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SAEM EXAM QUESTIONS 2026-2027 ACTUAL EXAM 2000
REAL EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS) ,
SAEM Practice 2026, Edited SAEM Exam Set
"Which coronary vessel is usually the cause of the myocardial infarction
in a patient with ST elevation in V1, V2, and V3?
A. left anterior descending (LAD)
B. left circumflex artery
C. posterior descending branch of the right coronary artery
D. right coronary artery (RCA)
E. right ventricular branch of the right coronary artery"
"A. left anterior descending (LAD)
The answer is A. This EKG pattern is consistent with that of anterior
wall myocardial infarction (MI). The LAD supplies the anterior wall of
the myocardium. The left circumflex artery, the LAD, or a branch of the
RCA supplies the lateral wall of the left ventricle. Proximal occlusion of
the LAD will give ST elevation in leads V1-6, aVL and I (an anterolateral
MI). Occlusion of a branch of the RCA will result in an inferolateral MI
(ST elevation in leads II, III, aVF and I, aVL, V5 and V6). The RCA
supplies the inferior wall and SA node. Occlusion in leads II, III and aVF
causes an inferior MI. The right ventricle is usually supplied by the
RCA or, less commonly, a dominant left circumflex. ST elevation in
leads V4 and V5 of a right-side leads EKG suggests infarction of the
right ventricle. A posterior MI (ST depression in V1-V3) results from
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occlusion of the RCA, its posterior descending branch, or a dominant
left circumflex."
"A 51-year-old male with long-standing hypertension presents with
abrupt onset of severe chest pain radiating to the back. He describes a
tearing sensation. Vital signs are HR 110, BP 175/105, RR 20, T 37.4. EKG
shows LVH. CBC, electrolytes, BUN/Creatinine are all normal. CXR is as
shown below. What diagnostic test would be most appropriate for
making a definitive diagnosis at this time?
[image shows CXR w/ wide mediastinum]
A. MRI of the thoracic spine
B. Aortogram
C. CT of the chest with IV contrast
D. Esophagram using Gastrograffin"
"C. CT of the chest with IV contrast
"CT of the chest is the test most often used to confirm the diagnosis of
aortic dissection. CT is readily available in most Emergency
Departments, and has a sensitivity of 83-98% and specificity of 87-
100% for aortic dissection (highest accuracy with helical scans). Other
benefits associated with the use of CT include the ability to identify
intramural thrombus, pericardial effusion, and potentially reveal
another etiology for the patient's pain. The major disadvantage of CT
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is the need for iodinated contrast, which requires normal renal
function.""
"A 60 year old male presented to the emergency department with chest
pain. He subsequently became unresponsive. The monitor shows the
rhythm below. The rhythm is:
[image monomorphic wide QRS tachycardia with no p waves]
A. sinus tachycardia
B. ventricular tachycardia
C. atrial fibrillation with rapid ventricular response
D. atrial flutter"
"B. ventricular tachycardia
The answer is B. Ventricular tachycardia is wide and complex. It is
distinguished from supraventricular tachycardia by width and
morphology of the QRS complexes. (Though there are numerous
exceptions, supraventricular tachycardias usually exhibit narrow QRS
complexes with morphology similar to that when the patient is in
sinus rhythm.)"
"A 64 year old female presents to the emergency department with chief
complaints of occipital headache and chest pain. Physical examination
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reveals a blood pressure of 200/118 as well as edema of the optic disk.
Of the diagnoses below, the most likely is:
A. hypertensive crisis
B. acute hypertensive (non-emergency/non-urgency) episode
C. hypertensive urgency
D. moderate hypertension
E. white-coat hypertension"
"A. hypertensive crisis
The answer is A. Elevated blood pressure in the setting of optic disk
edema is a hallmark of malignant hypertension (also known as
hypertensive emergency or hypertensive crisis). While hypertensive
urgency is not consistently defined in the medical literature, this
patient's presentation indicates that there is some end-organ damage
and thus the diagnosis is malignant hypertension. The white-coat""
syndrome, in which patients' blood pressures are elevated only in the
clinical setting and not at home, has been shown to account for as
many as a fifth of all cases of newly diagnosed ""hypertension.""
Understanding of this phenomenom is important for emergency
physicians, since its frequency explains why patients should not be
given a diagnosis of new-onset hypertension based on E.D.
measurements."""
"A 14 year old presents just after smoking crack cocaine and complains
of chest pain. He describes it as sharp and stabbing in the middle of his
SAEM EXAM QUESTIONS 2026-2027 ACTUAL EXAM 2000
REAL EXAM QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (VERIFIED ANSWERS) ,
SAEM Practice 2026, Edited SAEM Exam Set
"Which coronary vessel is usually the cause of the myocardial infarction
in a patient with ST elevation in V1, V2, and V3?
A. left anterior descending (LAD)
B. left circumflex artery
C. posterior descending branch of the right coronary artery
D. right coronary artery (RCA)
E. right ventricular branch of the right coronary artery"
"A. left anterior descending (LAD)
The answer is A. This EKG pattern is consistent with that of anterior
wall myocardial infarction (MI). The LAD supplies the anterior wall of
the myocardium. The left circumflex artery, the LAD, or a branch of the
RCA supplies the lateral wall of the left ventricle. Proximal occlusion of
the LAD will give ST elevation in leads V1-6, aVL and I (an anterolateral
MI). Occlusion of a branch of the RCA will result in an inferolateral MI
(ST elevation in leads II, III, aVF and I, aVL, V5 and V6). The RCA
supplies the inferior wall and SA node. Occlusion in leads II, III and aVF
causes an inferior MI. The right ventricle is usually supplied by the
RCA or, less commonly, a dominant left circumflex. ST elevation in
leads V4 and V5 of a right-side leads EKG suggests infarction of the
right ventricle. A posterior MI (ST depression in V1-V3) results from
,2|Page
occlusion of the RCA, its posterior descending branch, or a dominant
left circumflex."
"A 51-year-old male with long-standing hypertension presents with
abrupt onset of severe chest pain radiating to the back. He describes a
tearing sensation. Vital signs are HR 110, BP 175/105, RR 20, T 37.4. EKG
shows LVH. CBC, electrolytes, BUN/Creatinine are all normal. CXR is as
shown below. What diagnostic test would be most appropriate for
making a definitive diagnosis at this time?
[image shows CXR w/ wide mediastinum]
A. MRI of the thoracic spine
B. Aortogram
C. CT of the chest with IV contrast
D. Esophagram using Gastrograffin"
"C. CT of the chest with IV contrast
"CT of the chest is the test most often used to confirm the diagnosis of
aortic dissection. CT is readily available in most Emergency
Departments, and has a sensitivity of 83-98% and specificity of 87-
100% for aortic dissection (highest accuracy with helical scans). Other
benefits associated with the use of CT include the ability to identify
intramural thrombus, pericardial effusion, and potentially reveal
another etiology for the patient's pain. The major disadvantage of CT
,3|Page
is the need for iodinated contrast, which requires normal renal
function.""
"A 60 year old male presented to the emergency department with chest
pain. He subsequently became unresponsive. The monitor shows the
rhythm below. The rhythm is:
[image monomorphic wide QRS tachycardia with no p waves]
A. sinus tachycardia
B. ventricular tachycardia
C. atrial fibrillation with rapid ventricular response
D. atrial flutter"
"B. ventricular tachycardia
The answer is B. Ventricular tachycardia is wide and complex. It is
distinguished from supraventricular tachycardia by width and
morphology of the QRS complexes. (Though there are numerous
exceptions, supraventricular tachycardias usually exhibit narrow QRS
complexes with morphology similar to that when the patient is in
sinus rhythm.)"
"A 64 year old female presents to the emergency department with chief
complaints of occipital headache and chest pain. Physical examination
, 4|Page
reveals a blood pressure of 200/118 as well as edema of the optic disk.
Of the diagnoses below, the most likely is:
A. hypertensive crisis
B. acute hypertensive (non-emergency/non-urgency) episode
C. hypertensive urgency
D. moderate hypertension
E. white-coat hypertension"
"A. hypertensive crisis
The answer is A. Elevated blood pressure in the setting of optic disk
edema is a hallmark of malignant hypertension (also known as
hypertensive emergency or hypertensive crisis). While hypertensive
urgency is not consistently defined in the medical literature, this
patient's presentation indicates that there is some end-organ damage
and thus the diagnosis is malignant hypertension. The white-coat""
syndrome, in which patients' blood pressures are elevated only in the
clinical setting and not at home, has been shown to account for as
many as a fifth of all cases of newly diagnosed ""hypertension.""
Understanding of this phenomenom is important for emergency
physicians, since its frequency explains why patients should not be
given a diagnosis of new-onset hypertension based on E.D.
measurements."""
"A 14 year old presents just after smoking crack cocaine and complains
of chest pain. He describes it as sharp and stabbing in the middle of his
