SAEM ACTUAL EXAM 400 QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
Question 1
A 42 year old former custodial worker presents stating, "I think that people can hear
what I am thinking." In the emergency department, he becomes extremely agitated
and threatening, and his psychoses become more severe. In choosing an
antipsychotic medication, which of the following would be the most appropriate
choice?
A. haloperidol
B. chlorpromazine
C. thioridazine
D. ketamine
Correct Answer
A. haloperidol
The answer is A. Haloperidol is the most studied high potency antipsychotic agent
used in agitated patients. Typical dosing is 5-10 mg IM every 10-30 minutes.
Unlike thioridazine, haloperidol does not cause respiratory depression, has
negligible anticholinergic side effects, and rarely causes hypotension. Although
benzodiazepines can be used in the agitated patient, respiratory depression can
occur, and close monitoring is essential.
Page 1 of 586
,Question 2
"An 82 year old woman with osteoporosis slips and falls onto her right hip. She
cannot get up and is brought to the emergency department by ambulance. As you
enter the room you notice her right leg is abducted and externally rotated. What type
of injury does she most likely have?
A. Subtrochanteric femur fracture
B. Intertrochanteric femur fracture
C. Femoral neck fracture
D. Acetabular fracture
E. Posterior hip dislocation"
Correct Answer
"C. Femoral neck fracture
The answer is C. Patients with dislocation tend to have internal (not external)
rotation."
Question 3
A Wood's light is an ultraviolet source that emits light of 365nm wavelength resulting
in different fluorescent patterns when directed at different organisms. Which of the
following correctly matches the organism to its fluorescent pattern?
A. Erythrasma - red or pink
B. Tinea versicolor - green or yellow
C. Pseudomonas - yellow or green
D. Porphyria cutanea - urine color change to orange or yellow
E. All of the above
Correct Answer
E. All of the above
Page 2 of 586
,Question 4
A mother brings her 6 week old boy to the emergency room. She states the baby has
been vomiting everything she's tried to feed him for the past 12 hours. She states that
he usually eats readily and completes an entire feeding, but he is unable to keep
anything down. The emesis is non-bloody and non-bilious, however it is projectile in
nature. What is the most likely condition in this patient?
A. viral gastroenteritis
B. constipation
C. appendicitis
D. intussusception
E. pyloric stenosis
Correct Answer
E. pyloric stenosis
The answer is E. Hypertrophic pyloric stenosis typically presents in the second to
sixth week of life and is four times more common in males than females. Infants
with hypertrophic pyloric stenosis typically are vigorous eaters but shortly afterward
regurgitate the entire feeding contents in a projectile fashion. The emesis is non-
bilious. The classic finding on exam is an "olive" palpable in the abdomen, and
diagnosis is typically via ultrasound. Intussusception typically presents between the
ages of 5 and 12 months. Gastroenteritis is characterized by diarrhea as well as
vomiting. Neither constipation nor appendicitis typically present with protracted
vomiting, though the latter condition tends to present atypically in young children
(and elderly adults).
Question 5
"While lifting weights after a few months off of his training regimen, the patient
depicted in the figure below felt a pop in the right arm. He has weakness of, and pain
with, elbow flexion and supination. Of the choices below, which is the most likely
diagnosis?
[image]
A. humerus fracture
B. acromioclavicular separation
C. rotator cuff tear
D. biceps rupture
E. elbow dislocation"
Correct Answer
"D. biceps rupture"
Page 3 of 586
, Question 6
"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?
A. Avulsion fracture of the greater tuberosity of the humerus
B. Compression fracture of the posteriolateral aspect of the humeral head (Hill-Sachs
deformity)
C. Clavicle fracture
D. Acromioclavicular joint separation
E. Fracture of the anterior glenoid lip (Bankart's fracture)"
Correct Answer
"B. Compression fracture of the posteriolateral aspect of the humeral head (Hill-
Sachs deformity)"
Question 7
"Which medication is ideal for the agitated or combative patient?
A. Nitrous oxide
B. Hydromorphone
C. Haloperidol
D. Propofol"
Correct Answer
The answer is C. Drugs with a relatively short half-life allow for more careful
monitoring of chemically restrained patients. Patients may be given multiple
administrations of the restraining agent as needed. Antipsychotics (such as
haloperidol) and benzodiazepines (such as lorazepam) exhibit most of these
characteristics and are commonly used in combination in the emergency
department. The use of 5 mg of haloperidol IV/IM with 2 mg of lorazepam IV/IM,
repeated every 30 minutes as needed, is recommended for the combative patient
who does not have contraindications to these medications. Half doses should be
used in the elderly.
Page 4 of 586
CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS)
Question 1
A 42 year old former custodial worker presents stating, "I think that people can hear
what I am thinking." In the emergency department, he becomes extremely agitated
and threatening, and his psychoses become more severe. In choosing an
antipsychotic medication, which of the following would be the most appropriate
choice?
A. haloperidol
B. chlorpromazine
C. thioridazine
D. ketamine
Correct Answer
A. haloperidol
The answer is A. Haloperidol is the most studied high potency antipsychotic agent
used in agitated patients. Typical dosing is 5-10 mg IM every 10-30 minutes.
Unlike thioridazine, haloperidol does not cause respiratory depression, has
negligible anticholinergic side effects, and rarely causes hypotension. Although
benzodiazepines can be used in the agitated patient, respiratory depression can
occur, and close monitoring is essential.
Page 1 of 586
,Question 2
"An 82 year old woman with osteoporosis slips and falls onto her right hip. She
cannot get up and is brought to the emergency department by ambulance. As you
enter the room you notice her right leg is abducted and externally rotated. What type
of injury does she most likely have?
A. Subtrochanteric femur fracture
B. Intertrochanteric femur fracture
C. Femoral neck fracture
D. Acetabular fracture
E. Posterior hip dislocation"
Correct Answer
"C. Femoral neck fracture
The answer is C. Patients with dislocation tend to have internal (not external)
rotation."
Question 3
A Wood's light is an ultraviolet source that emits light of 365nm wavelength resulting
in different fluorescent patterns when directed at different organisms. Which of the
following correctly matches the organism to its fluorescent pattern?
A. Erythrasma - red or pink
B. Tinea versicolor - green or yellow
C. Pseudomonas - yellow or green
D. Porphyria cutanea - urine color change to orange or yellow
E. All of the above
Correct Answer
E. All of the above
Page 2 of 586
,Question 4
A mother brings her 6 week old boy to the emergency room. She states the baby has
been vomiting everything she's tried to feed him for the past 12 hours. She states that
he usually eats readily and completes an entire feeding, but he is unable to keep
anything down. The emesis is non-bloody and non-bilious, however it is projectile in
nature. What is the most likely condition in this patient?
A. viral gastroenteritis
B. constipation
C. appendicitis
D. intussusception
E. pyloric stenosis
Correct Answer
E. pyloric stenosis
The answer is E. Hypertrophic pyloric stenosis typically presents in the second to
sixth week of life and is four times more common in males than females. Infants
with hypertrophic pyloric stenosis typically are vigorous eaters but shortly afterward
regurgitate the entire feeding contents in a projectile fashion. The emesis is non-
bilious. The classic finding on exam is an "olive" palpable in the abdomen, and
diagnosis is typically via ultrasound. Intussusception typically presents between the
ages of 5 and 12 months. Gastroenteritis is characterized by diarrhea as well as
vomiting. Neither constipation nor appendicitis typically present with protracted
vomiting, though the latter condition tends to present atypically in young children
(and elderly adults).
Question 5
"While lifting weights after a few months off of his training regimen, the patient
depicted in the figure below felt a pop in the right arm. He has weakness of, and pain
with, elbow flexion and supination. Of the choices below, which is the most likely
diagnosis?
[image]
A. humerus fracture
B. acromioclavicular separation
C. rotator cuff tear
D. biceps rupture
E. elbow dislocation"
Correct Answer
"D. biceps rupture"
Page 3 of 586
, Question 6
"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?
A. Avulsion fracture of the greater tuberosity of the humerus
B. Compression fracture of the posteriolateral aspect of the humeral head (Hill-Sachs
deformity)
C. Clavicle fracture
D. Acromioclavicular joint separation
E. Fracture of the anterior glenoid lip (Bankart's fracture)"
Correct Answer
"B. Compression fracture of the posteriolateral aspect of the humeral head (Hill-
Sachs deformity)"
Question 7
"Which medication is ideal for the agitated or combative patient?
A. Nitrous oxide
B. Hydromorphone
C. Haloperidol
D. Propofol"
Correct Answer
The answer is C. Drugs with a relatively short half-life allow for more careful
monitoring of chemically restrained patients. Patients may be given multiple
administrations of the restraining agent as needed. Antipsychotics (such as
haloperidol) and benzodiazepines (such as lorazepam) exhibit most of these
characteristics and are commonly used in combination in the emergency
department. The use of 5 mg of haloperidol IV/IM with 2 mg of lorazepam IV/IM,
repeated every 30 minutes as needed, is recommended for the combative patient
who does not have contraindications to these medications. Half doses should be
used in the elderly.
Page 4 of 586
