SAEM M4 Exam questions and
answers
True or False: gastric distension due to excessive volume or rate of ventilation
impairing ventilatory function is a reason to intubate a neonate✔✔False
management for nursemaid elbow injury✔✔apply pressure to the radial head while
flexing and supinating elbow
A 17 year old boy injured his right shoulder playing football. He tried to arm-tackle a
player when his right arm was pulled away from his body and back (abducted and
extended). He felt a sudden pain in his shoulder. He presents to the emergency
department holding his arm in slight abduction and external rotation by his good arm.
He has severe pain with adduction or internal rotation. What is the most common
fracture associated with this injury?✔✔compression fracture of the posteriolateral
aspect of the humeral head (Hill-Sachs deformity)
What are most common heart rhythms seen in pediatric arrest?✔✔bradycardia or
asystole
risk factors for neonatal resuscitation✔✔prematurity
IUGR
multiple gestation
thick meconium
In the post-arrest setting, which of the following is the drug of choice in treating
hypotension in a child:✔✔epi
Low body temperatures in newborns can lead to severe physiologic consequences,
which include all EXCEPT:
Answers:
1. metabolic acidosis
2. increased oxygen consumption
3. hypoglycemia
4. apnea
5. hyperglycemia✔✔3. hypoglycemia
In a newborn, bradycardia is most commonly an indicator of:✔✔hypoxemia
All the following are signs of hypoxemia in a newborn, EXCEPT:
Answers:
1.cyanosis
2.lethargy
3.tachycardia
4.unresponsiveness
,5.bradycardia✔✔3. tachycardia
A newborn presents to the emergency department a few days after hospital
discharge. The infant has been noted to be drooling, choking, and coughing, and the
mother reports seeing bubbles at the baby's mouth. Which is the most likely
explanation?
Answers:
1.osteogenesis imperfecta
2.inborn error of metabolism
3.congenital diaphragmatic hernia
4.foreign body
5.tracheoesophageal fistula✔✔5. tracheoesophageal fistula
Which of the following pairs of maneuvers are consistent with current
recommendations for emergency care for a choking 5-month-old infant?
Answers:
1.back blow then blind finger sweep
2.back blow then chest thrust
3.chest thrust then Heimlich maneuver
4.Heimlich maneuver then blind finger sweep
5.Heimlich maneuver then chest thrust✔✔2.back blow then chest thrust
All of these steps are involved in pediatric rapid sequence intubation (RSI) EXCEPT:
Answers:
1.If administering succinylcholine, pretreatment with atropine is always indicated in
children under age 10.
2.Lidocaine pretreatment is usually provided to children with head trauma.
3.When deciding which size endotracheal tube to use, one may approximate by
using the size of the small finger or nares as a reference.
4.Due to the fragility of the pediatric C-spine, a cervical collar should always be
placed prior to intubation for children under age ten.
5.Uncuffed endotracheal tubes are the preferred devices used in children under 6-8
years of age.✔✔4.Due to the fragility of the pediatric C-spine, a cervical collar should
always be placed prior to intubation for children under age ten.
A 23 year old woman is dropped off by her boyfriend after an unknown overdose.
You notice that she is has very large pupils and is sweating profusely. Her
respiratory rate, blood pressure and heart rate are elevated. Which of the following is
the most likely agent to have caused her symptoms?
Answers:
1.Jimson weed
2.Cocaine
3.Heroin
4.Insulin✔✔2. cocaine
, A mother brings in her 4 year old child who was happily eating "blackberries" from
weeds in the garden and is now acting strangely. She has identified them as
Belladonna from a quick internet search. Which physical examination finding might
you also expect to find in this child?
Answers:
1.Diaphoresis
2.Flushed skin
3.Miosis
4.Urinary incontinence✔✔2. flushed skin
For which of the following cases is activated charcoal therapy most appropriate?
Answers:
1.Acetaminophen overdose
2.Drain cleaner ingestion
3.Iron supplement overdose
4.Lithium overdose✔✔1. Acetaminophen overdose
A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the
best treatment method for this overdose?
Answers:
1.Activated charcoal
2.Gastric lavage
3.Hemodialysis
4.Whole bowel irrigation✔✔3.Hemodialysis
A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her
family indicates she has been taking for years to help with her anxiety. The bottle
indicates that the prescription was filled yesterday with 90 pills and is now empty.
The patient is minimally responsive to painful stimuli and does not react when you
suction secretions out of her posterior pharynx. What is your next management
step?
Answers:
1.Administration of flumazenil
2.Administration of narcan
3.Close observation
4.Intubation for airway support✔✔4.Intubation for airway support
A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3
hours prior to presentation in the ED. Which of the following arterial blood gas results
would you expect to come from this patient?
Answers:
1.pH 7.14 pCO2 68 pO2 102 HCO3 23
2.pH 7.33 pCO2 48 pO2 58 HCO3 29
3.pH 7.45 pCO2 21 pO2 124 HCO3 14
answers
True or False: gastric distension due to excessive volume or rate of ventilation
impairing ventilatory function is a reason to intubate a neonate✔✔False
management for nursemaid elbow injury✔✔apply pressure to the radial head while
flexing and supinating elbow
A 17 year old boy injured his right shoulder playing football. He tried to arm-tackle a
player when his right arm was pulled away from his body and back (abducted and
extended). He felt a sudden pain in his shoulder. He presents to the emergency
department holding his arm in slight abduction and external rotation by his good arm.
He has severe pain with adduction or internal rotation. What is the most common
fracture associated with this injury?✔✔compression fracture of the posteriolateral
aspect of the humeral head (Hill-Sachs deformity)
What are most common heart rhythms seen in pediatric arrest?✔✔bradycardia or
asystole
risk factors for neonatal resuscitation✔✔prematurity
IUGR
multiple gestation
thick meconium
In the post-arrest setting, which of the following is the drug of choice in treating
hypotension in a child:✔✔epi
Low body temperatures in newborns can lead to severe physiologic consequences,
which include all EXCEPT:
Answers:
1. metabolic acidosis
2. increased oxygen consumption
3. hypoglycemia
4. apnea
5. hyperglycemia✔✔3. hypoglycemia
In a newborn, bradycardia is most commonly an indicator of:✔✔hypoxemia
All the following are signs of hypoxemia in a newborn, EXCEPT:
Answers:
1.cyanosis
2.lethargy
3.tachycardia
4.unresponsiveness
,5.bradycardia✔✔3. tachycardia
A newborn presents to the emergency department a few days after hospital
discharge. The infant has been noted to be drooling, choking, and coughing, and the
mother reports seeing bubbles at the baby's mouth. Which is the most likely
explanation?
Answers:
1.osteogenesis imperfecta
2.inborn error of metabolism
3.congenital diaphragmatic hernia
4.foreign body
5.tracheoesophageal fistula✔✔5. tracheoesophageal fistula
Which of the following pairs of maneuvers are consistent with current
recommendations for emergency care for a choking 5-month-old infant?
Answers:
1.back blow then blind finger sweep
2.back blow then chest thrust
3.chest thrust then Heimlich maneuver
4.Heimlich maneuver then blind finger sweep
5.Heimlich maneuver then chest thrust✔✔2.back blow then chest thrust
All of these steps are involved in pediatric rapid sequence intubation (RSI) EXCEPT:
Answers:
1.If administering succinylcholine, pretreatment with atropine is always indicated in
children under age 10.
2.Lidocaine pretreatment is usually provided to children with head trauma.
3.When deciding which size endotracheal tube to use, one may approximate by
using the size of the small finger or nares as a reference.
4.Due to the fragility of the pediatric C-spine, a cervical collar should always be
placed prior to intubation for children under age ten.
5.Uncuffed endotracheal tubes are the preferred devices used in children under 6-8
years of age.✔✔4.Due to the fragility of the pediatric C-spine, a cervical collar should
always be placed prior to intubation for children under age ten.
A 23 year old woman is dropped off by her boyfriend after an unknown overdose.
You notice that she is has very large pupils and is sweating profusely. Her
respiratory rate, blood pressure and heart rate are elevated. Which of the following is
the most likely agent to have caused her symptoms?
Answers:
1.Jimson weed
2.Cocaine
3.Heroin
4.Insulin✔✔2. cocaine
, A mother brings in her 4 year old child who was happily eating "blackberries" from
weeds in the garden and is now acting strangely. She has identified them as
Belladonna from a quick internet search. Which physical examination finding might
you also expect to find in this child?
Answers:
1.Diaphoresis
2.Flushed skin
3.Miosis
4.Urinary incontinence✔✔2. flushed skin
For which of the following cases is activated charcoal therapy most appropriate?
Answers:
1.Acetaminophen overdose
2.Drain cleaner ingestion
3.Iron supplement overdose
4.Lithium overdose✔✔1. Acetaminophen overdose
A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the
best treatment method for this overdose?
Answers:
1.Activated charcoal
2.Gastric lavage
3.Hemodialysis
4.Whole bowel irrigation✔✔3.Hemodialysis
A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her
family indicates she has been taking for years to help with her anxiety. The bottle
indicates that the prescription was filled yesterday with 90 pills and is now empty.
The patient is minimally responsive to painful stimuli and does not react when you
suction secretions out of her posterior pharynx. What is your next management
step?
Answers:
1.Administration of flumazenil
2.Administration of narcan
3.Close observation
4.Intubation for airway support✔✔4.Intubation for airway support
A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3
hours prior to presentation in the ED. Which of the following arterial blood gas results
would you expect to come from this patient?
Answers:
1.pH 7.14 pCO2 68 pO2 102 HCO3 23
2.pH 7.33 pCO2 48 pO2 58 HCO3 29
3.pH 7.45 pCO2 21 pO2 124 HCO3 14
