Page 1 of 109
SAEM M4 EXAM QUESTIONS AND CORRECT VERIFIED
SOLUTIONS LATEST UPDATE THIS YEAR
SAEM M4 Exam
10-Line Exam Coverage
Approach to critically ill patients, initial stabilization, and emergency department
prioritization.
Chest pain, acute coronary syndromes, dysrhythmias, cardiac arrest, and aortic
emergencies.
Dyspnea, asthma, COPD exacerbations, pulmonary embolism, pneumothorax, and
respiratory failure.
Abdominal pain, gastrointestinal bleeding, bowel emergencies, pancreatitis, and
hepatobiliary disease.
Neurologic emergencies including stroke, seizures, headache, altered mental status, and
spinal emergencies.
Trauma assessment, hemorrhage control, traumatic brain injury, fractures, burns, and
cervical-spine management.
Shock, sepsis, fluid resuscitation, vasopressors, electrolyte abnormalities, and acid-base
disorders.
Toxicology, overdoses, environmental emergencies, anaphylaxis, and envenomation.
Pediatric, obstetric, gynecologic, and geriatric emergency presentations commonly
encountered in the ED.
Emergency procedures, diagnostic testing, disposition decisions, analgesia, sedation, and
evidence-based acute management.
250 SAEM M4-Style MCQs
1. A 67-year-old man presents with crushing substernal chest pain, diaphoresis, and nausea
beginning 45 minutes ago. ECG demonstrates ST elevations in leads II, III, and aVF. What is the
most appropriate immediate management?
A. Schedule outpatient stress testing
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B. Administer aspirin and activate reperfusion therapy
C. Give intravenous antibiotics and observe
D. Obtain a D-dimer before further treatment
Answer: B
Rationale: Inferior ST elevation with ongoing ischemic symptoms represents STEMI requiring
immediate antiplatelet therapy and urgent reperfusion.
2. A 58-year-old woman with sudden dyspnea, pleuritic chest pain, tachycardia, and recent
orthopedic surgery is suspected of having pulmonary embolism. She is hypotensive and severely
hypoxemic. What treatment is most appropriate?
A. Outpatient oral anticoagulation
B. Intravenous thrombolytic therapy
C. Inhaled corticosteroids
D. Immediate discharge after chest radiography
Answer: B
Rationale: Massive pulmonary embolism causing hemodynamic instability requires urgent
reperfusion, commonly systemic thrombolysis when no contraindication exists.
3. A 24-year-old patient develops wheezing, hypotension, facial swelling, and generalized
urticaria minutes after eating peanuts. Which medication should be administered first?
A. Diphenhydramine intravenously
B. Methylprednisolone intravenously
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C. Epinephrine intramuscularly
D. Albuterol nebulization alone
Answer: C
Rationale: Intramuscular epinephrine is the first-line treatment for anaphylaxis and should not
be delayed for antihistamines or corticosteroids.
4. A 72-year-old patient develops sudden aphasia and right-sided weakness 70 minutes before
emergency department arrival. CT shows no hemorrhage. What is the most important next
consideration?
A. Intravenous thrombolysis eligibility
B. Immediate lumbar puncture
C. Discharge with aspirin only
D. Administration of heparin before imaging
Answer: A
Rationale: An otherwise eligible patient with disabling ischemic stroke within the treatment
window should be rapidly assessed for intravenous thrombolysis.
5. A 19-year-old college student presents with fever, severe headache, photophobia, neck
stiffness, and altered mental status. What treatment should occur without unnecessary delay?
A. Oral acyclovir alone
B. Empiric intravenous antibiotics
C. Observation until cultures return
D. Immediate discharge after headache treatment
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Answer: B
Rationale: Suspected bacterial meningitis requires prompt empiric intravenous antibiotics
because treatment delays increase morbidity and mortality.
6. A 45-year-old man presents with severe epigastric pain radiating to the back and persistent
vomiting. Lipase is markedly elevated. Which diagnosis is most likely?
A. Acute pancreatitis
B. Acute appendicitis
C. Renal colic
D. Mesenteric ischemia
Answer: A
Rationale: Characteristic epigastric pain radiating posteriorly combined with significant lipase
elevation strongly supports acute pancreatitis.
7. A 31-year-old woman presents with right lower-quadrant pain, anorexia, nausea, and low-
grade fever. Which diagnosis should be strongly considered?
A. Appendicitis
B. Acute cystitis
C. Diverticulitis of the sigmoid colon
D. Esophageal rupture
Answer: A
Rationale: Progressive right-lower-quadrant abdominal pain with anorexia, nausea, and fever is
a classic presentation of appendicitis.
SAEM M4 EXAM QUESTIONS AND CORRECT VERIFIED
SOLUTIONS LATEST UPDATE THIS YEAR
SAEM M4 Exam
10-Line Exam Coverage
Approach to critically ill patients, initial stabilization, and emergency department
prioritization.
Chest pain, acute coronary syndromes, dysrhythmias, cardiac arrest, and aortic
emergencies.
Dyspnea, asthma, COPD exacerbations, pulmonary embolism, pneumothorax, and
respiratory failure.
Abdominal pain, gastrointestinal bleeding, bowel emergencies, pancreatitis, and
hepatobiliary disease.
Neurologic emergencies including stroke, seizures, headache, altered mental status, and
spinal emergencies.
Trauma assessment, hemorrhage control, traumatic brain injury, fractures, burns, and
cervical-spine management.
Shock, sepsis, fluid resuscitation, vasopressors, electrolyte abnormalities, and acid-base
disorders.
Toxicology, overdoses, environmental emergencies, anaphylaxis, and envenomation.
Pediatric, obstetric, gynecologic, and geriatric emergency presentations commonly
encountered in the ED.
Emergency procedures, diagnostic testing, disposition decisions, analgesia, sedation, and
evidence-based acute management.
250 SAEM M4-Style MCQs
1. A 67-year-old man presents with crushing substernal chest pain, diaphoresis, and nausea
beginning 45 minutes ago. ECG demonstrates ST elevations in leads II, III, and aVF. What is the
most appropriate immediate management?
A. Schedule outpatient stress testing
, Page 2 of 109
B. Administer aspirin and activate reperfusion therapy
C. Give intravenous antibiotics and observe
D. Obtain a D-dimer before further treatment
Answer: B
Rationale: Inferior ST elevation with ongoing ischemic symptoms represents STEMI requiring
immediate antiplatelet therapy and urgent reperfusion.
2. A 58-year-old woman with sudden dyspnea, pleuritic chest pain, tachycardia, and recent
orthopedic surgery is suspected of having pulmonary embolism. She is hypotensive and severely
hypoxemic. What treatment is most appropriate?
A. Outpatient oral anticoagulation
B. Intravenous thrombolytic therapy
C. Inhaled corticosteroids
D. Immediate discharge after chest radiography
Answer: B
Rationale: Massive pulmonary embolism causing hemodynamic instability requires urgent
reperfusion, commonly systemic thrombolysis when no contraindication exists.
3. A 24-year-old patient develops wheezing, hypotension, facial swelling, and generalized
urticaria minutes after eating peanuts. Which medication should be administered first?
A. Diphenhydramine intravenously
B. Methylprednisolone intravenously
, Page 3 of 109
C. Epinephrine intramuscularly
D. Albuterol nebulization alone
Answer: C
Rationale: Intramuscular epinephrine is the first-line treatment for anaphylaxis and should not
be delayed for antihistamines or corticosteroids.
4. A 72-year-old patient develops sudden aphasia and right-sided weakness 70 minutes before
emergency department arrival. CT shows no hemorrhage. What is the most important next
consideration?
A. Intravenous thrombolysis eligibility
B. Immediate lumbar puncture
C. Discharge with aspirin only
D. Administration of heparin before imaging
Answer: A
Rationale: An otherwise eligible patient with disabling ischemic stroke within the treatment
window should be rapidly assessed for intravenous thrombolysis.
5. A 19-year-old college student presents with fever, severe headache, photophobia, neck
stiffness, and altered mental status. What treatment should occur without unnecessary delay?
A. Oral acyclovir alone
B. Empiric intravenous antibiotics
C. Observation until cultures return
D. Immediate discharge after headache treatment
, Page 4 of 109
Answer: B
Rationale: Suspected bacterial meningitis requires prompt empiric intravenous antibiotics
because treatment delays increase morbidity and mortality.
6. A 45-year-old man presents with severe epigastric pain radiating to the back and persistent
vomiting. Lipase is markedly elevated. Which diagnosis is most likely?
A. Acute pancreatitis
B. Acute appendicitis
C. Renal colic
D. Mesenteric ischemia
Answer: A
Rationale: Characteristic epigastric pain radiating posteriorly combined with significant lipase
elevation strongly supports acute pancreatitis.
7. A 31-year-old woman presents with right lower-quadrant pain, anorexia, nausea, and low-
grade fever. Which diagnosis should be strongly considered?
A. Appendicitis
B. Acute cystitis
C. Diverticulitis of the sigmoid colon
D. Esophageal rupture
Answer: A
Rationale: Progressive right-lower-quadrant abdominal pain with anorexia, nausea, and fever is
a classic presentation of appendicitis.
