Prometric Exam Questions for Emergency Medicine Specialists 2026: 15 Practice MCQs with Answers and Rationale for the EME5531 Paper

The emergency medicine specialist paper (EME5531) is the most scenario-driven of the physician exams: a patient arrives, you have the first minutes, and the question asks for the next best action. It covers resuscitation, airway, trauma, cardiac and neurological emergencies, toxicology, paediatrics, obstetrics and procedural skills, usually 100 to 150 single-best-answer questions in 2.5 to 3 hours with a pass mark of about 60%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each. The paper follows current ALS, ATLS and PALS-style guidance, so where your local practice differs, the exam goes with the guideline.

For titles and the route, read the emergency medicine specialist guide. For timed papers use the Emergency Medicine specialist bank, about 3,800 questions.

Resuscitation and airway

Question 1

During adult cardiac arrest with refractory ventricular fibrillation, amiodarone is given:

1. 300 mg IV after the third shock, with a further 150 mg after the fifth
2. 150 mg before the first shock
3. Only after return of spontaneous circulation
4. Never with adrenaline

Answer: A. Amiodarone 300 mg is given after the third shock alongside adrenaline 1 mg, with 150 mg after the fifth shock. Lidocaine is an alternative where amiodarone is unavailable.

Question 2

Which patient most needs rapid sequence induction rather than awake or delayed intubation?

1. A stable patient with a known difficult airway and no urgency
2. A patient with a GCS of 6 after head injury who is vomiting
3. A patient with mild asthma on nebulisers
4. A patient with a sore throat

Answer: B. A low GCS with an unprotected airway and active vomiting needs definitive airway protection now. RSI with pre-oxygenation, an induction agent and a rapid-onset relaxant, with a plan for failure, is the standard. A known difficult airway in a stable patient is managed awake with expert help.

Question 3

A patient in anaphylaxis has received two doses of intramuscular adrenaline with persistent hypotension and bronchospasm. The next step is:

1. Oral antihistamine
2. Refractory anaphylaxis protocol: adrenaline infusion with monitoring, further fluid boluses, and critical care involvement
3. Stop all treatment and observe
4. Intramuscular steroid only

Answer: B. Refractory anaphylaxis is managed with a titrated adrenaline infusion, large-volume crystalloid, nebulised bronchodilators and senior support. Antihistamines and steroids are not life-saving treatments.

Trauma

Question 4

A trauma patient has a systolic blood pressure of 80 mmHg, a distended abdomen and a positive FAST scan. The next step is:

1. CT abdomen with contrast
2. Immediate transfer to theatre for laparotomy, with massive transfusion protocol activated
3. Observation for four hours
4. Diagnostic peritoneal lavage

Answer: B. A haemodynamically unstable patient with free fluid needs surgery, not CT. Balanced blood product resuscitation and tranexamic acid within three hours accompany the transfer.

Question 5

According to the Canadian CT Head Rule, which feature is a high-risk criterion for CT after minor head injury?

1. A single episode of vomiting
2. GCS less than 15 at two hours after injury
3. Headache
4. Age 40

Answer: B. High-risk criteria include GCS below 15 at two hours, suspected open or depressed skull fracture, signs of basal skull fracture, two or more episodes of vomiting, and age 65 or over. A single vomit and headache alone do not qualify.

Question 6

A child presents with a burn covering 15% of body surface area. Fluid resuscitation using the Parkland formula over the first 24 hours is:

1. 2 mL/kg per % burn, half in the first 8 hours
2. 4 mL/kg per % burn of crystalloid, half in the first 8 hours from the time of injury, plus maintenance fluid in children
3. 10 mL/kg bolus only
4. No fluids until 20% burns

Answer: B. Children need formal resuscitation from about 10% burns (adults from 15 to 20%), using 4 mL/kg per % burn, half in the first eight hours from the time of the burn, plus maintenance in children, titrated to urine output.

Cardiac and neurological emergencies

Question 7

A patient has a regular broad-complex tachycardia at 170/min with a blood pressure of 110/70 mmHg and no adverse features. The first-line drug is:

1. Adenosine 6 mg
2. Amiodarone 300 mg IV over 20 to 60 minutes
3. Verapamil
4. Digoxin

Answer: B. A stable broad-complex regular tachycardia is treated as ventricular tachycardia with amiodarone; synchronised cardioversion if adverse features develop. Verapamil in VT can cause cardiovascular collapse.

Question 8

A patient with a confirmed ischaemic stroke presented within 3 hours of onset, has no contraindications, and the NIHSS is 12. The treatment is:

1. Aspirin 300 mg and admit
2. Intravenous thrombolysis, with assessment for mechanical thrombectomy if there is a large-vessel occlusion
3. Heparin infusion
4. Observation only

Answer: B. Thrombolysis is given within 4.5 hours of onset in eligible patients, and large-vessel occlusion is treated with thrombectomy up to 6 hours, longer with perfusion imaging. Antiplatelets are started after haemorrhage is excluded and thrombolysis is complete.

Question 9

A patient has been seizing for 10 minutes despite one dose of IV lorazepam. The next step is:

1. A second dose of lorazepam, then a second-line agent such as levetiracetam, valproate or phenytoin if seizures continue
2. Immediate general anaesthesia
3. Oral carbamazepine
4. Wait another 20 minutes

Answer: A. Status epilepticus follows a stepped protocol: benzodiazepine, repeated once, then a second-line antiepileptic, then anaesthesia with intensive care if seizures persist. Check glucose and consider thiamine early.

Toxicology

Question 10

A patient took 20 g of paracetamol 6 hours ago. The management is:

1. Activated charcoal now and discharge
2. Take a paracetamol level at or after 4 hours post-ingestion, plot on the treatment nomogram, and start N-acetylcysteine if above the line or if timing is uncertain
3. Wait for liver function tests to rise
4. Give naloxone

Answer: B. N-acetylcysteine is most effective within 8 hours, so it is started immediately in a large or staggered overdose while awaiting the level. Charcoal is only useful within about an hour of ingestion.

Question 11

A patient on tricyclic antidepressants presents with a wide QRS of 140 ms and hypotension. The specific treatment is:

1. Intravenous sodium bicarbonate
2. Flumazenil
3. Procainamide
4. Beta blocker

Answer: A. Sodium bicarbonate narrows the QRS and treats arrhythmia and hypotension in tricyclic toxicity. Class Ia antiarrhythmics worsen sodium channel blockade; flumazenil can provoke seizures.

Paediatric and obstetric emergencies

Question 12

A 2-year-old has a barking cough, stridor at rest and moderate recession. The treatment is:

1. Oral dexamethasone, with nebulised adrenaline for severe or worsening stridor
2. Antibiotics only
3. Throat examination with a tongue depressor
4. Discharge with steam inhalation

Answer: A. Croup is treated with a single dose of corticosteroid; nebulised adrenaline buys time in severe cases. Distressing the child or examining the throat can precipitate obstruction, and is also the trap if epiglottitis is possible.

Question 13

For a 10 kg child in shock, the initial fluid bolus is:

1. 10 to 20 mL/kg of isotonic crystalloid, reassessed after each bolus
2. 100 mL/kg over 15 minutes
3. 5% dextrose 50 mL
4. No fluid until blood pressure falls

Answer: A. Boluses of 10 to 20 mL/kg with reassessment are standard, with caution in cardiac disease, DKA and severe malnutrition. Hypotension is a late sign in children.

Question 14

A woman at 34 weeks presents with a seizure and blood pressure of 170/110 mmHg. The drug of choice is:

1. Diazepam
2. Magnesium sulfate 4 g IV loading dose then infusion, with antihypertensive therapy and obstetric delivery planning
3. Phenytoin
4. Oral nifedipine alone

Answer: B. Eclampsia is treated with magnesium sulfate, blood pressure control with labetalol, hydralazine or nifedipine, left lateral positioning and urgent obstetric involvement. Delivery is the definitive treatment.

Procedures and environment

Question 15

A construction worker is brought in collapsed with a core temperature of 41.5 °C, confusion and hot dry skin. The priority is:

1. Rapid active cooling to below about 39 °C by cold-water immersion or evaporative cooling with ice packs, airway protection and fluids
2. Paracetamol and observation
3. Warm blankets
4. Antibiotics

Answer: A. Exertional heat stroke is common in Gulf summers and is lethal without immediate cooling. Antipyretics do not work, and cooling must start before transfer or investigations.

How to use these questions

• Reproduce the algorithms from memory: ALS, tachycardia and bradycardia, status epilepticus, anaphylaxis, trauma primary survey.
• Know the doses and time windows: thrombolysis, N-acetylcysteine, tranexamic acid, amiodarone, magnesium.
• Cover paediatrics and obstetrics; adult-only emergency physicians lose marks there.
• Practise under time in the Emergency Medicine bank, following the error-log method.

Pre-hospital clinicians sit the paramedic papers instead: paramedic sample questions. Other specialty banks are listed in specialty question banks. When you hold eligibility, join the doctor talent pool; emergency physicians are among the most requested profiles.

Frequently asked questions

How many questions are in the emergency medicine Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice gives the exact format.

What is the pass mark?

About 60% for the specialist paper, scaled at some authorities.

Which guidelines does the exam follow?

Current international resuscitation, trauma and paediatric life support guidance. Where local practice differs, answer by the guideline.

Can a general practitioner sit the emergency medicine paper?

Only if classified as an emergency medicine specialist on the basis of a recognised postgraduate qualification. GPs sit GEN5331.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.