SAEM SET 1 QUESTIONS WITH
CORRECT DETAILED ANSWERS
"The chest X-ray in the Figure was taken in an intoxicated patient who is conversant, but an unreliable
j
historian. The X-ray findings are best described as indicating:
[image]
A. Esophageal foreign body
B. Intratracheal foreign body
C. mediastinitis from esophageal perforation
D. normal chest" - "A. Esophageal foreign body
The answer is A. The film reveals a classic appearance of a round foreign body (in this case, a pull-top
from a beer can) in the esophagus. The foreign body appears to lie outside the tracheal shadow. There is
no sign of mediastinal air (which would be expected with penetrating trauma). The X-ray reveals no signs
of mediastinitis, but the risk of esophageal perforation and ultimate mediastinitis prompts endoscopic
intervention in this patient."
"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
yellowish tinge without blood. Of the following choices, which is the most appropriate management for
this patient?
A. No specific treatment required
B. Application of calcium hydroxide, placement of aluminum foil, and dental follow-up
C. Placement of tooth fragment in saline gauze, outpatient dental follow-up
D. Immediate dental consult to avoid abscess formation
E. Replace fractured piece and place acrylic splint" - "D. Immediate dental consult to avoid abscess
formation
The answer is D. Ellis II dental fracture involves enamel and dentin. The fracture site typically has a
yellowish tinge. Ellis III dental fractures are characterized by exposure of pinkish pulp and often blood.
These fractures require immediate dental consultation to prevent abscess formation."
,"A 22 year old man is punched in the nose during a fight. He presents to the emergency department with
obvious nasal bone deformity. Pressure controls the bleeding. Physical exam reveals no maxillary bone or
orbital rim tenderness, intact vision and extraocular movement. The oropharynx and mandible are
unremarkable. Nasal inspection reveals a swollen, ecchymotic, tender nasal septum. Which of the
following is the most appropriate initial step?
A. Outpatient follow-up with an ENT specialist to surgically correct a deviated septum
B. Plastic surgery consult for immediate reduction of nasal fracture
C. Facial CT scan to rule out more serious facial fractures
D. Incision and drainage of the septal hematoma followed by nasal packing
E. Needle aspiration of the septal hematoma" - "D. Incision and drainage of the septal hematoma
followed by nasal packing"
"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?
A. Inferior orbital wall fracture
B. Superior orbital rim fracture
C. Ethmoid fracture
D. Zygomatic arch fracture
E. Inferior orbital rim fracture" - "A. Inferior orbital wall fracture
The answer is A. The patient most likely has an orbital floor fracture with entrapment."
"A 32 year old man is struck several times in the head with a baseball bat. Upon emergency medical
service arrival, he is mildly confused, vomits once, and complains of a severe headache. The emergency
medical technicians establish two large-bore IVs. Prior to arrival at the emergency department, he loses
consciousness and begins to seize. He is actively seizing when he is brought into the trauma bay. What
should be the first step in the management of this patient?
A. Administration of phenytoin 1000mg IV
B. Administration of mannitol 50 g IV
C. Rapid sequence intubation using paralytic agent
D. Emergency craniotomy
E. Administration of 2 liters NS bolus" - "C. Rapid sequence intubation using paralytic agent
, The answer is C. The airway should be managed as the first priority in this patient. The other maneuvers
may be helpful but are secondary to securing an airway and providing oxygenation/ventilation. Airway
comes first!"
"A 46 year old man is brought in by EMS after a motor vehicle collision in which he was an unrestrained
driver. Although he has no obvious injury to his head or neck, he complains of chest pain and appears
very short of breath. His vital signs are: T 99.2 F, BP 85/57, HR 123, RR 36, SpO2 95% on non-rebreather.
The CXR demonstrates a
tension pneumothorax. Of the following, which is the most appropriate next step in this man's care?
A. Placement of a chest tube followed by a chest xray to determine proper placement
B. Transfusion of 2 units of O-negative packed red blood cells
C. Performance of a chest CT scan to further delineate the pathology
D. Placement of a needle decompression device, followed by repeat CXR" - "D. Placement of a needle
decompression device, followed by repeat CXR
This patient needs emergent chest decompression and this is rapidly done by needle thoracostomy. A
chest CT may be performed, but only once he is stabilized. A formal chest tube will be placed, but
placement may not be rapid enough and he may decompensate in the meantime. Transfusion of blood
does nothing to correct the physiology of a tension pneumothorax"
"The most sensitive bedside test for nerve injury in a finger after trauma is:
A. light touch
B. O'Riain wrinkle test
C. pain
D. temperature sensation
E. two-point discrimination" - "E. two-point discrimination
The correct answer is E. Light touch is a good screening test, but two-point discrimination is more
sensitive and should be used routinely in evaluating injuries to digits. The O'Riain wrinkle test involves
placing the digit in warm water and looking for wrinkling of the digital pulps. Presence of wrinkling
indicates the nerve is intact."
"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
CORRECT DETAILED ANSWERS
"The chest X-ray in the Figure was taken in an intoxicated patient who is conversant, but an unreliable
j
historian. The X-ray findings are best described as indicating:
[image]
A. Esophageal foreign body
B. Intratracheal foreign body
C. mediastinitis from esophageal perforation
D. normal chest" - "A. Esophageal foreign body
The answer is A. The film reveals a classic appearance of a round foreign body (in this case, a pull-top
from a beer can) in the esophagus. The foreign body appears to lie outside the tracheal shadow. There is
no sign of mediastinal air (which would be expected with penetrating trauma). The X-ray reveals no signs
of mediastinitis, but the risk of esophageal perforation and ultimate mediastinitis prompts endoscopic
intervention in this patient."
"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
yellowish tinge without blood. Of the following choices, which is the most appropriate management for
this patient?
A. No specific treatment required
B. Application of calcium hydroxide, placement of aluminum foil, and dental follow-up
C. Placement of tooth fragment in saline gauze, outpatient dental follow-up
D. Immediate dental consult to avoid abscess formation
E. Replace fractured piece and place acrylic splint" - "D. Immediate dental consult to avoid abscess
formation
The answer is D. Ellis II dental fracture involves enamel and dentin. The fracture site typically has a
yellowish tinge. Ellis III dental fractures are characterized by exposure of pinkish pulp and often blood.
These fractures require immediate dental consultation to prevent abscess formation."
,"A 22 year old man is punched in the nose during a fight. He presents to the emergency department with
obvious nasal bone deformity. Pressure controls the bleeding. Physical exam reveals no maxillary bone or
orbital rim tenderness, intact vision and extraocular movement. The oropharynx and mandible are
unremarkable. Nasal inspection reveals a swollen, ecchymotic, tender nasal septum. Which of the
following is the most appropriate initial step?
A. Outpatient follow-up with an ENT specialist to surgically correct a deviated septum
B. Plastic surgery consult for immediate reduction of nasal fracture
C. Facial CT scan to rule out more serious facial fractures
D. Incision and drainage of the septal hematoma followed by nasal packing
E. Needle aspiration of the septal hematoma" - "D. Incision and drainage of the septal hematoma
followed by nasal packing"
"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?
A. Inferior orbital wall fracture
B. Superior orbital rim fracture
C. Ethmoid fracture
D. Zygomatic arch fracture
E. Inferior orbital rim fracture" - "A. Inferior orbital wall fracture
The answer is A. The patient most likely has an orbital floor fracture with entrapment."
"A 32 year old man is struck several times in the head with a baseball bat. Upon emergency medical
service arrival, he is mildly confused, vomits once, and complains of a severe headache. The emergency
medical technicians establish two large-bore IVs. Prior to arrival at the emergency department, he loses
consciousness and begins to seize. He is actively seizing when he is brought into the trauma bay. What
should be the first step in the management of this patient?
A. Administration of phenytoin 1000mg IV
B. Administration of mannitol 50 g IV
C. Rapid sequence intubation using paralytic agent
D. Emergency craniotomy
E. Administration of 2 liters NS bolus" - "C. Rapid sequence intubation using paralytic agent
, The answer is C. The airway should be managed as the first priority in this patient. The other maneuvers
may be helpful but are secondary to securing an airway and providing oxygenation/ventilation. Airway
comes first!"
"A 46 year old man is brought in by EMS after a motor vehicle collision in which he was an unrestrained
driver. Although he has no obvious injury to his head or neck, he complains of chest pain and appears
very short of breath. His vital signs are: T 99.2 F, BP 85/57, HR 123, RR 36, SpO2 95% on non-rebreather.
The CXR demonstrates a
tension pneumothorax. Of the following, which is the most appropriate next step in this man's care?
A. Placement of a chest tube followed by a chest xray to determine proper placement
B. Transfusion of 2 units of O-negative packed red blood cells
C. Performance of a chest CT scan to further delineate the pathology
D. Placement of a needle decompression device, followed by repeat CXR" - "D. Placement of a needle
decompression device, followed by repeat CXR
This patient needs emergent chest decompression and this is rapidly done by needle thoracostomy. A
chest CT may be performed, but only once he is stabilized. A formal chest tube will be placed, but
placement may not be rapid enough and he may decompensate in the meantime. Transfusion of blood
does nothing to correct the physiology of a tension pneumothorax"
"The most sensitive bedside test for nerve injury in a finger after trauma is:
A. light touch
B. O'Riain wrinkle test
C. pain
D. temperature sensation
E. two-point discrimination" - "E. two-point discrimination
The correct answer is E. Light touch is a good screening test, but two-point discrimination is more
sensitive and should be used routinely in evaluating injuries to digits. The O'Riain wrinkle test involves
placing the digit in warm water and looking for wrinkling of the digital pulps. Presence of wrinkling
indicates the nerve is intact."
"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
