SAEM EXAM 2026–2027 EMERGENCY MEDICINE
PRACTICE EXAM 300 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE
LATEST UPDATE ALREADY GRADED A+
ASSURED PASS
The SAEM M4 National Emergency Medicine Exam 2026–2027 practice resource
provides 300 unique multiple-choice questions with detailed rationales, organized
into twelve core sections. It covers resuscitation, trauma, cardiovascular,
respiratory, neurologic, medical/surgical, environmental, pediatric, geriatric,
obstetric, infectious disease, EMS, and ethics topics. Each question mirrors the
exam blueprint and includes evidence-based explanations aligned with Tintinalli’s
and Rosen’s references. Designed for fourth-year medical students, this
comprehensive review strengthens clinical reasoning, identifies knowledge gaps,
and builds confidence for certification success. It is an essential self-assessment
tool for effective, focused emergency medicine exam preparation and improved
patient care.
SECTION 1: RESUSCITATION AND CRITICAL CARE
(Questions 1–40)
1. A 55-year-old male presents to the ED in cardiac arrest. After 2 minutes of CPR,
the rhythm check reveals ventricular fibrillation. What is the most appropriate next
intervention?
A) Continue CPR for 2 more minutes
B) Defibrillate at 120–200 joules biphasic
C) Administer epinephrine 1 mg IV
D) Administer amiodarone 300 mg IV
Answer: B) Defibrillate at 120–200 joules biphasic
,Rationale: For VF/pVT, defibrillation is the definitive treatment. The 2020 AHA
guidelines recommend immediate defibrillation for shockable rhythms.
Epinephrine and amiodarone are administered after the second and third shocks,
respectively.
2. A patient with return of spontaneous circulation (ROSC) after cardiac arrest
remains comatose. What is the recommended target temperature for targeted
temperature management (TTM)?
A) 30–32°C
B) 32–36°C
C) 36–38°C
D) 28–30°C
Answer: B) 32–36°C
Rationale: The TTM trial demonstrated that targeting a temperature between 32°C
and 36°C improves neurological outcomes compared to no temperature control.
The specific target within this range should be selected based on clinical judgment.
3. Which of the following is the most common reversible cause of cardiac arrest?
A) Hypovolemia
B) Hypoxia
C) Hydrogen ion (acidosis)
D) Hypokalemia/hyperkalemia
Answer: B) Hypoxia
Rationale: Hypoxia is the most common reversible cause of cardiac arrest. The Hs
and Ts mnemonic includes hypoxia as a primary cause that must be rapidly
identified and corrected during resuscitation.
4. A patient presents with severe anaphylaxis and impending airway compromise.
What is the first-line medication?
A) Diphenhydramine 50 mg IV
B) Methylprednisolone 125 mg IV
C) Epinephrine 0.3–0.5 mg IM
D) Albuterol nebulized
Answer: C) Epinephrine 0.3–0.5 mg IM
Rationale: Epinephrine is the first-line treatment for anaphylaxis. IM
administration into the anterolateral thigh is preferred. Antihistamines and
corticosteroids are adjuncts but do not reverse airway compromise.
,5. What is the recommended compression-to-ventilation ratio for adult CPR?
A) 15:2
B) 30:2
C) 50:2
D) Continuous compressions without ventilations
Answer: B) 30:2
Rationale: The AHA recommends a compression-to-ventilation ratio of 30:2 for
single-rescuer adult CPR. For two-rescuer pediatric CPR, the ratio is 15:2.
6. A patient in septic shock has a mean arterial pressure (MAP) of 55 mmHg
despite adequate fluid resuscitation. What is the recommended initial vasopressor?
A) Dopamine
B) Norepinephrine
C) Epinephrine
D) Vasopressin
Answer: B) Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock. It has been
shown to have fewer arrhythmias than dopamine and is recommended by the
Surviving Sepsis Campaign.
7. Which of the following is a contraindication to fibrinolytic therapy in acute
ischemic stroke?
A) Blood pressure 170/90 mmHg
B) Platelet count 150,000
C) Intracranial hemorrhage on CT
D) Age 75 years
Answer: C) Intracranial hemorrhage on CT
Rationale: Intracranial hemorrhage on CT is an absolute contraindication to
fibrinolytic therapy. Blood pressure must be <185/110 mmHg, but 170/90 is
acceptable. Age and platelet count are not absolute contraindications.
8. A patient presents with a tension pneumothorax. What is the immediate
management?
A) Chest tube placement
B) Needle decompression
C) Observation
, D) Bronchoscopy
Answer: B) Needle decompression
Rationale: Tension pneumothorax is a life-threatening emergency requiring
immediate needle decompression. Chest tube placement follows after initial
decompression.
9. What is the most common cause of pulseless electrical activity (PEA)?
A) Ventricular fibrillation
B) Hypovolemia
C) Asystole
D) Complete heart block
Answer: B) Hypovolemia
Rationale: Hypovolemia is the most common cause of PEA. The Hs and Ts
mnemonic is used to identify reversible causes during PEA arrest.
10. A patient with severe hyperkalemia has ECG changes including peaked T
waves and widened QRS. What is the first medication to administer?
A) Insulin and glucose
B) Calcium gluconate
C) Sodium bicarbonate
D) Kayexalate
Answer: B) Calcium gluconate
Rationale: Calcium gluconate stabilizes the myocardium by antagonizing the
effects of potassium on cardiac conduction. It acts within minutes and is the first-
line treatment for hyperkalemia with ECG changes.
11. Which of the following is the correct dose of epinephrine for cardiac arrest?
A) 0.1 mg IV every 3–5 minutes
B) 1 mg IV every 3–5 minutes
C) 0.5 mg IV every 5 minutes
D) 2 mg IV every 10 minutes
Answer: B) 1 mg IV every 3–5 minutes
Rationale: The standard dose of epinephrine for cardiac arrest is 1 mg IV/IO every
3–5 minutes. Higher doses have not been shown to improve outcomes.
PRACTICE EXAM 300 ACTUAL QUESTIONS AND
CORRECT ANSWERS WITH RATIONALE
LATEST UPDATE ALREADY GRADED A+
ASSURED PASS
The SAEM M4 National Emergency Medicine Exam 2026–2027 practice resource
provides 300 unique multiple-choice questions with detailed rationales, organized
into twelve core sections. It covers resuscitation, trauma, cardiovascular,
respiratory, neurologic, medical/surgical, environmental, pediatric, geriatric,
obstetric, infectious disease, EMS, and ethics topics. Each question mirrors the
exam blueprint and includes evidence-based explanations aligned with Tintinalli’s
and Rosen’s references. Designed for fourth-year medical students, this
comprehensive review strengthens clinical reasoning, identifies knowledge gaps,
and builds confidence for certification success. It is an essential self-assessment
tool for effective, focused emergency medicine exam preparation and improved
patient care.
SECTION 1: RESUSCITATION AND CRITICAL CARE
(Questions 1–40)
1. A 55-year-old male presents to the ED in cardiac arrest. After 2 minutes of CPR,
the rhythm check reveals ventricular fibrillation. What is the most appropriate next
intervention?
A) Continue CPR for 2 more minutes
B) Defibrillate at 120–200 joules biphasic
C) Administer epinephrine 1 mg IV
D) Administer amiodarone 300 mg IV
Answer: B) Defibrillate at 120–200 joules biphasic
,Rationale: For VF/pVT, defibrillation is the definitive treatment. The 2020 AHA
guidelines recommend immediate defibrillation for shockable rhythms.
Epinephrine and amiodarone are administered after the second and third shocks,
respectively.
2. A patient with return of spontaneous circulation (ROSC) after cardiac arrest
remains comatose. What is the recommended target temperature for targeted
temperature management (TTM)?
A) 30–32°C
B) 32–36°C
C) 36–38°C
D) 28–30°C
Answer: B) 32–36°C
Rationale: The TTM trial demonstrated that targeting a temperature between 32°C
and 36°C improves neurological outcomes compared to no temperature control.
The specific target within this range should be selected based on clinical judgment.
3. Which of the following is the most common reversible cause of cardiac arrest?
A) Hypovolemia
B) Hypoxia
C) Hydrogen ion (acidosis)
D) Hypokalemia/hyperkalemia
Answer: B) Hypoxia
Rationale: Hypoxia is the most common reversible cause of cardiac arrest. The Hs
and Ts mnemonic includes hypoxia as a primary cause that must be rapidly
identified and corrected during resuscitation.
4. A patient presents with severe anaphylaxis and impending airway compromise.
What is the first-line medication?
A) Diphenhydramine 50 mg IV
B) Methylprednisolone 125 mg IV
C) Epinephrine 0.3–0.5 mg IM
D) Albuterol nebulized
Answer: C) Epinephrine 0.3–0.5 mg IM
Rationale: Epinephrine is the first-line treatment for anaphylaxis. IM
administration into the anterolateral thigh is preferred. Antihistamines and
corticosteroids are adjuncts but do not reverse airway compromise.
,5. What is the recommended compression-to-ventilation ratio for adult CPR?
A) 15:2
B) 30:2
C) 50:2
D) Continuous compressions without ventilations
Answer: B) 30:2
Rationale: The AHA recommends a compression-to-ventilation ratio of 30:2 for
single-rescuer adult CPR. For two-rescuer pediatric CPR, the ratio is 15:2.
6. A patient in septic shock has a mean arterial pressure (MAP) of 55 mmHg
despite adequate fluid resuscitation. What is the recommended initial vasopressor?
A) Dopamine
B) Norepinephrine
C) Epinephrine
D) Vasopressin
Answer: B) Norepinephrine
Rationale: Norepinephrine is the first-line vasopressor for septic shock. It has been
shown to have fewer arrhythmias than dopamine and is recommended by the
Surviving Sepsis Campaign.
7. Which of the following is a contraindication to fibrinolytic therapy in acute
ischemic stroke?
A) Blood pressure 170/90 mmHg
B) Platelet count 150,000
C) Intracranial hemorrhage on CT
D) Age 75 years
Answer: C) Intracranial hemorrhage on CT
Rationale: Intracranial hemorrhage on CT is an absolute contraindication to
fibrinolytic therapy. Blood pressure must be <185/110 mmHg, but 170/90 is
acceptable. Age and platelet count are not absolute contraindications.
8. A patient presents with a tension pneumothorax. What is the immediate
management?
A) Chest tube placement
B) Needle decompression
C) Observation
, D) Bronchoscopy
Answer: B) Needle decompression
Rationale: Tension pneumothorax is a life-threatening emergency requiring
immediate needle decompression. Chest tube placement follows after initial
decompression.
9. What is the most common cause of pulseless electrical activity (PEA)?
A) Ventricular fibrillation
B) Hypovolemia
C) Asystole
D) Complete heart block
Answer: B) Hypovolemia
Rationale: Hypovolemia is the most common cause of PEA. The Hs and Ts
mnemonic is used to identify reversible causes during PEA arrest.
10. A patient with severe hyperkalemia has ECG changes including peaked T
waves and widened QRS. What is the first medication to administer?
A) Insulin and glucose
B) Calcium gluconate
C) Sodium bicarbonate
D) Kayexalate
Answer: B) Calcium gluconate
Rationale: Calcium gluconate stabilizes the myocardium by antagonizing the
effects of potassium on cardiac conduction. It acts within minutes and is the first-
line treatment for hyperkalemia with ECG changes.
11. Which of the following is the correct dose of epinephrine for cardiac arrest?
A) 0.1 mg IV every 3–5 minutes
B) 1 mg IV every 3–5 minutes
C) 0.5 mg IV every 5 minutes
D) 2 mg IV every 10 minutes
Answer: B) 1 mg IV every 3–5 minutes
Rationale: The standard dose of epinephrine for cardiac arrest is 1 mg IV/IO every
3–5 minutes. Higher doses have not been shown to improve outcomes.
