Emergency Medicine SAEM exam test bank_2023/2024.
Management of Large Subungual Hematoma - ANSWER-Drainage (18-Gauge) or Hot Micro-
Cauterization
Reason to Avoid Suction in Ear Foreign Body Removal - ANSWER-Perforation of Tympanic
Membrane
Management of Skin Abscess - ANSWER-Linear Incision for Non-Face vs. Needle Drainage for
Face
Catheter for Bartholin Cyst - ANSWER-Word
Grading of Laryngeal Opening - ANSWER-Cormack-Lehane
Preferred Induction Agent in Reactive Airway Disease for Dilation Effects - ANSWER-Ketamine
Induction Agent Avoided in Sepsis Due To Adrenal Suppression - ANSWER-Etomidate
Sudden-Onset Back Pain Worsened by Coughing Soon After Epidural Anesthesia - ANSWER-
Epidural Hematoma
Presentation of Adhesive Arachnoiditis - ANSWER-Progressive Neuropathy
Tom, Dick, and Very Nervous Harry - ANSWER-Anterior to Posterior of Medial Ankle: Tibialis
Posterior, Digitorum Longus, Vein, Nerve, Hallucis Longus
Absolute Contra-Indication to Crico-Thyrotomy - ANSWER-Age Under 5
Anesthesia for Suturing D.I.P. of Finger in Patient with Underlying Vascular Disease - ANSWER-
Lidocaine (2%) Without Epinephrine Around Digital Nerve for Fingers, Toes, Penis, Nose
Earliest Sign of Lidocaine Toxicity (Over 5 mg/kg) - ANSWER-Lightheadedness (Also Peri-Oral
Numbness, Tinnitus, Visual and Auditory Disturbances, Shivering, Twitching, and Generalized
Tonic-Clonic Seizures)
(1) Avoid Vertical Mattress Sutures.
(2) Avoid Topical Skin Adhesives (Risk of Dehiscence from Sweating). - ANSWER-Palm
Glottis Spasm and Chest Wall Rigidity from Sedative (Rapid High Dose of IV Form) - ANSWER-
Fentanyl (Effects Not Always Reversed by Naloxone)
Management of Long-Lasting L.P. Headache - ANSWER-Autologous Blood Patch
,Timing of Tetanus Prophylaxis - ANSWER-Within First Few Days (Suture Within First 24 Hours)
Normal C.S.F.-to-Blood Glucose Ratio - ANSWER-0.6
Size of Needle Decompression Needle - ANSWER-14 Gauge (2nd Intercostal at Midclavicular
Line)
Large Paronychia and Cellulitis - ANSWER-Removal of Affected Nail Under Digital Block; Start
Antibiotics
Signs of Acute Appendicitis - ANSWER-1. Rovsing: Right Lower from Left Lower.
2. Psoas: Extension.
3. Obturator: Rotation.
Suggested by Abdominal Pain Preceding Nausea and Vomiting - ANSWER-Surgery (Small Bowel
Obstruction)
Peak of Gastric Acid Secretion at Rest - ANSWER-2 A.M.
Timing of Presentation of Hypertrophic Pyloric Stenosis (Non-Bilious) vs. Intussusception
(Bilious) - ANSWER-4 Weeks vs. 8 Months
Over 95% Sensitive and Specific for Renal Stones - ANSWER-Helical C.T.
Intermittent Left Lower Quadrant Pain (Afebrile), Loose Stools (Non-Bloody); Good Follow-Up -
ANSWER-Discharge on High-Fiber Diet (Consider Laxatives and Stool Softeners)
Abdominal Wall Condition in Anti-Coagulated Patient with Trauma or Coughing - ANSWER-
Rectus Sheath Hematoma
(1) Age 30.
(2) Prior Abdominal Surgery or Pregnancy.
(3) Marathons. - ANSWER-Risk Factors for Cecal (Cross-Country) Volvulus
Possible Chest X-Ray Finding of Hepatic Abscess - ANSWER-Right-Sided Effusion and Elevated
Hemi-Diaphragm
Referred Pain from Ureteral Colic - ANSWER-Inguinal (Ovarian Torsion Does Not Cause Sacral
Pain)
Elderly Patient, Diverticulitis Without Perforation (Without Peritonitis) - ANSWER-I.V. Fluids
(Elderly), Antibiotics, and Bowel Rest (Peritonitis Requires Surgery)
Proximal vs. Distal Esophageal Perforation - ANSWER-Iatrogenic vs. Spontaneous
, Rigidity; Elevated Temperatures, Altered Mental Status, Choreo-Athetosis, Autonomic
Dysfunction (Diaphoresis, Incontinence, Arrhythmia) - ANSWER-Dantrolene (Or Bromocriptine,
Amantadine, Lorazepam) for Neuroleptic Malignant Syndrome
Indicated by Temperature Over 105 - ANSWER-Non-Infectious
Extra-Pyramidal: Involuntary Periodic Movements of Tongue, Lips, or Mouth - ANSWER-Tardive
Dyskinesia
Extra-Pyramidal: Torticollis, Fixed Upper Gaze (Oculogyric Crisis), or Arching of Back
(Opisthotonus) - ANSWER-Benztropine (2mg Cogentin) or Benadryl (25mg) for Dystonia from
Typical Anti-Psychotics
Extra-Pyramidal: Restlessness - ANSWER-Beta-Blocker for Akathisia
E.C.G. Finding of Haloperidol Toxicity - ANSWER-Long Q.T.
Illicit Drug Causing Vertical Nystagmus - ANSWER-Phencyclidine (PCP)
Controls Agitation Without Respiratory Depression (Negligible Anticholinergic Side Effects) -
ANSWER-Haloperidol (5mg IM q30); B-52 is Benadryl (50 Milligrams), 5 Milligrams of
Haloperidol, and 2 Milligrams of Lorazepam
Risk of Protracted Struggle in Restraints - ANSWER-Metabolic Acidosis
Risk of Flumazenil in Chronic Benzodiazepine User - ANSWER-Withdrawal Seizures
Altered Chronic Alcoholic, Non-Gap Metabolic Acidosis - ANSWER-Isopropyl Alcohol
Glucose and Magnesium Recommendations for Altered Alcoholic - ANSWER-1. Thiamine Before
Glucose; and,
2. Give Magnesium Regardless of Magnesium Level (Low Stores).
Waxing and Waning Global Inability to Relate to Environment and Process Sensory Input
(Increased Alertness and Psychomotor Activity) - ANSWER-Delirium
Most Common Dementia - ANSWER-Alzheimer More Common Than Vascular Dementia
Management of Seizures in Eclampsia - ANSWER-Magnesium; Consider Labetalol or Hydralazine
for Diastolic Over 110 After Seizure Stops
Relationship Between Alcohol and Seizures - ANSWER-Direct Toxicity vs. Withdrawal vs. Head
Injury from Fall
Most Common Cause of Delirium in Elderly - ANSWER-Medications
Management of Large Subungual Hematoma - ANSWER-Drainage (18-Gauge) or Hot Micro-
Cauterization
Reason to Avoid Suction in Ear Foreign Body Removal - ANSWER-Perforation of Tympanic
Membrane
Management of Skin Abscess - ANSWER-Linear Incision for Non-Face vs. Needle Drainage for
Face
Catheter for Bartholin Cyst - ANSWER-Word
Grading of Laryngeal Opening - ANSWER-Cormack-Lehane
Preferred Induction Agent in Reactive Airway Disease for Dilation Effects - ANSWER-Ketamine
Induction Agent Avoided in Sepsis Due To Adrenal Suppression - ANSWER-Etomidate
Sudden-Onset Back Pain Worsened by Coughing Soon After Epidural Anesthesia - ANSWER-
Epidural Hematoma
Presentation of Adhesive Arachnoiditis - ANSWER-Progressive Neuropathy
Tom, Dick, and Very Nervous Harry - ANSWER-Anterior to Posterior of Medial Ankle: Tibialis
Posterior, Digitorum Longus, Vein, Nerve, Hallucis Longus
Absolute Contra-Indication to Crico-Thyrotomy - ANSWER-Age Under 5
Anesthesia for Suturing D.I.P. of Finger in Patient with Underlying Vascular Disease - ANSWER-
Lidocaine (2%) Without Epinephrine Around Digital Nerve for Fingers, Toes, Penis, Nose
Earliest Sign of Lidocaine Toxicity (Over 5 mg/kg) - ANSWER-Lightheadedness (Also Peri-Oral
Numbness, Tinnitus, Visual and Auditory Disturbances, Shivering, Twitching, and Generalized
Tonic-Clonic Seizures)
(1) Avoid Vertical Mattress Sutures.
(2) Avoid Topical Skin Adhesives (Risk of Dehiscence from Sweating). - ANSWER-Palm
Glottis Spasm and Chest Wall Rigidity from Sedative (Rapid High Dose of IV Form) - ANSWER-
Fentanyl (Effects Not Always Reversed by Naloxone)
Management of Long-Lasting L.P. Headache - ANSWER-Autologous Blood Patch
,Timing of Tetanus Prophylaxis - ANSWER-Within First Few Days (Suture Within First 24 Hours)
Normal C.S.F.-to-Blood Glucose Ratio - ANSWER-0.6
Size of Needle Decompression Needle - ANSWER-14 Gauge (2nd Intercostal at Midclavicular
Line)
Large Paronychia and Cellulitis - ANSWER-Removal of Affected Nail Under Digital Block; Start
Antibiotics
Signs of Acute Appendicitis - ANSWER-1. Rovsing: Right Lower from Left Lower.
2. Psoas: Extension.
3. Obturator: Rotation.
Suggested by Abdominal Pain Preceding Nausea and Vomiting - ANSWER-Surgery (Small Bowel
Obstruction)
Peak of Gastric Acid Secretion at Rest - ANSWER-2 A.M.
Timing of Presentation of Hypertrophic Pyloric Stenosis (Non-Bilious) vs. Intussusception
(Bilious) - ANSWER-4 Weeks vs. 8 Months
Over 95% Sensitive and Specific for Renal Stones - ANSWER-Helical C.T.
Intermittent Left Lower Quadrant Pain (Afebrile), Loose Stools (Non-Bloody); Good Follow-Up -
ANSWER-Discharge on High-Fiber Diet (Consider Laxatives and Stool Softeners)
Abdominal Wall Condition in Anti-Coagulated Patient with Trauma or Coughing - ANSWER-
Rectus Sheath Hematoma
(1) Age 30.
(2) Prior Abdominal Surgery or Pregnancy.
(3) Marathons. - ANSWER-Risk Factors for Cecal (Cross-Country) Volvulus
Possible Chest X-Ray Finding of Hepatic Abscess - ANSWER-Right-Sided Effusion and Elevated
Hemi-Diaphragm
Referred Pain from Ureteral Colic - ANSWER-Inguinal (Ovarian Torsion Does Not Cause Sacral
Pain)
Elderly Patient, Diverticulitis Without Perforation (Without Peritonitis) - ANSWER-I.V. Fluids
(Elderly), Antibiotics, and Bowel Rest (Peritonitis Requires Surgery)
Proximal vs. Distal Esophageal Perforation - ANSWER-Iatrogenic vs. Spontaneous
, Rigidity; Elevated Temperatures, Altered Mental Status, Choreo-Athetosis, Autonomic
Dysfunction (Diaphoresis, Incontinence, Arrhythmia) - ANSWER-Dantrolene (Or Bromocriptine,
Amantadine, Lorazepam) for Neuroleptic Malignant Syndrome
Indicated by Temperature Over 105 - ANSWER-Non-Infectious
Extra-Pyramidal: Involuntary Periodic Movements of Tongue, Lips, or Mouth - ANSWER-Tardive
Dyskinesia
Extra-Pyramidal: Torticollis, Fixed Upper Gaze (Oculogyric Crisis), or Arching of Back
(Opisthotonus) - ANSWER-Benztropine (2mg Cogentin) or Benadryl (25mg) for Dystonia from
Typical Anti-Psychotics
Extra-Pyramidal: Restlessness - ANSWER-Beta-Blocker for Akathisia
E.C.G. Finding of Haloperidol Toxicity - ANSWER-Long Q.T.
Illicit Drug Causing Vertical Nystagmus - ANSWER-Phencyclidine (PCP)
Controls Agitation Without Respiratory Depression (Negligible Anticholinergic Side Effects) -
ANSWER-Haloperidol (5mg IM q30); B-52 is Benadryl (50 Milligrams), 5 Milligrams of
Haloperidol, and 2 Milligrams of Lorazepam
Risk of Protracted Struggle in Restraints - ANSWER-Metabolic Acidosis
Risk of Flumazenil in Chronic Benzodiazepine User - ANSWER-Withdrawal Seizures
Altered Chronic Alcoholic, Non-Gap Metabolic Acidosis - ANSWER-Isopropyl Alcohol
Glucose and Magnesium Recommendations for Altered Alcoholic - ANSWER-1. Thiamine Before
Glucose; and,
2. Give Magnesium Regardless of Magnesium Level (Low Stores).
Waxing and Waning Global Inability to Relate to Environment and Process Sensory Input
(Increased Alertness and Psychomotor Activity) - ANSWER-Delirium
Most Common Dementia - ANSWER-Alzheimer More Common Than Vascular Dementia
Management of Seizures in Eclampsia - ANSWER-Magnesium; Consider Labetalol or Hydralazine
for Diastolic Over 110 After Seizure Stops
Relationship Between Alcohol and Seizures - ANSWER-Direct Toxicity vs. Withdrawal vs. Head
Injury from Fall
Most Common Cause of Delirium in Elderly - ANSWER-Medications
