SAEM M4 LATEST 2026 TEST PAPER QUESTIONS AND
ANSWERS GRADED A+
✔✔A 23 year old woman is dropped off by her boyfriend after an unknown overdose.
You notice that she is has very large pupils and is sweating profusely. Her respiratory
rate, blood pressure and heart rate are elevated. Which of the following is the most
likely agent to have caused her symptoms?
Answers:
1.Jimson weed
2.Cocaine
3.Heroin
4.Insulin - ✔✔2. cocaine
✔✔A mother brings in her 4 year old child who was happily eating "blackberries" from
weeds in the garden and is now acting strangely. She has identified them as Belladonna
from a quick internet search. Which physical examination finding might you also expect
to find in this child?
Answers:
1.Diaphoresis
2.Flushed skin
3.Miosis
4.Urinary incontinence - ✔✔2. flushed skin
✔✔For which of the following cases is activated charcoal therapy most appropriate?
Answers:
1.Acetaminophen overdose
2.Drain cleaner ingestion
3.Iron supplement overdose
4.Lithium overdose - ✔✔1. Acetaminophen overdose
✔✔A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the
best treatment method for this overdose?
Answers:
1.Activated charcoal
2.Gastric lavage
3.Hemodialysis
4.Whole bowel irrigation - ✔✔3.Hemodialysis
✔✔A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her
family indicates she has been taking for years to help with her anxiety. The bottle
indicates that the prescription was filled yesterday with 90 pills and is now empty. The
,patient is minimally responsive to painful stimuli and does not react when you suction
secretions out of her posterior pharynx. What is your next management step?
Answers:
1.Administration of flumazenil
2.Administration of narcan
3.Close observation
4.Intubation for airway support - ✔✔4.Intubation for airway support
✔✔A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3
hours prior to presentation in the ED. Which of the following arterial blood gas results
would you expect to come from this patient?
Answers:
1.pH 7.14 pCO2 68 pO2 102 HCO3 23
2.pH 7.33 pCO2 48 pO2 58 HCO3 29
3.pH 7.45 pCO2 21 pO2 124 HCO3 14
4.pH 7.47 pCO2 31 pO2 96 HCO3 25 - ✔✔3.pH 7.45 pCO2 21 pO2 124 HCO3 14
✔✔A teenager presents one hour after ingesting a "handful" of acetaminophen tablets.
Which of the following statements is TRUE?
Answers:
1.An acetaminophen level drawn at hour four dictates need for antidotal therapy.
2.Serial liver function tests are indicated in all acetaminophen ingestions.
3.Renal sequelae are expected.
4.The intravenous formulation of N-acetylcysteine is safer than oral N-acetylcysteine. -
✔✔1.An acetaminophen level drawn at hour four dictates need for antidotal therapy.
✔✔A 2 year old child presents with an overdose of her mother's iron containing
multivitamins. What antidote should you consider for iron toxicity?
Answers:
1.Deferoxamine
2.Glucagon
3.Methylene blue
4.Pyridoxine - ✔✔1.Deferoxamine
✔✔Severe lead toxicity can commonly result in which of the following clinical symptoms
Answers:
1.Constipation
2.Dermatitis
3.Memory loss
4.Stocking glove peripheral neuropathy - ✔✔3.Memory loss
, ✔✔A 27 year old woman is brought into the emergency department by her roommate
30 minutes after ingesting a bottle of aspirin in a suicide attempt. Which of the following
acid-base disorders is most likely to be present in this patient?
Answers:
1.Respiratory acidosis due to somnolence causing decreased respiratory drive
2.Respiratory alkalosis due to stimulation of the respiratory center and increased CO2
production
3.Primary respiratory acidosis with compensatory metabolic alkalosis
4.Primary metabolic acidosis with compensatory respiratory alkalosis - ✔✔2.Respiratory
alkalosis due to stimulation of the respiratory center and increased CO2 production
✔✔The most common cause of intrinsic lower gastrointestinal (GI) bleeding in an adult
is:
Answers:
1.Cancer
2.Diverticulosis
3.Inflammatory bowel disease
4.Polyps - ✔✔2.Diverticulosis
✔✔Which of the following bacteria does NOT produce bloody diarrhea?
Answers:
1.Campylobacter enteritis
2.Clostridium perfringens
3.Escherichia coli 0157
4.Yersinia enterocolitica - ✔✔2.Clostridium perfringens
✔✔With respect to laboratory findings in diabetic ketoacidosis (DKA) and hyperglycemic
hyperosmolar nonketotic coma (HHNC), all of the following guidelines are generally true
EXCEPT:
Answers:
1.Patients with HHNC typically have blood glucose > 700 mg/dL, whereas patients with
DKA have blood glucose > 350 mg/dL.
2.Serum ketones are present in patients with DKA but not usually in patients with
HHNC.
3.Serum bicarbonate is typically severely low (<10mEq) in patients with either DKA or
HHNC.
4.Serum osmolality in patients with HHNC is typically > 350 mOsm/L.
5.BUN is elevated more in patients with HHNC (>50 mg/dL) than in patients with DKA
(25-50 mg/dL). - ✔✔3.Serum bicarbonate is typically severely low (<10mEq) in patients
with either DKA or HHNC.
ANSWERS GRADED A+
✔✔A 23 year old woman is dropped off by her boyfriend after an unknown overdose.
You notice that she is has very large pupils and is sweating profusely. Her respiratory
rate, blood pressure and heart rate are elevated. Which of the following is the most
likely agent to have caused her symptoms?
Answers:
1.Jimson weed
2.Cocaine
3.Heroin
4.Insulin - ✔✔2. cocaine
✔✔A mother brings in her 4 year old child who was happily eating "blackberries" from
weeds in the garden and is now acting strangely. She has identified them as Belladonna
from a quick internet search. Which physical examination finding might you also expect
to find in this child?
Answers:
1.Diaphoresis
2.Flushed skin
3.Miosis
4.Urinary incontinence - ✔✔2. flushed skin
✔✔For which of the following cases is activated charcoal therapy most appropriate?
Answers:
1.Acetaminophen overdose
2.Drain cleaner ingestion
3.Iron supplement overdose
4.Lithium overdose - ✔✔1. Acetaminophen overdose
✔✔A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the
best treatment method for this overdose?
Answers:
1.Activated charcoal
2.Gastric lavage
3.Hemodialysis
4.Whole bowel irrigation - ✔✔3.Hemodialysis
✔✔A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her
family indicates she has been taking for years to help with her anxiety. The bottle
indicates that the prescription was filled yesterday with 90 pills and is now empty. The
,patient is minimally responsive to painful stimuli and does not react when you suction
secretions out of her posterior pharynx. What is your next management step?
Answers:
1.Administration of flumazenil
2.Administration of narcan
3.Close observation
4.Intubation for airway support - ✔✔4.Intubation for airway support
✔✔A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3
hours prior to presentation in the ED. Which of the following arterial blood gas results
would you expect to come from this patient?
Answers:
1.pH 7.14 pCO2 68 pO2 102 HCO3 23
2.pH 7.33 pCO2 48 pO2 58 HCO3 29
3.pH 7.45 pCO2 21 pO2 124 HCO3 14
4.pH 7.47 pCO2 31 pO2 96 HCO3 25 - ✔✔3.pH 7.45 pCO2 21 pO2 124 HCO3 14
✔✔A teenager presents one hour after ingesting a "handful" of acetaminophen tablets.
Which of the following statements is TRUE?
Answers:
1.An acetaminophen level drawn at hour four dictates need for antidotal therapy.
2.Serial liver function tests are indicated in all acetaminophen ingestions.
3.Renal sequelae are expected.
4.The intravenous formulation of N-acetylcysteine is safer than oral N-acetylcysteine. -
✔✔1.An acetaminophen level drawn at hour four dictates need for antidotal therapy.
✔✔A 2 year old child presents with an overdose of her mother's iron containing
multivitamins. What antidote should you consider for iron toxicity?
Answers:
1.Deferoxamine
2.Glucagon
3.Methylene blue
4.Pyridoxine - ✔✔1.Deferoxamine
✔✔Severe lead toxicity can commonly result in which of the following clinical symptoms
Answers:
1.Constipation
2.Dermatitis
3.Memory loss
4.Stocking glove peripheral neuropathy - ✔✔3.Memory loss
, ✔✔A 27 year old woman is brought into the emergency department by her roommate
30 minutes after ingesting a bottle of aspirin in a suicide attempt. Which of the following
acid-base disorders is most likely to be present in this patient?
Answers:
1.Respiratory acidosis due to somnolence causing decreased respiratory drive
2.Respiratory alkalosis due to stimulation of the respiratory center and increased CO2
production
3.Primary respiratory acidosis with compensatory metabolic alkalosis
4.Primary metabolic acidosis with compensatory respiratory alkalosis - ✔✔2.Respiratory
alkalosis due to stimulation of the respiratory center and increased CO2 production
✔✔The most common cause of intrinsic lower gastrointestinal (GI) bleeding in an adult
is:
Answers:
1.Cancer
2.Diverticulosis
3.Inflammatory bowel disease
4.Polyps - ✔✔2.Diverticulosis
✔✔Which of the following bacteria does NOT produce bloody diarrhea?
Answers:
1.Campylobacter enteritis
2.Clostridium perfringens
3.Escherichia coli 0157
4.Yersinia enterocolitica - ✔✔2.Clostridium perfringens
✔✔With respect to laboratory findings in diabetic ketoacidosis (DKA) and hyperglycemic
hyperosmolar nonketotic coma (HHNC), all of the following guidelines are generally true
EXCEPT:
Answers:
1.Patients with HHNC typically have blood glucose > 700 mg/dL, whereas patients with
DKA have blood glucose > 350 mg/dL.
2.Serum ketones are present in patients with DKA but not usually in patients with
HHNC.
3.Serum bicarbonate is typically severely low (<10mEq) in patients with either DKA or
HHNC.
4.Serum osmolality in patients with HHNC is typically > 350 mOsm/L.
5.BUN is elevated more in patients with HHNC (>50 mg/dL) than in patients with DKA
(25-50 mg/dL). - ✔✔3.Serum bicarbonate is typically severely low (<10mEq) in patients
with either DKA or HHNC.
