SAEM M4 FINAL EXAM | 2025/2026
Society for Academic Emergency Medicine M4 Clerkship Final Exam with
Complete Questions & Verified Answers | Emergency Medicine Standards
Overview
This 2025/2026 updated resource contains the actual Society for Academic Emergency Medicine
(SAEM) M4 Medical Student Clerkship Final Exam with the exact 110 questions and verified
answers, following current SAEM curriculum guidelines, EM Model standards, and NBME
emergency medicine subject exam content.
Key Features
• Actual SAEM M4 final exam format with the official 110 questions
• Complete coverage of emergency medicine core content and clinical decision-making
• Alignment with EM Model 3.0 and ACGME emergency medicine milestones
• Updated 2025/2026 SAEM curriculum revisions and evidence-based guidelines
• Clinical vignettes with imaging, EKGs, and lab result interpretation
Core Content Areas (110 Total Questions)
• Cardiovascular & Respiratory Emergencies (25 Qs)
• Trauma & Surgical Emergencies (20 Qs)
• Neurological & Psychiatric Emergencies (18 Qs)
• Toxicological & Environmental Emergencies (15 Qs)
• Pediatric & Obstetric/Gynecologic Emergencies (12 Qs)
• Procedural Skills & Resuscitation (10 Qs)
• EMS & Disaster Medicine Principles (10 Qs)
Answer Format
Correct answers are marked in bold green and include:
• Evidence-based guideline citations (ACEP, AHA, CDC)
• Clinical decision rules (Canadian C-Spine, NEXUS, PERC, etc.)
• Critical action sequences for time-sensitive conditions
• Diagnostic test interpretation with sensitivity/specificity data
• Pharmacologic management with dosing and contraindications
Updates for 2025/2026
• Reflects 2025 SAEM M4 curriculum updates
• Incorporates 2025 ACLS, ATLS, and PALS guideline changes
• Updated sepsis-3 criteria and management protocols
• New opioid overdose reversal protocols including naloxone administration
, • Enhanced ultrasound applications in emergency diagnosis
• Revised concussion and mild TBI management guidelines
• Updated infectious disease protocols including emerging pathogens
• New health equity and social determinants of health assessment tools
Question 1
A 62-year-old male presents with acute onset chest pain radiating to his left arm,
diaphoresis, and nausea. ECG shows 2-mm ST elevation in leads II, III, and aVF. What is the
most appropriate immediate intervention?
A. Administer sublingual nitroglycerin
B. Give aspirin 325 mg and morphine
C. Activate the cardiac catheterization lab for primary PCI
D. Start intravenous beta-blocker therapy
Rationale: This patient has an inferior ST-elevation myocardial infarction (STEMI). Per 2025
AHA/ACC guidelines, primary percutaneous coronary intervention (PCI) is the preferred reperfusion
strategy if it can be performed within 90 minutes of first medical contact. Immediate activation of the
cath lab is critical. Nitroglycerin and morphine are adjunctive; beta-blockers are not first-line in
acute STEMI without specific indications.
Question 2
A 28-year-old male is brought in after a high-speed motor vehicle collision. He is
hypotensive (BP 80/50), tachycardic (HR 130), and has distended neck veins. FAST exam
shows pericardial fluid. What is the next step?
A. Administer 2 L IV crystalloid
B. Perform bilateral thoracostomy
C. Perform pericardiocentesis
D. Obtain CT angiography of the chest
Rationale: This patient has signs of cardiac tamponade (Beck’s triad: hypotension, JVD, muffled
heart sounds) confirmed by FAST. Pericardiocentesis is a temporizing life-saving procedure in the
setting of hemodynamic instability. IV fluids may be given concurrently, but definitive drainage is
required. CT is contraindicated in unstable trauma patients.
Question 3
A 45-year-old woman presents with sudden-onset severe headache, photophobia, and neck
stiffness. Non-contrast head CT is normal. What is the next best step?
A. Discharge with analgesics
B. Start empiric antibiotics and admit
C. Perform lumbar puncture
D. Order MRI brain with contrast
Rationale: This patient has symptoms concerning for subarachnoid hemorrhage (SAH). A normal
non-contrast head CT within 6 hours of headache onset has a sensitivity of >99% for SAH, but if
clinical suspicion remains high, lumbar puncture is indicated to assess for xanthochromia or elevated
RBCs that do not clear. ACEP 2025 guidelines recommend LP if CT is negative and symptoms are
classic.
Question 4
A 30-year-old male is found unresponsive with pinpoint pupils and respiratory rate of 6.
What is the first-line treatment?
Society for Academic Emergency Medicine M4 Clerkship Final Exam with
Complete Questions & Verified Answers | Emergency Medicine Standards
Overview
This 2025/2026 updated resource contains the actual Society for Academic Emergency Medicine
(SAEM) M4 Medical Student Clerkship Final Exam with the exact 110 questions and verified
answers, following current SAEM curriculum guidelines, EM Model standards, and NBME
emergency medicine subject exam content.
Key Features
• Actual SAEM M4 final exam format with the official 110 questions
• Complete coverage of emergency medicine core content and clinical decision-making
• Alignment with EM Model 3.0 and ACGME emergency medicine milestones
• Updated 2025/2026 SAEM curriculum revisions and evidence-based guidelines
• Clinical vignettes with imaging, EKGs, and lab result interpretation
Core Content Areas (110 Total Questions)
• Cardiovascular & Respiratory Emergencies (25 Qs)
• Trauma & Surgical Emergencies (20 Qs)
• Neurological & Psychiatric Emergencies (18 Qs)
• Toxicological & Environmental Emergencies (15 Qs)
• Pediatric & Obstetric/Gynecologic Emergencies (12 Qs)
• Procedural Skills & Resuscitation (10 Qs)
• EMS & Disaster Medicine Principles (10 Qs)
Answer Format
Correct answers are marked in bold green and include:
• Evidence-based guideline citations (ACEP, AHA, CDC)
• Clinical decision rules (Canadian C-Spine, NEXUS, PERC, etc.)
• Critical action sequences for time-sensitive conditions
• Diagnostic test interpretation with sensitivity/specificity data
• Pharmacologic management with dosing and contraindications
Updates for 2025/2026
• Reflects 2025 SAEM M4 curriculum updates
• Incorporates 2025 ACLS, ATLS, and PALS guideline changes
• Updated sepsis-3 criteria and management protocols
• New opioid overdose reversal protocols including naloxone administration
, • Enhanced ultrasound applications in emergency diagnosis
• Revised concussion and mild TBI management guidelines
• Updated infectious disease protocols including emerging pathogens
• New health equity and social determinants of health assessment tools
Question 1
A 62-year-old male presents with acute onset chest pain radiating to his left arm,
diaphoresis, and nausea. ECG shows 2-mm ST elevation in leads II, III, and aVF. What is the
most appropriate immediate intervention?
A. Administer sublingual nitroglycerin
B. Give aspirin 325 mg and morphine
C. Activate the cardiac catheterization lab for primary PCI
D. Start intravenous beta-blocker therapy
Rationale: This patient has an inferior ST-elevation myocardial infarction (STEMI). Per 2025
AHA/ACC guidelines, primary percutaneous coronary intervention (PCI) is the preferred reperfusion
strategy if it can be performed within 90 minutes of first medical contact. Immediate activation of the
cath lab is critical. Nitroglycerin and morphine are adjunctive; beta-blockers are not first-line in
acute STEMI without specific indications.
Question 2
A 28-year-old male is brought in after a high-speed motor vehicle collision. He is
hypotensive (BP 80/50), tachycardic (HR 130), and has distended neck veins. FAST exam
shows pericardial fluid. What is the next step?
A. Administer 2 L IV crystalloid
B. Perform bilateral thoracostomy
C. Perform pericardiocentesis
D. Obtain CT angiography of the chest
Rationale: This patient has signs of cardiac tamponade (Beck’s triad: hypotension, JVD, muffled
heart sounds) confirmed by FAST. Pericardiocentesis is a temporizing life-saving procedure in the
setting of hemodynamic instability. IV fluids may be given concurrently, but definitive drainage is
required. CT is contraindicated in unstable trauma patients.
Question 3
A 45-year-old woman presents with sudden-onset severe headache, photophobia, and neck
stiffness. Non-contrast head CT is normal. What is the next best step?
A. Discharge with analgesics
B. Start empiric antibiotics and admit
C. Perform lumbar puncture
D. Order MRI brain with contrast
Rationale: This patient has symptoms concerning for subarachnoid hemorrhage (SAH). A normal
non-contrast head CT within 6 hours of headache onset has a sensitivity of >99% for SAH, but if
clinical suspicion remains high, lumbar puncture is indicated to assess for xanthochromia or elevated
RBCs that do not clear. ACEP 2025 guidelines recommend LP if CT is negative and symptoms are
classic.
Question 4
A 30-year-old male is found unresponsive with pinpoint pupils and respiratory rate of 6.
What is the first-line treatment?
