Image Interpretation Questions on Medical Board Exams Matter

David BeardPersonal Education

ECG image interpretation

Why Image Interpretation Skills Matter for Board Exam Review

Image interpretation questions or “image-based questions” on medical board exams are an important component of medical board exams – so image interpretation skills assessment matters when preparing for exams. For example, image interpretation questions can be up to 15 points on your initial ABEM Qualifying Examination or ABEM ConCert™ Examination (MOC). The pictorial questions are formatted just like all of the other assessment questions, a single-answer multiple choice question, with an image as the subject of the question. Board exam image interpretation questions are commonly called “image-based questions.”

  • image-based questions on medical board exams
  • image-based questions on medical board exams
  • image-based questions on medical board exams

The exams may use X-Rays, ECGs, dermatological presentations, pictures, or rhythm strips. There is no ultrasound interpretation, and any CT scans are limited to the head only. The usual format on the examination is going to be a question directly about the diagnostic interpretation of an image:

A 55-year-old woman with chest pain and unstable vital signs is brought in to you by emergency medical services. The paramedics obtained electrocardiography (ECG) en route to your facility (see Figure).

What do the ECG findings demonstrate?
left bundle branch block with Sgarbossa criteria
De Winter syndrome
left main coronary occlusion

ECG image interpretation

(That one isn’t a trick question – but it isn’t pericarditis!)

You want to make sure that your study resources include a lot of standard ECG, X-ray, and picture resources so that you have multiple examples of the question types that will be given to you during the exam.

The image interpretation questions are going to come in the same percentage basis as the rest of the exam, that is, following the ABEM Model of the Clinical Practice of Emergency Medicine structure, with a certain percentage of questions taken from each topic.

9% – Signs, Symptoms and Presentations
8% – Abdominal & Gastrointestinal Disorders
10% – Cardiovascular Disorders
1% – Cutaneous Disorders
2% – Endocrine, Metabolic & Nutritional Disorders
3% – Environmental Disorders
5% – Head, Ear, Eye, Nose & Throat Disorders
2% – Hematologic Disorders
2% – Immune System Disorders
5% – Systemic Infectious Disorders
3% – Musculoskeletal Disorders (non-traumatic)
5% – Nervous System Disorders
4% – Obstetrics and Gynecology
4% – Psychobehavioral Disorders
3% – Renal and Urogenital Disorders
8% – Thoracic-Respiratory Disorders
5% – Toxicologic Disorders
10% – Traumatic Disorders

And for the math inclined, that’s 89% of the exam – 11% is procedures and skills.

In addition to ensuring that your study resources include a wide variety of image interpretation questions, you might also consider some of the smaller study resources that focus specifically on EKG interpretation and Radiology interpretation. Dermatology (Cutaneous disorders) assessment questions are a smaller part of the examination, but very practical in general knowledge review.

(PS: Answer to the question above? Left main coronary occlusion.)

See also: MedChallenger EM, Med-Challenger ECG Interpretation Basics, and Med-Challenger Acute Care Radiology.

Reference: ABEM Blueprint Model –
Reference: 2016 Model of the Clinical Practice of Emergency Medicine –