SAEM M4 Final Exam 2025/2026 |
1
Society for Academic Emergency
Medicine M4 Clerkship Final Exam
which cardiac marker is most senstive - 100 correct answer as-
troponin I
-dectable in serum 3-6h after an MI
-eleveated for 14d
card enzymme table - 100 correct answer as-
define ST elevations - 100 correct answer as-1mm or more in 2
contiguous limb leads
-2 mm elevatios in precordial leads
unstable angina risk scores - 100 correct answer as--TIMI
-UA/NSTEMI
if need to control HR or BP in ACS what use - 100 correct answer
as-beta blocker
ACS 2 therapies needed - 100 correct answer as--heparin
-antiplatelet
dissection gender - 100 correct answer as-2-3x more common in
men
4 genetic syndrmes that risk dissection - 100 correct answer as-
=marfan
-ehlers danlos
-turner
-loeys-dietz
,2
stanford classificaiton of dissections - 100 correct answer as--type
A=ascending
-type B=descending
debakey classification - 100 correct answer as--splits type A into I
and II
-I involves ascending and descending aorta.
-II involves just the ascending
III=just descending
dissection pathophys - 100 correct answer as-tear in aortic intima
permits entry of blood into the media
-pulsatile tear propagates along
when is BP different enough in arms for dissection - 100 correct
answer as-over 20 different in SBP
cxr signs of dissection 6 - 100 correct answer as--wide
mediastinum >8cm at aortic knob
-abnormal aortic or cardiac contour
-apical pleural cap
-displaced intimal calcification
-paratracheal stripe >5mm
-opacified aortopulm window
BP in dissection - 100 correct answer as--HTN unless
complications like horrhage or cardiogenic shock have occurred
-ascending more likely hypotension
-descending more liekly HTN
dissection incidence of neuro deficits - 100 correct answer as-1/6
how often see pulse deficits dissection? murmur? - 100 correct
answer as--15-30% (2 fold more common in A than B)
, -murmur in under 30%
3
type A v. type B based on hx - 100 correct answer as--type A
more likely to cause chest pain or syncope and less liekly to
cause back or abd pain
defintive study for dissection - 100 correct answer as-CTA
EKG in dissection - 100 correct answer as--1/3 have normal
tracing
-5% look like STEMI
tx type A - 100 correct answer as-emergent surgical repair
goal of dissection mgmt - 100 correct answer as--keep both the
heart rate and BP as low as possible while still ensuring end
organ perfusion
-use beta blockers to reduce rate to 60 or less
-if after BB BP is over 120, then use vasodilators
which beta blocker use? why - 100 correct answer as-esmolol bc
short acting and titratable
which vasodilator use - 100 correct answer as-nitroprusside or
nicardipine
surgical indications for type B - 100 correct answer as--end organ
damage
-HTN refractory to meds
-dissection propagating
-aneurysmal expansion of aorta
when giving thrombolytics in stemi what must document? - 100
correct answer as--why low suspicion for dissection (normal
, mediastinum, no upper extrem BP difference, equal pulses
4
everywhere, no neuro findings, no mumrmu, no back pain)
order of meds is imp - 100 correct answer as--beta block than
vasodilate (reflex tachycardia)
why get chf exacerbation - 100 correct answer as--heart has no
reserve to compensate for some increased burden or demand
name of classification of chf - 100 correct answer as-NYHA
the classes of CHF by NYHA - 100 correct answer as-1: ordinary
activity, not limited by symptoms
2: ordinary activity leads to dyspnea and fatigue
3: marked limitation of ordinary activity
IV: sx at rest or any physical activity
systolic dysfxn - 100 correct answer as-dialted LV with impaired
contraciltiy
causes of systolic dyxfxn - 100 correct answer as--ischemia
-cardiomyopathy
-myocarditis
-dysrhythmias
diastolic dysfxn - 100 correct answer as-LV has impared ability to
realx (ex: infiltrative cardiomyopathy
very sensitive signs chf - 100 correct answer as--exertional
dyspnea
-orthopnea
JVD measurement - 100 correct answer as->4cm
1
Society for Academic Emergency
Medicine M4 Clerkship Final Exam
which cardiac marker is most senstive - 100 correct answer as-
troponin I
-dectable in serum 3-6h after an MI
-eleveated for 14d
card enzymme table - 100 correct answer as-
define ST elevations - 100 correct answer as-1mm or more in 2
contiguous limb leads
-2 mm elevatios in precordial leads
unstable angina risk scores - 100 correct answer as--TIMI
-UA/NSTEMI
if need to control HR or BP in ACS what use - 100 correct answer
as-beta blocker
ACS 2 therapies needed - 100 correct answer as--heparin
-antiplatelet
dissection gender - 100 correct answer as-2-3x more common in
men
4 genetic syndrmes that risk dissection - 100 correct answer as-
=marfan
-ehlers danlos
-turner
-loeys-dietz
,2
stanford classificaiton of dissections - 100 correct answer as--type
A=ascending
-type B=descending
debakey classification - 100 correct answer as--splits type A into I
and II
-I involves ascending and descending aorta.
-II involves just the ascending
III=just descending
dissection pathophys - 100 correct answer as-tear in aortic intima
permits entry of blood into the media
-pulsatile tear propagates along
when is BP different enough in arms for dissection - 100 correct
answer as-over 20 different in SBP
cxr signs of dissection 6 - 100 correct answer as--wide
mediastinum >8cm at aortic knob
-abnormal aortic or cardiac contour
-apical pleural cap
-displaced intimal calcification
-paratracheal stripe >5mm
-opacified aortopulm window
BP in dissection - 100 correct answer as--HTN unless
complications like horrhage or cardiogenic shock have occurred
-ascending more likely hypotension
-descending more liekly HTN
dissection incidence of neuro deficits - 100 correct answer as-1/6
how often see pulse deficits dissection? murmur? - 100 correct
answer as--15-30% (2 fold more common in A than B)
, -murmur in under 30%
3
type A v. type B based on hx - 100 correct answer as--type A
more likely to cause chest pain or syncope and less liekly to
cause back or abd pain
defintive study for dissection - 100 correct answer as-CTA
EKG in dissection - 100 correct answer as--1/3 have normal
tracing
-5% look like STEMI
tx type A - 100 correct answer as-emergent surgical repair
goal of dissection mgmt - 100 correct answer as--keep both the
heart rate and BP as low as possible while still ensuring end
organ perfusion
-use beta blockers to reduce rate to 60 or less
-if after BB BP is over 120, then use vasodilators
which beta blocker use? why - 100 correct answer as-esmolol bc
short acting and titratable
which vasodilator use - 100 correct answer as-nitroprusside or
nicardipine
surgical indications for type B - 100 correct answer as--end organ
damage
-HTN refractory to meds
-dissection propagating
-aneurysmal expansion of aorta
when giving thrombolytics in stemi what must document? - 100
correct answer as--why low suspicion for dissection (normal
, mediastinum, no upper extrem BP difference, equal pulses
4
everywhere, no neuro findings, no mumrmu, no back pain)
order of meds is imp - 100 correct answer as--beta block than
vasodilate (reflex tachycardia)
why get chf exacerbation - 100 correct answer as--heart has no
reserve to compensate for some increased burden or demand
name of classification of chf - 100 correct answer as-NYHA
the classes of CHF by NYHA - 100 correct answer as-1: ordinary
activity, not limited by symptoms
2: ordinary activity leads to dyspnea and fatigue
3: marked limitation of ordinary activity
IV: sx at rest or any physical activity
systolic dysfxn - 100 correct answer as-dialted LV with impaired
contraciltiy
causes of systolic dyxfxn - 100 correct answer as--ischemia
-cardiomyopathy
-myocarditis
-dysrhythmias
diastolic dysfxn - 100 correct answer as-LV has impared ability to
realx (ex: infiltrative cardiomyopathy
very sensitive signs chf - 100 correct answer as--exertional
dyspnea
-orthopnea
JVD measurement - 100 correct answer as->4cm
