(Society for Academic Emergency Medicine) aSAEM Practice Actual
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A 55 year-old man is brought down from the outpatient procedures
clinic after becoming severely short of breath during an endoscopy
under light sedation. His pulse oximeter is reading 100% on a non-
rebreather mask. You notice an interesting discoloration of his blood
when it is drawn. What antidote should be administered?
A. Deferoxamine
B. Methylene blue
C. Hydroxycobalamin
D. Amyl nitrite -ANSWER-B. Methylene blue
The answer is B. Nitrates/nitrites, local anesthetics, dapsone, and
phenazopyridine are the common causes of methemoglobinemia.
Methemoglobinemia causes the oxygen dissociation curve to shift to
the left, making the remaining hemoglobin less likely to give up oxygen
to the tissues. Blood from patients with methemoglobinemia is a
chocolate brown color. Methylene blue is the antidote. Pulse oximetry
is unreliable in patients with methemoglobinemia, since the pulse
oximeter cannot differentiate oxyhemoglobin from
methemoglobinemia.
A 27 year old woman is brought into the emergency department by her
roommate 30 minutes after ingesting a bottle of aspirin in a suicide
,attempt. Which of the following acid-base disorders is most likely to be
present in this patient?
A. Primary metabolic acidosis with compensatory respiratory alkalosis
B. Respiratory acidosis due to somnolence causing decreased
respiratory drive
C. Respiratory alkalosis due to stimulation of the respiratory center and
increased CO2 production
D. Primary respiratory acidosis with compensatory metabolic alkalosis -
ANSWER-C. Respiratory alkalosis due to stimulation of the respiratory
center and increased CO2 production
The answer is C. Aspirin, a salicylate, directly stimulates the medullary
chemoreceptor trigger zone and respiratory center, leading to
increased CO2 production and increased respiratory rate, causing a
primary respiratory alkalosis. A primary metabolic acidosis typically
develops as well. Salicylates are absorbed from the stomach and bowel
wall and typically have onset of action within 30 minutes.
During opiate withdrawal which of the following symptoms would you
expect to find?
A. Urinary retention
B. Tachypnea
C. Pruritis
D. Constipation -ANSWER-B. Tachypnea
,The answer is B. Withdrawal syndromes tend to have symptoms that
are the reverse of intoxication syndromes. In opiate withdrawal,
individuals present with CNS excitation, diarrhea, mydriasis, tachypnea
and often abdominal cramping and vomiting. While uncomfortable,
opiate withdrawal is not life threatening and is managed
symptomatically
A thin 18 year old female complains of acute onset of sharp right-sided
chest pain this morning. She has developed some mild shortness of
breath during the morning and thought she should get it checked out.
Her chest X-ray is shown in the Figure. The next course of action should
be:
[image ??]
photo courtesy of eMedicine.com
A. Needle decompression
B. Electrocardiogram
C. Chest tube placement
D. Antibiotics -ANSWER-C. Chest tube placement
The answer is C. This patient has a large right-sided spontaneous
pneumothorax that is not under tension. She needs oxygen and chest
tube placement. This can be done with proper procedural analgesia and
sedation since there is no immediate threat. Primary spontaneous
pneumothorax tends to occur in healthy young men (and, less
commonly, women) of taller than average height. Other risk factors
include cigarette smoking, asthma, COPD, interstitial lung disease,
connective tissue diseases, and lung cancers.
, 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 tube can be followed into r lung]
A. Endotracheal tube adjustment
B. Nasogastric tube placement
C. Needle decompression
D. Chest tube placement -ANSWER-A. Endotracheal tube adjustment
The answer is A. 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. Gas embolism
B. Bilateral pulmonary embolism
Exam 2026 || Most Recent Exam 2026|2027 Actual Complete Real
Exam Questions And Correct Answers (Verified Answers) Already
Graded A+ | Guaranteed Success!! Newest Exam | Just Released!!
A 55 year-old man is brought down from the outpatient procedures
clinic after becoming severely short of breath during an endoscopy
under light sedation. His pulse oximeter is reading 100% on a non-
rebreather mask. You notice an interesting discoloration of his blood
when it is drawn. What antidote should be administered?
A. Deferoxamine
B. Methylene blue
C. Hydroxycobalamin
D. Amyl nitrite -ANSWER-B. Methylene blue
The answer is B. Nitrates/nitrites, local anesthetics, dapsone, and
phenazopyridine are the common causes of methemoglobinemia.
Methemoglobinemia causes the oxygen dissociation curve to shift to
the left, making the remaining hemoglobin less likely to give up oxygen
to the tissues. Blood from patients with methemoglobinemia is a
chocolate brown color. Methylene blue is the antidote. Pulse oximetry
is unreliable in patients with methemoglobinemia, since the pulse
oximeter cannot differentiate oxyhemoglobin from
methemoglobinemia.
A 27 year old woman is brought into the emergency department by her
roommate 30 minutes after ingesting a bottle of aspirin in a suicide
,attempt. Which of the following acid-base disorders is most likely to be
present in this patient?
A. Primary metabolic acidosis with compensatory respiratory alkalosis
B. Respiratory acidosis due to somnolence causing decreased
respiratory drive
C. Respiratory alkalosis due to stimulation of the respiratory center and
increased CO2 production
D. Primary respiratory acidosis with compensatory metabolic alkalosis -
ANSWER-C. Respiratory alkalosis due to stimulation of the respiratory
center and increased CO2 production
The answer is C. Aspirin, a salicylate, directly stimulates the medullary
chemoreceptor trigger zone and respiratory center, leading to
increased CO2 production and increased respiratory rate, causing a
primary respiratory alkalosis. A primary metabolic acidosis typically
develops as well. Salicylates are absorbed from the stomach and bowel
wall and typically have onset of action within 30 minutes.
During opiate withdrawal which of the following symptoms would you
expect to find?
A. Urinary retention
B. Tachypnea
C. Pruritis
D. Constipation -ANSWER-B. Tachypnea
,The answer is B. Withdrawal syndromes tend to have symptoms that
are the reverse of intoxication syndromes. In opiate withdrawal,
individuals present with CNS excitation, diarrhea, mydriasis, tachypnea
and often abdominal cramping and vomiting. While uncomfortable,
opiate withdrawal is not life threatening and is managed
symptomatically
A thin 18 year old female complains of acute onset of sharp right-sided
chest pain this morning. She has developed some mild shortness of
breath during the morning and thought she should get it checked out.
Her chest X-ray is shown in the Figure. The next course of action should
be:
[image ??]
photo courtesy of eMedicine.com
A. Needle decompression
B. Electrocardiogram
C. Chest tube placement
D. Antibiotics -ANSWER-C. Chest tube placement
The answer is C. This patient has a large right-sided spontaneous
pneumothorax that is not under tension. She needs oxygen and chest
tube placement. This can be done with proper procedural analgesia and
sedation since there is no immediate threat. Primary spontaneous
pneumothorax tends to occur in healthy young men (and, less
commonly, women) of taller than average height. Other risk factors
include cigarette smoking, asthma, COPD, interstitial lung disease,
connective tissue diseases, and lung cancers.
, 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 tube can be followed into r lung]
A. Endotracheal tube adjustment
B. Nasogastric tube placement
C. Needle decompression
D. Chest tube placement -ANSWER-A. Endotracheal tube adjustment
The answer is A. 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. Gas embolism
B. Bilateral pulmonary embolism
