Download SAEM M4 Exam TEST BANK UPDATED 2025-2026. QUESTIONS & CORRECT DETAILED ANSWERS. GRADED A and more Exams Medical Sciences in PDF only on Docsity!
SAEM M4 Exam TEST BANK
UPDATED 2025-2026. QUESTIONS &
CORRECT DETAILED ANSWERS WITH
RATIONALES. GRADED A
A 17 year old boy injured his right shoulder playing football. He tried to arm-tackle a player when his right arm was pulled away from his body and back (abducted and extended). He felt a sudden pain in his shoulder. He presents to the emergency department holding his arm in slight abduction and external rotation by his good arm. He has severe pain with adduction or internal rotation. What is the most common fracture associated with this injury? - ANScompression fracture of the posteriolateral aspect of the humeral head (Hill-Sachs deformity) A 19 year old male presents to the emergency department with allergic- mediated pruritis over large portions of his body. Which of the following is true regarding this condition? Answers: 1.H2 antagonists such as ranitidine or famotidine have never been shown to provide benefit. 2.Topical antihistamine agents should be encouraged to manage the pruritis.
3.There is no role for therapies such as Domeboro solution (1:10 diluted aluminum sulfate soaks), potassium permanganate baths, and oat-meal baths. 4.Oral doses of antihistamines should be encouraged initially. 5.Second generation antihistamines such astemizole, fexofenadine, and loratadine are more effective but cause increased levels of sedation and should be avoided if possible. - ANS4.Oral doses of antihistamines should be encouraged initially. A 2 year old child presents with an overdose of her mother's iron containing multivitamins. What antidote should you consider for iron toxicity? Answers: 1.Deferoxamine 2.Glucagon 3.Methylene blue 4.Pyridoxine - ANS1.Deferoxamine A 20 year old college female recently returned from spring break after hiking in the Virginia woods approximately two weeks prior to her presentation to the E.D. One day prior to presentation, she developed fever, chills, and anorexia. In the emergency department, she complains of headache, photophobia, and myalgias. On exam, one notices a disseminated, non-blanching, papular rash. Which of the following statements regarding this condition is FALSE? Answers:
A 23 year old man is stabbed in the anterior neck with a 3-inch knife during a street fight. At the scene, there is some bleeding, which is controlled with direct pressure. He presents to the emergency department breathing comfortably and in no distress. His pulse is 88, blood pressure 126/76, and oxygen saturation 99% on room air. There is a 1cm laceration 2cm above the right sternoclavicular junction, lateral to the trachea. There is mild oozing and no obvious underlying hematoma. There is no obvious subcutaneous air, and he has clear lung sounds. What is the most appropriate management for this patient? Answers: 1.Immediate operative exploration 2.Local wound exploration and discharge home if no significant injury identified 3.Local wound exploration and discharge home after 6-hour observation period 4.Angiography, esophogram, and admission for observation 5.CT scan of the neck and discharge home after 6 hours of - ANS4.Angiography, esophogram, and admission for observation A 23 year old woman is dropped off by her boyfriend after an unknown overdose. You notice that she is has very large pupils and is sweating profusely. Her respiratory rate, blood pressure and heart rate are elevated. Which of the following is the most likely agent to have caused her symptoms?
Answers: 1.Jimson weed 2.Cocaine 3.Heroin 4.Insulin - ANS2. cocaine A 24 year old female gardener presents to the emergency department with foot pain 30 minutes after working barefoot in her garden. She saw a scorpion in the area. Which of the following signs or symptoms are most expected? Answers: 1.Puncture mark 2.Local erythema and swelling 3.Pain and paresthesias 4.Cranial nerve abnormalities - ANS3.Pain and paresthesias A 24 year old woman is playing racquetball and sustains a direct blow from the ball to the right eye. She presents to the emergency department complaining of eye pain and double vision. On exam, her right eye does not track properly with upward gaze. This finding suggests which of the following injuries? Select all that apply 1.Inferior orbital rim fracture 2.Superior orbital rim fracture 3.Inferior orbital wall fracture
4. 0.6:1 - ANS4. 0.6:
A 25 year old man returns to the ED, 24 hours after being released from the hospital with a new diagnosis of schizophrenia. He has recently started to take haloperidal for his psychotic symptoms. In the ED he is noted to have involuntary contractions of the muscles of the face, a protruding tongue, deviation of the head to one side, and sustained upward deviation of the eyes. Vital signs are stable, and initial labs show no electrolyte or hematological abnormalities. Of the following choices, the preferred medication for this condition is: Answers: 1.diphenhydramine 2.lorazepam 3.phenobarbital 4.metoprolol - ANS2.lorazepam A 27 year old woman is brought into the emergency department by her roommate 30 minutes after ingesting a bottle of aspirin in a suicide attempt. Which of the following acid-base disorders is most likely to be present in this patient? Answers: 1.Respiratory acidosis due to somnolence causing decreased respiratory drive 2.Respiratory alkalosis due to stimulation of the respiratory center and increased CO2 production
3.Primary respiratory acidosis with compensatory metabolic alkalosis 4.Primary metabolic acidosis with compensatory respiratory alkalosis - ANS2.Respiratory alkalosis due to stimulation of the respiratory center and increased CO2 production A 28 year old man is shot in the right chest. His vital signs are: T 97.9, HR 120, BP 70/50, RR 12, SPO2 84%. He has significant JVD, his trachea is deviated to the left, and he has decreased breath sounds on the right. The patient's diagnosis is: Answers: 1.Hypovolemic shock 2.Tension pneumothorax 3.Cardiac tamponade 4.Lung laceration 5.Spinal cord injury - ANS2.Tension pneumothorax A 35 year old woman presents complaining of left wrist pain for several months. She works as a waitress and has noticed increasing wrist pain associated with intermittent numbness and tingling of her thumb, index finger and long finger on the left hand. She states the pain is worse at night and after work. On exam she has tingling in her leftthumb and first digit when her wrists are held in flexion for 60 seconds. This is a positive ____________ test and suggests the diagnosis of ______________. Answers: 1.Finkelstein test/De Quervain's tendonitis
the wound. The patient became symptomatic soon after the student gave the anesthetic. Which of the following is usually the earliest sign of lidocaine toxicity? Answers: 1.Nausea/vomiting 2.Nystagmus 3.Lightheadedness and dizziness 4.Tonic-clinic seizures - ANS3.Lightheadedness and dizziness A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her family indicates she has been taking for years to help with her anxiety. The bottle indicates that the prescription was filled yesterday with 90 pills and is now empty. The patient is minimally responsive to painful stimuli and does not react when you suction secretions out of her posterior pharynx. What is your next management step? Answers: 1.Administration of flumazenil 2.Administration of narcan 3.Close observation 4.Intubation for airway support - ANS4.Intubation for airway support A 44 year old woman presents complaining of the acute onset of left eye pain while walking into a movie theater one hour ago. On physical examination, she has stable vital signs. Her visual acuity is 20/25 on the right eye and 20/200 on the left eye. Her pupillary exam is notable for a
minimally reactive dilated left pupil and a steamy cornea. The left eye is red and obviously painful. Which of the following conditions is mostlikely? Answers: 1.acute angle closure glaucoma 2.central retinal artery occlusion 3.hypopyon 4.optic neuritis 5.vitreous hemorrhage - ANS1.acute angle closure glaucoma A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the best treatment method for this overdose? Answers: 1.Activated charcoal 2.Gastric lavage 3.Hemodialysis 4.Whole bowel irrigation - ANS3.Hemodialysis A 46 year old woman presents to the emergency department complaining of abrupt onset of intermittent severe pain in the left flank and abdomen that woke her from sleep. She is pacing around the stretcher and appears extremely uncomfortable. She has never experienced this type of pain previously and denies fevers or other symptoms. Renal calculus is suspected. Which of the following is true regarding the diagnosis of renal calculi in this patient?
3.If the infection is bacterial, the primary role of antibiotic therapy is to prevent complications 4.Treatment of choice is azithromycin 5.Vaccination prevents recurrence - ANS3.If the infection is bacterial, the primary role of antibiotic therapy is to prevent complications A 53 year old man with non-insulin dependent diabetes mellitus presents with pain, redness, and swelling of the right foot and lower leg, accompanied by a temperature of 102. X-rays reveal no subcutaneous gas and show no evidence of osteomyelitis. The patient has been admitted on three previous occasions for cellulitis of the right foot and notes that this episode is identical. Which of the following antibiotics is the most appropriate initial therapy for a presumed diagnosis of cellulitis? Answers: 1.oral dicloxacillin 2.intravenous nafcillin 3.intravenous gentamicin 4.intravenous ampicillin-sulbactam 5.intravenous cefazolin - ANS4.intravenous ampicillin-sulbactam A 53 year-old known alcoholic presents with agitation, vomiting and altered mental status. His fingerstick glucose is 148. His serum ethanol level is undetectable and his head CT is normal. An ABG shows a pH of 7.21, pCO2 of 34, pO2 of 98 on room air. His basic chemistry panel includes a sodium of 136, potassium 4.1, chloride 108, bicarbonate 14, BUN 12,
creatinine 1.1. What substance are you concerned that he may have ingested Answers: 1.Ethylene glycol 2.Salicylates 3.Isopropyl alcohol 4.Methanol - ANS3.Isopropyl alcohol A 54 year old male comes to the emergency department complaining of intermittent pain, swelling and constant burning sensation involving his right leg. He tells you that six months ago he injured his leg in a car accident and his x-rays were negative. The symptoms have gradually worsened over the past few months. He is presenting to the emergency department because he doesn't have a primary care doctor. On physicalexamination you notice that his leg is edematous, erythematous, dry and warm. The leg is also characterized by hair loss, allodynia and hyperesthesia. Of the following, which is the most appropriate emergency department course? Answers: 1.Arrange follow-up for presumed complex regional pain syndrome 2.Obtain a CT scan of his leg to rule out osteomyelitis 3.Order a venogram to rule out a deep venous thrombosis 4.Perform a femoral nerve block to control his pain - ANS1.Arrange follow- up for presumed complex regional pain syndrome
saturation 99%, T 36.8. His EKG shows ST segment elevation in leads II, III, aVF and V1. ST-segment elevation is greater in lead III than in lead II. What additional diagnostic test is indicated prior to giving nitroglycerin? Answers: 1.CXR 2.d-dimer 3.Echocardiogram 4.EKG with right-sided leads - ANS4.EKG with right-sided leads A 60 year old male presents with new onset confusion. Which of the following suggests a functional, as opposed to an organic etiology? Answers: 1.abnormal vital signs 2.acute onset 3.auditory hallucinations 4.disorientation - ANS3.auditory hallucinations A 65 year old male with a past medical history of poorly controlled hypertension presents with new onset unilateral arm and leg weakness. There is no disturbance of consciousness and there is no evidence of cortical findings (such as aphasia, agnosia, or hemianopsia). What is the most likely location of the vascular obstruction? Answers: 1.anterior cerebral artery
2.middle cerebral artery 3.posterior cerebral artery 4.lacunar 5.basilar artery - ANS4.lacunar A 65-year-old female presents 2 weeks after an MI complaining of chest pain, fever, and shortness of breath. She has a new friction rub on exam and a leukocytosis. She most likely has: Answers: 1.congestive heart failure 2.Dressler's syndrome 3.new myocardial infarction 4.pneumonia 5.pulmonary embolism - ANS2.Dressler's syndrome A 67-year old male presents in acute respiratory failure. You have chosen etomidate as the induction agent to perform rapid sequence intubation (RSI) on your patient. He is allergic to eggs and penicillin. Which of the following is true regarding etomidate? Answers: 1.Has a large side effect profile and other agents should be considered first for induction in RSI 2.Is not safe to use in patients with cardiovascular disease due to its detrimental effects on myocardial contractility 3.It should not be used in patients allergic to soy or eggs
2.pH 7.33 pCO2 48 pO2 58 HCO3 29 3.pH 7.45 pCO2 21 pO2 124 HCO3 14 4.pH 7.47 pCO2 31 pO2 96 HCO3 25 - ANS3.pH 7.45 pCO2 21 pO2 124 HCO3 14 A 72-year-old male presents with five hours of substernal chest pain and pressure despite taking three sublingual nitroglycerin. You order an EKG. What findings on the EKG would indicate that this patient is potentially a candidate for thrombolytic therapy? Answers: 1.Atrial fibrillation with a rapid ventricular response 2.ST-segment depression of at least 2mm in any precordial lead 3.ST-segment elevation of at least 1 mm in two or more contiguous leads 4.Ventricular tachycardia - ANS3.ST-segment elevation of at least 1 mm in two or more contiguous leads A 78 year old man presents with acute onset of painless, complete visual loss in the right eye. Which of the following best explains his symptoms? Answers: 1.acute angle closure glaucoma 2.central retinal artery occlusion 3.herpes keratitis 4.iritis 5.optic neuritis - ANS2.central retinal artery occlusion
A fracture in which there are more than two fragments is: Answers: 1.compound 2.comminuted 3.oblique 4.spiral 5.transverse - ANS2.comminuted A mother brings in her 4 year old child who was happily eating "blackberries" from weeds in the garden and is now acting strangely. She has identified them as Belladonna from a quick internet search. Which physical examination finding might you also expect to find in this child? Answers: 1.Diaphoresis 2.Flushed skin 3.Miosis 4.Urinary incontinence - ANS2. flushed skin A newborn presents to the emergency department a few days after hospital discharge. The infant has been noted to be drooling, choking, and coughing, and the mother reports seeing bubbles at the baby's mouth. Which is the most likely explanation? Answers: 1.osteogenesis imperfecta
