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114+ Free ER Board Practice Questions
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Sample ER Board Practice Questions
Try these sample questions to test your ER Board exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 114+ question experience with AI tutoring.
1A 28-year-old male presents to the ED after a motor vehicle collision with a Glasgow Coma Scale (GCS) of 6. His blood pressure is 110/70 mmHg, heart rate is 98 bpm, and SpO2 is 98% on room air. An emergency airway is indicated. During rapid sequence intubation, which of the following is the most appropriate induction agent in the setting of suspected traumatic brain injury (TBI) to optimize cerebral perfusion pressure?
A.Propofol (2.0 mg/kg IV)
B.Etomidate (0.3 mg/kg IV)
C.Midazolam (0.3 mg/kg IV)
D.Thiopental (5.0 mg/kg IV)
Explanation: Etomidate (0.3 mg/kg IV) is the preferred induction agent in patients with head injuries or suspected elevated intracranial pressure (ICP) who may have compromised hemodynamics. It is hemodynamically neutral and maintains cerebral perfusion pressure (CPP = MAP - ICP) without causing the vasodilation and hypotension seen with other induction agents.
2A 34-year-old female is brought to the resuscitation bay in hemorrhagic shock after a pelvic crush injury. Her blood pressure is 74/40 mmHg and heart rate is 135 bpm. The massive transfusion protocol (MTP) is activated. After the administration of 6 units of packed red blood cells (PRBCs) and 6 units of fresh frozen plasma (FFP), the patient develops QTc prolongation and muscle tremors. Which of the following is the most likely cause of these symptoms?
A.Hyperkalemia from rapid RBC lysis
B.Hypocalcemia caused by citrate toxicity
C.Hypomagnesemia from dilutional coagulopathy
D.Metabolic acidosis from tissue hypoperfusion
Explanation: Citrate is used as an anticoagulant in stored blood products (PRBCs, FFP, platelets). During rapid massive transfusion, citrate can bind ionized calcium in the patient's blood, leading to hypocalcemia. This manifests as prolonged QTc interval, muscle tremors, tetany, or paresthesias. Treatment is intravenous calcium (chloride or gluconate).
3A 62-year-old male is in cardiac arrest with refractory ventricular fibrillation. He has received three shocks, CPR, 1 mg of epinephrine, and 300 mg of amiodarone. A fourth shock is delivered, and rhythm check shows persistent ventricular fibrillation. Which of the following is the most appropriate next intervention?
A.Administer Lidocaine 1.5 mg/kg IV
B.Perform double sequential external defibrillation (DSED)
C.Administer Vasopressin 40 units IV
D.Initiate an Esmolol infusion (500 mcg/kg bolus, then 50 mcg/kg/min)
Explanation: Double sequential external defibrillation (DSED) is the rapid application of sequential shocks from two defibrillators with pads in different vectors (anterolateral and anteroposterior). Clinical trials (e.g., the DOSE VF trial) have shown that DSED significantly improves survival to hospital discharge in patients with refractory ventricular fibrillation compared to standard defibrillation.
4A 45-year-old male with severe diabetic ketoacidosis (pH 6.85, bicarbonate 4 mEq/L, pCO2 12 mmHg) requires emergency intubation for airway protection due to obtundation. During rapid sequence intubation, which of the following is the most critical ventilator setting parameter to prevent immediate cardiac arrest post-intubation?
A.Set a low tidal volume (6 mL/kg) to prevent barotrauma
B.Set a high respiratory rate (30-35 breaths/minute) to match the pre-intubation minute ventilation
C.Set a high positive end-expiratory pressure (PEEP > 15 cmH2O) to recruit alveoli
D.Maintain a prolonged expiratory time (I:E ratio of 1:4) to prevent auto-PEEP
Explanation: Patients with severe metabolic acidosis rely on extreme respiratory compensation (hyperventilation) to maintain pH. If intubated and ventilated with standard settings, their minute ventilation drops, leading to rapid increase in pCO2, severe worsening of acidemia, and sudden cardiac arrest. The ventilator must be set with a high respiratory rate and tidal volume to match their pre-intubation ventilation.
5According to the Advanced Trauma Life Support (ATLS) 10th edition guidelines, what is the preferred anatomical site for needle decompression of a tension pneumothorax in an adult patient?
A.Second intercostal space in the midclavicular line
B.Fourth intercostal space in the midclavicular line
C.Fifth intercostal space, slightly anterior to the midaxillary line
D.Third intercostal space in the midaxillary line
Explanation: ATLS 10th edition guidelines recommend the fifth intercostal space, just anterior to the midaxillary line (same level as a chest tube), as the preferred site for needle decompression in adults. This site has a thinner chest wall and higher success rate compared to the historically preferred second intercostal space in the midclavicular line.
6A 22-year-old male is brought to the ED after falling from a height of 6 meters. He is hemodynamically unstable with a blood pressure of 80/40 mmHg and heart rate of 140 bpm. The pelvis is unstable to manual compression. What is the most appropriate anatomical landmark for the application of a pelvic binder?
A.Around the iliac crests
B.Around the femoral shafts
C.Around the greater trochanters
D.Around the anterior superior iliac spines (ASIS)
Explanation: A pelvic binder must be centered directly over the greater trochanters of the femurs. This applies pressure at the level of the pubic symphysis, which maximizes the mechanical leverage to reduce pelvic volume and control venous bleeding in unstable pelvic fractures.
7A 58-year-old female presents with cardiogenic shock due to an acute myocardial infarction. Her blood pressure is 78/42 mmHg, heart rate is 112 bpm, and index lactate is 4.2 mmol/L. What is the first-line vasopressor of choice to improve perfusion pressure while minimizing the risk of tachyarrhythmias?
A.Dopamine
B.Norepinephrine
C.Epinephrine
D.Phenylephrine
Explanation: Norepinephrine is the first-line vasopressor in cardiogenic shock. Compared to dopamine, norepinephrine is associated with significantly fewer arrhythmic events and a lower risk of death, as shown in the SOAP II trial.
8A 64-year-old male is resuscitated from cardiac arrest (VF rhythm) and achieves return of spontaneous circulation (ROSC). He remains comatose. Targeted temperature management (TTM) is initiated. Which of the following is the most appropriate target temperature range and duration according to current guidelines?
A.32°C to 36°C for at least 24 hours
B.30°C to 32°C for 48 hours
C.36°C to 37.5°C for 12 hours
D.35°C to 36°C for 72 hours
Explanation: Current post-cardiac arrest guidelines recommend Targeted Temperature Management (TTM) targeting a constant temperature between 32°C and 36°C for at least 24 hours for patients who remain comatose after ROSC, followed by active prevention of fever (>37.5°C) for another 48 hours.
9A 25-year-old male presents with a stab wound to zone II of the left neck. On physical examination, he is alert and oriented. His blood pressure is 122/80 mmHg, heart rate is 88 bpm, and respiratory rate is 16/min. He has a small, non-expanding hematoma over the wound. There is no active bleeding, stridor, or subcutaneous emphysema. Which of the following is the most appropriate next step in management?
A.Immediate transfer to the operating room for surgical exploration
B.Perform a CT angiography of the neck
C.Local wound exploration in the emergency department
D.Discharge home after a 6-hour observation period
Explanation: In stable patients with penetrating neck injuries crossing the platysma but without 'hard signs' of vascular or aerodigestive tract injury, CT angiography of the neck is the diagnostic modality of choice to evaluate for subclinical vascular or structural injuries.
10A 19-year-old male is brought to the ED after a diving accident. He is awake but paralyzed from the nipple line down. His vital signs show a blood pressure of 82/40 mmHg, heart rate of 48 bpm, and respiratory rate of 20/min. His extremities are warm and dry. What is the pathophysiology of his hemodynamic state?
A.Hemorrhagic shock from internal bleeding
B.Cardiogenic shock from myocardial contusion
C.Neurogenic shock from loss of sympathetic vascular tone
D.Spinal shock from temporary loss of spinal cord reflexes
Explanation: This patient has neurogenic shock, which occurs after spinal cord injury (typically above T6) due to loss of sympathetic vascular tone. This leads to vasodilation (warm, flushed extremities), hypotension, and loss of cardiac accelerator fibers, causing bradycardia instead of reflex tachycardia.
About the ER Board Exam
This practice exam covers resuscitation, trauma care, medical/surgical emergencies, pediatric emergencies, toxicology, and EMS disaster management.
Assessment
100 multiple-choice questions
Time Limit
3 hours
Passing Score
60%
Exam Fee
Free (Saudi Commission for Health Specialties (SCFHS))
ER Board Exam Content Outline
20%
Resuscitation & Trauma Care
ACLS, ATLS, airway management, shock, and major trauma stabilization.
20%
Medical Emergencies
Cardiovascular, pulmonary, neurology, and gastrointestinal emergency medicine.
20%
Pediatric Emergencies
Paediatric resuscitation, infections, dehydration, and trauma.
20%
Surgical & Toxicological Emergencies
Acute abdomen, poisonings, envenomations, and drug overdoses.
20%
EMS & Disaster Management
Pre-hospital care protocols, triage, and disaster preparedness planning.
How to Pass the ER Board Exam
What You Need to Know
- Passing score: 60%
- Assessment: 100 multiple-choice questions
- Time limit: 3 hours
- Exam fee: Free
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
Frequently Asked Questions
What is the format of the ER Board exam?
The exam consists of 100 multiple-choice questions covering all five content domains.
What is the passing score for the ER Board exam?
Candidates must score at least 60% to pass the exam.