S A E M N AT I O N A L E X A M P R E PA R AT I O N · M4
CURRICULUM EDITION
EMERGENCY
MEDICINE
SAEM EXAM TEST BANK
A 200-question, twelve-section comprehensive review with full
answer rationales — aligned with the SAEM M4 National Emergency
Medicine Examination curriculum, CDEM guidelines, and the EM
Model. Covers trauma, cardiovascular, airway, neurologic,
toxicologic, pediatric, obstetric, environmental, procedural, and
medico-legal competencies.
2026/2027 Edition
200 Questions · 12 Sections · Complete Answer Key & Rationales · Recall 15% /
Application 50% / Analysis 35%
E N D - O F - R O TAT I O N E X A M I N AT I O N R E S O U R C E
,EMERGENCY MEDICINE SAEM EXAM TEST BANK_2026/2027
EMERGENCY MEDICINE SAEM EXAM TEST
BANK_2026/2027
Comprehensive Test Bank · Aligned with the SAEM M4 National Emergency Medicine Exam Curriculum, CDEM
(Clerkship Directors in Emergency Medicine) Guidelines, and the EM Model Curriculum · 200 Questions across 12
Sections, with Answer Key and Full Rationales · Cognitive Mix: 15% Recall / 50% Application / 35% Analysis
Questions Q1 - Q25
SECTION 1: TRAUMA
Q1. A 24-year-old unrestrained driver is brought to the emergency department after a high-speed
motor vehicle collision. He is in severe respiratory distress with diminished breath sounds over the
right chest, hyperresonance to percussion, distended neck veins, tracheal deviation to the left, and a
blood pressure of 78/48 mmHg. What is the most appropriate immediate next step?
A. Obtain a portable chest radiograph to confirm the diagnosis
B. Perform immediate needle decompression with a 14-gauge needle at the 2nd intercostal space
at the midclavicular line [CORRECT]
C. Perform rapid sequence intubation before any thoracic intervention
D. Order a CT chest to characterize the pulmonary injury
Correct Answer: B
Rationale: This patient has a clinical diagnosis of tension pneumothorax (distressed patient, absent breath
sounds, hyperresonance, tracheal deviation, hypotension, and JVD), and needle decompression must be
performed immediately with a 14-gauge, 8 cm needle at the 2nd intercostal space at the midclavicular line or
the 4th-5th intercostal space at the anterior/midaxillary line, per ATLS 10th edition and the SAEM M4
curriculum. Obtaining radiographs or CT delays a lethal intervention, and intubation with positive-pressure
ventilation before decompression will rapidly worsen the tension physiology. The definitive airway and chest
tube follow only after decompression.
Q2. A 31-year-old man presents after being struck in the orbit with a baseball. He has severe eye
pain, decreased visual acuity, obvious proptosis of the globe, restricted extraocular movements, and
an elevated intraocular pressure with an afferent pupillary defect. Which of the following is the
most appropriate management?
A. Discharge with outpatient ophthalmology follow-up in 48 hours
B. Perform an emergent lateral canthotomy and inferior cantholysis [CORRECT]
C. Apply a rigid eye shield and obtain outpatient CT of the orbit
D. Administer topical antibiotics and recheck intraocular pressure in the morning
Correct Answer: B
Rationale: Traumatic proptosis with impaired extraocular movements, elevated intraocular pressure, and
vision loss indicates a retrobulbar hematoma raising intraorbital pressure, which threatens the optic nerve
through ischemia; the vision-saving intervention is an emergent lateral canthotomy with inferior cantholysis,
a key SAEM M4 procedural competency. Outpatient follow-up, eye shielding, or delayed recheck all permit
permanent optic nerve ischemia. A blowout fracture, by contrast, presents with enophthalmos and
infraorbital anesthesia rather than proptosis.
SAEM M4 National Exam Preparation · CDEM Guidelines · EM Model Curriculum 1
,EMERGENCY MEDICINE SAEM EXAM TEST BANK_2026/2027
Q3. A 72-year-old woman presents after falling down a flight of stairs, striking her hyperextended
neck. She has bilateral upper extremity weakness and paresthesias with intact lower extremity
strength and sensation, and she has known severe cervical degenerative joint disease. Which of the
following best describes the diagnosis and appropriate management?
A. Anterior cord syndrome; emergent surgical decompression without imaging
B. Brown-Sequard syndrome; corticosteroids and outpatient rehabilitation
C. Cauda equina syndrome; urgent lumbar puncture
D. Central cord syndrome; cervical immobilization, cervical MRI, and IV
corticosteroids [CORRECT]
Correct Answer: D
Rationale: Central cord syndrome classically follows a hyperextension injury in an elderly patient with
cervical spondylosis, producing weakness and sensory loss that are greatest in the upper extremities with
relative lower-extremity sparing, as outlined in the EM Model neurotrauma objectives. Management includes
cervical immobilization, MRI to define cord compression, and IV corticosteroids per the SAEM M4
curriculum framework. Anterior cord syndrome causes motor paralysis with loss of pain/temperature but
preserved position-vibration sense, Brown-Sequard is a hemisection with ipsilateral motor and contralateral
pain loss, and cauda equina involves bowel/bladder dysfunction with saddle anesthesia.
Q4. A 45-year-old man punched in the left orbit now presents with numbness over the left cheek,
epistaxis, subcutaneous emphysema on palpation, and double vision when looking upward. CT
confirms a fracture involving the orbital floor with herniation into the adjacent paranasal sinus.
Which structure is most likely involved in this injury?
A. Maxillary sinus with fracture of the orbital floor (blowout fracture) [CORRECT]
B. Frontal sinus with fracture of the orbital roof
C. Ethmoid sinus with fracture of the medial orbital wall
D. Sphenoid sinus with fracture of the optic canal
Correct Answer: A
Rationale: The classic orbital blowout fracture involves the orbital floor into the maxillary sinus, producing
infraorbital (V2) anesthesia, epistaxis, subcutaneous emphysema, and vertical diplopia worse with upgaze
from inferior rectus entrapment, exactly as emphasized in the SAEM M4 facial trauma objectives. Medial
wall (lamina papyracea) fractures involve the ethmoid sinus and more often cause horizontal diplopia and
orbital emphysema with nose blowing. Roof fractures involve the frontal sinus and are associated with
supraorbital nerve injury, while optic canal fractures threaten vision without diplopia.
Q5. Following blunt orbital trauma, the presence of proptosis of the globe most specifically
suggests which underlying injury?
A. Orbital floor blowout fracture
B. Retrobulbar hematoma [CORRECT]
C. Traumatic hyphema
D. Medial wall (ethmoid) fracture with orbital emphysema
Correct Answer: B
Rationale: Proptosis after trauma is the hallmark of a retrobulbar hematoma expanding within the
fixed-volume orbit, and it is frequently accompanied by impaired extraocular movements, elevated
intraocular pressure, and an afferent pupillary defect, requiring emergent lateral canthotomy per SAEM M4
SAEM M4 National Exam Preparation · CDEM Guidelines · EM Model Curriculum 2
, EMERGENCY MEDICINE SAEM EXAM TEST BANK_2026/2027
curriculum guidance. Blowout fractures classically produce enophthalmos, not proptosis. Hyphema presents
with blood in the anterior chamber and a level visible on slit-lamp examination, and medial wall fractures
cause emphysema without significant proptosis.
Q6. A 19-year-old multisystem trauma patient from a motorcycle crash is brought in actively
seizing with a declining level of consciousness (GCS 6), an unprotected airway, and inadequate
oxygenation despite adjuncts. According to the ATLS-based SAEM M4 trauma curriculum, what is
the first priority in this patient?
A. Immediate CT head to identify the intracranial lesion
B. Administration of IV phenytoin for seizure prophylaxis
C. Airway management with rapid sequence intubation [CORRECT]
D. Emergent cervical spine CT before any intervention
Correct Answer: C
Rationale: In the seizing trauma patient, airway management with rapid sequence intubation is the first
priority, since hypoxia and hypercapnia are the most rapidly lethal secondary insults to the injured brain and
the airway cannot be protected during generalized seizure activity, as emphasized in the SAEM M4 and
ATLS airway priorities (A before B before C). CT head and cervical imaging follow only after oxygenation
and ventilation are secured. Anticonvulsants such as phenytoin are adjunctive therapy given after the airway
is controlled.
Q7. During the primary survey of a trauma patient, after ensuring a patent airway with cervical
spine protection, the next step in the ATLS-structured assessment is:
A. Disability assessment with Glasgow Coma Scale scoring
B. Breathing and ventilation assessment with exposure of the chest [CORRECT]
C. Circulation with hemorrhage control and assessment of perfusion
D. Full exposure of the patient with environmental control
Correct Answer: B
Rationale: The ATLS 10th edition primary survey follows the sequence A (airway with cervical spine
protection), B (breathing and ventilation), C (circulation with hemorrhage control), D (disability/neurologic
status), and E (exposure/environmental control), a sequence reproduced verbatim in the SAEM M4 trauma
curriculum. Disability comes after circulation, and full exposure is the final component of the primary
survey. Reversing or skipping this order risks missing immediately life-threatening thoracic or hemorrhagic
problems.
Q8. A 30-year-old man presents after a fall with heart rate 118/min, blood pressure 118/96 mmHg,
anxiety, and pallor. Estimated blood loss is approximately 20% of his blood volume. According to
the ATLS classification of hemorrhagic shock, which class does this patient represent?
A. Class II hemorrhagic shock [CORRECT]
B. Class I hemorrhagic shock
C. Class III hemorrhagic shock
D. Class IV hemorrhagic shock
Correct Answer: A
Rationale: Class II hemorrhage (approximately 15-30% blood loss) is characterized by tachycardia,
narrowed pulse pressure with a relatively preserved systolic pressure, anxiety, and pallor, matching this
SAEM M4 National Exam Preparation · CDEM Guidelines · EM Model Curriculum 3
CURRICULUM EDITION
EMERGENCY
MEDICINE
SAEM EXAM TEST BANK
A 200-question, twelve-section comprehensive review with full
answer rationales — aligned with the SAEM M4 National Emergency
Medicine Examination curriculum, CDEM guidelines, and the EM
Model. Covers trauma, cardiovascular, airway, neurologic,
toxicologic, pediatric, obstetric, environmental, procedural, and
medico-legal competencies.
2026/2027 Edition
200 Questions · 12 Sections · Complete Answer Key & Rationales · Recall 15% /
Application 50% / Analysis 35%
E N D - O F - R O TAT I O N E X A M I N AT I O N R E S O U R C E
,EMERGENCY MEDICINE SAEM EXAM TEST BANK_2026/2027
EMERGENCY MEDICINE SAEM EXAM TEST
BANK_2026/2027
Comprehensive Test Bank · Aligned with the SAEM M4 National Emergency Medicine Exam Curriculum, CDEM
(Clerkship Directors in Emergency Medicine) Guidelines, and the EM Model Curriculum · 200 Questions across 12
Sections, with Answer Key and Full Rationales · Cognitive Mix: 15% Recall / 50% Application / 35% Analysis
Questions Q1 - Q25
SECTION 1: TRAUMA
Q1. A 24-year-old unrestrained driver is brought to the emergency department after a high-speed
motor vehicle collision. He is in severe respiratory distress with diminished breath sounds over the
right chest, hyperresonance to percussion, distended neck veins, tracheal deviation to the left, and a
blood pressure of 78/48 mmHg. What is the most appropriate immediate next step?
A. Obtain a portable chest radiograph to confirm the diagnosis
B. Perform immediate needle decompression with a 14-gauge needle at the 2nd intercostal space
at the midclavicular line [CORRECT]
C. Perform rapid sequence intubation before any thoracic intervention
D. Order a CT chest to characterize the pulmonary injury
Correct Answer: B
Rationale: This patient has a clinical diagnosis of tension pneumothorax (distressed patient, absent breath
sounds, hyperresonance, tracheal deviation, hypotension, and JVD), and needle decompression must be
performed immediately with a 14-gauge, 8 cm needle at the 2nd intercostal space at the midclavicular line or
the 4th-5th intercostal space at the anterior/midaxillary line, per ATLS 10th edition and the SAEM M4
curriculum. Obtaining radiographs or CT delays a lethal intervention, and intubation with positive-pressure
ventilation before decompression will rapidly worsen the tension physiology. The definitive airway and chest
tube follow only after decompression.
Q2. A 31-year-old man presents after being struck in the orbit with a baseball. He has severe eye
pain, decreased visual acuity, obvious proptosis of the globe, restricted extraocular movements, and
an elevated intraocular pressure with an afferent pupillary defect. Which of the following is the
most appropriate management?
A. Discharge with outpatient ophthalmology follow-up in 48 hours
B. Perform an emergent lateral canthotomy and inferior cantholysis [CORRECT]
C. Apply a rigid eye shield and obtain outpatient CT of the orbit
D. Administer topical antibiotics and recheck intraocular pressure in the morning
Correct Answer: B
Rationale: Traumatic proptosis with impaired extraocular movements, elevated intraocular pressure, and
vision loss indicates a retrobulbar hematoma raising intraorbital pressure, which threatens the optic nerve
through ischemia; the vision-saving intervention is an emergent lateral canthotomy with inferior cantholysis,
a key SAEM M4 procedural competency. Outpatient follow-up, eye shielding, or delayed recheck all permit
permanent optic nerve ischemia. A blowout fracture, by contrast, presents with enophthalmos and
infraorbital anesthesia rather than proptosis.
SAEM M4 National Exam Preparation · CDEM Guidelines · EM Model Curriculum 1
,EMERGENCY MEDICINE SAEM EXAM TEST BANK_2026/2027
Q3. A 72-year-old woman presents after falling down a flight of stairs, striking her hyperextended
neck. She has bilateral upper extremity weakness and paresthesias with intact lower extremity
strength and sensation, and she has known severe cervical degenerative joint disease. Which of the
following best describes the diagnosis and appropriate management?
A. Anterior cord syndrome; emergent surgical decompression without imaging
B. Brown-Sequard syndrome; corticosteroids and outpatient rehabilitation
C. Cauda equina syndrome; urgent lumbar puncture
D. Central cord syndrome; cervical immobilization, cervical MRI, and IV
corticosteroids [CORRECT]
Correct Answer: D
Rationale: Central cord syndrome classically follows a hyperextension injury in an elderly patient with
cervical spondylosis, producing weakness and sensory loss that are greatest in the upper extremities with
relative lower-extremity sparing, as outlined in the EM Model neurotrauma objectives. Management includes
cervical immobilization, MRI to define cord compression, and IV corticosteroids per the SAEM M4
curriculum framework. Anterior cord syndrome causes motor paralysis with loss of pain/temperature but
preserved position-vibration sense, Brown-Sequard is a hemisection with ipsilateral motor and contralateral
pain loss, and cauda equina involves bowel/bladder dysfunction with saddle anesthesia.
Q4. A 45-year-old man punched in the left orbit now presents with numbness over the left cheek,
epistaxis, subcutaneous emphysema on palpation, and double vision when looking upward. CT
confirms a fracture involving the orbital floor with herniation into the adjacent paranasal sinus.
Which structure is most likely involved in this injury?
A. Maxillary sinus with fracture of the orbital floor (blowout fracture) [CORRECT]
B. Frontal sinus with fracture of the orbital roof
C. Ethmoid sinus with fracture of the medial orbital wall
D. Sphenoid sinus with fracture of the optic canal
Correct Answer: A
Rationale: The classic orbital blowout fracture involves the orbital floor into the maxillary sinus, producing
infraorbital (V2) anesthesia, epistaxis, subcutaneous emphysema, and vertical diplopia worse with upgaze
from inferior rectus entrapment, exactly as emphasized in the SAEM M4 facial trauma objectives. Medial
wall (lamina papyracea) fractures involve the ethmoid sinus and more often cause horizontal diplopia and
orbital emphysema with nose blowing. Roof fractures involve the frontal sinus and are associated with
supraorbital nerve injury, while optic canal fractures threaten vision without diplopia.
Q5. Following blunt orbital trauma, the presence of proptosis of the globe most specifically
suggests which underlying injury?
A. Orbital floor blowout fracture
B. Retrobulbar hematoma [CORRECT]
C. Traumatic hyphema
D. Medial wall (ethmoid) fracture with orbital emphysema
Correct Answer: B
Rationale: Proptosis after trauma is the hallmark of a retrobulbar hematoma expanding within the
fixed-volume orbit, and it is frequently accompanied by impaired extraocular movements, elevated
intraocular pressure, and an afferent pupillary defect, requiring emergent lateral canthotomy per SAEM M4
SAEM M4 National Exam Preparation · CDEM Guidelines · EM Model Curriculum 2
, EMERGENCY MEDICINE SAEM EXAM TEST BANK_2026/2027
curriculum guidance. Blowout fractures classically produce enophthalmos, not proptosis. Hyphema presents
with blood in the anterior chamber and a level visible on slit-lamp examination, and medial wall fractures
cause emphysema without significant proptosis.
Q6. A 19-year-old multisystem trauma patient from a motorcycle crash is brought in actively
seizing with a declining level of consciousness (GCS 6), an unprotected airway, and inadequate
oxygenation despite adjuncts. According to the ATLS-based SAEM M4 trauma curriculum, what is
the first priority in this patient?
A. Immediate CT head to identify the intracranial lesion
B. Administration of IV phenytoin for seizure prophylaxis
C. Airway management with rapid sequence intubation [CORRECT]
D. Emergent cervical spine CT before any intervention
Correct Answer: C
Rationale: In the seizing trauma patient, airway management with rapid sequence intubation is the first
priority, since hypoxia and hypercapnia are the most rapidly lethal secondary insults to the injured brain and
the airway cannot be protected during generalized seizure activity, as emphasized in the SAEM M4 and
ATLS airway priorities (A before B before C). CT head and cervical imaging follow only after oxygenation
and ventilation are secured. Anticonvulsants such as phenytoin are adjunctive therapy given after the airway
is controlled.
Q7. During the primary survey of a trauma patient, after ensuring a patent airway with cervical
spine protection, the next step in the ATLS-structured assessment is:
A. Disability assessment with Glasgow Coma Scale scoring
B. Breathing and ventilation assessment with exposure of the chest [CORRECT]
C. Circulation with hemorrhage control and assessment of perfusion
D. Full exposure of the patient with environmental control
Correct Answer: B
Rationale: The ATLS 10th edition primary survey follows the sequence A (airway with cervical spine
protection), B (breathing and ventilation), C (circulation with hemorrhage control), D (disability/neurologic
status), and E (exposure/environmental control), a sequence reproduced verbatim in the SAEM M4 trauma
curriculum. Disability comes after circulation, and full exposure is the final component of the primary
survey. Reversing or skipping this order risks missing immediately life-threatening thoracic or hemorrhagic
problems.
Q8. A 30-year-old man presents after a fall with heart rate 118/min, blood pressure 118/96 mmHg,
anxiety, and pallor. Estimated blood loss is approximately 20% of his blood volume. According to
the ATLS classification of hemorrhagic shock, which class does this patient represent?
A. Class II hemorrhagic shock [CORRECT]
B. Class I hemorrhagic shock
C. Class III hemorrhagic shock
D. Class IV hemorrhagic shock
Correct Answer: A
Rationale: Class II hemorrhage (approximately 15-30% blood loss) is characterized by tachycardia,
narrowed pulse pressure with a relatively preserved systolic pressure, anxiety, and pallor, matching this
SAEM M4 National Exam Preparation · CDEM Guidelines · EM Model Curriculum 3
