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100+ Free Emergency Medicine Shelf Practice Questions
NBME Advanced Clinical Science Subject Exam: Emergency Medicine practice questions are available now; exam metadata is being verified.
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A 76-year-old woman on warfarin has sudden headache, vomiting, left-sided weakness, and CT showing right basal ganglia hemorrhage. INR is 4.1. What is the best immediate treatment?
A
B
C
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2026 Statistics
Key Facts: Emergency Medicine Shelf Exam
110
Official Items
NBME Subject Examination Timing Chart
2 hr 45 min
Official Exam Time
NBME Subject Examination Timing Chart
60%-65%
Management Task Weight
NBME Emergency Medicine Content Outline
25%-30%
Diagnosis Task Weight
NBME Emergency Medicine Content Outline
10%-15%
Resuscitation/Trauma Focus
NBME Emergency Medicine Content Outline
10%-15%
Environmental/Toxicologic Focus
NBME Emergency Medicine Content Outline
100
Practice Questions Here
Open Exam Prep
For the Emergency Medicine shelf, prioritize first actions: identify unstable patients, secure airway and breathing, treat shock, activate reperfusion or surgery when time-sensitive, choose the highest-yield diagnostic test, give antidotes early, and decide who can be safely discharged versus admitted or transferred.
Sample Emergency Medicine Shelf Practice Questions
Try these sample questions to test your Emergency Medicine Shelf exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 72-year-old man arrives by ambulance with gurgling respirations, oxygen saturation 78%, and no response to painful stimulus after a house fire. Soot is present in the oropharynx. Which emergency severity index level is most appropriate?
A.ESI level 1 because he requires immediate life-saving airway intervention
B.ESI level 2 because he is high risk but stable
C.ESI level 3 because he will need multiple resources
D.ESI level 4 because only one diagnostic test is likely needed
Explanation: ESI level 1 is assigned to patients who require immediate life-saving intervention, including airway management for apnea, severe hypoxia, or inability to protect the airway.
2A 58-year-old woman collapses in the waiting room. She is pulseless and apneic. The monitor shows coarse ventricular fibrillation. High-quality CPR is in progress. What is the next best step?
A.Synchronized cardioversion
B.Intravenous adenosine
C.Transcutaneous pacing
D.Unsynchronized defibrillation
Explanation: Pulseless ventricular fibrillation is a shockable cardiac arrest rhythm. The immediate next step is unsynchronized defibrillation with ongoing CPR and ACLS care.
3A 66-year-old man with fever, confusion, lactate 5.1 mmol/L, blood pressure 78/44 mm Hg, and suspected pneumonia receives 30 mL/kg crystalloid and broad-spectrum antibiotics. His mean arterial pressure remains 54 mm Hg. What should be started next?
A.Intravenous furosemide
B.Oral midodrine and discharge
C.Norepinephrine infusion
D.Atenolol infusion
Explanation: Persistent hypotension after initial fluid resuscitation in septic shock should be treated with vasopressors, with norepinephrine as first-line therapy, while source control and reassessment continue.
4A 29-year-old man is brought after a high-speed collision. He is pale and diaphoretic with blood pressure 72/38 mm Hg, heart rate 142/min, cool extremities, and a distended abdomen. Bedside FAST shows free intraperitoneal fluid. What is the best immediate management?
A.Administer 4 liters of crystalloid and observe for response
B.Activate massive transfusion and take him for emergent operative hemorrhage control
C.Obtain a CT scan of the abdomen before any intervention
D.Give intravenous heparin for possible pulmonary embolism
Explanation: Unstable blunt trauma with a positive FAST has presumed intra-abdominal hemorrhage. Balanced blood product resuscitation and immediate operative hemorrhage control are indicated.
5A 24-year-old woman develops diffuse urticaria, wheezing, lip swelling, and hypotension 10 minutes after receiving ceftriaxone. What medication should be given first?
A.Intramuscular epinephrine
B.Oral diphenhydramine alone
C.Nebulized albuterol alone
D.Intravenous methylprednisolone alone
Explanation: Anaphylaxis with airway or circulatory involvement requires immediate intramuscular epinephrine. Antihistamines, bronchodilators, fluids, and steroids are adjuncts after epinephrine.
6A 61-year-old man has crushing substernal chest pressure for 45 minutes. ECG shows 3-mm ST elevation in leads V2 through V5. The hospital has an immediately available catheterization laboratory. What is the best next step?
A.Perform an exercise stress test
B.Discharge with outpatient cardiology follow-up
C.Give fibrinolysis despite immediate PCI availability
D.Activate the catheterization laboratory for primary PCI
Explanation: Acute STEMI at a PCI-capable hospital should be treated with immediate primary percutaneous coronary intervention to restore coronary perfusion.
7A 69-year-old woman has chest pressure at rest, diaphoresis, ST depressions in V4 through V6, and elevated troponin. Blood pressure is stable and there is no bleeding history. Which treatment should be started while arranging admission?
A.Alteplase infusion
B.Oral amoxicillin-clavulanate
C.Aspirin and therapeutic anticoagulation
D.No antithrombotic therapy because ST elevation is absent
Explanation: NSTEMI is treated with antiplatelet therapy, anticoagulation, anti-ischemic therapy, statin therapy, and risk-based invasive evaluation. Fibrinolysis is not used for NSTEMI.
8A 70-year-old man has abrupt tearing chest pain radiating to the back. Blood pressure is 214/118 mm Hg. CT angiography shows an intimal flap involving the ascending aorta. What is the next best step?
A.Immediate fibrinolysis for presumed myocardial infarction
B.Intravenous beta-blockade and emergent cardiothoracic surgery consultation
C.Oral anticoagulation and outpatient follow-up
D.Observation with repeat imaging in 6 months
Explanation: Stanford type A aortic dissection involves the ascending aorta and requires emergent surgical repair. IV beta-blockade is started first to reduce shear stress.
9A 42-year-old woman 1 week after hysterectomy has sudden dyspnea, pleuritic chest pain, syncope, blood pressure 76/40 mm Hg, and right ventricular dilation on bedside echocardiography. What is the best treatment if there is no absolute contraindication?
A.Systemic thrombolysis
B.Aspirin only
C.Outpatient apixaban starter pack
D.Inhaled bronchodilator therapy alone
Explanation: Massive pulmonary embolism causes obstructive shock and right ventricular strain. Systemic thrombolysis is indicated when hypotension is present and bleeding risk is acceptable.
10A 55-year-old woman with metastatic lung cancer has severe dyspnea, blood pressure 82/48 mm Hg, jugular venous distention, muffled heart sounds, and pulsus paradoxus. Bedside ultrasound shows a large pericardial effusion with right ventricular diastolic collapse. What is the next best step?
A.High-dose loop diuretics
B.Outpatient echocardiography
C.Intravenous beta-blocker
D.Urgent pericardiocentesis
Explanation: Cardiac tamponade is obstructive shock due to elevated pericardial pressure. Hemodynamic compromise with chamber collapse requires urgent pericardial drainage.
About the Emergency Medicine Shelf Practice Questions
Verified exam format metadata for NBME Advanced Clinical Science Subject Exam: Emergency Medicine is pending. The practice questions above remain available while official exam length, timing, passing score, fee, and administrator details are reviewed.