SAEM M4 VERIFIED QUESTIONS AND ANSWERS EXAM. LATEST UPDATE.

SAEM M4 VERIFIED QUESTIONS AND ANSWERS EXAM. LATEST UPDATE. True or False: gastric distension due to excessive volume or rate of ventilation impairing ventilatory function is a reason to intubate a neonate - Correct Ans: False Management for nursemaid elbow injury - Correct Ans: 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? - Correct Ans: compression fracture of the posteriolateral aspect of the humeral head (Hill-Sachs deformity) What are most common heart rhythms seen in pediatric arrest? - Correct Ans: bradycardia or asystole Risk factors for neonatal resuscitation - Correct Ans: prematurity IUGR Multiple gestation 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 - Correct Ans: 3. Hypoglycemia In a newborn, bradycardia is most commonly an indicator of: - Correct Ans: hypoxemia All the following are signs of hypoxemia in a newborn, EXCEPT: Answers: sis rgy cardia ponsiveness cardia - Correct Ans: 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: genesis imperfecta n error of metabolism nital diaphragmatic hernia gn body eoesophageal fistula - Correct Ans: 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: blow then blind finger sweep blow then chest thrust thrust then Heimlich maneuver 4.Heimlich maneuver then blind finger sweep 5.Heimlich maneuver then chest thrust - Correct Ans: 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 - Correct Ans: 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 - Correct Ans: 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 - Correct Ans: 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 - Correct Ans: 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 - Correct Ans: 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: 7.14 pco2 68 po2 102 HCO3 23 7.33 pco2 48 po2 58 HCO3 29 7.45 pco2 21 po2 124 HCO3 14 7.47 pco2 31 po2 96 HCO3 25 - Correct Ans: 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. - Correct Ans: 1.An acetaminophen level drawn at hour four dictates need for antidotal therapy. A 2 year old child presents with an overdose of her mother's iron containing multivitamins. What antidote should you consider for iron toxicity? Answers: 1.Deferoxamine 2.Glucagon 3.Methylene blue 4.Pyridoxine - Correct Ans: 1.Deferoxamine Severe lead toxicity can commonly result in which of the following clinical symptoms Answers: 1.Constipation 2.Dermatitis 3.Memory loss 4.Stocking glove peripheral neuropathy - Correct Ans: 3.Memory loss 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? Answers: 1. Respiratory acidosis due to somnolence causing decreased respiratory drive 2. Respiratory alkalosis due to stimulation of the respiratory center and increased CO2 production 3.Primary respiratory acidosis with compensatory metabolic alkalosis 4.Primary metabolic acidosis with compensatory respiratory alkalosis - Correct Ans: 2.Respiratory alkalosis due to stimulation of the respiratory center and increased CO2 production The most common cause of intrinsic lower gastrointestinal (GI) bleeding in an adult is: Answers: 1.Cancer 2.Diverticulosis 3.Inflammatory bowel disease 4.Polyps - Correct Ans: 2.Diverticulosis Which of the following bacteria does NOT produce bloody diarrhea? Answers: 1.Campylobacter enteritis 2.Clostridium perfringens 3.Escherichia coli 0157 4.Yersinia enterocolitica - Correct Ans: 2.Clostridium perfringens With respect to laboratory findings in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic coma (HHNC), all of the following guidelines are generally true EXCEPT: Answers: 1. Patients with HHNC typically have blood glucose 700 mg/dl, whereas patients with DKA have blood glucose 350 mg/dl. 2. Serum ketones are present in patients with DKA but not usually in patients with HHNC. 3.Serum bicarbonate is typically severely low (10meq) in patients with either DKA or HHNC. 4.Serum osmolality in patients with HHNC is typically 350 mosm/L. 5.BUN is elevated more in patients with HHNC (50 mg/dl) than in patients with DKA (25-50 mg/dl). - 3.Serum bicarbonate is typically severely low (10meq) in patients with either DKA or HHNC. Regarding the treatment of hyperosmolar hypertonic nonketotic coma (HHNC) and its associated symptoms, which of the following is correct: Answers: 1. Half of the fluid deficit should be corrected over the first hour and the remainder over the following 8 hours. 2. Since patients are not acidotic, close monitoring of glucose is not necessary. 3.Hyperosmolarity should be corrected within the first few hours in the emergency department. 4.Phenytoin (Dilantin) is often ineffective for seizures associated with HHNC. 5.In HHNC patients with severe dehydration, bleeding diathesis is a major clinical concern. - 4.Phenytoin (Dilantin) is often ineffective for seizures associated with HHNC. Regarding the development of cerebral edema in patients being treated for DKA, all of the following are true EXCEPT: