acute pyelonephritis (blood pressure 76/44 mmHg, serum lactate 4.8 mmol/L). According to international Surviving Sepsis Campaign guidelines, what is the recommended initial crystalloid fluid resuscitation volume?

A.10 mL/kg of 0.45% sodium chloride over 6 hours

B.At least 30 mL/kg of balanced crystalloid within the first 3 hours

C.50 mL/kg of 5% dextrose in water within 1 hour

D.A fixed volume of 500 mL normal saline followed by immediate vasopressors

Explanation: Surviving Sepsis Campaign guidelines recommend administration of at least 30 mL/kg of intravenous crystalloid (preferably balanced crystalloids such as lactated Ringer's or Plasma-Lyte) within the first 3 hours of resuscitation for patients with sepsis-induced hypoperfusion or septic shock. Fluid responsiveness should be reassessed dynamically to avoid harmful hypervolemia.

7A patient with fever and hypotension is evaluated with invasive hemodynamics. Measurements reveal a high cardiac index (4.8 L/min/m2), low systemic vascular resistance index (SVRI 950 dyn·s/cm5/m2), and low pulmonary capillary wedge pressure (PCWP 6 mmHg). Which shock state does this profile reflect?

A.Cardiogenic shock secondary to acute myocardial infarction

B.Obstructive shock secondary to massive pulmonary embolism

C.Distributive shock secondary to severe sepsis

D.Hypovolemic shock secondary to massive gastrointestinal hemorrhage

Explanation: Distributive shock (most commonly septic shock) is characterized hemodynamically by profound peripheral vasodilation (low systemic vascular resistance) and a hyperdynamic compensatory state resulting in elevated cardiac index and low-to-normal intracardiac filling pressures. Conversely, cardiogenic and hypovolemic shock exhibit high systemic vascular resistance as compensatory vasoconstriction occurs.

8A 60-year-old man in cardiac arrest has persistent ventricular fibrillation refractory to five conventional defibrillation shocks, high-dose epinephrine, and amiodarone. The resuscitation team prepares for dual sequential external defibrillation (DSED). Which principle correctly describes DSED implementation?

A.Apply both sets of pads simultaneously in the anterolateral position and fire them exactly at the same millisecond from one defibrillator

B.Connect one manual defibrillator to two cables and double the joule output through a single pair of pads

C.Deliver shocks from two separate defibrillators spaced 10 minutes apart while pausing chest compressions

D.Apply two separate pad pairs in anterolateral and anteroposterior orientations, firing two separate defibrillators with a rapid sequential interval of less than 100 milliseconds

Explanation: Dual sequential external defibrillation (DSED) uses two separate defibrillators with one pad pair in the standard anterolateral position and the second pair in the anteroposterior position. The two devices are triggered in rapid succession (<100 milliseconds apart), changing the defibrillation vector and overcoming elevated myocardial transthoracic impedance to successfully terminate refractory ventricular fibrillation.

9A 24-year-old motor vehicle collision unrestrained driver sustains a complete cervical spinal cord transection at C5. On arrival, vital signs show blood pressure 80/46 mmHg and heart rate 46 beats/min. Extremities are warm and well-perfused. What pathophysiological mechanism accounts for this hemodynamic state?

A.Loss of sympathetic outflow leading to unopposed parasympathetic vagal tone and profound vasodilation

B.Excessive sympathetic stimulation with catecholamine depletion and adrenal exhaustion

C.Concealed retroperitoneal hemorrhage causing severe hypovolemia

D.Pericardial tamponade causing mechanical outflow tract obstruction

Explanation: Neurogenic shock results from disruption of descending autonomic sympathetic pathways within the cervical or upper thoracic spinal cord (above T6). The loss of sympathetic vascular tone causes profound arterial and venous vasodilation (warm extremities, hypotension), while loss of cardiac sympathetic accelerator fibers leaves parasympathetic vagal tone unopposed, producing classic paradoxical bradycardia.

10A 35-year-old male with extensive bilateral crush injuries to his lower extremities sustained 4 days ago presents in acute respiratory failure. You decide to perform rapid sequence intubation. What paralytic dosing and selection is most appropriate?

A.Succinylcholine 1.5 mg/kg intravenous push

B.Rocuronium 1.2 mg/kg intravenous push

C.Vecuronium 0.05 mg/kg intravenous push

D.Cisatracurium 0.1 mg/kg intravenous push

Explanation: Succinylcholine is strictly contraindicated in subacute crush injuries, denervation syndromes, or extensive burns older than 24 to 72 hours due to upregulation of extrajunctional acetylcholine receptors, which can trigger massive, fatal hyperkalemic cardiac arrest. High-dose rocuronium (1.2 mg/kg IV) provides intubating conditions within 45 to 60 seconds comparable to succinylcholine without affecting serum potassium.

About the Iran Specialty Board - Emergency Medicine Exam

The Iranian Medical Specialty Board Examination in Emergency Medicine (آزمون دانشنامه تخصصی طب اورژانس) is the apex certifying credential for emergency physicians in the Islamic Republic of Iran. Completion of a recognized three-year residency program in Emergency Medicine accredited by the Iranian Ministry of Health and Medical Education (MOHME)—hosted across premier academic medical centers including Tehran University of Medical Sciences (TUMS), Shahid Beheshti University of Medical Sciences (SBMU), Iran University of Medical Sciences (IUMS), Shiraz University of Medical Sciences, Isfahan University of Medical Sciences, and Tabriz University of Medical Sciences—culminates in this dual-phase national evaluation. Graduating residents must first clear the certification (گواهینامه تخصصی) criteria and successfully pass the rigorous 152-question written examination with at least 105 correct answers (70%) without penalty for incorrect choices. Attaining board certification (دانشنامه تخصصی) confers board diplomat status, authorizing independent tertiary hospital practice, academic university faculty appointments, and enrollment in subspecialty fellowship training programs such as Medical Toxicology, Pediatric Emergency Medicine, Disaster Medicine, and Critical Care Medicine. The exam covers resuscitation and advanced airway management, cardiovascular and pulmonary crises, trauma resuscitations, mass casualty incident management, toxidromes and regional envenomations (e.g., Hemiscorpius lepturus, saw-scaled viper), acute neurology, and urgent surgical and pediatric pathologies. This resource is an independent English-language MCQ study adaptation developed by OpenExamPrep to facilitate clinical reasoning, vignette deconstruction, and core curriculum mastery. It is not an official exam paper and is not sponsored by or affiliated with Sanjesh Pezeshki.

Exam sponsor: Council for Medical and Specialized Education & Sanjesh Pezeshki (دبیرخانه شورای آموزش پزشکی و تخصصی و مرکز سنجش آموزش پزشکی). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

The Iranian Specialty Board (دانشنامه تخصصی) in Emergency Medicine is administered annually in late summer (Shahrivar / September) under the auspices of the Secretariat for the Council for Medical and Specialized Education and the National Center for Health Assessment (Sanjesh Pezeshki). The examination is conducted in two mandatory consecutive stages: (1) The National Written Stage consisting of 152 multiple-choice questions administered over 240 minutes (1.6 minutes per question) with zero negative marking. Candidates must achieve a minimum qualifying score of 70% of the written total (105 of 150 points) to pass the written gate. (2) The National Clinical/Practical Stage (OSCE) administered within days of written results, evaluating clinical decision-making across structured multi-station oral examinations, point-of-care ultrasound (POCUS) video loops, ECG and radiological interpretation stations, airway/procedural skill stations, and computerized high-fidelity resuscitation simulation scenarios. Official syllabus references are Tintinalli's Emergency Medicine: A Comprehensive Study Guide and Rosen's Emergency Medicine: Concepts and Clinical Practice.

Time Limit

240 minutes

Passing Score

70% of the written total (105 of 150 points)

Exam / Certification Fees

Set annually by the Iranian Ministry of Health and Medical Education (MOHME) via Sanjesh Pezeshki

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

20%

Resuscitation, Shock & Advanced Airway Management (احیا، شوک و مدیریت پیشرفته راه هوایی)

Adult and pediatric advanced life support (ACLS/PALS) algorithms, post-cardiac arrest care, targeted temperature management (TTM), rapid sequence intubation (RSI) pharmacology, difficult and failed airway algorithms, surgical cricothyroidotomy, non-invasive positive pressure ventilation (BiPAP/CPAP), mechanical ventilation management in ARDS and severe obstructive airway disease, differentiation and resuscitation of hypovolemic, cardiogenic, distributive, and obstructive shock, and invasive hemodynamic monitoring.

20%

Cardiovascular & Pulmonary Emergencies (اورژانس‌های قلب و عروق و ریه)

Acute coronary syndromes (STEMI, high-risk non-STEMI equivalents such as de Winter, Wellens, and Sgarbossa criteria), acute decompensated heart failure, cardiogenic pulmonary edema, Stanford Type A and Type B aortic dissection, acute pulmonary embolism risk stratification and systemic vs. catheter-directed thrombolysis, cardiac tamponade, unstable tachydysrhythmias and electrical cardioversion, symptomatic bradydysrhythmias and transcutaneous pacing, acute severe asthma exacerbations, life-threatening COPD exacerbations, and tension pneumothorax.

20%

Trauma Management, Disaster Medicine & Environmental Emergencies (مدیریت تروما، حوادث و بلایا و طب محیطی)

Advanced Trauma Life Support (ATLS) protocols, massive transfusion protocols and tranexamic acid (TXA) utilization, traumatic brain injury (TBI) resuscitation, secondary brain insult prevention, blunt and penetrating thoracic trauma (massive hemothorax, cardiac box injuries), FAST and extended-FAST (eFAST) ultrasound, blunt abdominal trauma and hollow viscus rupture, unstable pelvic fracture stabilization and preperitoneal packing, extremity compartment syndrome, mass casualty triage protocols (START, SALT), disaster incident command systems, severe hypothermia, heat stroke, electrical burns, and submersion.

15%

Toxicology & Overdoses (سم‌شناسی بالینی و مسمومیت‌ها)

Anticholinergic, cholinergic, sympathomimetic, sedative-hypnotic, and opioid toxidromes; regional Iranian venomous snakes (Pseudocerastes persicus, Echis carinatus, Vipera lebetina) and antivenom therapy; scorpion envenomation (cytotoxic Hemiscorpius lepturus vs. neurotoxic Androctonus crassicauda); acute organophosphate and carbamate poisoning and oxime therapy; opioid and synthetic fentanyl toxicity; acetaminophen overdose nomograms and IV/oral N-acetylcysteine protocols; salicylate poisoning, urinary alkalinization, and hemodialysis thresholds; beta-blocker and calcium channel blocker overdose antidote regimens (high-dose insulin euglycemia); toxic alcohols (methanol and ethylene glycol) with fomepizole/ethanol and hemodialysis; carbon monoxide and cyanide intoxication.

15%

Neurologic, Gastrointestinal & Metabolic Emergencies (اورژانس‌های اعصاب، گوارش و متابولیک)

Acute ischemic stroke evaluation, intravenous alteplase/tenecteplase criteria, endovascular thrombectomy indications and contraindications, spontaneous intracerebral hemorrhage blood pressure reduction, aneurysmal subarachnoid hemorrhage diagnosis and nimodipine therapy, generalized convulsive status epilepticus stepped medical protocol, acute bacterial meningitis empiric antibiotic and dexamethasone regimens, acute upper and lower gastrointestinal hemorrhage resuscitation, variceal bleeding pharmacotherapy and endoscopic timing, acute pancreatitis severity stratification, mesenteric ischemia, diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) fluid/insulin protocols, severe hyperkalemia emergent stabilization, and adrenal crisis.

10%

Pediatric, Obstetric & Orthopedic Emergencies (اورژانس‌های کودکان، مامایی و ارتوپدی)

Pediatric respiratory emergencies (croup, epiglottitis, foreign body airway obstruction, bronchiolitis), pediatric septic shock and crystalloid resuscitation guidelines, neonatal fever and resuscitation, preeclampsia with severe features and magnesium sulfate seizure prophylaxis, eclamptic seizure management, postpartum hemorrhage stepped protocols, ectopic pregnancy diagnosis and ruptured ectopic management, perimortem cesarean section (resuscitative hysterotomy), septic arthritis differentiation, open fracture classification and urgent antimicrobial prophylaxis, and acute joint dislocations.

Preparing for the Iran Specialty Board - Emergency Medicine Exam

What You Need to Know

Passing score: 70% of the written total (105 of 150 points)
Assessment: The Iranian Specialty Board (دانشنامه تخصصی) in Emergency Medicine is administered annually in late summer (Shahrivar / September) under the auspices of the Secretariat for the Council for Medical and Specialized Education and the National Center for Health Assessment (Sanjesh Pezeshki). The examination is conducted in two mandatory consecutive stages: (1) The National Written Stage consisting of 152 multiple-choice questions administered over 240 minutes (1.6 minutes per question) with zero negative marking. Candidates must achieve a minimum qualifying score of 70% of the written total (105 of 150 points) to pass the written gate. (2) The National Clinical/Practical Stage (OSCE) administered within days of written results, evaluating clinical decision-making across structured multi-station oral examinations, point-of-care ultrasound (POCUS) video loops, ECG and radiological interpretation stations, airway/procedural skill stations, and computerized high-fidelity resuscitation simulation scenarios. Official syllabus references are Tintinalli's Emergency Medicine: A Comprehensive Study Guide and Rosen's Emergency Medicine: Concepts and Clinical Practice.
Time limit: 240 minutes
Exam / certification fees: Set annually by the Iranian Ministry of Health and Medical Education (MOHME) via Sanjesh Pezeshki Official sources

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Iran Specialty Board - Emergency Medicine: Suggested Study Strategy

1Prioritize High-Weight Triad: Resuscitation (20%), Cardiovascular/Pulmonary (20%), and Trauma (20%) together account for 60% of all written board questions. Absolute mastery of ACLS/PALS algorithms, difficult airway decision pathways, acute coronary syndromes, and ATLS shock protocols is the bedrock of passing.

2Master Regional Iranian Toxicology & Envenomation: Pay special attention to clinical manifestations and management of regional Iranian envenomations—specifically the cytotoxic, microangiopathic hemolytic effects of Hemiscorpius lepturus ('Ghadim' scorpion) and Viperidae venom (Echis carinatus, Pseudocerastes), as well as organophosphate pesticide protocols and toxic alcohol poisoning.

3Memorize Specific Diagnostic Cutoffs & Time Windows: Focus on exact therapeutic windows and cutoffs frequently queried in written items, such as IV thrombolytic eligibility time windows in acute ischemic stroke (up to 4.5 hours), door-to-balloon time goals in STEMI (<90 minutes), Rumack-Matthew nomogram 4-hour acetaminophen levels (150 mcg/mL), and hyperkalemia ECG progression.

4Hone 84-Second Clinical Decision Pacing: Train on multi-sentence clinical vignettes containing vital signs, laboratory data, and ECG descriptions to rapidly identify life-threatening diagnoses and choose the definitive next step in management within 75 to 80 seconds.

5Exploit Zero Negative Marking: Since incorrect answers carry no score deductions, never leave any question unanswered on test day. Develop the skill of rapid distractor elimination to maximize expected value across challenging multi-step scenario questions.

Frequently Asked Questions

What is the Iranian Specialty Board Examination in Emergency Medicine (آزمون دانشنامه تخصصی طب اورژانس)?

The Iranian Specialty Board in Emergency Medicine (Daneshnameh Takhasosi Teb Oorzhans) is the highest official medical certifying examination for emergency physicians in Iran. Concurrently administered by the National Center for Health Assessment (Sanjesh Pezeshki) and the Secretariat for the Council for Medical and Specialized Education of the Ministry of Health and Medical Education, it grants board-certified specialist status (Diplomate of the Iranian Board of Emergency Medicine), enabling independent practice, hospital department leadership, academic university faculty appointments, and subspecialty fellowship eligibility.

What are the structure, question count, and time limit of the written examination?

The written examination consists of exactly 152 four-option multiple-choice questions administered in a single morning session lasting 240 minutes (4 hours). This provides candidates an average of 95 seconds per question to read, evaluate, and solve complex clinical vignettes.

What is the passing score for the written board exam, and is there negative marking?

The passing score for the written examination is set strictly at 70% (105 points out of a written total of 150). There is NO negative marking in the Iranian Specialty Board exam: incorrect answers receive zero points and do not detract from the cumulative score. Candidates scoring 105 or above qualify immediately for the practical clinical examination (OSCE).

How is the clinical / OSCE stage structured?

Candidates who pass the written exam proceed to the multi-station clinical examination (OSCE and PMP/simulation). This stage evaluates practical competencies through standardized patient interactions, video and static point-of-care ultrasound (POCUS) interpretation, electrocardiography and neuroimaging stations, procedural airway and vascular access skill demonstrations, and high-fidelity computerized emergency scenario simulations.

What are the primary reference textbooks designated by the Ministry of Health for this board exam?

The designated core reference textbooks for the Iranian Emergency Medicine Specialty Board are Tintinalli's Emergency Medicine: A Comprehensive Study Guide (latest approved edition) and Rosen's Emergency Medicine: Concepts and Clinical Practice, supplemented by national clinical practice guidelines published by the Iranian Society of Emergency Medicine (ISEM) and the Ministry of Health.

Is this OpenExamPrep practice bank an official exam or affiliated with Sanjesh Pezeshki?

No. This question bank is an independent English-language educational study adaptation developed by OpenExamPrep for conceptual practice and revision. The official Iranian specialty board examination is conducted in Persian under the authority of Sanjesh Pezeshki and the Ministry of Health and Medical Education. This resource is not affiliated with, endorsed by, or sponsored by Sanjesh Pezeshki.

Free Practice Questions for Iran Specialty Board - Emergency Medicine

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