AMC MCQ Emergency Questions: 10 Free Practice MCQs
Ten AMC MCQ-style emergency questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 40 emergency questions and many more across every topic.
1 / 10
A 12-year-old boy was bitten on the ankle by an unidentified snake at 4 pm and has been observed with a pressure immobilisation bandage in place. At 4 am he is fully awake, has no symptoms, and serial coagulation studies, full blood examination and creatine kinase are all normal.
What is the most appropriate disposition?
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Answer: D. Continue observation and discharge during daylight hours if he remains well
Why: Serial blood tests and clinical examination after suspected snakebite take a minimum of 12 hours from the time of the bite, and this boy has now completed them with normal results and no symptoms. Even so, children with suspected snakebite should only be discharged in daylight hours, because neurological envenomation can be subtle and is most reliably detected while the child is awake. Removing the pressure immobilisation bandage is also restricted to a centre with full treatment facilities and, if envenomation were present, would wait until antivenom had been given. Intensive care admission, antivenom and observation beyond daylight are therefore not justified here.
- A. Neurological signs after Australian snakebite can be subtle and may only become apparent when the child is awake and observed, so discharge in the early hours is unsafe.
- B. Critical care admission is not required once examination and serial blood tests remain normal, and he is better managed with short stay observation.
- C. Antivenom is indicated only where there is evidence of envenomation, and exposing a non-envenomed child to it creates risks of anaphylaxis and serum sickness for no benefit.
- E. The bandage is left in place until the child is in a centre with full treatment facilities, and removing it does not remove the need for observation.
Sources: The Royal Children's Hospital Melbourne. Clinical Practice Guidelines: Snakebite. January 2018.
2 / 10
A 35-year-old woman develops generalised urticaria, facial swelling and audible wheeze 10 minutes after eating peanuts. Her blood pressure is 85/50 mmHg and an adrenaline autoinjector is available.
What is the first-line treatment?
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Answer: D. Intramuscular adrenaline into the anterolateral thigh
Why: Adrenaline is the first-line treatment for anaphylaxis and is given intramuscularly into the anterolateral thigh without delay when there is airway, breathing or circulatory compromise. Repeat dosing is required after 5 minutes, or earlier, if the features persist or worsen. Corticosteroids and antihistamines are not recommended as routine initial treatment, although antihistamines help angioedema, urticaria and pruritus once the patient is stable, and a bronchodilator alone does not address circulatory collapse.
- A. Corticosteroids are not recommended routinely and act too slowly to reverse airway or circulatory compromise in acute anaphylaxis.
- B. A bronchodilator may help wheeze but does not treat the circulatory collapse or airway swelling of anaphylaxis.
- C. Antihistamines are useful for skin features once the patient is stable but do not treat life-threatening airway, breathing or circulatory problems.
Sources: ANZCOR Guideline 11.10 Resuscitation in Special Circumstances (2026)
3 / 10
A 44-year-old man with known bee sting allergy has received two intramuscular doses of adrenaline 5 minutes apart for anaphylaxis. His wheeze and hypotension have not improved and his systolic pressure remains 80 mmHg.
How is refractory anaphylaxis best defined in this situation?
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Answer: A. No improvement in respiratory or cardiovascular features despite two doses of intramuscular adrenaline.
Why: Refractory anaphylaxis is recognised when respiratory or cardiovascular features fail to improve despite two doses of intramuscular adrenaline. Expert help is then sought early and an intravenous adrenaline infusion forms the basis of treatment, with boluses of 10 to 20 micrograms reserved for those experienced in their use while an infusion is prepared. Needing a second dose, a single low blood pressure reading, or the absence of skin features are not by themselves evidence of refractoriness.
- B. A second dose is commonly required and does not by itself define a refractory episode, which is judged by the response to treatment.
- C. A single blood pressure reading does not define refractoriness, which depends on the response to repeated adrenaline.
- D. Absence of skin features can occur in severe anaphylaxis but is not how a refractory episode is defined.
Sources: ANZCOR Guideline 11.10 Resuscitation in Special Circumstances (2026)
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4 / 10
A 78-year-old woman is found unresponsive in a residential aged care facility. Cardiopulmonary resuscitation is started and the monitor shows asystole. She has intravenous access and an advanced airway in place.
When should the first dose of adrenaline be given?
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Answer: C. As soon as feasible during cardiopulmonary resuscitation, then every second loop.
Why: In asystole and pulseless electrical activity there is no shockable rhythm, so the emphasis is on good compressions, intravenous access, airway support and early drug treatment. Adrenaline is given as soon as feasible and then with every second loop of the algorithm, which equates to roughly every 4 minutes. Withholding the vasopressor altogether, or waiting for a particular capnography value or three completed rounds before the first dose, delays a recommended intervention.
- A. Delaying the first vasopressor until three completed rounds postpones a recommended treatment in a rhythm that does not respond to defibrillation.
- B. A rising end tidal carbon dioxide suggests return of spontaneous circulation and is used to monitor compression quality rather than to time the first dose.
- D. Vasopressors do have a role in asystole and pulseless electrical activity, so omitting them would remove a recommended intervention while defibrillation is the therapy that is withheld.
Sources: ANZCOR Guideline 11.2 Protocols for Adult Advanced Life Support (2026)
5 / 10
A 13-year-old boy is receiving his acetylcysteine infusion after a paracetamol overdose. Thirty minutes into the first bag he develops flushing, generalised itch, wheeze and a fall in blood pressure. The infusion is stopped and he is stabilised with oxygen and fluid.
What is the most appropriate next step with the acetylcysteine infusion?
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Answer: E. Give promethazine and restart the infusion after 30 minutes at half the previous rate
Why: Acetylcysteine commonly causes a non-immunologic reaction that can include flushing, rash, itch, wheeze, angioedema and hypotension, and it is not a true immunoglobulin E mediated anaphylaxis. The infusion is ceased, promethazine is given, and the infusion is recommenced after 30 minutes at half the previous rate, with a slow increase to the full rate over the next 30 minutes. A previous such reaction does not preclude future use. Permanently stopping the infusion, restarting at the original rate, changing to an oral preparation or giving adrenaline with a delayed restart all fail to deliver the hepatoprotective dose safely.
- A. A previous non-immunologic reaction does not preclude further use, and abandoning treatment leaves the paracetamol hepatotoxicity untreated.
- B. Restarting at the former rate risks recurrence of the reaction, so the infusion is resumed only at half the previous rate after treatment and a short wait.
- C. The intravenous route used for this infusion is the standard therapy, and changing route does not reliably prevent a further reaction.
- D. Adrenaline is reserved for a true anaphylactic emergency, whereas this non-immunologic reaction is managed with an antihistamine and a planned slower restart.
Sources: The Royal Children's Hospital Melbourne. Clinical Practice Guidelines: Paracetamol poisoning. July 2023.
6 / 10
A 4-year-old girl presented after swallowing an unknown number of her mother's iron tablets. She had vomiting and abdominal pain for two hours, but six hours after the ingestion she is comfortable, has no abdominal pain and is drinking well.
What is the most appropriate next step?
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Answer: B. Admit for observation with serial serum iron concentrations and clinical review
Why: Iron poisoning classically passes through a quiescent phase from about six to twenty four hours after ingestion, during which gastrointestinal symptoms improve while iron continues to be absorbed and distributed. Apparent recovery during this window can therefore precede cardiogenic shock, metabolic acidosis and hepatic necrosis, and the child requires admission for observation with serial serum iron concentrations measured four hourly until they fall. A normal abdominal X-ray does not exclude ongoing absorption, activated charcoal does not bind iron, and desferrioxamine is an intravenous therapy used under observation, so none of those alternatives allows safe discharge.
- A. Resolution of gastrointestinal symptoms does not exclude serious poisoning, because the improvement may simply be the quiescent phase that precedes cardiogenic shock and acidosis.
- C. A normal or unchanged film does not exclude continuing absorption of iron, so it cannot be used to justify discharge in a symptomatic child.
- D. Desferrioxamine is given intravenously under close observation and is not used as outpatient therapy.
- E. Charcoal does not bind iron, and four hours is far too short to exclude the delayed systemic effects of a significant ingestion.
Sources: The Royal Children's Hospital Melbourne. Clinical Practice Guidelines: Iron poisoning. June 2020.
7 / 10
A 40-year-old man has a cervical spine fracture after a diving accident. He is hypotensive with a blood pressure of 82/50 mmHg and a pulse of 52 beats per minute, his peripheries are warm, and he is passing urine normally.
What is the most likely explanation for his hypotension?
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Answer: E. Neurogenic shock from the cervical cord injury
Why: Neurogenic shock after a cervical or high thoracic cord injury produces hypotension with bradycardia, warm extremities and preserved urinary output, because interruption of sympathetic outflow leaves the vagal tone unopposed and the vasculature dilated. This contrasts with hypovolaemic shock, which causes tachycardia and cool, vasoconstricted peripheries. The distinction matters because management differs: neurogenic shock is treated with cautious fluid replacement and, if required, inotropes to maintain a systolic blood pressure above 90 mmHg, with the head down position and care to maintain normothermia because temperature regulation may be lost. Tamponade, tension pneumothorax and myocardial injury each have additional physical findings that are absent here.
- A. Occult blood loss produces tachycardia and cool peripheries, whereas this man is bradycardic with warm extremities and preserved urine output.
- B. Tamponade causes obstructive shock with raised jugular venous pressure and pulsus paradoxus rather than isolated bradycardia with warm limbs.
- C. A tension pneumothorax causes respiratory distress with unilateral absent breath sounds and is not suggested by these findings.
- D. Blunt cardiac injury usually causes arrhythmia or pump failure with pulmonary oedema, not bradycardia with preserved urine output.
Sources: Neurosurgical Society of Australasia. The Management of Acute Neurotrauma in Rural and Remote Locations. 3rd edition, 2009.
8 / 10
A 31-year-old woman at 32 weeks gestation has been involved in a low speed collision. She has no vaginal bleeding and no abdominal pain, but on examination the uterus is tender and she is having more than one contraction every ten minutes. The cardiotocograph is normal.
How long should fetal monitoring continue?
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Answer: C. Extend cardiotocography to 24 hours
Why: At 22 weeks gestation or more, continuous cardiotocography is commenced as soon as feasible and continued for a minimum of four hours after any maternal trauma, because the fetal heart rate is a sensitive surrogate for maternal perfusion and can change before maternal deterioration is apparent. Monitoring is extended to 24 hours when there is more than one contraction every ten minutes, uterine tenderness, significant abdominal pain, ruptured membranes, vaginal bleeding, a positive Kleihauer-Betke test or an abnormal trace, and this woman has two of those features. Mild trauma does not exempt her from monitoring, symptoms are an unreliable guide, and a normal ultrasound does not exclude abruption.
- A. Even minor injuries are associated with placental abruption, preterm labour and fetal loss, and around half of fetal losses follow minor trauma.
- B. Four hours is only the minimum after trauma, and her uterine tenderness and frequent contractions are indications to extend monitoring.
- D. Relying on symptoms under-estimates risk, because abruption can occur with few symptoms and initially normal observations.
- E. Ultrasound is not sensitive enough to exclude abruption, for which false negative rates are high, so it cannot end monitoring.
Sources: Queensland Clinical Guidelines. Traumatic injury in pregnancy. Guideline No. MN26.31-V3-R31. Queensland Health. 2026.
9 / 10
A 3-year-old boy was briefly submerged in a backyard pool. He was pulled out immediately, coughed a few times and is now alert and playful. His respiratory rate is 24 breaths per minute, oxygen saturation is 98 per cent on room air and his chest is clear on auscultation.
What is the most appropriate plan?
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Answer: B. Observe for eight hours and discharge if he remains asymptomatic with a normal examination and saturations
Why: Most drowning episodes cause minimal or no respiratory impairment and need no more than a period of observation. Guidelines advise observation for eight hours from the time of drowning, with discharge only if the child remains asymptomatic, has a normal respiratory examination, saturations of at least 95 per cent, has had water safety education and has no ongoing safety concerns. Immediate discharge is unsafe because respiratory deterioration can be delayed. A chest X-ray does not predict outcome and does not shorten observation, prophylactic antibiotics have no role, and intensive care ventilation is reserved for children who are actually compromised.
- A. Respiratory deterioration after a drowning episode can be delayed, so a period of observation is needed even when the initial examination is normal.
- C. Assisted ventilation is reserved for children with respiratory compromise, which he does not have.
- D. Chest X-ray findings do not correlate with clinical outcome, so a normal film does not replace a period of observation.
- E. Prophylactic antibiotics have no role and are restricted to children with signs of infection or submersion in grossly contaminated water.
Sources: The Royal Children's Hospital Melbourne. Clinical Practice Guidelines: Drowning. June 2020.
10 / 10
A 70-year-old man becomes pulseless in the intensive care unit 6 hours after coronary artery bypass grafting. The cardiothoracic team is on site and the unit follows the cardiothoracic advanced life support algorithm.
What is the recommended timeframe for emergency re-sternotomy in this situation?
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Answer: A. Within 5 minutes of the onset of the cardiac arrest, by a trained team.
Why: Cardiopulmonary arrest after cardiac surgery is usually caused by a small number of reversible problems such as tamponade, bleeding, tension pneumothorax, pacing failure or graft problems, and emergency re-sternotomy addresses most of them. The trained team should complete re-sternotomy within 5 minutes of the onset of the arrest, and chest compressions should not be withheld while this is prepared. Waiting for drugs to work, for compressions to fail, or for transfer to an operating theatre all waste that critical window.
- B. This delay is far too long; reversible causes after cardiac surgery are addressed by re-sternotomy rather than by prolonged drug therapy.
- C. Waiting for compressions to fail before opening the chest wastes the time in which re-sternotomy is most likely to succeed.
- D. Re-sternotomy is performed where the patient arrests rather than after transfer, which would add harmful delay.
Sources: ANZCOR Guideline 11.10 Resuscitation in Special Circumstances (2026)
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Exam-style questions written by MedHub for practice. They are not official exam questions.