SAEM Practice 2020 EXAM Questions AND Correct Answers
"Silent Suicide" is defined as:
A. an act of slowly killing oneself by nonviolent means, such as
starvation or non-compliance with essential medical treatment
B. an attempted suicide
C. suicide involving a number of willing and sometimes not so willing
participants
D. a self-destructive act disguised as an accident
E. recurrent self-destructive acts, such as heavy drinking in the
presence of alcoholic liver disease - ✔✔A. an act of slowly killing
oneself by nonviolent means, such as starvation or non-compliance
with essential medical treatment
The answer is A. "Silent Suicide" is most common in elderly patients
and frequently goes unrecognized. Such patients may present to the
emergency department repeatedly because of non-compliance with
treatment of their medical disorders. "Occult Suicide" is applied to
self-destructive acts disguised as accidents and should be suspected in
those who have "accidental" self-inflicted gun shot wounds, and in
those who "unintentionally" overdose, or who fall from a height.
"Chronic Suicidal Behavior" consists of recurrent self-destructive acts.
"Mass or Group Suicide" is suicide involving a number of people.
"Parasuicide" is an attempted suicide, which is seen more as a gesture
than a serious act.
,19 year old man is brought in to the emergency department by EMS
after being found obtunded in his apartment. No additional history is
available. On arrival, the patient is minimally responsive with
sonorous respirations and a palpable rapid pulse. The most
appropriate initial diagnostic test would be
A. Arterial blood gas
B. Electrocardiogram
C. Fingerstick glucose
D. Urine drug screen - ✔✔C. Fingerstick glucose
Hypoglycemia is a common and readily treatable cause for altered
mental status. An ABG is unlikely to be diagnostic and more likely to
reflect secondary abnormalities caused by respiratory depression.
While a urine drug screen may show positives, it cannot quantitate
the amount of a substance or the time period in which the exposure
occurred so a positive screen may not reflect cause and effect. An
EKG, while a part of a toxicology evaluation, is not an appropriate
initiate screening test for an unstable patient until airway and readily
reversible causes have been addressed.
56 year old male presents with sub-sternal chest pain for 4 hours with
worsening shortness of breath for the last 2 hours. The patient's heart
rate is 108 beats per minute, respiratory rate of 24 breaths per
minute, and oxygenation saturation of 94% on room air. On physical
examination, the patient appears dyspneic. On auscultation, he has a
harsh II/VI systolic murmur with rales midway up bilateral lung fields.
A bedside echocardiogram is done which shows papillary muscle
,rupture. Which valve's regurgitation is responsible for this patient's
shortness of breath?
A. Mitral valve
B. Aortic valve
C. Pulmonic valve
D. Tricuspid valve - ✔✔A. Mitral valve
60 year old male presents to the emergency department with chest
pain. His monitor strip, shown below, reveals:
[image: unexpected, non-conducted atrial impulses. The R-R interval
and P-R intervals are constant. ]
A. first degree AV block
B. complete heart block
C. second degree AV block Mobitz Type 1
D. second degree AV block Mobitz Type 2 - ✔✔D. second degree AV
block Mobitz Type 2
-- For further reading, see Tintinalli, et al., Emergency Medicine: A
Comprehensive
Study Guide, 5th edition, page 184.
6What does the dotted line in the figure depict?
[image]
, Figure used with permission from Hamilton et al, Emergency
Medicine: An approach to clinical problem-solving
A. Placement site for skin clamps.
B. The needle entry angle that optimizes eversion of sutured skin
edges.
C. The approach for subcuticular suture.
D. The injection plane for local anesthesia infiltration.
E. Use of a "finder needle" to mark suture entry points. - ✔✔B. The
needle entry angle that optimizes eversion of sutured skin edges.
The answer is B. Eversion of the skin edges is maximized by directing
the needle entry as shown in the figure. Injection for local anesthesia
should usually be performed through the wound, rather than through
intact skin. Use of skin clamps can damage tissue; in cases where skin
stabilization is needed gentle forceps application is preferred.
Subcuticular sutures are placed deep to the skin.
A "BLS" ambulance differs from an "ALS" ambulance in that the BLS
ambulance:
A. is stocked with different supplies and equipment
B. operates under off-line, as opposed to on-line, medical control
C. arrives at the patient first
D. is staffed by one EMT crew member (and one driver) rather than
two EMTs
"Silent Suicide" is defined as:
A. an act of slowly killing oneself by nonviolent means, such as
starvation or non-compliance with essential medical treatment
B. an attempted suicide
C. suicide involving a number of willing and sometimes not so willing
participants
D. a self-destructive act disguised as an accident
E. recurrent self-destructive acts, such as heavy drinking in the
presence of alcoholic liver disease - ✔✔A. an act of slowly killing
oneself by nonviolent means, such as starvation or non-compliance
with essential medical treatment
The answer is A. "Silent Suicide" is most common in elderly patients
and frequently goes unrecognized. Such patients may present to the
emergency department repeatedly because of non-compliance with
treatment of their medical disorders. "Occult Suicide" is applied to
self-destructive acts disguised as accidents and should be suspected in
those who have "accidental" self-inflicted gun shot wounds, and in
those who "unintentionally" overdose, or who fall from a height.
"Chronic Suicidal Behavior" consists of recurrent self-destructive acts.
"Mass or Group Suicide" is suicide involving a number of people.
"Parasuicide" is an attempted suicide, which is seen more as a gesture
than a serious act.
,19 year old man is brought in to the emergency department by EMS
after being found obtunded in his apartment. No additional history is
available. On arrival, the patient is minimally responsive with
sonorous respirations and a palpable rapid pulse. The most
appropriate initial diagnostic test would be
A. Arterial blood gas
B. Electrocardiogram
C. Fingerstick glucose
D. Urine drug screen - ✔✔C. Fingerstick glucose
Hypoglycemia is a common and readily treatable cause for altered
mental status. An ABG is unlikely to be diagnostic and more likely to
reflect secondary abnormalities caused by respiratory depression.
While a urine drug screen may show positives, it cannot quantitate
the amount of a substance or the time period in which the exposure
occurred so a positive screen may not reflect cause and effect. An
EKG, while a part of a toxicology evaluation, is not an appropriate
initiate screening test for an unstable patient until airway and readily
reversible causes have been addressed.
56 year old male presents with sub-sternal chest pain for 4 hours with
worsening shortness of breath for the last 2 hours. The patient's heart
rate is 108 beats per minute, respiratory rate of 24 breaths per
minute, and oxygenation saturation of 94% on room air. On physical
examination, the patient appears dyspneic. On auscultation, he has a
harsh II/VI systolic murmur with rales midway up bilateral lung fields.
A bedside echocardiogram is done which shows papillary muscle
,rupture. Which valve's regurgitation is responsible for this patient's
shortness of breath?
A. Mitral valve
B. Aortic valve
C. Pulmonic valve
D. Tricuspid valve - ✔✔A. Mitral valve
60 year old male presents to the emergency department with chest
pain. His monitor strip, shown below, reveals:
[image: unexpected, non-conducted atrial impulses. The R-R interval
and P-R intervals are constant. ]
A. first degree AV block
B. complete heart block
C. second degree AV block Mobitz Type 1
D. second degree AV block Mobitz Type 2 - ✔✔D. second degree AV
block Mobitz Type 2
-- For further reading, see Tintinalli, et al., Emergency Medicine: A
Comprehensive
Study Guide, 5th edition, page 184.
6What does the dotted line in the figure depict?
[image]
, Figure used with permission from Hamilton et al, Emergency
Medicine: An approach to clinical problem-solving
A. Placement site for skin clamps.
B. The needle entry angle that optimizes eversion of sutured skin
edges.
C. The approach for subcuticular suture.
D. The injection plane for local anesthesia infiltration.
E. Use of a "finder needle" to mark suture entry points. - ✔✔B. The
needle entry angle that optimizes eversion of sutured skin edges.
The answer is B. Eversion of the skin edges is maximized by directing
the needle entry as shown in the figure. Injection for local anesthesia
should usually be performed through the wound, rather than through
intact skin. Use of skin clamps can damage tissue; in cases where skin
stabilization is needed gentle forceps application is preferred.
Subcuticular sutures are placed deep to the skin.
A "BLS" ambulance differs from an "ALS" ambulance in that the BLS
ambulance:
A. is stocked with different supplies and equipment
B. operates under off-line, as opposed to on-line, medical control
C. arrives at the patient first
D. is staffed by one EMT crew member (and one driver) rather than
two EMTs
