SAEM LATEST EXAM ACTUAL QUESTIONS AND
ANSWERS SURE A+
✔✔Which of the following cervical spine fractures is considered stable?
A. Transverse process fracture
B. Flexion teardrop fracture
C. Bilateral facet dislocation
D. Hangman's fracture of C2
E. Jefferson fracture of C1 - ✔✔A. Transverse process fracture
The answer is A.
A transverse process fracture involves only one of the supporting spinal columns (the
posterior column) and is therefore stable.
✔✔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?
A. Local wound exploration and discharge home if no significant injury identified
B. Angiography, esophogram, and admission for observation
C. Local wound exploration and discharge home after 6-hour observation period
D. CT scan of the neck and discharge home after 6 hours of observation
E. Immediate operative - ✔✔B. Angiography, esophogram, and admission for
observation
The answer is B. Zone I penetrating neck injuries are located between the sternal notch
and the cricoid cartilage. A major concern is injury to non-compressible vascular
structures such as common carotid, vertebral, subclavian, aortic arch. Other structures
in this area include trachea, esophagus, and lung apices. Physical exam is often
unreliable and angiography, esophogram, and observation are warranted.
✔✔Which of the following patients should undergo abdominal trauma evaluation?
A. 22 year old with stab wound to fourth intercostal space on right
B. 30 year old with pelvic pain and tenderness after fall
C. 25 year old restrained passenger in high-speed MVA; no abdominal complaints
D. None of the above
E. All of the above - ✔✔E. All of the above
The answer is E. The diaphragm can rise to as high a level as the fourth intercostal
space and can be injured by stab wounds at this level. Unsuspected injuries are
common in high speed motor vehicle crashes. Pelvic injuries are associated with intra-
, abdominal injuries and can distract a patient from such an injury. Therefore, all of these
patients need an evaluation of their abdomens.
✔✔Which of the following trauma patients can be managed conservatively without
immediate laparotomy in the OR?
A. 27 year old man with hemoperitoneum by bedside ultrasound; hypotensive
B. 19 year old man with splenic laceration; peritoneal signs on exam
C. 24 year old man with liver laceration; hemodynamically stable
D. 30 year old man with a gunshot wound to the epigastrium
E. All of the above should go to the OR for exploratory laparotomy. - ✔✔C. 24 year old
man with liver laceration; hemodynamically stable
✔✔Which of the following is an accurate statement?
A. Bedside ultrasound is the test of choice for diagnosing solid organ injury.
B. Diagnostic peritoneal lavage usually cannot identify the presence of
hemoperitoneum.
C. Bedside ultrasound can image the retroperitoneum.
D. Bedside ultrasound can reliably determine the etiology of hemoperitoneum.
E. Diagnostic peritoneal lavage cannot determine the etiology of hemoperitoneum. -
✔✔E. Diagnostic peritoneal lavage cannot determine the etiology of hemoperitoneum.
The answer is E. Diagnostic peritoneal lavage is extremely sensitive for the detection of
hemoperitoneum and can lead to many negative laparotomies. Neither bedside
ultrasound nor diagnostic peritoneal lavage can identify the source of the hemorrhage
though. A trauma ultrasound at the bedside can only identify fluid in the peritoneal
cavity, and CT scan is the test of choice for diagnosing solid organ injury.
✔✔A 36 year old man is a restrained driver involved in a high speed MVA where his car
is struck on the driver's side door with significant intrusion. His physical exam is
significant for a large contusion on his left flank. His abdominal exam is benign and
rectal exam reveals a normal prostate. A Foley catheter is placed with return of gross
hematuria. Which test is indicated to evaluate for the presence of urologic injury?
A. CT abdomen / pelvis with IV and transurethral contrast
B. Ultrasound of the bladder
C. CT abdomen / pelvis without contrast
D. Ultrasound of the kidneys
E. CT abdomen / pelvis with IV contrast alone - ✔✔A. CT abdomen / pelvis with IV and
transurethral contrast
✔✔In which of these patients is emergency department thoracotomy indicated?
A. All of the above should undergo emergency department thoracotomy.
B. Unbelted driver in a high-speed motor vehicle crash who loses his pulse while being
extricated, and arrives at the E.D. after a 45-minute transport
C. Patient with stab wound to the anterior chest who is dyspneic with an oxygen
saturation of 80% and a blood pressure of 168/102
ANSWERS SURE A+
✔✔Which of the following cervical spine fractures is considered stable?
A. Transverse process fracture
B. Flexion teardrop fracture
C. Bilateral facet dislocation
D. Hangman's fracture of C2
E. Jefferson fracture of C1 - ✔✔A. Transverse process fracture
The answer is A.
A transverse process fracture involves only one of the supporting spinal columns (the
posterior column) and is therefore stable.
✔✔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?
A. Local wound exploration and discharge home if no significant injury identified
B. Angiography, esophogram, and admission for observation
C. Local wound exploration and discharge home after 6-hour observation period
D. CT scan of the neck and discharge home after 6 hours of observation
E. Immediate operative - ✔✔B. Angiography, esophogram, and admission for
observation
The answer is B. Zone I penetrating neck injuries are located between the sternal notch
and the cricoid cartilage. A major concern is injury to non-compressible vascular
structures such as common carotid, vertebral, subclavian, aortic arch. Other structures
in this area include trachea, esophagus, and lung apices. Physical exam is often
unreliable and angiography, esophogram, and observation are warranted.
✔✔Which of the following patients should undergo abdominal trauma evaluation?
A. 22 year old with stab wound to fourth intercostal space on right
B. 30 year old with pelvic pain and tenderness after fall
C. 25 year old restrained passenger in high-speed MVA; no abdominal complaints
D. None of the above
E. All of the above - ✔✔E. All of the above
The answer is E. The diaphragm can rise to as high a level as the fourth intercostal
space and can be injured by stab wounds at this level. Unsuspected injuries are
common in high speed motor vehicle crashes. Pelvic injuries are associated with intra-
, abdominal injuries and can distract a patient from such an injury. Therefore, all of these
patients need an evaluation of their abdomens.
✔✔Which of the following trauma patients can be managed conservatively without
immediate laparotomy in the OR?
A. 27 year old man with hemoperitoneum by bedside ultrasound; hypotensive
B. 19 year old man with splenic laceration; peritoneal signs on exam
C. 24 year old man with liver laceration; hemodynamically stable
D. 30 year old man with a gunshot wound to the epigastrium
E. All of the above should go to the OR for exploratory laparotomy. - ✔✔C. 24 year old
man with liver laceration; hemodynamically stable
✔✔Which of the following is an accurate statement?
A. Bedside ultrasound is the test of choice for diagnosing solid organ injury.
B. Diagnostic peritoneal lavage usually cannot identify the presence of
hemoperitoneum.
C. Bedside ultrasound can image the retroperitoneum.
D. Bedside ultrasound can reliably determine the etiology of hemoperitoneum.
E. Diagnostic peritoneal lavage cannot determine the etiology of hemoperitoneum. -
✔✔E. Diagnostic peritoneal lavage cannot determine the etiology of hemoperitoneum.
The answer is E. Diagnostic peritoneal lavage is extremely sensitive for the detection of
hemoperitoneum and can lead to many negative laparotomies. Neither bedside
ultrasound nor diagnostic peritoneal lavage can identify the source of the hemorrhage
though. A trauma ultrasound at the bedside can only identify fluid in the peritoneal
cavity, and CT scan is the test of choice for diagnosing solid organ injury.
✔✔A 36 year old man is a restrained driver involved in a high speed MVA where his car
is struck on the driver's side door with significant intrusion. His physical exam is
significant for a large contusion on his left flank. His abdominal exam is benign and
rectal exam reveals a normal prostate. A Foley catheter is placed with return of gross
hematuria. Which test is indicated to evaluate for the presence of urologic injury?
A. CT abdomen / pelvis with IV and transurethral contrast
B. Ultrasound of the bladder
C. CT abdomen / pelvis without contrast
D. Ultrasound of the kidneys
E. CT abdomen / pelvis with IV contrast alone - ✔✔A. CT abdomen / pelvis with IV and
transurethral contrast
✔✔In which of these patients is emergency department thoracotomy indicated?
A. All of the above should undergo emergency department thoracotomy.
B. Unbelted driver in a high-speed motor vehicle crash who loses his pulse while being
extricated, and arrives at the E.D. after a 45-minute transport
C. Patient with stab wound to the anterior chest who is dyspneic with an oxygen
saturation of 80% and a blood pressure of 168/102
