Page 1 of 39
SAEM EXAM QUESTIONS ACTUAL EXAM 400 REAL
EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+
Goal of asthma treatment .....ANSWER.....- relax smooth muscle
and decrease inflammation in lower airways
- inhaled B-agonist, inhaled anticholingergic, systemic
corticosteroids, and IV mag
- give IV or oral steroid: prednisone, methylprenisolone, or
dexamethasone
- avoid inhaled steroids --> outpatient tx only
Severity of ARDS .....ANSWER.....- Ratio of arterial partial
pressure of oxygen to the fraction of inspired oxygen
- < 100 = severe
- 101-200 = moderate
,Page 2 of 39
- 200 - 300 = mild
CHF Exacerbation - Medication Management .....ANSWER.....-
high dose nitroglycerin ( vasodilate, venodilate)
- IV lasix, but takes hours to have effect
Contraindications to BiPAP .....ANSWER.....facial trauma,
vomiting, AMS
Epinephrine Dosing - Anaphylaxis .....ANSWER.....- Subcutaneous
epinephrine: 0.3 mg 1:1,000
- IV epinephrine: 0.3 mg 1:10,000 (less concentrated)
AutoPEEP .....ANSWER.....- Breath stacking
- high peak pressure with bronchoconstriction, difficult time
exhaling
- removal from the ventilator for the patient to exhale
Initial TV .....ANSWER.....6-8 mL/kg x ideal body weight
,Page 3 of 39
Methemoglobinemia .....ANSWER.....- hypoxia out of proportion
that does not respond to supplemental oxygen
Management of ruptured AAA .....ANSWER.....- Transfuse! Blood!!
- Operative Management
- No evidence saying that lowering BP is beneficial
Aortic Dissection Management .....ANSWER.....- Anything involving
ascending requires surgical management, sometimes descending
can be managed medically
- B-blocker is first line (IV esmolol) because is can lower the
SBP/MAP without reflex tachycardia
- Treating pain is also critical to lower HR
Aortic Dissection Diagnosis .....ANSWER.....- Might have a STEMI
as a result, this is why CXR required prior to going to the cath
lab
, Page 4 of 39
- Upper extremity pulse defect has low sensitivity but should be
checked
- D-dimer not helpful
- CT w/ IV contrast or TEE but not if emergent
Concern for right ventricular involvment .....ANSWER.....- When ST
elevation in lead III higher than lead II
- Elevation in V1 in setting of inferior MI
- Repeat EKG w/ right leads!!
- Nitro contraindicated, give fluids
Cocaine induced MI .....ANSWER.....Tx = Benzo
- Same as acute printzmetal → (O2, Heparin, ASA, NTG, CCB,
benzo)
- NO Beta blocker bc of vasospasm and risk for further
hypotension
SAEM EXAM QUESTIONS ACTUAL EXAM 400 REAL
EXAM QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (VERIFIED ANSWERS) |ALREADY
GRADED A+
Goal of asthma treatment .....ANSWER.....- relax smooth muscle
and decrease inflammation in lower airways
- inhaled B-agonist, inhaled anticholingergic, systemic
corticosteroids, and IV mag
- give IV or oral steroid: prednisone, methylprenisolone, or
dexamethasone
- avoid inhaled steroids --> outpatient tx only
Severity of ARDS .....ANSWER.....- Ratio of arterial partial
pressure of oxygen to the fraction of inspired oxygen
- < 100 = severe
- 101-200 = moderate
,Page 2 of 39
- 200 - 300 = mild
CHF Exacerbation - Medication Management .....ANSWER.....-
high dose nitroglycerin ( vasodilate, venodilate)
- IV lasix, but takes hours to have effect
Contraindications to BiPAP .....ANSWER.....facial trauma,
vomiting, AMS
Epinephrine Dosing - Anaphylaxis .....ANSWER.....- Subcutaneous
epinephrine: 0.3 mg 1:1,000
- IV epinephrine: 0.3 mg 1:10,000 (less concentrated)
AutoPEEP .....ANSWER.....- Breath stacking
- high peak pressure with bronchoconstriction, difficult time
exhaling
- removal from the ventilator for the patient to exhale
Initial TV .....ANSWER.....6-8 mL/kg x ideal body weight
,Page 3 of 39
Methemoglobinemia .....ANSWER.....- hypoxia out of proportion
that does not respond to supplemental oxygen
Management of ruptured AAA .....ANSWER.....- Transfuse! Blood!!
- Operative Management
- No evidence saying that lowering BP is beneficial
Aortic Dissection Management .....ANSWER.....- Anything involving
ascending requires surgical management, sometimes descending
can be managed medically
- B-blocker is first line (IV esmolol) because is can lower the
SBP/MAP without reflex tachycardia
- Treating pain is also critical to lower HR
Aortic Dissection Diagnosis .....ANSWER.....- Might have a STEMI
as a result, this is why CXR required prior to going to the cath
lab
, Page 4 of 39
- Upper extremity pulse defect has low sensitivity but should be
checked
- D-dimer not helpful
- CT w/ IV contrast or TEE but not if emergent
Concern for right ventricular involvment .....ANSWER.....- When ST
elevation in lead III higher than lead II
- Elevation in V1 in setting of inferior MI
- Repeat EKG w/ right leads!!
- Nitro contraindicated, give fluids
Cocaine induced MI .....ANSWER.....Tx = Benzo
- Same as acute printzmetal → (O2, Heparin, ASA, NTG, CCB,
benzo)
- NO Beta blocker bc of vasospasm and risk for further
hypotension
