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Saudi Board Part One Examination – Emergency Medicine: free practice test

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Practice test questions with answers and explanations

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01A 78-year-old woman with pneumonia and septic shock has a heart rate of 132/min and blood pressure of 84/46 mm Hg. She has no chest pain. ECG shows sinus tachycardia with diffuse 1-mm ST depression, and high-sensitivity troponin rises from 40 to 110 ng/L (reference < 14 ng/L). What is the most likely mechanism of the troponin rise?

Practice question Unit: Cardiovascular

  1. ASpontaneous coronary artery dissection of the left anterior descending artery

    Spontaneous dissection typically affects younger women and presents with chest pain and regional changes.

  2. BRupture of an atherosclerotic plaque with occlusive coronary thrombus

    Plaque rupture with thrombosis defines type 1 infarction, which is less likely without symptoms or regional ECG change.

  3. CCoronary vasospasm triggered by septic shock and catecholamines

    Vasospasm usually produces transient ST elevation with chest pain, not diffuse depression in sepsis.

  4. DMyocardial oxygen supply–demand mismatch caused by shock and tachycardia ✓ Correct answer

    Hypotension and tachycardia reduce supply and raise demand, producing type 2 infarction without plaque rupture.

Reference: SCFHS Saudi Board Part One Exam Blueprint – Emergency Medicine (24-27, v.2), Section 1: Cardiovascular, p. 3; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, chapter: Acute Coronary Syndromes

02A 40-year-old pedestrian struck by a car is hypotensive at 84/52 mm Hg. The pelvic radiograph shows an open-book pelvic fracture with symphyseal diastasis. FAST is negative. Which immediate measure is most appropriate while blood is transfused?

Practice question Unit: Trauma

  1. AA pelvic binder centred over the greater trochanters ✓ Correct answer

    A binder at the trochanters reduces pelvic volume and tamponades venous bleeding in open-book fractures.

  2. BSpringing the pelvis several times to confirm instability

    Repeated pelvic manipulation can dislodge clot and increase bleeding.

  3. CA binder placed at the level of the iliac crests

    Binders placed too high are ineffective and may widen the fracture.

  4. DInsertion of a urinary catheter to assess for urethral injury

    Catheterisation is not an immediate bleeding-control measure and may be unsafe in urethral injury.

Reference: SCFHS Saudi Board Part One Exam Blueprint – Emergency Medicine (24-27, v.2), Section 2: Trauma, p. 3; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, chapter: Pelvis Injuries; Advanced Trauma Life Support (ATLS), 10th edition (2018), abdominal and pelvic trauma

03A 31-year-old man had respiratory depression and miosis that reversed with naloxone. His urine immunoassay drug screen is negative for opiates. What is the most likely explanation?

Practice question Unit: Toxicology / Environmental

  1. AA false-negative due to drinking water before the test

    Dilution is less likely than an assay that cannot detect the drug.

  2. BA benzodiazepine such as alprazolam, also reversed by naloxone

    Benzodiazepine toxicity does not respond to naloxone.

  3. CThe naloxone response was a placebo effect

    Prompt reversal of apnoea with naloxone indicates opioid toxicity.

  4. DA synthetic opioid such as fentanyl, missed by the assay ✓ Correct answer

    Standard opiate immunoassays detect morphine-derived opiates and often miss fentanyl and other synthetics.

Reference: SCFHS Saudi Board Part One Exam Blueprint – Emergency Medicine (24-27, v.2), Section 3: Toxicology / Environmental, p. 3; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, chapter: Opioids; T: General Management of Poisoned Patients

04A 40-year-old man has shoulder pain after a generalised tonic–clonic seizure. His arm is held adducted and internally rotated, and he cannot externally rotate it. An AP radiograph shows a symmetrical, rounded humeral head. What is the most likely diagnosis?

Practice question Unit: Orthopedic / Musculoskeletal

  1. ARotator cuff tendinopathy

    Tendinopathy does not cause fixed internal rotation after a seizure.

  2. BPosterior shoulder dislocation ✓ Correct answer

    Seizures and electric shocks cause posterior dislocation, with a "light bulb" humeral head on AP views.

  3. CAnterior glenohumeral dislocation

    Anterior dislocation holds the arm in abduction and external rotation.

  4. DAcromioclavicular joint separation

    AC separation causes a step deformity at the shoulder tip.

Reference: SCFHS Saudi Board Part One Exam Blueprint – Emergency Medicine (24-27, v.2), Section 4: Orthopedic / Musculoskeletal, p. 3; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, chapter: Shoulder and Humerus Injuries

05A 72-year-old man has a painful vesicular rash on the right forehead and on the tip of his nose. What does the nasal involvement indicate?

Practice question Unit: Head / Eyes / Ears / Nose / Throat

  1. AHigh risk of eye involvement ✓ Correct answer

    Hutchinson sign reflects nasociliary nerve involvement and predicts ocular zoster.

  2. BDisseminated zoster

    A single dermatome is affected.

  3. CSecondary bacterial infection

    Nasal tip lesions reflect the distribution of the nerve, not infection.

  4. DSpread to the maxillary branch

    The nasal tip is supplied by the ophthalmic division.

Reference: SCFHS Saudi Board Part One Exam Blueprint – Emergency Medicine (24-27, v.2), Section 5: Head / Eyes / Ears / Nose / Throat, p. 3; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, chapter: Eye Emergencies (herpes zoster ophthalmicus)

06A 52-year-old man vomits forcefully after a large meal with alcohol and then develops severe retrosternal pain. He is tachycardic, and crepitus is felt above the clavicles. Which investigation best confirms the suspected diagnosis?

Practice question Unit: Abdominal / Gastrointestinal

  1. AUrgent upper endoscopy with air insufflation

    Insufflation can enlarge a perforation and worsen mediastinal contamination.

  2. BSerial troponin and 12-lead ECG

    These assess acute coronary syndrome but cannot show oesophageal rupture.

  3. CCT chest with water-soluble oral contrast ✓ Correct answer

    CT with water-soluble contrast shows extraluminal air, fluid and contrast leak from a ruptured oesophagus.

  4. DBarium swallow first

    Barium leaking into the mediastinum causes severe inflammation, so water-soluble contrast is used first.

Reference: SCFHS Saudi Board Part One Exam Blueprint – Emergency Medicine (24-27, v.2), Section 6: Abdominal / Gastrointestinal, p. 3; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, chapter: Esophageal Emergencies (Boerhaave syndrome)

07A 30-year-old woman at 30 weeks' gestation has painless bright red vaginal bleeding. She is stable. Her antenatal scans are not available. Which action should be avoided until placental position is known?

Practice question Unit: Obstetrics / Gynaecology

  1. AGroup and crossmatch of blood

    Blood should be prepared in antepartum haemorrhage.

  2. BContinuous fetal heart monitoring

    Fetal monitoring is appropriate at this gestation.

  3. CAbdominal ultrasound of the placenta

    Ultrasound is the safe way to locate the placenta.

  4. DDigital vaginal examination ✓ Correct answer

    A digital examination can provoke massive bleeding from a praevia.

Reference: SCFHS Saudi Board Part One Exam Blueprint – Emergency Medicine (24-27, v.2), Section 7: Obstetrics / Gynaecology, p. 3; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, chapter: Maternal Emergencies After 20 Weeks of Pregnancy (placenta praevia); Essentials of Patient Safety

08A 26-year-old taxi driver had a first unprovoked generalised seizure. He is back to baseline, with normal examination, glucose, electrolytes and CT. He asks to return to work tomorrow. What is the most appropriate advice?

Practice question Unit: Neurology / Psychiatry

  1. AInform his employer without his consent

    Confidentiality applies; the duty is to advise him first.

  2. BStart lifelong phenytoin, then driving is allowed

    Drug treatment is not routine after one seizure and does not permit driving.

  3. CAdvise no driving and arrange neurology review ✓ Correct answer

    Patients must be told to stop driving per local rules and be referred.

  4. DDriving is allowed as all tests are normal

    Normal tests do not remove the risk of recurrence while driving.

Reference: SCFHS Saudi Board Part One Exam Blueprint – Emergency Medicine (24-27, v.2), Section 8: Neurology / Psychiatry, p. 3; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, chapter: Seizures (first seizure); SCFHS Professionalism and Ethics Handbook for Residents

09A 30-year-old man is drowsy with deep, rapid breathing. Results: Na 140, Cl 100, HCO₃ 10 mmol/L; pH 7.12. What is the anion gap and the type of acidosis?

Practice question Unit: Endocrine / Metabolic

  1. A10; hyperchloraemic acidosis

    The gap is raised, not normal.

  2. B30; high anion gap metabolic acidosis ✓ Correct answer

    Na − (Cl + HCO₃) = 30, a high anion gap.

  3. C20; normal anion gap acidosis

    The gap is 140 − (100 + 10) = 30, which is raised.

  4. D50; mixed metabolic and respiratory acidosis

    The sum is incorrect and the problem is metabolic.

Reference: SCFHS Saudi Board Part One Exam Blueprint – Emergency Medicine (24-27, v.2), Section 9: Endocrine / Metabolic, p. 3; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, chapter: Acid–Base Disorders (anion gap)

10A 3-year-old girl has fever, irritability and tender, widespread erythema that wrinkles and peels in sheets, especially around the mouth and in skin folds. The oral mucosa is normal. What is the most likely diagnosis?

Practice question Unit: Dermatology / Cutaneous / Infectious Disease

  1. AKawasaki disease with desquamation

    Kawasaki peeling is periungual and late, after days of fever with conjunctivitis and lip changes.

  2. BStaphylococcal scalded skin syndrome ✓ Correct answer

    SSSS is caused by exfoliative toxins splitting the superficial epidermis, typically in young children and sparing mucosa; treat with IV anti-staphylococcal antibiotics.

  3. CStreptococcal scarlet fever

    Scarlet fever causes a sandpaper rash with strawberry tongue, and peeling comes later.

  4. DToxic epidermal necrolysis from a drug

    TEN usually follows a drug and involves the mucosa, with full-thickness epidermal necrosis.

Reference: SCFHS Saudi Board Part One Exam Blueprint – Emergency Medicine (24-27, v.2), Section 14: Dermatology / Cutaneous / Infectious Disease, p. 3; Tintinalli's Emergency Medicine: A Comprehensive Study Guide, chapter: Life-Threatening Dermatoses

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