AMC MCQ Emergency medicine Questions: 10 Free Practice MCQs
Emergency medicine in the AMC MCQ tests the first minutes of care. The blueprint expects a primary survey, immediate resuscitation, and a safe decision about disposition. Sepsis, anaphylaxis, overdose, trauma, arrhythmia and the patient who is not yet diagnosed all appear. The marked answer is usually the intervention that stabilises the patient while the cause is still being worked up, not the most complete investigation.
Where candidates lose marks
- Completing the history before treating a compromised airway or breathing.
- Missing sepsis and delaying antibiotics and fluids within the first hour.
- Forgetting reversible causes in a collapsed patient, including glucose, opioids and arrhythmia.
- Discharging a patient without observation, safety netting and a clear follow-up plan.
Guideline to follow: The AMC MCQ follows the Australian Commission on Safety and Quality in Health Care sepsis standard, ANZCOR resuscitation guidelines, the ATLS approach and eTG.
Ten AMC MCQ-style emergency medicine questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 185 emergency medicine 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 74-year-old woman presents to her GP with a 2-week history of a throbbing unilateral headache, scalp tenderness when brushing her hair, and pain in her jaw when chewing meat. Her ESR is 85 mm/hr.
What is the most likely diagnosis, and what is the immediate management to prevent permanent complications?
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Answer: C. Giant Cell Arteritis; initiate high-dose oral Prednisolone (40-60mg daily) immediately, prior to temporal artery biopsy
Why: Giant Cell Arteritis (temporal arteritis) is a large-vessel vasculitis that occurs in older adults. Key features include headache, jaw claudication, scalp tenderness, and visual disturbances. Due to the high risk of permanent blindness from anterior ischemic optic neuropathy, high-dose corticosteroids (Prednisolone 40-60mg daily) must be started immediately upon clinical suspicion, before confirming with a temporal artery biopsy.
- A. This clinical picture is typical for Giant Cell Arteritis, which requires urgent steroid treatment, not migraine therapy.
- B. TMJ dysfunction does not cause scalp tenderness or a significantly elevated ESR.
- D. Trigeminal neuralgia presents with brief, lancinating pain and does not correlate with systemic inflammatory markers.
Sources: eTG Rheumatology, Giant Cell Arteritis; RACGP Guidelines
3 / 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)
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4 / 10
A 64-year-old woman is admitted to the emergency department with sudden-onset shortness of breath and pleuritic chest pain. On assessment, her blood pressure is 80/50 mmHg, heart rate is 128 bpm, respiratory rate is 28 breaths per minute, and oxygen saturation is 88% on high-flow oxygen. A bedside echocardiogram reveals acute right ventricular strain.
Which of the following is the most appropriate immediate next step in management?
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Answer: A. Administer systemic thrombolytic therapy (e.g., Alteplase) immediately
Why: This patient has a massive (high-risk) pulmonary embolism, characterized by hemodynamic instability (systolic BP < 90 mmHg). In unstable patients, diagnostic CTPA is often unsafe due to the risk of cardiac arrest during transfer. Bedside echocardiogram showing right ventricular overload is sufficient to justify immediate reperfusion therapy (systemic thrombolysis with alteplase or tenecteplase) alongside supportive resuscitation.
- B. Transferring a hemodynamically unstable patient out of the resuscitation bay for a CTPA is unsafe and should be avoided.
- C. LMWH is the treatment of choice for hemodynamically stable PE, but unstable massive PE requires rapid thrombolysis, not just anticoagulation.
- D. Needle thoracocentesis is indicated for tension pneumothorax, not for acute pulmonary embolism causing obstructive shock.
Sources: eTG complete, Cardiovascular, Pulmonary Embolism; ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism
5 / 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)
6 / 10
A 19-year-old university student is brought to the Emergency Department in an obtunded state. She was found next to an empty bottle of Amitriptyline. Her ECG shows sinus tachycardia, a QTc of 490 ms, and a QRS duration of 140 ms.
What is the immediate pharmacological intervention of choice to prevent ventricular arrhythmias?
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Answer: C. Sodium Bicarbonate (8.4% IV bolus)
Why: Tricyclic Antidepressants (TCAs) block cardiac fast sodium channels, leading to QRS widening (>100 ms is associated with seizures, >160 ms with ventricular arrhythmias). Intravenous Sodium Bicarbonate is indicated if the QRS is >100 ms, if there are arrhythmias, or if there is hypotension. The mechanism is twofold: increasing sodium concentration overrides the competitive blockade, and systemic alkalosis decreases the affinity of TCAs for the sodium channels.
- A. Amiodarone can worsen QTc prolongation and should be avoided in TCA overdose.
- B. Flumazenil is a benzodiazepine antagonist. It has no role in TCA overdose and can precipitate severe seizures.
- D. Physostigmine can cause cardiac arrest in TCA overdose and is contraindicated.
Sources: Australian Toxicology Guidelines (Toxinx); eTG Complete - TCA Toxicity
7 / 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)
8 / 10
A 45-year-old man is brought to the emergency department after a motorcycle crash with an unstable pelvic fracture and deteriorating observations. He is unable to communicate and no family member is present.
According to the RACS position paper, what is the appropriate approach to consent for immediate life-saving surgery?
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Answer: A. Proceed with intervention and document the efforts made to obtain consent
Why: The RACS position paper states that in an emergency where immediate intervention is necessary to preserve life or prevent harm, it may not be possible to provide complete information or obtain written consent. In those circumstances consent should be sought from next of kin, family or those with power of attorney where practicable, and efforts to obtain consent should be documented. Delaying surgery for a tribunal order, asking a nurse to sign as if a substitute decision-maker, or relying on implied consent without any documentation do not meet that position.
- B. Waiting for a guardianship order would risk the patient's life, and the position paper expects intervention first with consent sought where practicable.
- C. A nurse is not a lawful substitute decision-maker, so this would not provide valid authority to proceed.
- D. Treatment may start on that basis, but RACS explicitly requires that efforts to obtain consent are documented.
Sources: Royal Australasian College of Surgeons, Informed consent (2019)
9 / 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.
10 / 10
A 28-year-old woman with a history of Graves' disease is admitted with severe agitation, hyperpyrexia (39.8°C), tachycardia (148 bpm, atrial fibrillation), and mild jaundice. She recently had an emergency appendectomy.
Which of the following is the most likely diagnosis?
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Answer: B. Thyroid storm (thyrotoxic crisis)
Why: Thyroid storm is an endocrine emergency triggered by stress (surgery, infection, trauma) in patients with uncontrolled hyperthyroidism. The Burch-Wartofsky Point Scale is used for clinical diagnosis, assessing thermoregulatory dysfunction, cardiovascular effects (tachycardia, AF, heart failure), GI-hepatic dysfunction (jaundice), and CNS agitation. Treatment involves a multi-drug regimen to block hormone synthesis, release, and peripheral conversion.
- A. While sepsis can cause fever and tachycardia, the history of Graves' disease, atrial fibrillation, and jaundice suggests a severe hyperthyroid crisis.
- C. Pheochromocytoma crisis presents with severe hypertension, headache, and sweating; hyperpyrexia to 40°C and jaundice are less typical.
- D. Malignant hyperthermia occurs during anesthesia exposure to inhalational agents or succinylcholine, not as a subacute postoperative presentation.
Sources: eTG complete, Endocrine, Thyroid Storm; Endocrine Society Clinical Practice Guidelines on Hyperthyroidism
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