The #1 Special Purpose Exam Review

Med-Challenger SPEX

Med-Challenger SPEX is the highest quality, easiest to use (SPEX) Special Purpose Examination review question bank and knowledge improvement suite for special purpose exam review, built on the Federation of State Medical Boards (FSMB) and National Board of Medical Examiners’ (NBME) exam specifications. Med-Challenger’s special purpose review course is 100% pass-guaranteed and provides over 3500 case-based SPEX-style Q&A, media banks, and ongoing content updates.

What’s more, with 266 AMA PRA Category 1 CME credits, Med-Challenger’s SPEX review Qbank gives physicians everything needed to ace special purpose exams with less time, labor, and worry.

Join the over 5,000 physicians who’ve used Med-Challenger SPEX to outperform on exams – and protect their practice. Try it for free today.

Useful year after year for Exams, MOC & CME requirements.
With Med-Challenger, it’s well in hand.

The Challenger SPEX review course was extremely thorough. I worked through the whole thing three times in a row and then took about 20 exams. When I had passed five in a row, as I think they suggest, I knew I was ready.S. Gilbert, MD, JD
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Special Purpose Exam Review, Med-Challenger SPEX

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Proven SPEX Exam Success with Med-Challenger

Pass the SPEX exam, guaranteed.

See why Med-Challenger SPEX is the #1 Special Purpose Exam Review in addition to having the MOST Q&A and HIGHEST pass-rate.

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    Time-saving adaptive learning engine leaves nothing behind

    Time-saving adaptive learning engine prioritizes missed and yet-to-be-seen content so you get every ounce of value from your review purchase.

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    Automatic prescriptive remediation takes you where you need to go next

    Automatic prescriptive remediation guidance offers “deeper dives” to repair your weak areas of knowledge.

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    Adaptive, SPEX blueprint-based exam simulation

    Simulate the board examination instantly, while taking Q&A in the right subject areas and in the right amounts, everytime.

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    Practice, Review & Assessment modes for enhanced retention

    Work the way you want. No pressure practice mode, read-friendly Review mode, and CME credit assessments

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    Create your own custom exams!

    Create your own exams with our Custom Exam Builder. Save your custom exams and re-use them for study or routine self-assessment.

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    Earn CME credits as you study

    Earn CME credits within assets quickly. Manage credit claims and produce CME certificates.

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    Dashboards, analytics & reports keep things on track

    Track your progress and scores, compare against global averages, maximize your purchases, and maximize your time.

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    Daily content updates & new Q&A, plus peer-to-peer fun

    With your Med-Challenger account, you can play our weekly Quick Quiz game with new content and peer leaderboards

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    Work anywhere, anytime, on any device - in less time

    Work on any device from anywhere. 100% responsive design and time-saving adaptive tools.

Proven SPEX Exam Success

After 25 years in exam review, we know how to get results – and fast.

Board Exam Pass-rate
Avg. Score Improvement
Avg. Study Time Saved
Over 0
Special Purpose Practitioners Served

Included Content & Questions

For Med-Challenger SPEX Special Purpose Exam Review Qbank

Over 0
Topics Covered
Over 0
Board-style Questions

Special Purpose Question Topics

NBME publishes a content blueprint of the material that will appear on the exam.

This is how we determine which material appears in your adaptive Qbank.

General Principles
Disorders of Blood
Disorders of the Nervous System/Special Senses
Mental Disorders
Disorders of the Skin
Disorders of the Musculoskeletal System
Disorders of the Respiratory System
Cardiovascular Disorders
Gastrointestinal Disorders
Renal and Urinary Disorders
Disorders of the Male Reproductive System
Female Reproductive System and Pregnancy
Disorders of the Endocrine System
Immunologic Disorders

High-Yield SPEX Review Questions

SPEX-style, blueprint-based Q&A.
Just like you’ll see on the actual SPEX exam.

Positively-stated, Case-based Question Stems

No “negatively phrased” questions, no “A and B”…you know what we mean. Our questions always address important “key point” blueprint-based content in a well structured manner.

A 39-year-old man with no significant past medical history presents with a “swollen eye.” He was working in his yard a few days ago and was hit by small twig. He did not notice any symptoms immediately but subsequently developed prominent swelling of his left eye and a temperature of 102.2°F.

He complains of pain with ocular movements. He cannot spontaneously open his eye because of marked palpebral edema. The area looks very swollen and the globe is proptotic (see figure).


When the ocular eye is examined, his vision is blurry and ocular movements cannot be properly evaluated because of intense pain with movement in all directions.

What is the appropriate management for this patient’s condition?

Clear Answer Options

A question’s difficulty is defined by the choice of distractors. Good distractors determine the difficulty level of a question. Therefore, good distractors are one of the most important features of a high quality question.

Obtain orbital CT and if no orbital involvement is identified discharge on oral antibiotics with close follow-up.
Immediately begin intravenous antibiotics and obtain orbital computed tomography (orbital CT) and admit for treatment of orbital cellulitis.
Immediately begin intravenous antibiotics and obtain orbital or sinus plain radiographs to look for retro-orbital gas or abscess formation.
Discharge on oral antibiotics with strict instructions to return promptly for worsening eye pain or decreased ocular mobility.
Discharge on topical antibiotic ophthalmic drops every 2 hours while awake and ophthalmic antibiotic ointment at bedtime.

High-yield Remediation

Understanding why an answer choice is incorrect is just as important as knowing why it is correct. Med-Challenger questions contain detailed explanations for the correct and incorrect answer choices along with integrated media for those that learn best by visual stimuli.


The above patient is presenting with signs of orbital cellulitis

Orbital cellulitis and periorbital cellulitis, which is also called preseptal cellulitis, may present with some similar external manifestations, including swelling of the eyelid, discoloration of the orbital skin, redness, and warmth. Traumatic injury may precede either condition. But periorbital cellulitis never presents with involvement of vision, ocular pain with movement, or limitations in ocular movement. Patients with orbital cellulitis, on the other hand, may have proptosis, loss of trigeminal nerve sensation, decreased ocular mobility, ocular pain, tenderness with eye movement, and increased intraocular pressure.

Orbital cellulitis requires admission to the hospital, treatment with intravenous antibiotics, imaging, and evaluation by surgery. Periorbital cellulitis may be followed on an outpatient basis for the first 24-48 hours of antibiotic therapy. Orbital computed tomography scans are extremely useful for diagnosing orbital cellulitis or abscesses; sinus and orbital radiography tend to be less specific.


Aldemir-Kocabaş, Bilge, et al. “Periorbital and Orbital Cellulitis: From Presentation to Outcome.” (2014).

Sharma R, Brunette DD. Ophthalmology. In: Marx JA, et al., eds. Rosen’s Emergency Medicine. 8th ed. 2014: 909-930.

Table of Contents

Everything you need to know for SPEX exams.

Abdominal Pain
Acute Pelvic Pain in Women
Acute Vaginal Bleeding
Back Pain
Chest Pain
Depressed Consciousness and Coma
Dizziness and Vertigo
Fever in the Adult Patient
Gastrointestinal Bleeding
Headache: Initial Approach
Nausea and Vomiting
Seizures: Initial Approach
Disseminated Intravascular Coagulation
Hematologic Malignancies
Management of Malignant Pain
Pediatric Hematology and Oncology
Sickle Cell Disease
Transfusion Medicine (Principles and Complications)
Central Nervous System Disorders: Delirium and Dementia
Central Nervous System Disorders: Demyelinating/Inflammatory Diseases
Central Nervous System Disorders: Diseases of Movement Control
Central Nervous System Disorders: Seizures
Central Nervous System Disorders: Spinal Cord Syndromes
Central Nervous System Infections
Cerebrovascular Accidents: Epidemiology and Presentation
Cerebrovascular Accidents: Initial Work-up
Cerebrovascular Accidents: Preventive Care
Cerebrovascular Accidents: Treatment
Headache: Cervical Neck Vessels, Subarachnoid, and Venous Emergencies
Headache: Cluster, Migraine, and Tension
Headache: Less Common Etiologies
Neurologic Assessment
Pediatric Neurologic Disorders
Peripheral Nervous System Disorders: Neuromuscular Junction Disease
Peripheral Nervous System Disorders: Neuropathies
Selected Cranial Nerve Disorders
Eye: Assessment
Eye: Glaucoma
Eye: Inflammation and Infection
Eye: Pharmacology
Eye: Vascular Disorders
Neoplasms of the Head and Neck
Nose: Infection and Inflammation
Oral Cavity: Medical Disorders
Otologic Infections
Otologic Signs, Symptoms, Presentations
Pediatric Eye, Ear, Nose, and Throat Disorders
Throat and Soft Tissue Neck: Medical Disorders
Affective Disorders
Anxiety Disorders
Dissociative Disorders
Eating Disorders
Factitious Disorders and Malingering
Obsessive-Compulsive Disorder
Pediatric Psychiatric Disorders
Personality Disorders
Psychiatric Assessment
Psychological Factors Affecting Medical Disorders
Somatoform Disorders
Suicidal Behavior
Thought Disorders
Cancers of the Skin
Cutaneous Infections
Dermatitis (non-infectious)
Maculopapular Lesions
Papular/Nodular Lesions
Pediatric Dermatology
Ulcerative Lesions
Vesicular/Bullous Lesions
Bone and Joint Infections
Bone Tumors
Crystal-induced Arthropathy
Deep Soft Tissue Infections
Disorders of Muscles
Infectious, Inflammatory, and Reactive Arthritis
Neck and Back Pain
Pediatric Rheumatology and Musculoskeletal Disorders
Rheumatoid Arthritis
Sports Injuries/Trauma
Systemic Lupus Erythematosus
Systemic Sclerosis
Acute Upper Airway Disorders (Incl. Peds.)
Asthma and other Obstructive Lung Disease
Interstitial Lung Disease
Lower Respiratory Tract Infections
Lung Cancer
Occupational and Environmental Lung Disease
Pleural Disease
Pulmonary Vascular Disease
Sleep Medicine
Upper Respiratory Tract Infections
Congenital Heart Disease in the Adult
Congestive Heart Failure
Dysrhythmias/Conduction Defects
Ischemic Heart Disease
Myocardial Disease
Pericardial Disease
Valvular Heart Disease
Vascular Disease
Pediatric Cardiovascular Disorders
Biliary Tract Disease
Colonic and Anorectal Disease
Esophageal Disorders
Foodborne and Waterborne Diseases
Gastrointestinal or Hepatic Cancer
Liver Disease
Obstruction, Ischemia, Perforation, Peritonitis
Pancreatic Disease
Pediatric Gastrointestinal Disorders
Small Intestinal Disease
Stomach or Duodenum
Undiagnosed Gastrointestinal Hemorrhage

Acute Renal Failure
Chronic Kidney Disease
Glomerular Disorders
Nephropathy, Contrast Induced
Pediatric Nephrology and Urology
Prostate Disorders
Renal Failure: Chronic
Renal Transplantation
Urinary Incontinence
Urinary Retention
Urinary Tract Infections
Urological Assessment
Urological Cancer
Water and Electrolyte Balance
Penile Disorders
Prostate Disorders
Sexually Transmitted Infections: Male
Testicular Disorders
Acute Complications of Pregnancy
Breast Cancer
Chronic Medical Illness During Pregnancy
General Approach to the Pregnant Patient
Gynecologic Cancer
Gynecological Assessment
Menopause and Hormone Therapy
Screening and Regular Health Care in Adult Women
Sexual Assault
Sexually Transmitted Infections: Female Genital Lesions
Sexually Transmitted Infections: Vaginal Discharge
Adrenal Disorders
Clinical Context: Alcoholic and Lactic Acidosis
Diabetes Mellitus
Disorders of Calcium Metabolism and Bone
Endocrine Disorders: Diabetic Ketoacidosis
Endocrine Disorders: Hyperosmolar Hyperglycemic State
Lipid Disorders
Pediatric Endocrine Disorders
Thyroid Disorders
Auto-Immune Collagen Vascular Disorders
Drug Allergy
Food Allergy
Hypersensitivity Reactions
Pediatric Allergy and Immunology
Primary Immunodeficiency Disorders
The Immunocompromised/Solid-Organ Transplant Patient
Bacterial Infections: Diphtheria, Pertussis, Tetanus
Bacterial Infections: Meningococcemia, Pneumococcemia
Bacterial Infections: MRSA, VRE, ESBL
Bacterial Infections: Tuberculosis
Parasitic Infections
Pediatric Infectious Diseases
Sepsis Syndromes
Systemic Fungal Infections
Tick-Borne Illnesses
Viral Infections: Hantavirus
Viral Infections: HIV and AIDS
Viral Infections: Influenza, Mononucleosis, Herpes
Viral Infections: Rabies
Childhood Immunizations
Child Safety
Development Milestones
Disease Prevention
Failure to Thrive
Female Pubertal Development
Gynecologic Healthcare
Male Pubertal Development
Normal Growth
Periodic Health Examination/Screening
Pregnancy and Contraception
Self-Identity and Family Influence
Sexuality and Emotional Development
Sexually Transmitted Infections
Geriatrics: Assessment
Geriatrics: Depression
Geriatrics: Falls
Geriatrics: Gait Impairment
Geriatrics: Medical Conditions
Geriatrics: Pharmacotherapy
Geriatrics: Special Problems of the Elderly
Geriatrics: Urinary Incontinence
Airway: Adult
Airway: Pediatric
Breathing: Ventilatory Support (Adult/Pediatrics)
Environmental Disorders
Perioperative Care
Postoperative Complications
Procedural Sedation: Adult
Resuscitation: Adult Cardiac
Resuscitation: Brain (After Cardiac Arrest)
Resuscitation: Neonatal
Resuscitation: Pediatric
Resuscitation: Shock
Resuscitation: Trauma
Toxicologic Disorders
Traumatic Disorders
Wound Management
Diet and Prevention
Exercise and Prevention
Cancer Prevention and Screening
Prevention of Cardiovascular Disease
Prevention of Infectious Disease
Patient Safety
Medical Error Prevention
End-of-Life Care

Written and Maintained by Experts

Continually Updated
All content is continually maintained by clinical expert peer-review.

Chief Editors:
Andrea Cecilia Eberly, MD, M.S., FAAEM

Mark E. Deutchman, MD, FAAFP
Professor, Department of Family Medicine
Director, Advanced Training Track
Director, Rural Health Track
University of Colorado Health Sciences Center
Denver, CO

Contributing Authors:

Kathleen K. Aiello, MD, FAAP
Ambler Pediatrics
Ambler, PA

Jennifer Amani, MD
Attending Physician
MBI Occupational Healthcare
Phoenix, AZ

David Auerbach, MD
Attending Physician
Montgomery Radiology Associates
Pottstown, PA

Kelly Bradley-Dodds, MD, FAAP
Program Director, Pediatric Residency
Attending Physician – Pediatrics, Emergency Medicine
Crozer-Chester Medical Center
Upland, PA

Gina Chung, MD
Assistant Professor
Dept. of Internal Medicine, Section of Medical Oncology
Yale University School of Medicine
New Haven, CT

Adam Cohen, MD
Depatment of Oncology
Huntsman Cancer Institute
Salt Lake City, UT

Michael Anthony Darracq, MD, MPH
Emergency Physician
Kaiser Permanente Medical Group, Southern California
San Diego, CA

Michael France, MD
Emergency Room Physician
Memorial Hospital of Carbon County
Rawlins, WY

Arthur Frazzano, MD, FAAFP
Founding Director, Area Health Education Center of RI Network
Director, Division of Health Policy and Advocacy and Associated
Fellowship Program
Associate Professor
Department of Family Medicine
Warren Alpert Medical School
Brown University
Providence, Rhode Island

Gerard Kiernan, MD
Dartmouth Hitchcock Clinic
Keene, NH

Daniel Hayes, MD
Internal Medicine Physician
West Linn, OR

Michael J. Hodgman, MD
Assistant Clinical Professor
SUNY Upstate Medical University
Upstate New York Poison Center
Syracuse, NY

Jassin M. Jouria, Jr., MD
University of Miami
Leonard M. Miller School of Medicine
Miami, FL

Alex Kadner, PhD
Medical Writer/Scientific Consultant, Neuroscience
Ballston Spa, NY

Miguel G. Madariaga, MD, MSc, FACP, DLSHTM
Director, Center for Wound Healing and Hyperbaric Medicine
Physician, Infectious Disease
Doylestown Hospital
Doylestown, Pennsylvania

Jeanna M. Marraffa, Pharm.D., DABAT
Clinical Assistant Professor, Department of Emergency Medicine
SUNY Upstate Medical University
Clinical Toxicologist
Upstate New York Poison Center
Syracuse, NY

Luis A. Mojicar, MD
Center for Living Well Clinic
Orlando, FL

George Smolinksi III, MD
Major, Medical Corps, U.S. Army
Physical Medicine Clinic
Landstuhl Regional Medical Center
Landstuhl, Germany

Richard Snyder, DO
Integrative Medicine Practitioner
LeHigh Valley Nephrology Associates

Rodrigo Tanchanco, MD, FACP
Christiana Medical Group
Newark, DE

Pranav Virmani, MD
Dept. of Emergency Medicine
Inova Loudoun Hospital and Medical Center
Leesburg, VA

Tricia A. Walters, MD
Family Medicine w/ Obstetrics
Wyatt, IN

Mary Wilson, MD
Emergency Medicine Physician
Mercy Hospital
Coon Rapids, MN

Cezary Wojcik, MD, PhD
Deaconess Hospital
Assistant Professor
Dept. of Anatomy & Cell Biology
Indiana University School of Medicine
Evansville, IN

Melissa Wolf, MD
Bozeman Deaconess Women’s Specialists
Bozeman, MT

Sean Wormuth, MD
Emergency Medicine Physician
Kaiser Permanente Medical Center
Vallejo, CA

Built-in CME Credit Resources

Earn CME credit while you study. Knock out requirements fast.

Earn Up To
AMA PRA Category 1 CME Credits™

CME Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of National Association for Continuing Education and Challenger Corporation. The National Association for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Earn and Claim Credits in a snap.

  • Score 80% or better on topic-based CME assessments
  • CME earnings will appear in your CME Claims Center
  • Produce PDF CME Certificates (claim credits) instantly
  • PDFs list all topics claimed for hassle-free submission
  • Return anytime to reprint or review historical earnings
Earn and Claim Credits Easily, Earn CME Credits, AMA PRA Category 1 CME Credits


Just wanted to inform you that I sat the SPEX exam and passed with a grade of 86. This was better than I expected from only 2 weeks of review and greatly because of your course.Godefroy Hardy St-Pierre, MD FRCSC
The Challenger SPEX review course was extremely thorough. I worked through the whole thing three times in a row and then took about 20 exams. When I had passed five in a row, as I think they suggest, I knew I was ready.S. Gilbert, MD, JD

You don’t just get the best content.
You get the best tools too.

Great content does nothing on it’s own. You have to use it.
We give you the most tools to “get it done” – your way.

All Features & Benefits


Other “QBanks” stop short.
With Med-Challenger, you not only get the largest SPEX QBank – you get a complete system of self-assessment, knowledge upkeep, and career MOC efficiency that serves you now and forever.

Med-Challenger's unique objective based user interface

Better than the best “QBank.”

Built for the SPEX exam – and everything beyond.

We give you over 3500 SPEX exam review questions with detailed explanations – more than any SPEX Review Question Bank.

But we also give you additional review tools, content assets, media banks, and time-saving career conveniences – like satisfying MOC requirements on-demand – useful every year.

Our special purpose exam review doesn’t just get you through exams, it keeps an eye toward your future, your ongoing practice needs, and your quality of life.

In fact, you can add multiple products to your single Med-Challenger account to cover every special need your specific practice career requires.

Searchable clinical media banks

And you’ll never have to re-buy assets ever again!

Instead of wasting time and money every year, we have a better plan -
One-time purchasing and a single low cost Premium Membership super-renewal!
Purchase products at regular price ONCE. Add items at any time. (You'll never pay full price again!)
Get a FULL YEAR of use with every purchase. Then, simply RENEW your Premium Membership when the time comes.
Only $199 / year renews access to ALL of your purchased Med-Challenger assets for another full year of use.
We keep everything current and ready at all times, even adding new materials to annual MOC subscription products.
No more re-buys! No more worries. Enjoy everything you need, on-demand, every year - for less.

With Med-Challenger, you can do everything your career requires, more easily, now and forever.

Package Options

Buy assets individually or by bundle.

Bundles include multiple assets for “entire career” coverage.
Compare the options below. Start a free trial.

Option 1

SPEX Basic

Everything for SPEX Exam

Med-Challenger Special Purpose Exam Review Course + AMA PRA Category 1 CME Credits
Special Purpose Exam Review, Med-Challenger SPEX, SPEX Exam, Complete Review, Ongoing Updates, CME Credits
One Time Purchase*

Asset included:

  • Special Purpose Exam Comprehensive Review
  • Adaptive Qbank with 3500+ SPEX-style questions
  • Board simulation with guided remediation
  • 266AMA PRA Cat. 1 Credits™
  • Money-back, pass guarantee

Benefits included:

  • One year of access (Premium Membership) free with purchase
  • One-time Purchase! Purchased assets remain in your account forever – No more re-buys!
  • Renew access to ALL PURCHASED ACCOUNT ASSETS for only $199/yr
  • Content updates and annual subscription product additions FREE with active Premium Membership
  • Time-saving adaptive learning engine prioritizes missed and yet-to-be-seen content
  • Automatic prescriptive remediation guidance targets weak areas
  • Ready-made blueprint-based exams
  • Create your own custom exams!
  • Find and earn CME credits within assets quickly
  • Easy CME certificate production
  • Dashboards
  • Analytics & Reports
  • Free weekly Quick Quiz game with new content and peer leaderboards
  • Fully responsive for use on all devices
  • Free customer support

72 hour free trial available

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The Library

Everything, Ever

The Med-Challenger Library Subscription: All Courses & All New Additions
Board Review Library, Med-Challenger Library Subscription, Every Specialty, Annual MOC, Exam Review, Ongoing Updates, CME Credits, Special CME's, New Products
One Time Purchase*

Assets included:

  • Emergency Medicine
  • Family Medicine
  • Internal Medicine
  • Pediatric Medicine
  • Pediatric Emergency
  • OB/GYN
  • Urgent Care
  • Special Purpose
  • Physician Assistant
  • Nurse Practitioner: Primary
  • Nurse Practitioner: Emergency
  • RN / NCLEX
  • EM LLSA Subscription
  • FM MC-FP KSA Subscription
  • PEDS MOC Part 2
  • Auscultation (Cardio & Pulm)
  • Dermatology
  • Ultrasound
  • ECG Interpretation
  • Radiology Interpretation
  • Risk Management & Malpractice
  • Self-Defense
  • State-required CME
  • Cardiac Center CME
  • Stroke Center CME
  • Trauma Center CME

  • AMA PRA Cat. 1 Credits™ and other CME types included
  • New Med-Challenger course assets including new titles and editions FREE as they are released.

Benefits included:

  • One year of access (Premium Membership) free with purchase
  • One-time Purchase! Purchased assets remain in your account forever – No more re-buys!
  • Renew access to ALL PURCHASED ACCOUNT ASSETS for only $199/yr
  • Content updates and annual subscription product additions FREE with active Premium Membership
  • Time-saving adaptive learning engine prioritizes missed and yet-to-be-seen content
  • Automatic prescriptive remediation guidance targets weak areas
  • Ready-made blueprint-based exams
  • Create your own custom exams!
  • Find and earn CME credits within assets quickly
  • Easy CME certificate production
  • Dashboards
  • Analytics & Reports
  • Free weekly Quick Quiz game with new content and peer leaderboards
  • Fully responsive for use on all devices
  • Free customer support

72 hour free trial available

Start Free Full Trial
Add The Library to Cart

How It Works

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Med-Challenger works for both practicing clinicians, clinician educators, and quality directors by providing a singularly efficient and effective system of knowledge review, exam prep, and recurring career requirement fulfillment adaptable to any learning environment or objective.

How it Works
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    1. Create your account

    A single account to hold your assets. Get one free.

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    2. Add assets

    One-time purchase your exam review and MOC requirements.

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    3. Get it done – your way.

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And by the way….
Med-Challenger also works for Group Education.

Add group education resources and education management controls to your training program or clinical group.