SAEM Final Exam Q's 2026/2027 | Actual Questions and Answers
Latest Updated 2026/2027 (Graded A+)
•
Management of Large Subungual Hematoma
- ✔✔Drainage (18-Gauge) or Hot Micro-Cauterization
•
Reason to Avoid Suction in Ear Foreign Body Removal
- ✔✔Perforation of Tympanic Membrane
•
Management of Skin Abscess
- ✔✔Linear Incision for Non-Face vs. Needle Drainage for Face
•
Catheter for Bartholin Cyst
- ✔✔Word
•
Grading of Laryngeal Opening
- ✔✔Cormack-Lehane
•
Preferred Induction Agent in Reactive Airway Disease for Dilation Effects
- ✔✔Ketamine
•
Induction Agent Avoided in Sepsis Due To Adrenal Suppression
- ✔✔Etomidate
•
Sudden-Onset Back Pain Worsened by Coughing Soon After Epidural Anesthesia
- ✔✔Epidural Hematoma
•
Presentation of Adhesive Arachnoiditis
- ✔✔Progressive Neuropathy
•
Tom, Dick, and Very Nervous Harry
- ✔✔Anterior to Posterior of Medial Ankle: Tibialis Posterior, Digitorum Longus, Vein, Nerve,
Hallucis Longus
•
Absolute Contra-Indication to Crico-Thyrotomy
,- ✔✔Age Under 5
•
Anesthesia for Suturing D.I.P. of Finger in Patient with Underlying Vascular Disease
- ✔✔Lidocaine (2%) Without Epinephrine Around Digital Nerve for Fingers, Toes, Penis,
Nose
•
Earliest Sign of Lidocaine Toxicity (Over 5 mg/kg)
- ✔✔Lightheadedness (Also Peri-Oral Numbness, Tinnitus, Visual and Auditory
Disturbances, Shivering, Twitching, and Generalized Tonic-Clonic Seizures)
•
(1) Avoid Vertical Mattress Sutures.
(2) Avoid Topical Skin Adhesives (Risk of Dehiscence from Sweating).
- ✔✔Palm
•
Glottis Spasm and Chest Wall Rigidity from Sedative (Rapid High Dose of IV Form)
- ✔✔Fentanyl (Effects Not Always Reversed by Naloxone)
•
Management of Long-Lasting L.P. Headache
- ✔✔Autologous Blood Patch
•
Timing of Tetanus Prophylaxis
- ✔✔Within First Few Days (Suture Within First 24 Hours)
•
Normal C.S.F.-to-Blood Glucose Ratio
- ✔✔0.6
•
Size of Needle Decompression Needle
- ✔✔14 Gauge (2nd Intercostal at Midclavicular Line)
•
Large Paronychia and Cellulitis
- ✔✔Removal of Affected Nail Under Digital Block; Start Antibiotics
•
Signs of Acute Appendicitis
i. - ✔✔1. Rovsing: Right Lower from Left Lower.
ii. 2. Psoas: Extension.
iii. 3. Obturator: Rotation.
,•
Suggested by Abdominal Pain Preceding Nausea and Vomiting
- ✔✔Surgery (Small Bowel Obstruction)
•
Peak of Gastric Acid Secretion at Rest
- ✔✔2 A.M.
•
Timing of Presentation of Hypertrophic Pyloric Stenosis (Non-Bilious) vs. Intussusception (Bilious)
- ✔✔4 Weeks vs. 8 Months
•
Over 95% Sensitive and Specific for Renal Stones
- ✔✔Helical C.T.
•
Intermittent Left Lower Quadrant Pain (Afebrile), Loose Stools (Non-Bloody); Good Follow-Up
- ✔✔Discharge on High-Fiber Diet (Consider Laxatives and Stool Softeners)
•
Abdominal Wall Condition in Anti-Coagulated Patient with Trauma or Coughing
- ✔✔Rectus Sheath Hematoma
•
(1) Age 30.
(2) Prior Abdominal Surgery or Pregnancy.
(3) Marathons.
- ✔✔Risk Factors for Cecal (Cross-Country) Volvulus
•
Possible Chest X-Ray Finding of Hepatic Abscess
- ✔✔Right-Sided Effusion and Elevated Hemi-Diaphragm
•
Referred Pain from Ureteral Colic
- ✔✔Inguinal (Ovarian Torsion Does Not Cause Sacral Pain)
•
Elderly Patient, Diverticulitis Without Perforation (Without Peritonitis)
- ✔✔I.V. Fluids (Elderly), Antibiotics, and Bowel Rest (Peritonitis Requires Surgery)
•
Proximal vs. Distal Esophageal Perforation
- ✔✔Iatrogenic vs. Spontaneous
, •
Rigidity; Elevated Temperatures, Altered Mental Status, Choreo-Athetosis, Autonomic Dysfunction
(Diaphoresis, Incontinence, Arrhythmia)
- ✔✔Dantrolene (Or Bromocriptine, Amantadine, Lorazepam) for Neuroleptic Malignant
Syndrome
•
Indicated by Temperature Over 105
- ✔✔Non-Infectious
•
Extra-Pyramidal: Involuntary Periodic Movements of Tongue, Lips, or Mouth
- ✔✔Tardive Dyskinesia
•
Extra-Pyramidal: Torticollis, Fixed Upper Gaze (Oculogyric Crisis), or Arching of Back (Opisthotonus)
- ✔✔Benztropine (2mg Cogentin) or Benadryl (25mg) for Dystonia from Typical
Anti-Psychotics
•
Extra-Pyramidal: Restlessness
- ✔✔Beta-Blocker for Akathisia
•
E.C.G. Finding of Haloperidol Toxicity
- ✔✔Long Q.T.
•
Illicit Drug Causing Vertical Nystagmus
- ✔✔Phencyclidine (PCP)
•
Controls Agitation Without Respiratory Depression (Negligible Anticholinergic Side Effects)
- ✔✔Haloperidol (5mg IM q30); B-52 is Benadryl (50 Milligrams), 5 Milligrams of Haloperidol,
and 2 Milligrams of Lorazepam
•
Risk of Protracted Struggle in Restraints
- ✔✔Metabolic Acidosis
•
Risk of Flumazenil in Chronic Benzodiazepine User
- ✔✔Withdrawal Seizures
•
Altered Chronic Alcoholic, Non-Gap Metabolic Acidosis
- ✔✔Isopropyl Alcohol
Latest Updated 2026/2027 (Graded A+)
•
Management of Large Subungual Hematoma
- ✔✔Drainage (18-Gauge) or Hot Micro-Cauterization
•
Reason to Avoid Suction in Ear Foreign Body Removal
- ✔✔Perforation of Tympanic Membrane
•
Management of Skin Abscess
- ✔✔Linear Incision for Non-Face vs. Needle Drainage for Face
•
Catheter for Bartholin Cyst
- ✔✔Word
•
Grading of Laryngeal Opening
- ✔✔Cormack-Lehane
•
Preferred Induction Agent in Reactive Airway Disease for Dilation Effects
- ✔✔Ketamine
•
Induction Agent Avoided in Sepsis Due To Adrenal Suppression
- ✔✔Etomidate
•
Sudden-Onset Back Pain Worsened by Coughing Soon After Epidural Anesthesia
- ✔✔Epidural Hematoma
•
Presentation of Adhesive Arachnoiditis
- ✔✔Progressive Neuropathy
•
Tom, Dick, and Very Nervous Harry
- ✔✔Anterior to Posterior of Medial Ankle: Tibialis Posterior, Digitorum Longus, Vein, Nerve,
Hallucis Longus
•
Absolute Contra-Indication to Crico-Thyrotomy
,- ✔✔Age Under 5
•
Anesthesia for Suturing D.I.P. of Finger in Patient with Underlying Vascular Disease
- ✔✔Lidocaine (2%) Without Epinephrine Around Digital Nerve for Fingers, Toes, Penis,
Nose
•
Earliest Sign of Lidocaine Toxicity (Over 5 mg/kg)
- ✔✔Lightheadedness (Also Peri-Oral Numbness, Tinnitus, Visual and Auditory
Disturbances, Shivering, Twitching, and Generalized Tonic-Clonic Seizures)
•
(1) Avoid Vertical Mattress Sutures.
(2) Avoid Topical Skin Adhesives (Risk of Dehiscence from Sweating).
- ✔✔Palm
•
Glottis Spasm and Chest Wall Rigidity from Sedative (Rapid High Dose of IV Form)
- ✔✔Fentanyl (Effects Not Always Reversed by Naloxone)
•
Management of Long-Lasting L.P. Headache
- ✔✔Autologous Blood Patch
•
Timing of Tetanus Prophylaxis
- ✔✔Within First Few Days (Suture Within First 24 Hours)
•
Normal C.S.F.-to-Blood Glucose Ratio
- ✔✔0.6
•
Size of Needle Decompression Needle
- ✔✔14 Gauge (2nd Intercostal at Midclavicular Line)
•
Large Paronychia and Cellulitis
- ✔✔Removal of Affected Nail Under Digital Block; Start Antibiotics
•
Signs of Acute Appendicitis
i. - ✔✔1. Rovsing: Right Lower from Left Lower.
ii. 2. Psoas: Extension.
iii. 3. Obturator: Rotation.
,•
Suggested by Abdominal Pain Preceding Nausea and Vomiting
- ✔✔Surgery (Small Bowel Obstruction)
•
Peak of Gastric Acid Secretion at Rest
- ✔✔2 A.M.
•
Timing of Presentation of Hypertrophic Pyloric Stenosis (Non-Bilious) vs. Intussusception (Bilious)
- ✔✔4 Weeks vs. 8 Months
•
Over 95% Sensitive and Specific for Renal Stones
- ✔✔Helical C.T.
•
Intermittent Left Lower Quadrant Pain (Afebrile), Loose Stools (Non-Bloody); Good Follow-Up
- ✔✔Discharge on High-Fiber Diet (Consider Laxatives and Stool Softeners)
•
Abdominal Wall Condition in Anti-Coagulated Patient with Trauma or Coughing
- ✔✔Rectus Sheath Hematoma
•
(1) Age 30.
(2) Prior Abdominal Surgery or Pregnancy.
(3) Marathons.
- ✔✔Risk Factors for Cecal (Cross-Country) Volvulus
•
Possible Chest X-Ray Finding of Hepatic Abscess
- ✔✔Right-Sided Effusion and Elevated Hemi-Diaphragm
•
Referred Pain from Ureteral Colic
- ✔✔Inguinal (Ovarian Torsion Does Not Cause Sacral Pain)
•
Elderly Patient, Diverticulitis Without Perforation (Without Peritonitis)
- ✔✔I.V. Fluids (Elderly), Antibiotics, and Bowel Rest (Peritonitis Requires Surgery)
•
Proximal vs. Distal Esophageal Perforation
- ✔✔Iatrogenic vs. Spontaneous
, •
Rigidity; Elevated Temperatures, Altered Mental Status, Choreo-Athetosis, Autonomic Dysfunction
(Diaphoresis, Incontinence, Arrhythmia)
- ✔✔Dantrolene (Or Bromocriptine, Amantadine, Lorazepam) for Neuroleptic Malignant
Syndrome
•
Indicated by Temperature Over 105
- ✔✔Non-Infectious
•
Extra-Pyramidal: Involuntary Periodic Movements of Tongue, Lips, or Mouth
- ✔✔Tardive Dyskinesia
•
Extra-Pyramidal: Torticollis, Fixed Upper Gaze (Oculogyric Crisis), or Arching of Back (Opisthotonus)
- ✔✔Benztropine (2mg Cogentin) or Benadryl (25mg) for Dystonia from Typical
Anti-Psychotics
•
Extra-Pyramidal: Restlessness
- ✔✔Beta-Blocker for Akathisia
•
E.C.G. Finding of Haloperidol Toxicity
- ✔✔Long Q.T.
•
Illicit Drug Causing Vertical Nystagmus
- ✔✔Phencyclidine (PCP)
•
Controls Agitation Without Respiratory Depression (Negligible Anticholinergic Side Effects)
- ✔✔Haloperidol (5mg IM q30); B-52 is Benadryl (50 Milligrams), 5 Milligrams of Haloperidol,
and 2 Milligrams of Lorazepam
•
Risk of Protracted Struggle in Restraints
- ✔✔Metabolic Acidosis
•
Risk of Flumazenil in Chronic Benzodiazepine User
- ✔✔Withdrawal Seizures
•
Altered Chronic Alcoholic, Non-Gap Metabolic Acidosis
- ✔✔Isopropyl Alcohol
