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Med-Challenger Urgent Care is the highest quality, easiest to use Urgent Care board review question bank for the American Board of Urgent Care Medicine (ABUCM) Certification exam and ABUCM Maintenance of Certification (MOC). Med-Challenger’s Urgent Care review course is 100% pass-guaranteed and provides over 3300 case-based Q&A following the American Board of Urgent Care Medicine exam blueprint, media banks, and ongoing content updates.

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Urgent Care Question Topics

ABUCM 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.

Administration, Ethics, and Medical Legal2%
Cardiovascular Disorders6%
ENT and Oral Surgery5%
Endocrinology and Metabolic Disorders2%
Gastrointestinal Disorders5%
Hematology and Oncology2%
Infectious Diseases and Travel Medicine7%
Obstetrics and Gynecology4%
Orthopedics and Sports Medicine9%
Pharmacology and Toxicology2%
Wound Care, Anesthesia, Other Procedures and Skills5%
Triage and Stabilization of Critically-ill Patient4%
Occupational Medicine3%
Disaster Medicine and Environmental Injuries2%
Public Health and Preventative Medicine2%
Research, Epidemiology, and EBM4%
Allergy and Immunology2%

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A 16-year-old patient presents 24 hours after a motor vehicle collision, complaining of retrosternal chest pain. He was a restrained driver who initially refused medical care because he “felt ok”. An AP chest x-ray is obtained that is later followed up by a lateral chest x-ray:

urgent care X-ray image

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Which of the following answers is correct?

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The patient’s physical exam will most likely reveal Beck’s triad
The patient should be sent for an esophagram
Auscultation will very likely reveal a Hamman’s crunch
The patient requires a pericardiocentesis
Preparations should be made to place a chest tube

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The x-ray findings are consistent with traumatic pneumomediastinum, which is the result of rapid increases in intraluminal pressure during sudden chest wall compression and/or significant shearing forces during rapid decelerations. These forces can cause isolated trauma to any combination of the mediastinal soft tissues (airway, esophagus, heart, great vessels).

The key point is that both traumatic esophageal tears and minor tracheobronchial tears are rare but potentially fatal injuries that can present with a 24-hour delay and with very subtle initial physical and X-ray findings. If initially undetected, tracheobronchial trauma may lead to tracheobronchial stenosis from granulation tissue and possibly lead to chronic airway obstruction. Undiagnosed esophageal tears can rapidly lead to fatal purulent mediastinitis.

Tracheobronchial tears occur in about 1-3% of patients with blunt chest trauma. Combined esophageal and tracheal rupture is seen in approximately 20% of these cases of tracheobonchial injury. Since esophageal injuries have a high morbidity and mortality, it is important to evaluate the esophagus in patients who have pneumomediastinum or a proven tracheobronchial injury from blunt trauma.

Signs and Symptoms of esophageal injury are dependent on the depth of esophageal wall involvement. The most common symptom of esophageal injury is retrosternal pleuritic chest pain. Other nonspecific symptoms include dysphagia, odynophagia, pleuritic chest pain, vomiting, and dyspnea. Signs of a full-thickness tear with or without tracheal trauma include subcutaneous emphysema, pneumomediastinum, pneumothorax, and demonstration of gastric contents in the pleural fluid.

Signs and symptoms of tracheobronchial trauma are mostly nonspecific: dyspnea, cough, hoarseness, hemoptysis, respiratory distress, and hypoxia. Subcutaneous emphysema is the only slightly more specific sign. About 80% of cases of tracheobronchial tears due to blunt trauma occur within 2.5 cm of the carina. Such tears result in a pneumomediastinum because the main bronchi are mediastinal structures up until the point where they divide to become the major lobar bronchi. The right main stem bronchus tends to be injured more commonly than the left because there is less protection from surrounding structures. Endo/bronchoscopy can confirm the diagnosis when the clinical and radiological signs raise suspicion about the presence of such an injury.

A Hamman’s crunch is a crunching sound of crepitation auscultated with each heartbeat (caused by the heart beating within air bubbles). Hamman’s crunch is classically considered to be a sign of pneumopericardium, but may be present in 30% of patients with pneumonmediastinum. However, the above patient had no signs of a pneumopericardium, so it is not VERY likely to hear Hamman’s crunch in the above scenario.

Interpretation of Chest X-Ray:

The AP chest-x-ray demonstrates free air dissecting along the superior mediastinum bilaterally, and also shows apical shadows over the left lung, which is consistent with subcutaneous emphysema. Vertical air densities can also be noted that are extending upward from the mediastinum (more noticeable on the left than on the right). There is also air superimposed over the inferior aspect of the aortic arch. The CXR is otherwise within normal limits. The lateral chest x-ray demonstrates mediastinal air trapping with thymic demarcation. An oblique air space is also present anteriorly and superiorly to the heart. There are also vertical air densities outlining the trachea. Neither x-ray shows any signs of a pneumothorax (no need for chest tube) or pericardial effusion (no Beck’s triad).

Pearls: The thymus reaches maximum size during adolescence.


Eckstein M. Thoracic Trauma. Chpt. 45 in Marx: Rosen’s Emergency Medicine, Concepts and Clinical Practice, 8th ed., 2014

Takada K, Matsumoto S, Hiramatsu T, Kojima E, Shizu M, Okachi S, et al. Spontaneous pneumomediastinum: an algorithm for diagnosis and management. Ther Adv Respir Dis 2009;3:301-7.

Devaraj U. Recurrent spontaneous pneumomediastinum in a young female: Hamman’s crunch revisited. Oxford Journals. Oxf Med Case Rep (2014) 2014 (2): 18-20.doi: 10.1093/omcr/omu008

Imaging of thymic epithelial neoplasms. Rosado-de-Christenson ML – Hematol Oncol Clin North Am – 01-JUN-2008; 22(3): 409-31

Table of Contents

Everything you need to know for Urgent Care exams and current Urgent Care practice.

Abdominal Pain
Acute Pelvic Pain in Women
Acute Vaginal Bleeding
Back Pain
Chest Pain
Depressed Consciousness and Coma
Dizziness & Vertigo
Fever in the Adult Patient
Gastrointestinal Bleeding
Headache: Initial Approach
Nausea and Vomiting
Seizures: Initial Approach
Cardiac Failure: Congestive State/Cor Pulmonale
Circulation Disorders: Aortic Aneurysms
Circulation Disorders: Aortic Dissection
Circulation Disorders: Hypertension – Emergency Management
Circulation Disorders: Peripheral Vascular Disease
Coronary Syndromes: Acute I, II
Dysrhythmia: Antiarrhythmic Pharmacology
Dysrhythmia: Basic Concepts
Dysrhythmia: Conduction Disorders
Dysrhythmia: Implantable Devices
Dysrhythmia: Supraventricular Dysrhythmias
Dysrhythmia: Ventricular Disorders
Pericarditis / Pericardial Tamponade (non-traumatic)
Valvular Heart Disease – Emergency Management
Cancers of the Skin
Cutaneous Infections I, II
Dermatitis (non-infectious)
Maculopapular Lesions
Papular/Nodular Lesions
Ulcerative Lesions
Vesicular/Bullous Lesions
Nose: Infection and Inflammation
Oral Cavity: Medical Disorders
Otologic Infections
Otologic Signs, Symptoms, & Presentations
Throat & Soft Tissue Neck: Medical Disorders
Clinical Context – Acid-Base Disorders
Clinical Context – Alcoholic and Lactic Acidosis
Clinical Context – Osmol and Anion Gaps
Electrolyte Disorders – Calcium, Magnesium, Phosphorus
Electrolyte Disorders – Potassium
Electrolyte Disorders – Sodium, Chloride
Endocrine Disorders – Adrenal Gland
Endocrine Disorders – Diabetic Ketoacidosis
Endocrine Disorders – Hyperosmolar Hyperglycemic State
Endocrine Disorders – Hypoglycemia
Endocrine Disorders– Thyroid Gland
Miscellaneous – Alcohol-Related Disease
Anorectal Disorders
Colitis, Ileitis, and Functional Bowel Disorders
Esophageal Disorders and Foreign Bodies
Foodborne and Waterborne Diseases
Gallbladder and Biliary Tract Disorders
Liver – Infectious Disorders
Liver – Noninfectious Disorders
Obstruction, Ischemia, Perforation, Peritonitis
Pediatric Gastrointestinal Disorders
Stomach and Duodenal Disorders
Gynecologic Infections – Genital Lesions
Gynecologic Infections – Vaginal Discharge
Pregnancy – Labor, Delivery and Their Complications
Pregnancy – Acute Medical/Surgical Complications
Pregnancy – Acute Obstetric Complications
Pregnancy – General Approach to the Pregnant Patient
Pregnancy – Pre-existing Medical Illness
Disorders of Hemostasis – Factor Deficiencies
Disorders of Hemostasis – Platelets/Fibrinogen
Red and White Blood Cell Disorders
Selected Oncologic Emergencies
Bacterial Infections – Diphtheria, Pertussis, Tetanus
Bacterial Infections – Meningococcemia, Pneumococcemia
Bacterial Infections – MRSA, VRE, ESBL
Bacterial Infections – Pediatric I, II
Bacterial Infections – Tuberculosis
Collagen Vascular/Immune Complex Disorders
Parasitic Infections
Sepsis Syndromes
Systemic Fungal Infections
The Immunocompromised/Solid-Organ Transplant Patient
Tick-Borne Illnesses
Viral Infections – Hantavirus
Viral Infections – HIV and AIDS
Viral Infections – Influenza, Mononucleosis, Herpes
Viral Infections – Pediatric
Viral Infections – Rabies
Male Genital Problems – Noninfectious
Nephropathy, Contrast Induced
Renal Failure: Acute
Renal Failure: Chronic
Renal Transplantation
Sexually Transmitted Infections – Male
Urinary Retention
Urinary Tract Infection
Urological Assessment
Central Nervous System Disorders: Delirium and Dementia
Central Nervous System Disorders: Demyelinating/Inflammatory
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: Treatment
Headache: Cervical Neck Vessels, Subarachnoid, and Venous Emergencies
Headache: Cluster, Migraine, and Tension
Headache: Less Common Etiologies
Neurological Assessment I, II
Pediatric Nervous System Disorders I, II
Peripheral Nervous System Disorders: Neuromuscular Junction Disease
Peripheral Nervous System Disorders: Neuropathies
Selected Cranial Nerve Disorders

EENT Trauma: Eye
Eye: Assessment
Eye: Glaucoma
Eye: Inflammation and Infection
Eye: Pharmacology
Eye: Vascular Disorders
Bone and Joint Infections
Deep Soft Tissue Infections
Disorders of Muscles
Disorders of the Spine
Evaluation for Sports Participation
Orthopedic Injuries: Ankle & Foot
Orthopedic Injuries: Cervical Spine
Orthopedic Injuries: Femur & Hip
Orthopedic Injuries: Hand I, II
Orthopedic Injuries: Humerus & Elbow
Orthopedic Injuries: Knee & Lower Leg
Orthopedic Injuries: Shoulder
Orthopedic Injuries: Wrist & Forearm
Overuse Syndromes (incl. Tendinopathy and Bursitis)
Sports Injuries/Trauma I, II
Acute Upper Airway Disorders (Incl. Peds.)
Disorders Of Pleura, Mediastinum, And Chest Wall
Obstructive/Restrictive Diseases – Fibrosis/Emphysema/Exposures (Incl. Peds) I, II
Obstructive/Restrictive Diseases – Reactive Lower Airway Disorders (Incl. Peds)
Pulmonary Embolism/Hypertension/Edema
Pulmonary Infections (Incl. Peds)
Affective Disorders
Anxiety Disorders
Dissociative Disorders
Eating Disorders
Factitious Disorders and Malingering
Obsessive-Compulsive Disorder
Pediatric Psychiatric Disorders I, II
Personality Disorders
Psychiatric Assessment
Psychological Factors Affecting Medical Disorders
Somatoform Disorders
Suicidal Behavior
Thought Disorders
Burns – Chemical
Burns – Thermal
EENT Trauma: Nose
EENT Trauma: Oral-Dental
EENT Trauma: Otologic
Geriatric Trauma
Mammalian Bite Wounds (Including Humans)
Peripheral Vascular Injury
Trauma in Pregnancy
Trauma: Abdominal I, II
Trauma: Assessment and Stabilization
Trauma: Face
Trauma: Foreign Bodies
Trauma: Genitourinary I, II
Trauma: Head
Trauma: Multiple and Blast Injuries
Trauma: Pelvic
Trauma: Soft Tissue Neck
Trauma: Spinal Cord
Trauma: Thoracic – Cardiovascular Injuries
Trauma: Thoracic – Chest Wall
Trauma: Thoracic – Esophageal Injuries
Trauma: Thoracic – Pulmonary Injuries
Electrical and Lightning Injuries
Heat-Related Illnesses
High Altitude Disorders
Hypothermia – Accidental
Scuba Diving and Dysbarism
Venomous Animal Injuries – Arthropods
Venomous Animal Injuries – Marine
Venomous Animal Injuries – Reptiles
Wound Management: Closure Techniques
Wound Management: Escharotomy
Wound Management: General
Wound Management: Incision and Drainage
Wound Management: Nail Trephination
Cardiac Arrest
Hypersensitivity Reactions
Psychiatric Emergencies
Respiratory Distress
Violence (incl. Domestic, Child and Elder Abuse, Sexual Assault)
Blood-Borne Pathogen Exposure Protocol
DOT Mini Review
Occupational Health
Pre-Employment Physicals
Worker’s Compensation
Medical Ethics in Urgent Care Clinic Management
Medical Law in Urgent Care Clinic Management
Professionalism, Risk Prevention, and Provider Wellness

Written and Maintained by Experts

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


Mark W. Perdue, PA-C
Physician Assistant
Mednow Urgent Care
Broken Arrow, OK

Contributing Editors / Clinical Reviewers:

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

Kimberly Collins, MD
Emergency Physician
MedExpress Urgent Care
Tampa, FL

Ann Dietrich, MD
Nationwide Children’s Hospital
Pediatric Director for the Center for EMS
Ohio State University
Wexler Medical Center
Columbus, OH

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

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

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

Janice Katz, MD
Womack Army Medical Center
Fort Bragg, NC

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

Mary Alice O’Brien, DNP, APRN, FNP-BC
Nurse Practitioner
CareSpot Urgent Care Centers
Jacksonville, FL

Joseph Scott Savage, DO, FAAEM, FACHE, FSCP, FAIHQ
Staff Physician
Emergency Dept.
Yale-New Haven Health System
Bridgeport Hospital
New Haven, CT

Charles E. Stewart, MD, EMDM, MPH
Medical Director
EMS Programs
Tulsa Tech
Tulsa, OK

Grace Thomas, MD
Attending Physician
Emergency Department
Level I Trauma Center
Wake Medical Hospital
Raliegh, NC

Ruby S. Thomas, MD, MPH, FAAP
Assistant Professor
Department of Community Health and Preventive Medicine
Morehouse School of Medicine
Atlanta, GA

Frank Townsend, III, MD, JD
Attending Physician
Emergency Department
Greater Baltimore Medical Center
Baltimore, MD

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

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

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

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