SAEM EXAM WITH VERIFIED QUESTIONS
AND WELL-DETAILED ANSWSERS||ALREADY
GRADED A+|| LATEST VERSION 2026
Which factor is least reliable in differentiating between organic and inorganic
causes of confusion?
A. acute versus chronic onset
B. Vital sign abnormalities
C. Presence of attention deficit
D. Signs of trauma - ANSWER-C. Presence of attention deficit
The answer is C. Presence of an attention deficit is common to all confusional
states. All the other options may be used to differentiate organic versus non-
organic causes of confusion. Characteristics of organic causes include acute
onset, abnormal vital signs, fluctuating level of consciousness, possibly signs of
trauma, and/or focal neurologic signs. Inorganic (functional) causes commonly
illustrate chronic onset, stable vital signs, absence of trauma or focal neurologic
symptoms, and/or delusions and illusions.
With regard to specific causes of hypertension, which of the following is true?
A. Hypertensive encephalopathy is more likely than hypertensive stroke in
patients whose mental status changes are reversible
B. Hypertensive encephalopathy causes adverse outcomes over days or weeks,
rather than hours
C. Patients with stroke syndromes must have blood pressure normalized as
quickly as possible to reduce the risks of worsening neurological deficit
,D. Laboratory analysis is rarely useful in cases of confirmed pediatric
hypertension
E. Laboratory analysis is rarely useful in cases of confirmed hypertension in
pregnant patients - ANSWER-A. Hypertensive encephalopathy is more likely
than hypertensive stroke in patients whose mental status changes are reversible
The answer is A. Hypertensive encephalopathy is a true medical emergency,
and can cause coma and death over hours; however, encephalopathy due to
hypertension is more likely reversible than encephalopathy from other causes.
Avoidance of overzealous blood pressure lowering is particularly critical for
patients with strokes. Laboratory analysis can be important in cases of
hypertension in pediatric patients (for whom renal/renovascular or
pheochromocytoma may be identified) and in pregnant patients (for whom
laboratory testing can help establish diagnoses such as the HELLP syndrome).
A 29 year old woman is found seizing by her husband and is rushed to the
emergency department. On presentation, she is noted to have a BP of 162/112,
is still seizing, and looks puffy all over. Her husband tells you that they are
expecting their first child in a few months. Which of the following is the next
best step in this patient's care?
A. Control the seizures with magnesium sulfate.
B. Draw blood to check CBC, LFT's, BUN, and creatinine.
C. Notify the labor floor that the patient is in the emergency department.
D. Perform a CT scan of head if seizures persist.
E. Start hydralazine to decrease the patient's blood pressure. - ANSWER-A.
Control the seizures with magnesium sulfate.
The answer is A. Antihypertensive therapy is only indicated in eclampsia if the
diastolic blood pressure remains > 110 mm Hg after seizures are controlled
because rapid lowering of blood pressure can result in uterine hypoperfusion.
All the other choices (A-D) are appropriate in the management of the patient
with eclampsia.
,Which of the following is *not* a feature of febrile seizures?
A. generalized tonic-clonic seizure
B. duration less than 15 minutes
C. associated with a rapid rise in body temperature
D. occurs in children ages 3 months to 5 years
E. associated with postictal state of 30 minutes - ANSWER-E. associated with
postictal state of 30 minutes
The answer is E. Febrile seizure is not associated with a postictal period. The
child usually rapidly regains alertness. Intracranial mass or infection should be a
concern if the duration of seizure is greater than 15 minutes or if altered mental
status persists after the cessation of seizure activity.
A 47 year old man with a history of alcohol abuse presents to the ED after
having a seizure. His past includes both seizures and blackouts. His last
alcoholic drink was the previous evening. This morning he experienced
palpitations, diaphoresis, and dizziness before losing consciousness and having
a seizure lasting under a minute. Which of the following is *true* statement
with to alcohol and its association with seizures?
A. In people with an underlying seizure disorder, excessive alcohol intake is a
risk-factor for seizure due to increased likelihood of head injury, predisposition
to metabolic disorders, and lowered seizure threshold.
B. Alcohol intake itself can precipitate seizures due to the neurotoxic effects of
alcohol and its metabolites.
C. Cessation of alcohol can precipitate seizures as part of the alcohol
withdrawal syndrome.
D. All of the above statements are true.
E. All of the above statements ar - ANSWER-D. All of the above statements
are true.
, A 68 year old diabetic male, previously living independently, is brought in by
his family. He has been acting abnormally for two days. The family reports he is
awake all night and sleepy during the day. He is confused about where he is and
the time of day, and sometimes doesn't recognize his daughter and son-in-law.
At other times he appears and acts almost normally. Which of the following is
*true* regarding his condition?
A. Infection is an unlikely cause of his condition unless his temperature is >
102°.
B. Dementia is the most likely cause of his condition and the family must be
counseled.
C. Medications are an unlikely cause of this condition in the elderly.
D. Patients can be agitated and combative, or calm and quiet in this condition.
E. Treatment includes maximizing sensory input. - ANSWER-D. Patients can
be agitated and combative, or calm and quiet in this condition.
The answer is D. The scenario describes a patient with delirium, a condition in
which patients may be agitated and combative, or calm and quiet. The most
common cause of delirium in the elderly is medications, accounting for 22-39%
of cases. Infection and metabolic abnormalities are other common causes, and
delirium may be the first indication that an infection is present. An elderly
patient with delirium resulting from an infection may have a normal
temperature, a low temperature, or a high temperature. Delirium is characterized
by an *acute onset of a disturbance in level of consciousness, cognition and
attentiveness*. It has a fluctuating course, and alterations in sleep-wake cycles
are common. Dementia, in contrast, has a slower course, that is gradually
progressive over months to years, and consciousness is preserved. In addition to
correcting the underlying cause, it is important to minimize stimulation, because
the patient with delirium has difficulty processing stimuli.
An 18 year old hockey player is hit in the mouth with a puck, fracturing a
maxillary canine tooth. He brings the severed piece of tooth with him. On
physical exam, the tooth is fractured halfway between the tip and the gumline.
The root of the tooth is still firmly intact. The exposed fracture site has a
AND WELL-DETAILED ANSWSERS||ALREADY
GRADED A+|| LATEST VERSION 2026
Which factor is least reliable in differentiating between organic and inorganic
causes of confusion?
A. acute versus chronic onset
B. Vital sign abnormalities
C. Presence of attention deficit
D. Signs of trauma - ANSWER-C. Presence of attention deficit
The answer is C. Presence of an attention deficit is common to all confusional
states. All the other options may be used to differentiate organic versus non-
organic causes of confusion. Characteristics of organic causes include acute
onset, abnormal vital signs, fluctuating level of consciousness, possibly signs of
trauma, and/or focal neurologic signs. Inorganic (functional) causes commonly
illustrate chronic onset, stable vital signs, absence of trauma or focal neurologic
symptoms, and/or delusions and illusions.
With regard to specific causes of hypertension, which of the following is true?
A. Hypertensive encephalopathy is more likely than hypertensive stroke in
patients whose mental status changes are reversible
B. Hypertensive encephalopathy causes adverse outcomes over days or weeks,
rather than hours
C. Patients with stroke syndromes must have blood pressure normalized as
quickly as possible to reduce the risks of worsening neurological deficit
,D. Laboratory analysis is rarely useful in cases of confirmed pediatric
hypertension
E. Laboratory analysis is rarely useful in cases of confirmed hypertension in
pregnant patients - ANSWER-A. Hypertensive encephalopathy is more likely
than hypertensive stroke in patients whose mental status changes are reversible
The answer is A. Hypertensive encephalopathy is a true medical emergency,
and can cause coma and death over hours; however, encephalopathy due to
hypertension is more likely reversible than encephalopathy from other causes.
Avoidance of overzealous blood pressure lowering is particularly critical for
patients with strokes. Laboratory analysis can be important in cases of
hypertension in pediatric patients (for whom renal/renovascular or
pheochromocytoma may be identified) and in pregnant patients (for whom
laboratory testing can help establish diagnoses such as the HELLP syndrome).
A 29 year old woman is found seizing by her husband and is rushed to the
emergency department. On presentation, she is noted to have a BP of 162/112,
is still seizing, and looks puffy all over. Her husband tells you that they are
expecting their first child in a few months. Which of the following is the next
best step in this patient's care?
A. Control the seizures with magnesium sulfate.
B. Draw blood to check CBC, LFT's, BUN, and creatinine.
C. Notify the labor floor that the patient is in the emergency department.
D. Perform a CT scan of head if seizures persist.
E. Start hydralazine to decrease the patient's blood pressure. - ANSWER-A.
Control the seizures with magnesium sulfate.
The answer is A. Antihypertensive therapy is only indicated in eclampsia if the
diastolic blood pressure remains > 110 mm Hg after seizures are controlled
because rapid lowering of blood pressure can result in uterine hypoperfusion.
All the other choices (A-D) are appropriate in the management of the patient
with eclampsia.
,Which of the following is *not* a feature of febrile seizures?
A. generalized tonic-clonic seizure
B. duration less than 15 minutes
C. associated with a rapid rise in body temperature
D. occurs in children ages 3 months to 5 years
E. associated with postictal state of 30 minutes - ANSWER-E. associated with
postictal state of 30 minutes
The answer is E. Febrile seizure is not associated with a postictal period. The
child usually rapidly regains alertness. Intracranial mass or infection should be a
concern if the duration of seizure is greater than 15 minutes or if altered mental
status persists after the cessation of seizure activity.
A 47 year old man with a history of alcohol abuse presents to the ED after
having a seizure. His past includes both seizures and blackouts. His last
alcoholic drink was the previous evening. This morning he experienced
palpitations, diaphoresis, and dizziness before losing consciousness and having
a seizure lasting under a minute. Which of the following is *true* statement
with to alcohol and its association with seizures?
A. In people with an underlying seizure disorder, excessive alcohol intake is a
risk-factor for seizure due to increased likelihood of head injury, predisposition
to metabolic disorders, and lowered seizure threshold.
B. Alcohol intake itself can precipitate seizures due to the neurotoxic effects of
alcohol and its metabolites.
C. Cessation of alcohol can precipitate seizures as part of the alcohol
withdrawal syndrome.
D. All of the above statements are true.
E. All of the above statements ar - ANSWER-D. All of the above statements
are true.
, A 68 year old diabetic male, previously living independently, is brought in by
his family. He has been acting abnormally for two days. The family reports he is
awake all night and sleepy during the day. He is confused about where he is and
the time of day, and sometimes doesn't recognize his daughter and son-in-law.
At other times he appears and acts almost normally. Which of the following is
*true* regarding his condition?
A. Infection is an unlikely cause of his condition unless his temperature is >
102°.
B. Dementia is the most likely cause of his condition and the family must be
counseled.
C. Medications are an unlikely cause of this condition in the elderly.
D. Patients can be agitated and combative, or calm and quiet in this condition.
E. Treatment includes maximizing sensory input. - ANSWER-D. Patients can
be agitated and combative, or calm and quiet in this condition.
The answer is D. The scenario describes a patient with delirium, a condition in
which patients may be agitated and combative, or calm and quiet. The most
common cause of delirium in the elderly is medications, accounting for 22-39%
of cases. Infection and metabolic abnormalities are other common causes, and
delirium may be the first indication that an infection is present. An elderly
patient with delirium resulting from an infection may have a normal
temperature, a low temperature, or a high temperature. Delirium is characterized
by an *acute onset of a disturbance in level of consciousness, cognition and
attentiveness*. It has a fluctuating course, and alterations in sleep-wake cycles
are common. Dementia, in contrast, has a slower course, that is gradually
progressive over months to years, and consciousness is preserved. In addition to
correcting the underlying cause, it is important to minimize stimulation, because
the patient with delirium has difficulty processing stimuli.
An 18 year old hockey player is hit in the mouth with a puck, fracturing a
maxillary canine tooth. He brings the severed piece of tooth with him. On
physical exam, the tooth is fractured halfway between the tip and the gumline.
The root of the tooth is still firmly intact. The exposed fracture site has a
