SAEM M4 LATEST 2026 STUDY GUIDE QUESTIONS AND
ANSWERS GRADED A+
✔✔Which of the following is true regarding the use of iodine in the treatment of thyroid
storm?
Answers:
1.Iodine should be the first drug administered in the treatment of thyroid storm.
2.Iodine should be administered only after treatment with propranolol.
3.Iodine should be administered at least one hour after propylthiouracil (PTU) has been
given.
4.Dexamethasone must be given 30 minutes prior to iodine administration.
5.Iodine should be administered even in patients with known iodine allergy. -
✔✔3.Iodine should be administered at least one hour after propylthiouracil (PTU) has
been given.
✔✔A 4 year old girl is brought to the ED two hours after being stung by a scorpion while
on a camping trip in Arizona. She has periods of agitation and restlessness alternating
with calmness. Her vital signs are: blood pressure 106/61, pulse 120, respiratory rate
24, temperature 37.0C, and oxygen saturations of 99% on room air. On physical
examination you note drooling, a disconjugate gaze, and occasional jerking movements
of the extremities.Which of the following is the most correct regarding the treatment of a
scorpion sting in this child?
Answers:
1.Treatment with antivemon is not indicated becase these symptoms will be self-limiting.
2.Complications of treatment with antivenom include delayed serum sickness
3.Analgesics have a minimal role in controlling symptoms
4.The patient should be intubated because respiratory failure is expected -
✔✔2.Complications of treatment with antivenom include delayed serum sickness
✔✔A 24 year old female gardener presents to the emergency department with foot pain
30 minutes after working barefoot in her garden. She saw a scorpion in the area. Which
of the following signs or symptoms are most expected?
Answers:
1.Puncture mark
2.Local erythema and swelling
3.Pain and paresthesias
4.Cranial nerve abnormalities - ✔✔3.Pain and paresthesias
✔✔A 48 year old farmer is plowing his field when a thunderstorm rapidly overcomes
him. Drivers on a nearby highway see him struck by lightening. You respond to the
scene with EMS. What is the least likely finding on physical exam?
,Answers:
1.respiratory arrest
2.cardiac asystole
3.extensive skin burns
4.Glascow Coma Score of 3 - ✔✔3.extensive skin burns
✔✔Which of the following anti-hypertensive medications is associated with a lupus-like
syndrome?
Answers:
1. hydralazine
2. labetalol
3. nicardipine
4. nitroglycerin
5. nitroprusside - ✔✔1. hydralazine
✔✔You need to treat an adult with no past medical history, who presents with a
hypertensive emergency. You have access to all of the following agents. Which of the
following is the preferred agent and initial dose?
Answers:
1. clonidine PO 0.1 mg
2. esmolol IV 100-500 mic/kg load
3. hydralazine IM 0.1-0.2 mg/kg
4. labetolol PO 0.2-1.0 mg/kg bolus
5. metoprolol PO 10 mg - ✔✔2. esmolol IV 100-500 mic/kg load
✔✔A 24 year old woman is playing racquetball and sustains a direct blow from the ball
to the right eye. She presents to the emergency department complaining of eye pain
and double vision. On exam, her right eye does not track properly with upward gaze.
This finding suggests which of the following injuries?
Select all that apply
1.Inferior orbital rim fracture
2.Superior orbital rim fracture
3.Inferior orbital wall fracture
4.Ethmoid fracture
5.Zygomatic arch fracture - ✔✔3.Inferior orbital wall fracture
✔✔The most sensitive bedside test for nerve injury in a finger after trauma is:
Select all that apply
1.light touch
2.O'Riain wrinkle test
3.pain
, 4.temperature sensation
5.two-point discrimination - ✔✔5.two-point discrimination
✔✔In a patient with a suspected ruptured globe from penetrating trauma to the eye, all
of the following should be performed EXCEPT:
Answers:
1.administration of broad spectrum antibiotic therapy
2.ascertainment of intraocular pressure via tonometry
3.ascertainment of tetanus status
4.ophthalmology consultation
5.visual acuity assessment - ✔✔2.ascertainment of intraocular pressure via tonometry
✔✔Following a motor vehicle crash, a 25 year old man presents complaining of a
painful right eye. Visual acuity is 20/200 in the right eye and 20/25 in the left eye. The
right eye protrudes from the orbit and the patient has right eye pain with extraocular
movement. What is the most likely cause of his symptoms?
Answers:
1.chemosis
2.hyphema
3.orbital blow-out fracture
4.retrobulbar hematoma
5.ruptured globe - ✔✔4.retrobulbar hematoma
✔✔Following a brawl at a local bar, a gentleman presents with an impressive right-sided
periorbital ecchymosis. All of the following physical examination findings would suggest
an orbital blowout fracture EXCEPT:
Answers:
1.anesthesia of the right infraorbital region
2.diplopia with upward gaze
3.proptosis
4.right-sided epistaxis
5.right-sided infraorbital subcutaneous emphysema - ✔✔3.proptosis
✔✔Which of the following cervical spine fractures is considered stable?
Answers:
1.Flexion teardrop fracture
2.Bilateral facet dislocation
3.Transverse process fracture
4.Jefferson fracture of C1
5.Hangman's fracture of C2 - ✔✔3.Transverse process fracture
ANSWERS GRADED A+
✔✔Which of the following is true regarding the use of iodine in the treatment of thyroid
storm?
Answers:
1.Iodine should be the first drug administered in the treatment of thyroid storm.
2.Iodine should be administered only after treatment with propranolol.
3.Iodine should be administered at least one hour after propylthiouracil (PTU) has been
given.
4.Dexamethasone must be given 30 minutes prior to iodine administration.
5.Iodine should be administered even in patients with known iodine allergy. -
✔✔3.Iodine should be administered at least one hour after propylthiouracil (PTU) has
been given.
✔✔A 4 year old girl is brought to the ED two hours after being stung by a scorpion while
on a camping trip in Arizona. She has periods of agitation and restlessness alternating
with calmness. Her vital signs are: blood pressure 106/61, pulse 120, respiratory rate
24, temperature 37.0C, and oxygen saturations of 99% on room air. On physical
examination you note drooling, a disconjugate gaze, and occasional jerking movements
of the extremities.Which of the following is the most correct regarding the treatment of a
scorpion sting in this child?
Answers:
1.Treatment with antivemon is not indicated becase these symptoms will be self-limiting.
2.Complications of treatment with antivenom include delayed serum sickness
3.Analgesics have a minimal role in controlling symptoms
4.The patient should be intubated because respiratory failure is expected -
✔✔2.Complications of treatment with antivenom include delayed serum sickness
✔✔A 24 year old female gardener presents to the emergency department with foot pain
30 minutes after working barefoot in her garden. She saw a scorpion in the area. Which
of the following signs or symptoms are most expected?
Answers:
1.Puncture mark
2.Local erythema and swelling
3.Pain and paresthesias
4.Cranial nerve abnormalities - ✔✔3.Pain and paresthesias
✔✔A 48 year old farmer is plowing his field when a thunderstorm rapidly overcomes
him. Drivers on a nearby highway see him struck by lightening. You respond to the
scene with EMS. What is the least likely finding on physical exam?
,Answers:
1.respiratory arrest
2.cardiac asystole
3.extensive skin burns
4.Glascow Coma Score of 3 - ✔✔3.extensive skin burns
✔✔Which of the following anti-hypertensive medications is associated with a lupus-like
syndrome?
Answers:
1. hydralazine
2. labetalol
3. nicardipine
4. nitroglycerin
5. nitroprusside - ✔✔1. hydralazine
✔✔You need to treat an adult with no past medical history, who presents with a
hypertensive emergency. You have access to all of the following agents. Which of the
following is the preferred agent and initial dose?
Answers:
1. clonidine PO 0.1 mg
2. esmolol IV 100-500 mic/kg load
3. hydralazine IM 0.1-0.2 mg/kg
4. labetolol PO 0.2-1.0 mg/kg bolus
5. metoprolol PO 10 mg - ✔✔2. esmolol IV 100-500 mic/kg load
✔✔A 24 year old woman is playing racquetball and sustains a direct blow from the ball
to the right eye. She presents to the emergency department complaining of eye pain
and double vision. On exam, her right eye does not track properly with upward gaze.
This finding suggests which of the following injuries?
Select all that apply
1.Inferior orbital rim fracture
2.Superior orbital rim fracture
3.Inferior orbital wall fracture
4.Ethmoid fracture
5.Zygomatic arch fracture - ✔✔3.Inferior orbital wall fracture
✔✔The most sensitive bedside test for nerve injury in a finger after trauma is:
Select all that apply
1.light touch
2.O'Riain wrinkle test
3.pain
, 4.temperature sensation
5.two-point discrimination - ✔✔5.two-point discrimination
✔✔In a patient with a suspected ruptured globe from penetrating trauma to the eye, all
of the following should be performed EXCEPT:
Answers:
1.administration of broad spectrum antibiotic therapy
2.ascertainment of intraocular pressure via tonometry
3.ascertainment of tetanus status
4.ophthalmology consultation
5.visual acuity assessment - ✔✔2.ascertainment of intraocular pressure via tonometry
✔✔Following a motor vehicle crash, a 25 year old man presents complaining of a
painful right eye. Visual acuity is 20/200 in the right eye and 20/25 in the left eye. The
right eye protrudes from the orbit and the patient has right eye pain with extraocular
movement. What is the most likely cause of his symptoms?
Answers:
1.chemosis
2.hyphema
3.orbital blow-out fracture
4.retrobulbar hematoma
5.ruptured globe - ✔✔4.retrobulbar hematoma
✔✔Following a brawl at a local bar, a gentleman presents with an impressive right-sided
periorbital ecchymosis. All of the following physical examination findings would suggest
an orbital blowout fracture EXCEPT:
Answers:
1.anesthesia of the right infraorbital region
2.diplopia with upward gaze
3.proptosis
4.right-sided epistaxis
5.right-sided infraorbital subcutaneous emphysema - ✔✔3.proptosis
✔✔Which of the following cervical spine fractures is considered stable?
Answers:
1.Flexion teardrop fracture
2.Bilateral facet dislocation
3.Transverse process fracture
4.Jefferson fracture of C1
5.Hangman's fracture of C2 - ✔✔3.Transverse process fracture
