SAEM EXAMINATION QUESTIONS WITH ANSWERS
All of the following are generally accepted indications for endotracheal intubation of the
pediatric trauma patient, EXCEPT:
Answers:
1.respiratory failure from hypoxia or hypoventilation
2.gastric distension due to excessive volume or rate of ventilation impairing ventilatory
function
3.GCS score less than or equal 9, to secure airway and provide controlled hyperventilation
4.any trauma patient in decompensated shock and resistant to initial fluid resuscitation
5.any inability to ventilate by bag-valve-mask methods or the need for prolonged control of
the airway - 2.gastric distension due to excessive volume or rate of ventilation
impairing ventilatory function
Regarding pediatric head injury, all the following are true EXCEPT:
Answers:
1.Head trauma is the leading cause of death among injured children.
2.A child's cranial vault is larger and heavier in proportion to its total body mass than an
adult's.
3.Pediatric epidural hematomas are venous in origin.
,4.A brief seizure occurring immediately after the insult, with rapid return to normal level of
consciousness is usually unassociated with intracranial parenchymal injury.
5.Retinal hemorrhages are a common finding in mild-moderate trauma. - 5.Retinal
hemorrhages are a common finding in mild-moderate trauma.
An 8 year old boy falls off his bike onto his outstretched hand with his elbow in extension. He
presents to the emergency department with obvious anterior bowing of his distal humerus.
His distal neurovascular exam is intact. The X-ray shows a transverse supracondylar humerus
fracture with dorsal displacement and angulation of the distal fragment. Of the following,
which is the most appropriate treatment?
Answers:
1.Splinting the extremity in its current position, and arranging for orthopedic follow-up
2.Fracture reduction and casting by the E.D. physician
3.Orthopedic consultation for possible open reduction and internal fixation (ORIF)
4.CT scan of the elbow
5.Splinting and hospital admission for neurovascular checks - 3.Orthopedic consultation
for possible open reduction and internal fixation (ORIF)
A 7 year old boy falls off his bike onto his outstretched arm and sustains a supracondylar
fracture. The fracture originates in the metaphysis and a portion of it extends into the physis
(growth plate) without extending through to the epiphysis. How is this fracture classified?
Answers:
1.Salter I
2.Salter II
, 3.Salter III
4.Salter IV
5.Salter V - 2.Salter II
A mother brings her 3 year old daughter into the emergency department for an arm injury.
The mother was holding her hand to cross a busy street. She pulled hard on her daughter's
arm to hurry across the street and the child began to cry. Since the incident the child has kept
her arm against her body in a slightly flexed and pronated position. She is tender over the
radial head and refuses to move her elbow, but there is no swelling or ecchymosis. What is
the most appropriate management for this girl?
Answers:
1.Obtain immediate X-rays of the elbow to rule out fracture
2.Obtain immediate orthopaedic consult for presumed elbow dislocation
3.Apply posterior elbow splint and follow-up with orthopedics within one day
4.Apply pressure to the radial head while flexing and supinating elbow
5.Apply traction to elbow and splint under conscious sedation - 4.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?
Answers:
All of the following are generally accepted indications for endotracheal intubation of the
pediatric trauma patient, EXCEPT:
Answers:
1.respiratory failure from hypoxia or hypoventilation
2.gastric distension due to excessive volume or rate of ventilation impairing ventilatory
function
3.GCS score less than or equal 9, to secure airway and provide controlled hyperventilation
4.any trauma patient in decompensated shock and resistant to initial fluid resuscitation
5.any inability to ventilate by bag-valve-mask methods or the need for prolonged control of
the airway - 2.gastric distension due to excessive volume or rate of ventilation
impairing ventilatory function
Regarding pediatric head injury, all the following are true EXCEPT:
Answers:
1.Head trauma is the leading cause of death among injured children.
2.A child's cranial vault is larger and heavier in proportion to its total body mass than an
adult's.
3.Pediatric epidural hematomas are venous in origin.
,4.A brief seizure occurring immediately after the insult, with rapid return to normal level of
consciousness is usually unassociated with intracranial parenchymal injury.
5.Retinal hemorrhages are a common finding in mild-moderate trauma. - 5.Retinal
hemorrhages are a common finding in mild-moderate trauma.
An 8 year old boy falls off his bike onto his outstretched hand with his elbow in extension. He
presents to the emergency department with obvious anterior bowing of his distal humerus.
His distal neurovascular exam is intact. The X-ray shows a transverse supracondylar humerus
fracture with dorsal displacement and angulation of the distal fragment. Of the following,
which is the most appropriate treatment?
Answers:
1.Splinting the extremity in its current position, and arranging for orthopedic follow-up
2.Fracture reduction and casting by the E.D. physician
3.Orthopedic consultation for possible open reduction and internal fixation (ORIF)
4.CT scan of the elbow
5.Splinting and hospital admission for neurovascular checks - 3.Orthopedic consultation
for possible open reduction and internal fixation (ORIF)
A 7 year old boy falls off his bike onto his outstretched arm and sustains a supracondylar
fracture. The fracture originates in the metaphysis and a portion of it extends into the physis
(growth plate) without extending through to the epiphysis. How is this fracture classified?
Answers:
1.Salter I
2.Salter II
, 3.Salter III
4.Salter IV
5.Salter V - 2.Salter II
A mother brings her 3 year old daughter into the emergency department for an arm injury.
The mother was holding her hand to cross a busy street. She pulled hard on her daughter's
arm to hurry across the street and the child began to cry. Since the incident the child has kept
her arm against her body in a slightly flexed and pronated position. She is tender over the
radial head and refuses to move her elbow, but there is no swelling or ecchymosis. What is
the most appropriate management for this girl?
Answers:
1.Obtain immediate X-rays of the elbow to rule out fracture
2.Obtain immediate orthopaedic consult for presumed elbow dislocation
3.Apply posterior elbow splint and follow-up with orthopedics within one day
4.Apply pressure to the radial head while flexing and supinating elbow
5.Apply traction to elbow and splint under conscious sedation - 4.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?
Answers:
