SAEM TEST BANK COMPLETE SOLVED
QUESTIONS EXPERT REVIEW FULL
SOLUTION
●● A 28 year old patient arrives after helicopter transfer from an
outlying center, where he had been intubated for altered mental status
after significant alcohol intoxication. There were no reported signs of
chest trauma, but the patient now has decreased breath sounds on the
left. His vital signs are stable. Based upon the chest X-ray in the figure,
what is the next step in management of this patient?
[image]
A. Nasogastric tube placement
B. Chest tube placement
C. Endotracheal tube adjustment
D. Needle decompression
Answer: The answer is C. The patient has a right-mainstem intubation
and resultant opacification of the left lung secondary to unilateral lack of
ventilation. In an adult male, the ETT should generally be inserted to a
depth (to the lip line) of 22-24cm; the corresponding depth range for an
adult female is 21-23cm
●● A 25-year old female presents to the ED with dyspnea and chest
pain. Chest CT, with contrast, is performed and some pertinent "slices"
are shown in the Figure. What is the diagnosis?
,[image]
A. Aortic dissection, Type I
B. Bilateral pulmonary embolism
C. Gas embolism
D. Acute Respiratory Distress Syndrome
Answer: The answer is B. Helical CT studies of the pulmonary
vasculature are increasingly used for detection of pulmonary embolism.
Though there are questions about CT's ability to detect small (e.g.
subsegmental) emboli, CT scans have high sensitivity for proximal
embolism such as that depicted in the accompanying figure. The patient
whose images are shown was found to have moderate-severe right
ventricular dysfunction and received thrombolytic therapy in the ED -
she had an excellent outcome.
●● The X-ray in the figure indicates:
[image]
A. Need to withdraw the endotracheal tube from the mainstem
B. A chest radiograph that was taken with the patient rotated
C. Right upper lobe pneumonia
D. Mediastinal shift due to fluid in the right hemithorax
,Answer: The answer is D. The patient is not intubated. The pathology in
the right hemithorax appears as hyperdensity, rather than air density (not
a pneumothorax), and involves more than the right upper lobe.
●● Regarding the epidemiology of asthma in the United States, which of
the following is true?
A. Etiology is thought to be genetic, not environmental
B. Prevalence increased in the 1980's, and then decreased in the 1990's
C. More common in males than females in adult and pediatric
populations
D. Incidence is comparable for Caucasians and African-Americans
Answer: The answer is B. Despite an increase in asthma prevalence in
the United States, Canada, Great Britain and Australia in the 1980s, the
1990s saw a decrease in prevalence in these areas. Regarding gender,
male children are more likely than female children to have asthma,
however the reverse is true with adults. African-Americans have a higher
prevalence of asthma than Caucasians. Migrants who relocate from an
area of low asthma prevalence to an area of high asthma prevalence tend
to have an increased prevalence of asthma suggesting a role for
environmental factors in the development of asthma.
●● Regarding pulsus paradoxus and asthma, which of the following
statement s is correct
A. The presence of pulsus paradoxis in asthma indicates severe disease
B. Pulsus paradoxus is pathognomonic for asthma
, C. The absence of pulsus paradoxis in asthma rules out severe disease
D. Pulsus paradoxus is a fall in systolic blood pressure during inspiration
Answer: The answer is A. Pulsus paradoxus is defined as a fall in
systolic blood pressure of greater than 10mm Hg upon inspiration. It is
typically present during acute asthma exacerbations in severe asthma;
however, its absence does not rule out severe disease. Although initially
present, a pulsus paradoxus may disappear after only minimal
improvement in air flow through the larger airways. Pulsus parodoxus
may occur in other diseases besides asthma (for example, pericardial
tamponade).
●● Which of the following is correct regarding the use of corticosteroids
in acute asthma exacerbation?
A. Beneficial effects occur within the first hour of administration.
B. Inhaled steroids should be avoided
C. Intravenous steroids are superior to the oral route
D. Tapering is needed with all corticosteroid regimens
Answer: The answer is B. Oral and intravenous steroids are equally
efficacious in treating an asthma exacerbation. Yet, in the setting of a
severe asthma exacerbation, a patient may have difficulty taking oral
medications and the intravenous route is preferred
●● Which of the following is true regarding the treatment of acute
asthma exacerbation in the Emergency Department?
QUESTIONS EXPERT REVIEW FULL
SOLUTION
●● A 28 year old patient arrives after helicopter transfer from an
outlying center, where he had been intubated for altered mental status
after significant alcohol intoxication. There were no reported signs of
chest trauma, but the patient now has decreased breath sounds on the
left. His vital signs are stable. Based upon the chest X-ray in the figure,
what is the next step in management of this patient?
[image]
A. Nasogastric tube placement
B. Chest tube placement
C. Endotracheal tube adjustment
D. Needle decompression
Answer: The answer is C. The patient has a right-mainstem intubation
and resultant opacification of the left lung secondary to unilateral lack of
ventilation. In an adult male, the ETT should generally be inserted to a
depth (to the lip line) of 22-24cm; the corresponding depth range for an
adult female is 21-23cm
●● A 25-year old female presents to the ED with dyspnea and chest
pain. Chest CT, with contrast, is performed and some pertinent "slices"
are shown in the Figure. What is the diagnosis?
,[image]
A. Aortic dissection, Type I
B. Bilateral pulmonary embolism
C. Gas embolism
D. Acute Respiratory Distress Syndrome
Answer: The answer is B. Helical CT studies of the pulmonary
vasculature are increasingly used for detection of pulmonary embolism.
Though there are questions about CT's ability to detect small (e.g.
subsegmental) emboli, CT scans have high sensitivity for proximal
embolism such as that depicted in the accompanying figure. The patient
whose images are shown was found to have moderate-severe right
ventricular dysfunction and received thrombolytic therapy in the ED -
she had an excellent outcome.
●● The X-ray in the figure indicates:
[image]
A. Need to withdraw the endotracheal tube from the mainstem
B. A chest radiograph that was taken with the patient rotated
C. Right upper lobe pneumonia
D. Mediastinal shift due to fluid in the right hemithorax
,Answer: The answer is D. The patient is not intubated. The pathology in
the right hemithorax appears as hyperdensity, rather than air density (not
a pneumothorax), and involves more than the right upper lobe.
●● Regarding the epidemiology of asthma in the United States, which of
the following is true?
A. Etiology is thought to be genetic, not environmental
B. Prevalence increased in the 1980's, and then decreased in the 1990's
C. More common in males than females in adult and pediatric
populations
D. Incidence is comparable for Caucasians and African-Americans
Answer: The answer is B. Despite an increase in asthma prevalence in
the United States, Canada, Great Britain and Australia in the 1980s, the
1990s saw a decrease in prevalence in these areas. Regarding gender,
male children are more likely than female children to have asthma,
however the reverse is true with adults. African-Americans have a higher
prevalence of asthma than Caucasians. Migrants who relocate from an
area of low asthma prevalence to an area of high asthma prevalence tend
to have an increased prevalence of asthma suggesting a role for
environmental factors in the development of asthma.
●● Regarding pulsus paradoxus and asthma, which of the following
statement s is correct
A. The presence of pulsus paradoxis in asthma indicates severe disease
B. Pulsus paradoxus is pathognomonic for asthma
, C. The absence of pulsus paradoxis in asthma rules out severe disease
D. Pulsus paradoxus is a fall in systolic blood pressure during inspiration
Answer: The answer is A. Pulsus paradoxus is defined as a fall in
systolic blood pressure of greater than 10mm Hg upon inspiration. It is
typically present during acute asthma exacerbations in severe asthma;
however, its absence does not rule out severe disease. Although initially
present, a pulsus paradoxus may disappear after only minimal
improvement in air flow through the larger airways. Pulsus parodoxus
may occur in other diseases besides asthma (for example, pericardial
tamponade).
●● Which of the following is correct regarding the use of corticosteroids
in acute asthma exacerbation?
A. Beneficial effects occur within the first hour of administration.
B. Inhaled steroids should be avoided
C. Intravenous steroids are superior to the oral route
D. Tapering is needed with all corticosteroid regimens
Answer: The answer is B. Oral and intravenous steroids are equally
efficacious in treating an asthma exacerbation. Yet, in the setting of a
severe asthma exacerbation, a patient may have difficulty taking oral
medications and the intravenous route is preferred
●● Which of the following is true regarding the treatment of acute
asthma exacerbation in the Emergency Department?
