The primary intent of this book is to serve as a study aid to improve performance on the EM Written Boards/Recertification or EM Inservice Exam. To achieve this goal the text is written in rapid-fire question/answer format. Misleading or confusing 'foils' are not provided. This eliminates the risk of erroneously assimilating an incorrect piece of information that made a big impression. Questions themselves often contain a pearl intended to be reinforced in association with the question/answer. Additional hooks are often attached to the answer in various forms including mnemonics, evoked visual imagery, repetition and humour. Additional information not requested in the question may be included in the answer. The structure and content of this new edition has been enhanced significantly. The first half of the text is presented in descending order of relative importance on the EM board exam. Information presented in the Pearls Topics sections is mostly limited to straightforward and more basic facts. The second section of the book consists of random pearls -- questions grouped into small clusters by topic presented in no particular order.