SAEM EXAM WITH QUESTIONS AND WELL-
DETAILED ANSWSERS||ALREADY GRADED
A+|| LATEST UPDATE 2026
"For which of the following cases (all of which are characterized by an
ingestion history known with certainty) is gastric lavage most likely indicated?
A. Adult patient, kerosene ingestion (8 oz, 20 minutes PTA)
B. Adult patient, nortriptyline ingestion (50 mg/tab x 100 tablets, 45 minutes
PTA)
C. Adult patient, metoprolol ingestion (100 mg/tab x 100 tablets, 6 hours PTA)
D. Adult patient, ibuprofen ingestion (800 mg/tab x 5 tabs, 20 minutes prior to
arrival (PTA) in the ED" - ANSWER-"B. Adult patient, nortriptyline ingestion
(50 mg/tab x 100 tablets, 45 minutes PTA)
The answer is B. Gastric lavage (GL) is generally not effective if performed
more than a few hours (exact time ranges depend on clinical circumstances)
after ingestion. Due to risks of lavage (aspiration, gastric/esophageal
perforation), trivial ingestions are not an indication for GL. Due to the risk of
aspiration with hydrocarbons and further injury with caustic ingestions, GL is
contraindicated for hydrocarbon and caustic ingestions"
"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?
A. Jimson weed
B. Cocaine
C. Heroin
,D. Insulin" - ANSWER-"B. Cocaine
Cocaine is a sympathomimetic. Sympathomimetics and anticholinergics such as
Jimson Weed can be differentiated by the presence of sweating although both
can cause delirium and mydriasis. Aspirin or salicyclate toxicity can cause
increased respiratory drive through direct stimulation of the medullary
respiratory center but should not cause papillary changes. Heroin will result in a
classic toxidrome of miosis, CNS and respiratory depression as will other
opiates."
"For a patient in neurogenic shock, the correct treatment would likely be all of
the following EXCEPT:
A. Spinal immobilization
B. Blood transfusion
C. High dose steroids
D. IV fluid bolus
E. Phenylephrine" - ANSWER-"B. Blood transfusion
The answer is B. Treatment of a spinal cord injury with neurogenic shock
includes high dose steroids, IV fluids, immobilization, and potentially pressors.
Blood transfusions are generally not indicated, and care must be taken to avoid
fluid overload. -- For further reading, see Tintinalli, et al., Emergency Medicine:
A Comprehensive Study Guide, 5th edition, pages 247-248."
"A 19 year old man is stabbed in the left chest in the 3rd intercostals space just
to the left of the sternum. His vital signs are: T 97.9, HR 130, BP 60/48, RR 18,
SPO2 84%. He has significant JVD and his lungs are clear. The patient's
diagnosis is:
A. Tension pneumothorax
B. Lung laceration
C. Spinal cord injury
D. Hypovolemic shock
,E. Cardiac tamponade" - ANSWER-"E. Cardiac tamponade
The answer is E. The patient has a stab wound to the left chest near the sternum.
His hypotension, clear lungs, and JVD suggest an obstructive shock. He likely
has cardiac tamponade and needs emergent decompression either with
pericardiocentesis or pericardial window."
"A 24 year old woman, brought by her sister, enters the emergency department.
The 24 year old is writhing in pain, clutching her abdomen and shivering. Her
sister states that the patient had a therapeutic abortion performed 3 days ago and
has been having worsening abdominal pain ever since. The patient's vital signs
are: T 103.4 F, HR 128, BP 104/72, RR 28, O2 saturation 100% in room air and
she has marked lower abdominal pain and voluntary guarding. The most
appropriate steps in treatment for this woman's condition include all of the
following EXCEPT:
A. broad-spectrum antibiotics
B. laboratory studies including basic chemistry, complete blood count with
differential, coagulations studies, DIC panel, serum pregnancy test, and blood
cultures
C. urgent ob/gyn consult to facilitate rapid transport of patient to the operating
room
D. intravenous fluids
E. high-dose steroids" - ANSWER-"E. high-dose steroids
The answer is E. This patient is most likely suffering from a septic abortion in
which retained products of conception developed a local infection. This
infection has now spread systemically causing the systemic inflammatory
response and potentially causing sepsis. Immediate intravenous fluids and
broad-spectrum antibiotics are necessary; however, steroids are contraindicated
in such a situation and could worsen the infection. The patient needs to be taken
to the OR urgently to remove the retained products of conception."
"A college student who had a mild upper respiratory tract infection last week,
presents during the spring. He appears toxic, with fever, headache, and a rash
, (see figure) which was also noted on the wrists, ankles, flanks, and axilla. Of
those listed below, which is the most likely diagnosis?
[image shows purple spotted rash on extremity]
A. angioedema
B. herpes zoster
C. Lyme disease
D. pemphigus vulgaris
E. meningococcemia" - ANSWER-"E. meningococcemia
The answer is E. This patient's presentation is consistent with
meningococcemia. Lyme disease often presents with a rash (erythema
chronicum migrans), but that rash has a different appearance (erythema with
central clearing). Pemphgus vulgaris is characterized by intraepidermal
blistering, and angioedema is seen more in the mucous membranes. Herpes
zoster has an appearance of grouped (painful) vesicles on an erythematous
base."
"Which of the following is a common physiologic finding in septic shock?
A. Decreased urine output
B. Increased pulmonary wedge pressure
C. Increased cardiac index
D. Increased systemic vascular resistance (SVR)
E. Normothermia" - ANSWER-"A. Decreased urine output
The answer is A. Patients in septic shock have decreased systemic vascular
resistance and cardiac index, secondary to endotoxins. They can be hyper- or
hypothermic but usually are not normothermic. The pulmonary wedge pressure
is often normal or low. Like all shock states, septic shock is generally associated
with decreased urine output."
"All of the following are common causes of septic shock EXCEPT:
DETAILED ANSWSERS||ALREADY GRADED
A+|| LATEST UPDATE 2026
"For which of the following cases (all of which are characterized by an
ingestion history known with certainty) is gastric lavage most likely indicated?
A. Adult patient, kerosene ingestion (8 oz, 20 minutes PTA)
B. Adult patient, nortriptyline ingestion (50 mg/tab x 100 tablets, 45 minutes
PTA)
C. Adult patient, metoprolol ingestion (100 mg/tab x 100 tablets, 6 hours PTA)
D. Adult patient, ibuprofen ingestion (800 mg/tab x 5 tabs, 20 minutes prior to
arrival (PTA) in the ED" - ANSWER-"B. Adult patient, nortriptyline ingestion
(50 mg/tab x 100 tablets, 45 minutes PTA)
The answer is B. Gastric lavage (GL) is generally not effective if performed
more than a few hours (exact time ranges depend on clinical circumstances)
after ingestion. Due to risks of lavage (aspiration, gastric/esophageal
perforation), trivial ingestions are not an indication for GL. Due to the risk of
aspiration with hydrocarbons and further injury with caustic ingestions, GL is
contraindicated for hydrocarbon and caustic ingestions"
"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?
A. Jimson weed
B. Cocaine
C. Heroin
,D. Insulin" - ANSWER-"B. Cocaine
Cocaine is a sympathomimetic. Sympathomimetics and anticholinergics such as
Jimson Weed can be differentiated by the presence of sweating although both
can cause delirium and mydriasis. Aspirin or salicyclate toxicity can cause
increased respiratory drive through direct stimulation of the medullary
respiratory center but should not cause papillary changes. Heroin will result in a
classic toxidrome of miosis, CNS and respiratory depression as will other
opiates."
"For a patient in neurogenic shock, the correct treatment would likely be all of
the following EXCEPT:
A. Spinal immobilization
B. Blood transfusion
C. High dose steroids
D. IV fluid bolus
E. Phenylephrine" - ANSWER-"B. Blood transfusion
The answer is B. Treatment of a spinal cord injury with neurogenic shock
includes high dose steroids, IV fluids, immobilization, and potentially pressors.
Blood transfusions are generally not indicated, and care must be taken to avoid
fluid overload. -- For further reading, see Tintinalli, et al., Emergency Medicine:
A Comprehensive Study Guide, 5th edition, pages 247-248."
"A 19 year old man is stabbed in the left chest in the 3rd intercostals space just
to the left of the sternum. His vital signs are: T 97.9, HR 130, BP 60/48, RR 18,
SPO2 84%. He has significant JVD and his lungs are clear. The patient's
diagnosis is:
A. Tension pneumothorax
B. Lung laceration
C. Spinal cord injury
D. Hypovolemic shock
,E. Cardiac tamponade" - ANSWER-"E. Cardiac tamponade
The answer is E. The patient has a stab wound to the left chest near the sternum.
His hypotension, clear lungs, and JVD suggest an obstructive shock. He likely
has cardiac tamponade and needs emergent decompression either with
pericardiocentesis or pericardial window."
"A 24 year old woman, brought by her sister, enters the emergency department.
The 24 year old is writhing in pain, clutching her abdomen and shivering. Her
sister states that the patient had a therapeutic abortion performed 3 days ago and
has been having worsening abdominal pain ever since. The patient's vital signs
are: T 103.4 F, HR 128, BP 104/72, RR 28, O2 saturation 100% in room air and
she has marked lower abdominal pain and voluntary guarding. The most
appropriate steps in treatment for this woman's condition include all of the
following EXCEPT:
A. broad-spectrum antibiotics
B. laboratory studies including basic chemistry, complete blood count with
differential, coagulations studies, DIC panel, serum pregnancy test, and blood
cultures
C. urgent ob/gyn consult to facilitate rapid transport of patient to the operating
room
D. intravenous fluids
E. high-dose steroids" - ANSWER-"E. high-dose steroids
The answer is E. This patient is most likely suffering from a septic abortion in
which retained products of conception developed a local infection. This
infection has now spread systemically causing the systemic inflammatory
response and potentially causing sepsis. Immediate intravenous fluids and
broad-spectrum antibiotics are necessary; however, steroids are contraindicated
in such a situation and could worsen the infection. The patient needs to be taken
to the OR urgently to remove the retained products of conception."
"A college student who had a mild upper respiratory tract infection last week,
presents during the spring. He appears toxic, with fever, headache, and a rash
, (see figure) which was also noted on the wrists, ankles, flanks, and axilla. Of
those listed below, which is the most likely diagnosis?
[image shows purple spotted rash on extremity]
A. angioedema
B. herpes zoster
C. Lyme disease
D. pemphigus vulgaris
E. meningococcemia" - ANSWER-"E. meningococcemia
The answer is E. This patient's presentation is consistent with
meningococcemia. Lyme disease often presents with a rash (erythema
chronicum migrans), but that rash has a different appearance (erythema with
central clearing). Pemphgus vulgaris is characterized by intraepidermal
blistering, and angioedema is seen more in the mucous membranes. Herpes
zoster has an appearance of grouped (painful) vesicles on an erythematous
base."
"Which of the following is a common physiologic finding in septic shock?
A. Decreased urine output
B. Increased pulmonary wedge pressure
C. Increased cardiac index
D. Increased systemic vascular resistance (SVR)
E. Normothermia" - ANSWER-"A. Decreased urine output
The answer is A. Patients in septic shock have decreased systemic vascular
resistance and cardiac index, secondary to endotoxins. They can be hyper- or
hypothermic but usually are not normothermic. The pulmonary wedge pressure
is often normal or low. Like all shock states, septic shock is generally associated
with decreased urine output."
"All of the following are common causes of septic shock EXCEPT:
