Emergency Medicine Practice Questions
Emergency medicine tests trauma resuscitation, life-threatening chest injuries, and burn fluid management, which is high-yield on the MCCQE, USMLE Step 2 CK, and PLAB. These four sample questions come from MediLingo's bank of 3,900+ questions across 23 specialties.
Sample questions
Question 1
A trauma patient develops sudden respiratory distress, hypotension, absent breath sounds on the right, and tracheal deviation to the left. What is the immediate management?
a) Needle decompression at 5th ICS anterior-midaxillary line (2nd ICS MCL acceptable), then chest tube ✓ Correct
b) Obtain a portable chest X-ray to confirm the diagnosis before any intervention
c) Administer 2 L of IV crystalloid and observe for hemodynamic improvement
d) Obtain a chest X-ray and await radiology confirmation before intervention
Key teaching point: Tension pneumothorax: clinical diagnosis (hypotension, unilateral absent breath sounds, tracheal deviation). Immediate needle decompression → chest tube.
Question 2
A stab wound victim presents with hypotension, distended neck veins, and muffled heart sounds. What is the bedside diagnostic and therapeutic procedure?
a) ED thoracotomy or pericardiocentesis with a plan for definitive surgery ✓ Correct
b) Administer IV esmolol to reduce heart rate and lower myocardial oxygen demand
c) Obtain a CT chest with contrast to confirm the diagnosis before any intervention
d) Give a 1 L crystalloid bolus to support preload and blood pressure while observing
Key teaching point: Beck's triad = hypotension + JVD + muffled heart sounds. Confirm with bedside echo (FAST). Pericardiocentesis temporizes; surgical drainage is definitive.
Question 3
In a trauma patient with uncontrolled active hemorrhage, what is the fluid resuscitation strategy before bleeding control?
a) Permissive hypotension: target SBP ~80-90 mmHg until hemorrhage control ✓ Correct
b) Give 3 liters crystalloid rapidly to normalize blood pressure
c) No fluids at all until surgical bleeding control
d) Colloids exclusively with no crystalloids for resuscitation in uncontrolled hemorrhage
Key teaching point: Permissive hypotension: keep SBP ~80-90 mmHg (MAP ~65) in uncontrolled hemorrhage until bleeding is controlled. Avoid clot disruption with over-resuscitation.
Question 4
A 70 kg adult has a 40% TBSA burn (partial/full thickness). Using the Parkland formula, how much fluid in the first 24 hours?
a) 4 mL × 70 kg × 40 = 11,200 mL; half in first 8 hrs from burn time, half over next 16 hrs ✓ Correct
b) 2 mL × 70 kg × 40 = 5,600 mL Ringer's lactate in the first 24 hours; half in 8 hrs, half in 16 hrs
c) 11,200 mL total, all infused in the first hour from the time of burn
d) 4,000 mL of Ringer's lactate over 24 hours regardless of weight or burn size
Key teaching point: Parkland: 4 mL RL × kg × %TBSA in 24h. Half in first 8h (from burn time), half in next 16h. Titrate to UOP 0.5 mL/kg/h (adults).
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