SAEM M4 Exam 2026/2027 | Actual Questions and Answers
Latest Updated 2026/2027 (Graded A+)
•
True or False: gastric distension due to excessive volume or rate of ventilation impairing ventilatory
function is a reason to intubate a neonate
- ✔✔False
•
management for nursemaid elbow injury
- ✔✔apply pressure to the radial head while flexing and supinating elbow
•
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?
- ✔✔compression fracture of the posteriolateral aspect of the humeral head (Hill-Sachs
deformity)
•
What are most common heart rhythms seen in pediatric arrest?
- ✔✔bradycardia or asystole
•
risk factors for neonatal resuscitation
i. - ✔✔prematurity
ii. IUGR
iii. multiple gestation
iv. thick meconium
•
In the post-arrest setting, which of the following is the drug of choice in treating hypotension in a child:
- ✔✔epi
•
Low body temperatures in newborns can lead to severe physiologic consequences, which include all
EXCEPT:
•
Answers:
1. metabolic acidosis 2. increased oxygen consumption
3. hypoglycemia
4. apnea
5. hyperglycemia
- ✔✔3. hypoglycemia
,•
In a newborn, bradycardia is most commonly an indicator of:
- ✔✔hypoxemia
•
All the following are signs of hypoxemia in a newborn, EXCEPT:
•
Answers:
1.cyanosis
2.lethargy
3.tachycardia
4.unresponsiveness
5.bradycardia
- ✔✔3. tachycardia
•
A newborn presents to the emergency department a few days after hospital discharge. The infant has
been noted to be drooling, choking, and coughing, and the mother reports seeing bubbles at the baby's
mouth. Which is the most likely explanation?
•
Answers:
1.osteogenesis imperfecta
2.inborn error of metabolism
3.congenital diaphragmatic hernia
4.foreign body
5.tracheoesophageal fistula
- ✔✔5. tracheoesophageal fistula
•
Which of the following pairs of maneuvers are consistent with current recommendations for emergency
care for a choking 5-month-old infant?
•
Answers:
1.back blow then blind finger sweep
2.back blow then chest thrust
3.chest thrust then Heimlich maneuver
4.Heimlich maneuver then blind finger sweep
5.Heimlich maneuver then chest thrust
- ✔✔2.back blow then chest thrust
•
All of these steps are involved in pediatric rapid sequence intubation (RSI) EXCEPT:
,•
Answers:
1.If administering succinylcholine, pretreatment with atropine is always indicated in children under age
10.
2.Lidocaine pretreatment is usually provided to children with head trauma.
3.When deciding which size endotracheal tube to use, one may approximate by using the size of the
small finger or nares as a reference.
4.Due to the fragility of the pediatric C-spine, a cervical collar should always be placed prior to
intubation for children under age ten.
5.Uncuffed endotracheal tubes are the preferred devices used in children under 6-8 years of age.
- ✔✔4.Due to the fragility of the pediatric C-spine, a cervical collar should always be placed
prior to intubation for children under age ten.
•
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?
•
Answers:
1.Jimson weed
2.Cocaine
3.Heroin
4.Insulin
- ✔✔2. cocaine
•
A mother brings in her 4 year old child who was happily eating "blackberries" from weeds in the garden
and is now acting strangely. She has identified them as Belladonna from a quick internet search. Which
physical examination finding might you also expect to find in this child?
•
Answers:
1.Diaphoresis
2.Flushed skin
3.Miosis
4.Urinary incontinence
- ✔✔2. flushed skin
•
For which of the following cases is activated charcoal therapy most appropriate?
•
Answers:
1.Acetaminophen overdose
2.Drain cleaner ingestion
3.Iron supplement overdose
4.Lithium overdose
- ✔✔1. Acetaminophen overdose
, •
A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the best treatment
method for this overdose?
•
Answers:
1.Activated charcoal
2.Gastric lavage
3.Hemodialysis
4.Whole bowel irrigation
- ✔✔3.Hemodialysis
•
A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her family indicates she
has been taking for years to help with her anxiety. The bottle indicates that the prescription was filled
yesterday with 90 pills and is now empty. The patient is minimally responsive to painful stimuli and does
not react when you suction secretions out of her posterior pharynx. What is your next management
step?
•
Answers:
1.Administration of flumazenil
2.Administration of narcan
3.Close observation
4.Intubation for airway support
- ✔✔4.Intubation for airway support
•
A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3 hours prior to
presentation in the ED. Which of the following arterial blood gas results would you expect to come from
this patient?
•
Answers:
1.pH 7.14 pCO2 68 pO2 102 HCO3 23
2.pH 7.33 pCO2 48 pO2 58 HCO3 29
3.pH 7.45 pCO2 21 pO2 124 HCO3 14
4.pH 7.47 pCO2 31 pO2 96 HCO3 25
- ✔✔3.pH 7.45 pCO2 21 pO2 124 HCO3 14
•
A teenager presents one hour after ingesting a "handful" of acetaminophen tablets. Which of the
following statements is TRUE?
•
Answers:
1.An acetaminophen level drawn at hour four dictates need for antidotal therapy.
2.Serial liver function tests are indicated in all acetaminophen ingestions.
3.Renal sequelae are expected.
4.The intravenous formulation of N-acetylcysteine is safer than oral N-acetylcysteine.
Latest Updated 2026/2027 (Graded A+)
•
True or False: gastric distension due to excessive volume or rate of ventilation impairing ventilatory
function is a reason to intubate a neonate
- ✔✔False
•
management for nursemaid elbow injury
- ✔✔apply pressure to the radial head while flexing and supinating elbow
•
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?
- ✔✔compression fracture of the posteriolateral aspect of the humeral head (Hill-Sachs
deformity)
•
What are most common heart rhythms seen in pediatric arrest?
- ✔✔bradycardia or asystole
•
risk factors for neonatal resuscitation
i. - ✔✔prematurity
ii. IUGR
iii. multiple gestation
iv. thick meconium
•
In the post-arrest setting, which of the following is the drug of choice in treating hypotension in a child:
- ✔✔epi
•
Low body temperatures in newborns can lead to severe physiologic consequences, which include all
EXCEPT:
•
Answers:
1. metabolic acidosis 2. increased oxygen consumption
3. hypoglycemia
4. apnea
5. hyperglycemia
- ✔✔3. hypoglycemia
,•
In a newborn, bradycardia is most commonly an indicator of:
- ✔✔hypoxemia
•
All the following are signs of hypoxemia in a newborn, EXCEPT:
•
Answers:
1.cyanosis
2.lethargy
3.tachycardia
4.unresponsiveness
5.bradycardia
- ✔✔3. tachycardia
•
A newborn presents to the emergency department a few days after hospital discharge. The infant has
been noted to be drooling, choking, and coughing, and the mother reports seeing bubbles at the baby's
mouth. Which is the most likely explanation?
•
Answers:
1.osteogenesis imperfecta
2.inborn error of metabolism
3.congenital diaphragmatic hernia
4.foreign body
5.tracheoesophageal fistula
- ✔✔5. tracheoesophageal fistula
•
Which of the following pairs of maneuvers are consistent with current recommendations for emergency
care for a choking 5-month-old infant?
•
Answers:
1.back blow then blind finger sweep
2.back blow then chest thrust
3.chest thrust then Heimlich maneuver
4.Heimlich maneuver then blind finger sweep
5.Heimlich maneuver then chest thrust
- ✔✔2.back blow then chest thrust
•
All of these steps are involved in pediatric rapid sequence intubation (RSI) EXCEPT:
,•
Answers:
1.If administering succinylcholine, pretreatment with atropine is always indicated in children under age
10.
2.Lidocaine pretreatment is usually provided to children with head trauma.
3.When deciding which size endotracheal tube to use, one may approximate by using the size of the
small finger or nares as a reference.
4.Due to the fragility of the pediatric C-spine, a cervical collar should always be placed prior to
intubation for children under age ten.
5.Uncuffed endotracheal tubes are the preferred devices used in children under 6-8 years of age.
- ✔✔4.Due to the fragility of the pediatric C-spine, a cervical collar should always be placed
prior to intubation for children under age ten.
•
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?
•
Answers:
1.Jimson weed
2.Cocaine
3.Heroin
4.Insulin
- ✔✔2. cocaine
•
A mother brings in her 4 year old child who was happily eating "blackberries" from weeds in the garden
and is now acting strangely. She has identified them as Belladonna from a quick internet search. Which
physical examination finding might you also expect to find in this child?
•
Answers:
1.Diaphoresis
2.Flushed skin
3.Miosis
4.Urinary incontinence
- ✔✔2. flushed skin
•
For which of the following cases is activated charcoal therapy most appropriate?
•
Answers:
1.Acetaminophen overdose
2.Drain cleaner ingestion
3.Iron supplement overdose
4.Lithium overdose
- ✔✔1. Acetaminophen overdose
, •
A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the best treatment
method for this overdose?
•
Answers:
1.Activated charcoal
2.Gastric lavage
3.Hemodialysis
4.Whole bowel irrigation
- ✔✔3.Hemodialysis
•
A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her family indicates she
has been taking for years to help with her anxiety. The bottle indicates that the prescription was filled
yesterday with 90 pills and is now empty. The patient is minimally responsive to painful stimuli and does
not react when you suction secretions out of her posterior pharynx. What is your next management
step?
•
Answers:
1.Administration of flumazenil
2.Administration of narcan
3.Close observation
4.Intubation for airway support
- ✔✔4.Intubation for airway support
•
A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3 hours prior to
presentation in the ED. Which of the following arterial blood gas results would you expect to come from
this patient?
•
Answers:
1.pH 7.14 pCO2 68 pO2 102 HCO3 23
2.pH 7.33 pCO2 48 pO2 58 HCO3 29
3.pH 7.45 pCO2 21 pO2 124 HCO3 14
4.pH 7.47 pCO2 31 pO2 96 HCO3 25
- ✔✔3.pH 7.45 pCO2 21 pO2 124 HCO3 14
•
A teenager presents one hour after ingesting a "handful" of acetaminophen tablets. Which of the
following statements is TRUE?
•
Answers:
1.An acetaminophen level drawn at hour four dictates need for antidotal therapy.
2.Serial liver function tests are indicated in all acetaminophen ingestions.
3.Renal sequelae are expected.
4.The intravenous formulation of N-acetylcysteine is safer than oral N-acetylcysteine.
