1|Page
SAEM EXAM QUESTIONS 2026-2027 ACTUAL EXAM
1500 REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS)
Which is not part of the Ottawa ankle rules?
A. inability to walk 4 steps at the time of the injury
B. inability to walk 4 steps in the emergency department
C. tenderness over the lateral malleolus
D. tenderness over the medial malleolus
E. tenderness over the talus
"E. tenderness over the talus
The correct answer is E. The Ottawa ankle rules are a validated (for
adults) set of physical exam findings to determine if an ankle X-ray is
needed after an injury. If any of the first 4 answers is present or if there
is tenderness over the navicular or base of the 5th metatarsal, an X-ray
should be obtained. If the correct answer to all questions is no, then an
X-ray is not needed."
,2|Page
Following a motor vehicle collision, in which of the following patients is
an emergency department Caesarian section most likely indicated,
assuming a fetus at 29-weeks gestation?
A. Mother with gunshot wound to abdomen, blood pressure 96/42;
fetal heart tones undetectable
B. Mother with severe head trauma, blood pressure 170/90; fetal heart
tones 120 beats per minute
C. Mother with abdominal pain, blood pressure of 80/40; fetal heart
tones 100 beats per minute
D. Mother with vaginal bleeding, blood pressure 118/78; fetal heart
tones 80 beats per minute
E. Mother pulseless and apneic for 2 minutes' duration and still in
arrest; fetal heart tones of 100 beats per minute
"E. Mother pulseless and apneic for 2 minutes' duration and still in
arrest; fetal heart tones of 100 beats per minute
The answer is E. Though emergency C-section after maternal death is a
rarely indicated procedure, rapid intervention (within minutes) of
maternal demise has resulted in viable births."
Which of the following is an accurate statement?
,3|Page
A. Bedside ultrasound is the test of choice for diagnosing solid organ
injury.
B. Diagnostic peritoneal lavage usually cannot identify the presence of
hemoperitoneum.
C. Bedside ultrasound can image the retroperitoneum.
D. Bedside ultrasound can reliably determine the etiology of
hemoperitoneum.
E. Diagnostic peritoneal lavage cannot determine the etiology of
hemoperitoneum.
E. Diagnostic peritoneal lavage cannot determine the etiology of
hemoperitoneum.
Diagnostic peritoneal lavage is extremely sensitive for the detection of
hemoperitoneum and can lead to many negative laparotomies.
Neither bedside ultrasound nor diagnostic peritoneal lavage can identify
the source of the hemorrhage though. A trauma ultrasound at the
bedside can only identify fluid in the peritoneal cavity, and CT scan is
the test of choice for diagnosing solid organ injury.
A 36 year old man is a restrained driver involved in a high speed MVA
where his car is struck on the driver's side door with significant
intrusion. His physical exam is significant for a large contusion on his left
flank. His abdominal exam is benign and rectal exam reveals a normal
prostate. A Foley catheter is placed with return of gross hematuria.
Which test is indicated to evaluate for the presence of urologic injury?
, 4|Page
A. CT abdomen / pelvis with IV and transurethral contrast
B. Ultrasound of the bladder
C. CT abdomen / pelvis without contrast
D. Ultrasound of the kidneys
E. CT abdomen / pelvis with IV contrast alone
A. CT abdomen / pelvis with IV and transurethral contrast
A 22 year old running back is struck from behind by a 300-pound
lineman. The blow occurs below the knee as his foot is firmly planted
and two other linemen are holding his upper body. He presents to the
emergency department with gross anterior dislocation of the tibia on
the femur. His foot is cool and pale, and dorsalis pedis and posterior
tibial pulses are not detected by Doppler ultrasound. What is the most
appropriate management for this patient?
A. Open reduction in OR with exploration of popliteal artery
B. Immediate reduction in emergency department under conscious
sedation without X-rays
C. Immediate orthopedic consultation without attempts to manipulate
the knee
D. Immediate arteriography to assess for popliteal artery disruption
"B. Immediate reduction in emergency department under conscious
sedation without X-rays
SAEM EXAM QUESTIONS 2026-2027 ACTUAL EXAM
1500 REAL EXAM QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES (VERIFIED
ANSWERS)
Which is not part of the Ottawa ankle rules?
A. inability to walk 4 steps at the time of the injury
B. inability to walk 4 steps in the emergency department
C. tenderness over the lateral malleolus
D. tenderness over the medial malleolus
E. tenderness over the talus
"E. tenderness over the talus
The correct answer is E. The Ottawa ankle rules are a validated (for
adults) set of physical exam findings to determine if an ankle X-ray is
needed after an injury. If any of the first 4 answers is present or if there
is tenderness over the navicular or base of the 5th metatarsal, an X-ray
should be obtained. If the correct answer to all questions is no, then an
X-ray is not needed."
,2|Page
Following a motor vehicle collision, in which of the following patients is
an emergency department Caesarian section most likely indicated,
assuming a fetus at 29-weeks gestation?
A. Mother with gunshot wound to abdomen, blood pressure 96/42;
fetal heart tones undetectable
B. Mother with severe head trauma, blood pressure 170/90; fetal heart
tones 120 beats per minute
C. Mother with abdominal pain, blood pressure of 80/40; fetal heart
tones 100 beats per minute
D. Mother with vaginal bleeding, blood pressure 118/78; fetal heart
tones 80 beats per minute
E. Mother pulseless and apneic for 2 minutes' duration and still in
arrest; fetal heart tones of 100 beats per minute
"E. Mother pulseless and apneic for 2 minutes' duration and still in
arrest; fetal heart tones of 100 beats per minute
The answer is E. Though emergency C-section after maternal death is a
rarely indicated procedure, rapid intervention (within minutes) of
maternal demise has resulted in viable births."
Which of the following is an accurate statement?
,3|Page
A. Bedside ultrasound is the test of choice for diagnosing solid organ
injury.
B. Diagnostic peritoneal lavage usually cannot identify the presence of
hemoperitoneum.
C. Bedside ultrasound can image the retroperitoneum.
D. Bedside ultrasound can reliably determine the etiology of
hemoperitoneum.
E. Diagnostic peritoneal lavage cannot determine the etiology of
hemoperitoneum.
E. Diagnostic peritoneal lavage cannot determine the etiology of
hemoperitoneum.
Diagnostic peritoneal lavage is extremely sensitive for the detection of
hemoperitoneum and can lead to many negative laparotomies.
Neither bedside ultrasound nor diagnostic peritoneal lavage can identify
the source of the hemorrhage though. A trauma ultrasound at the
bedside can only identify fluid in the peritoneal cavity, and CT scan is
the test of choice for diagnosing solid organ injury.
A 36 year old man is a restrained driver involved in a high speed MVA
where his car is struck on the driver's side door with significant
intrusion. His physical exam is significant for a large contusion on his left
flank. His abdominal exam is benign and rectal exam reveals a normal
prostate. A Foley catheter is placed with return of gross hematuria.
Which test is indicated to evaluate for the presence of urologic injury?
, 4|Page
A. CT abdomen / pelvis with IV and transurethral contrast
B. Ultrasound of the bladder
C. CT abdomen / pelvis without contrast
D. Ultrasound of the kidneys
E. CT abdomen / pelvis with IV contrast alone
A. CT abdomen / pelvis with IV and transurethral contrast
A 22 year old running back is struck from behind by a 300-pound
lineman. The blow occurs below the knee as his foot is firmly planted
and two other linemen are holding his upper body. He presents to the
emergency department with gross anterior dislocation of the tibia on
the femur. His foot is cool and pale, and dorsalis pedis and posterior
tibial pulses are not detected by Doppler ultrasound. What is the most
appropriate management for this patient?
A. Open reduction in OR with exploration of popliteal artery
B. Immediate reduction in emergency department under conscious
sedation without X-rays
C. Immediate orthopedic consultation without attempts to manipulate
the knee
D. Immediate arteriography to assess for popliteal artery disruption
"B. Immediate reduction in emergency department under conscious
sedation without X-rays
