SAEM M4 Final Exam 2025/2026 | Society for
Academic Emergency Medicine M4 Clerkship
Final Exam
Exam
This document provides comprehensive preparation for the Society for Academic
Emergency Medicine M4 Clerkship Final Examination, featuring complete questions with
verified answers for the 2025/2026 academic cycle. It covers emergency assessment,
trauma management, medical emergencies, procedural skills, and clinical decision-
making according to current emergency medicine standards and SAEM curriculum
requirements. This essential tool offers authentic exam simulation and systematic
content review to ensure mastery of emergency medicine principles and success on your
SAEM clerkship assessment.
A 58-year-old male previously in good health presents with chest pain for
two hours. Vital signs are BP 126/78, HR 80 (sinus rhythm), RR 14, oxygen
saturation 99%, T 36.8. His EKG shows ST segment elevation in leads II, III,
aVF and V1. ST-segment elevation is greater in lead III than in lead II. What
additional diagnostic test is indicated prior to giving nitroglycerin?
Answers:
1.CXR
2.d-dimer
3.Echocardiogram
4.EKG with right-sided leads - ,,,answer,,,..4.EKG with right-sided leads
,A patient with nontraumatic chest pain is administered nitroglycerin in the
field and has subsequent drop in blood pressure. An EKG reveals ST-
segment elevation in lead V4R. What is the diagnosis?
Answers:
1.anteroseptal MI
2.pericarditis
3.pulmonary embolism
4.unstable angina
5.right-ventricular MI - ,,,answer,,,..5.right-ventricular MI
A 71-year-old male presents after a syncopal episode. He reports 12
hours of recurrent substernal chest pressure. A report from the patient's
primary care physician's office states that an EKG performed four days
ago was completely normal. Repeat EKG in the ED reveals no ST-segment
elevation, but you do note a right bundle-branch block, and a left anterior
fascicle block. Troponin I is elevated above normal at 1.6. What
intervention would be indicated to provide definitive management for the
findings seen on EKG in this patient?
Answers:
1.Continuous cardiac monitoring for 24-48 hours
2.Emergent revascularization with thrombolytics or percutaneous
coronary intervention (PCI)
3.Radiofrequency ablation
4.Urgent placement of a cardiac pacemaker - ,,,answer,,,..4.Urgent
placement of a cardiac pacemaker
Which coronary vessel is usually the cause of the myocardial infarction in
a patient with ST elevation in V1, V2, and V3?
Answers:
1.left anterior descending (LAD)
,2.left circumflex artery
3.posterior descending branch of the right coronary artery
4.right coronary artery (RCA)
5.right ventricular branch of the right coronary artery - ,,,answer,,,..1.left
anterior descending (LAD)
A 65-year-old female presents 2 weeks after an MI complaining of chest
pain, fever, and shortness of breath. She has a new friction rub on exam
and a leukocytosis. She most likely has:
Answers:
1.congestive heart failure
2.Dressler's syndrome
3.new myocardial infarction
4.pneumonia
5.pulmonary embolism - ,,,answer,,,..2.Dressler's syndrome
A 25 year old man returns to the ED, 24 hours after being released from
the hospital with a new diagnosis of schizophrenia. He has recently
started to take haloperidal for his psychotic symptoms. In the ED he is
noted to have involuntary contractions of the muscles of the face, a
protruding tongue, deviation of the head to one side, and sustained
upward deviation of the eyes. Vital signs are stable, and initial labs show
no electrolyte or hematological abnormalities. Of the following choices,
the preferred medication for this condition is:
Answers:
1.diphenhydramine
2.lorazepam
3.phenobarbital
4.metoprolol - ,,,answer,,,..2.lorazepam
, A 55 year-old male presents with new onset agitation and confusion.
Which of the following medical histories would suggest a psychiatric (non-
organic) cause?
Answers:
1.History of diabetes mellitus only
2.History of alcohol abuse only
3.History of hypothyroidism only
4.History of chronic obstructive pulmonary disease only -
,,,answer,,,..3.History of hypothyroidism only
A 53 year-old known alcoholic presents with agitation, vomiting and
altered mental status. His fingerstick glucose is 148. His serum ethanol
level is undetectable and his head CT is normal. An ABG shows a pH of
7.21, pCO2 of 34, pO2 of 98 on room air. His basic chemistry panel
includes a sodium of 136, potassium 4.1, chloride 108, bicarbonate 14,
BUN 12, creatinine 1.1. What substance are you concerned that he may
have ingested
Answers:
1.Ethylene glycol
2.Salicylates
3.Isopropyl alcohol
4.Methanol - ,,,answer,,,..3.Isopropyl alcohol
True or False: gastric distension due to excessive volume or rate of
ventilation impairing ventilatory function is a reason to intubate a neonate
- ,,,answer,,,..False
Academic Emergency Medicine M4 Clerkship
Final Exam
Exam
This document provides comprehensive preparation for the Society for Academic
Emergency Medicine M4 Clerkship Final Examination, featuring complete questions with
verified answers for the 2025/2026 academic cycle. It covers emergency assessment,
trauma management, medical emergencies, procedural skills, and clinical decision-
making according to current emergency medicine standards and SAEM curriculum
requirements. This essential tool offers authentic exam simulation and systematic
content review to ensure mastery of emergency medicine principles and success on your
SAEM clerkship assessment.
A 58-year-old male previously in good health presents with chest pain for
two hours. Vital signs are BP 126/78, HR 80 (sinus rhythm), RR 14, oxygen
saturation 99%, T 36.8. His EKG shows ST segment elevation in leads II, III,
aVF and V1. ST-segment elevation is greater in lead III than in lead II. What
additional diagnostic test is indicated prior to giving nitroglycerin?
Answers:
1.CXR
2.d-dimer
3.Echocardiogram
4.EKG with right-sided leads - ,,,answer,,,..4.EKG with right-sided leads
,A patient with nontraumatic chest pain is administered nitroglycerin in the
field and has subsequent drop in blood pressure. An EKG reveals ST-
segment elevation in lead V4R. What is the diagnosis?
Answers:
1.anteroseptal MI
2.pericarditis
3.pulmonary embolism
4.unstable angina
5.right-ventricular MI - ,,,answer,,,..5.right-ventricular MI
A 71-year-old male presents after a syncopal episode. He reports 12
hours of recurrent substernal chest pressure. A report from the patient's
primary care physician's office states that an EKG performed four days
ago was completely normal. Repeat EKG in the ED reveals no ST-segment
elevation, but you do note a right bundle-branch block, and a left anterior
fascicle block. Troponin I is elevated above normal at 1.6. What
intervention would be indicated to provide definitive management for the
findings seen on EKG in this patient?
Answers:
1.Continuous cardiac monitoring for 24-48 hours
2.Emergent revascularization with thrombolytics or percutaneous
coronary intervention (PCI)
3.Radiofrequency ablation
4.Urgent placement of a cardiac pacemaker - ,,,answer,,,..4.Urgent
placement of a cardiac pacemaker
Which coronary vessel is usually the cause of the myocardial infarction in
a patient with ST elevation in V1, V2, and V3?
Answers:
1.left anterior descending (LAD)
,2.left circumflex artery
3.posterior descending branch of the right coronary artery
4.right coronary artery (RCA)
5.right ventricular branch of the right coronary artery - ,,,answer,,,..1.left
anterior descending (LAD)
A 65-year-old female presents 2 weeks after an MI complaining of chest
pain, fever, and shortness of breath. She has a new friction rub on exam
and a leukocytosis. She most likely has:
Answers:
1.congestive heart failure
2.Dressler's syndrome
3.new myocardial infarction
4.pneumonia
5.pulmonary embolism - ,,,answer,,,..2.Dressler's syndrome
A 25 year old man returns to the ED, 24 hours after being released from
the hospital with a new diagnosis of schizophrenia. He has recently
started to take haloperidal for his psychotic symptoms. In the ED he is
noted to have involuntary contractions of the muscles of the face, a
protruding tongue, deviation of the head to one side, and sustained
upward deviation of the eyes. Vital signs are stable, and initial labs show
no electrolyte or hematological abnormalities. Of the following choices,
the preferred medication for this condition is:
Answers:
1.diphenhydramine
2.lorazepam
3.phenobarbital
4.metoprolol - ,,,answer,,,..2.lorazepam
, A 55 year-old male presents with new onset agitation and confusion.
Which of the following medical histories would suggest a psychiatric (non-
organic) cause?
Answers:
1.History of diabetes mellitus only
2.History of alcohol abuse only
3.History of hypothyroidism only
4.History of chronic obstructive pulmonary disease only -
,,,answer,,,..3.History of hypothyroidism only
A 53 year-old known alcoholic presents with agitation, vomiting and
altered mental status. His fingerstick glucose is 148. His serum ethanol
level is undetectable and his head CT is normal. An ABG shows a pH of
7.21, pCO2 of 34, pO2 of 98 on room air. His basic chemistry panel
includes a sodium of 136, potassium 4.1, chloride 108, bicarbonate 14,
BUN 12, creatinine 1.1. What substance are you concerned that he may
have ingested
Answers:
1.Ethylene glycol
2.Salicylates
3.Isopropyl alcohol
4.Methanol - ,,,answer,,,..3.Isopropyl alcohol
True or False: gastric distension due to excessive volume or rate of
ventilation impairing ventilatory function is a reason to intubate a neonate
- ,,,answer,,,..False
