SAEM EXAM QUESTIONS ACTUAL EXAM 400 REAL EXAM QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS), SAEM Practice 2020

SAEM EXAM QUESTIONS 2024-2025
ACTUAL EXAM 400 REAL EXAM
QUESTIONS AND CORRECT
DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) ,
SAEM Practice 2020
"WhichA2coronaryA2vesselA2isA2usuallyA2theA2causeA2ofA2theA2myocardialA2infarctionA2inA2a
A2patientA2withA2STA2elevationA2inA2V1,A2V2,A2andA2V3?
A2A.A2leftA2anteriorA2descendingA2(LAD)
A2B.A2leftA2circumflexA2artery
A2C.A2posteriorA2descendingA2branchA2ofA2theA2rightA2coronaryA2artery
A2D.A2rightA2coronaryA2arteryA2(RCA)
A2E.A2rightA2ventricularA2branchA2ofA2theA2rightA2coronaryA2artery"A2-
A2Ans--"A.A2leftA2anteriorA2descendingA2(LAD)


TheA2answerA2isA2A.A2ThisA2EKGA2patternA2isA2consistentA2withA2thatA2ofA2anteriorA2wallA2
myocardialA2infarctionA2(MI).A2TheA2LADA2suppliesA2theA2anteriorA2wallA2ofA2theA2myocardi
um.A2TheA2leftA2circumflexA2artery,A2theA2LAD,A2orA2aA2branchA2ofA2theA2RCAA2suppliesA2t
heA2lateralA2wallA2ofA2theA2leftA2ventricle.A2ProximalA2occlusionA2ofA2theA2LADA2willA2giveA2
STA2elevationA2inA2leadsA2V1-
6,A2aVLA2andA2IA2(anA2anterolateralA2MI).A2OcclusionA2ofA2aA2branchA2ofA2theA2RCAA2willA2r
esultA2inA2anA2inferolateralA2MIA2(STA2elevationA2inA2leadsA2II,A2III,A2aVFA2andA2I,A2aVL,A2V
5A2andA2V6).A2TheA2RCAA2suppliesA2theA2inferiorA2wallA2andA2SAA2node.A2OcclusionA2inA2l
eadsA2II,A2IIIA2andA2aVFA2causesA2anA2inferiorA2MI.A2TheA2rightA2ventricleA2isA2usuallyA2sup
pliedA2byA2theA2RCAA2or,A2lessA2commonly,A2aA2dominantA2leftA2circumflex.A2STA2elevatio
nA2inA2leadsA2V4A2andA2V5A2ofA2aA2right-
sideA2leadsA2EKGA2suggestsA2infarctionA2ofA2theA2rightA2ventricle.A2AA2posteriorA2MIA2(STA
2depressionA2inA2V1-
V3)A2resultsA2fromA2occlusionA2ofA2theA2RCA,A2itsA2posteriorA2descendingA2branch,A2orA2a
A2dominantA2leftA2circumflex."


"AA251-year-oldA2maleA2withA2long-
standingA2hypertensionA2presentsA2withA2abruptA2onsetA2ofA2severeA2chestA2painA2radiatin
gA2toA2theA2back.A2HeA2describesA2aA2tearingA2sensation.A2VitalA2signsA2areA2HRA2110,A2B
PA2175/105,A2RRA220,A2TA237.4.A2EKGA2showsA2LVH.A2CBC,A2electrolytes,A2BUN/
CreatinineA2areA2allA2normal.A2CXRA2isA2asA2shownA2below.A2WhatA2diagnosticA2testA2wou
ldA2beA2mostA2appropriateA2forA2makingA2aA2definitiveA2diagnosisA2atA2thisA2time?
[imageA2showsA2CXRA2w/A2wideA2mediastinum]

,A2A.A2MRIA2ofA2theA2thoracicA2spine
A2B.A2Aortogram
A2C.A2CTA2ofA2theA2chestA2withA2IVA2contrast
A2D.A2EsophagramA2usingA2Gastrograffin"A2-
A2Ans--"C.A2CTA2ofA2theA2chestA2withA2IVA2contrast


"CTA2ofA2theA2chestA2isA2theA2testA2mostA2oftenA2usedA2toA2confirmA2theA2diagnosisA2ofA2ao
rticA2dissection.A2CTA2isA2readilyA2availableA2inA2mostA2EmergencyA2Departments,A2andA2
hasA2aA2sensitivityA2ofA283-98%A2andA2specificityA2ofA287-
100%A2forA2aorticA2dissectionA2(highestA2accuracyA2withA2helicalA2scans).A2OtherA2benefit
sA2associatedA2withA2theA2useA2ofA2CTA2includeA2theA2abilityA2toA2identifyA2intramuralA2thro
mbus,A2pericardialA2effusion,A2andA2potentiallyA2revealA2anotherA2etiologyA2forA2theA2patie
nt'sA2pain.A2TheA2majorA2disadvantageA2ofA2CTA2isA2theA2needA2forA2iodinatedA2contrast,A2
whichA2requiresA2normalA2renalA2function.""

"AA260A2yearA2oldA2maleA2presentedA2toA2theA2emergencyA2departmentA2withA2chestA2pain
.A2HeA2subsequentlyA2becameA2unresponsive.A2TheA2monitorA2showsA2theA2rhythmA2belo
w.A2TheA2rhythmA2is:
[imageA2monomorphicA2wideA2QRSA2tachycardiaA2withA2noA2pA2waves]
A2A.A2sinusA2tachycardia
A2B.A2ventricularA2tachycardia
A2C.A2atrialA2fibrillationA2withA2rapidA2ventricularA2response
A2D.A2atrialA2flutter"A2-A2Ans--"B.A2ventricularA2tachycardia


TheA2answerA2isA2B.A2VentricularA2tachycardiaA2isA2wideA2andA2complex.A2ItA2isA2distinguis
hedA2fromA2supraventricularA2tachycardiaA2byA2widthA2andA2morphologyA2ofA2theA2QRSA2c
omplexes.A2(ThoughA2thereA2areA2numerousA2exceptions,A2supraventricularA2tachycardia
sA2usuallyA2exhibitA2narrowA2QRSA2complexesA2withA2morphologyA2similarA2toA2thatA2whe
nA2theA2patientA2isA2inA2sinusA2rhythm.)"

"AA264A2yearA2oldA2femaleA2presentsA2toA2theA2emergencyA2departmentA2withA2chiefA2com
plaintsA2ofA2occipitalA2headacheA2andA2chestA2pain.A2PhysicalA2examinationA2revealsA2aA2
bloodA2pressureA2ofA2200/118A2asA2wellA2asA2edemaA2ofA2theA2opticA2disk.A2OfA2theA2diagn
osesA2below,A2theA2mostA2likelyA2is:
A2A.A2hypertensiveA2crisis
A2B.A2acuteA2hypertensiveA2(non-emergency/non-urgency) A2episode
A2C.A2hypertensiveA2urgency
A2D.A2moderateA2hypertension
A2E.A2white-coatA2hypertension"A2-A2Ans--"A.A2hypertensiveA2crisis


TheA2answerA2isA2A.A2ElevatedA2bloodA2pressureA2inA2theA2settingA2ofA2opticA2diskA2edem
aA2isA2aA2hallmarkA2ofA2malignantA2hypertensionA2(alsoA2knownA2asA2hypertensiveA2emerg
encyA2orA2hypertensiveA2crisis).A2WhileA2hypertensiveA2urgencyA2isA2notA2consistentlyA2de
finedA2inA2theA2medicalA2literature,A2thisA2patient'sA2presentationA2indicatesA2thatA2thereA2i
sA2someA2end-
organA2damageA2andA2thusA2theA2diagnosisA2isA2malignantA2hypertension.A2TheA2white-

,coat""A2syndrome,A2inA2whichA2patients'A2bloodA2pressuresA2areA2elevatedA2onlyA2inA2theA2
clinicalA2settingA2andA2notA2atA2home,A2hasA2beenA2shownA2toA2accountA2forA2asA2manyA2a
sA2aA2fifthA2ofA2allA2casesA2ofA2newlyA2diagnosedA2""hypertension.""A2UnderstandingA2ofA2t
hisA2phenomenomA2isA2importantA2forA2emergencyA2physicians,A2sinceA2itsA2frequencyA2e
xplainsA2whyA2patientsA2shouldA2notA2beA2givenA2aA2diagnosisA2ofA2new-
onsetA2hypertensionA2basedA2onA2E.D.A2measurements."""

"AA214A2yearA2oldA2presentsA2justA2afterA2smokingA2crackA2cocaineA2andA2complainsA2ofA2
chestA2pain.A2HeA2describesA2itA2asA2sharpA2andA2stabbingA2inA2theA2middleA2ofA2hisA2ches
t.A2HisA2EKGA2isA2normal.A2TheA2internA2readsA2theA2CXRA2asA2"negative"A2butA2yourA2sup
ervisingA2residentA2asksA2youA2toA2haveA2anotherA2lookA2(seeA2Figure),A2afterA2whichA2yo
uA2makeA2theA2diagnosisA2of:
[image:A2bigA2roundA2heart,A2blackA2inA2mediastinum,A2widened]
photoA2courtesyA2ofA2eMedicine.com
A2A.A2Pneumonia
A2B.A2AorticA2dissection
A2C.A2CongestiveA2heartA2failure
A2D.A2Pneumomediastinum" A2-A2Ans--"D.A2Pneumomediastinum


TheA2answerA2isA2D.A2LookA2closelyA2alongA2theA2rightA2heartA2borderA2andA2mediastinum
.A2ThereA2isA2aA2thinA2stripA2ofA2air.A2PneumomediastinumA2andA2pneumopericardiumA2re
sultA2fromA2ValsalvaA2maneuvers,A2barotrauma,A2asthma,A2andA2cocaineA2inhalationA2fro
mA2positiveA2pressureA2devices.A2OnA2physicalA2examA2thereA2mayA2beA2aA2Hamman'sA2s
ignA2orA2mediastinalA2crunchA2heardA2overA2theA2precordium.A2Westermark'sA2signA2isA2dil
ationA2ofA2pulmonaryA2vesselsA2proximalA2toA2aA2pulmonaryA2embolismA2resultingA2inA2aA2
cut-offA2appearanceA2ofA2theA2vesselA2onA2CXR."

"AA222A2yearA2oldA2presentsA2withA2chestA2painA2andA2theA2followingA2EKG:

[image:A2SeptalA2STA2elevations]

HeA2reportsA2noA2pastA2medicalA2historyA2andA2noA2familyA2historyA2ofA2medicalA2problem
s.A2WhichA2substanceA2shouldA2youA2specificallyA2questionA2himA2aboutA2using?

A2A.A2Cocaine
A2B.A2Heroin
A2C.A2Methamphetamine
A2D.A2Ecstasy"A2-A2Ans--"A.A2Cocaine


TheA2answerA2isA2A.A2CocaineA2toxicityA2canA2causeA2aA2varietyA2ofA2cardiovascularA2seq
uelaeA2including:A2cardiacA2dysrhythmias,A2coronaryA2arteryA2vasospasm,A2myocardial
ischemia/infarction,A2andA2aorticA2dissection.A2TheA2centralA2nervousA2systemA2isA2also
commonlyA2involvedA2withA2seizures,A2intracranialA2hemorrhages/infarctionsA2and
hypertensiveA2encephalopathyA2beingA2common.A2MesentericA2ischemiaA2canA2occurA2as
A2well
asA2rhabdomyolysis."

, "GenerallyA2speaking,A2aA2patientA2withA2aA2TIAA2historyA2whoA2presentsA2withA2aA2newA2s
troke,A2likelyA2hasA2whichA2kindA2ofA2stroke?
A2A.A2thereA2isA2equalA2likelihoodA2forA2anyA2strokeA2type
A2B.A2embolic
A2C.A2hypoperfusion
A2D.A2thrombotic
A2E.A2hemorrhagic"A2-A2Ans--"D.A2thrombotic


TheA2answerA2isA2D.A2TIAsA2areA2associatedA2withA2increasedA2riskA2forA2thromboticA2str
A2
okes,A2theA2resultA2ofA2ulcerationA2ofA2cerebralA2arteryA2plaque.A2PatientsA2withA2TIAA2hav
eA2aA25A2toA26%A2percentA2chanceA2perA2yearA2ofA2havingA2aA2stroke.A2AntiplateletA2thera
pyA2reducesA2riskA2ofA2strokeA2inA2theseA2patients."

"WhichA2ofA2theA2followingA2isA2notA2aA2knownA2complicationA2ofA2subarachnoidA2hemorrh
ageA2inA2theA2immediateA2severalA2weeksA2followingA2theA2initialA2bleed?
A2A.A2rebleeding
A2B.A2seizure
A2C.A2cerebralA2arteryA2vasospasm
A2D.A2hypernatremia
A2E.A2hydrocephalus"A2-A2Ans--"D.A2hypernatremia"


"AA236A2yearA2oldA2womanA2presentsA2toA2theA2emergencyA2departmentA2twoA2hoursA2afte
rA2theA2suddenA2onsetA2ofA2aA2severeA2occipitalA2headacheA2andA2nausea.A2SheA2hasA2aA
2historyA2ofA2migraineA2headachesA2thatA2typicallyA2occurA2inA2theA2rightA2frontalA2areaA2a
ndA2areA2associatedA2withA2anA2aura.A2HerA2temperatureA2isA298.8A2degreesA2Fahrenheit,
A2herA2neckA2isA2supple,A2andA2herA2neurologicalA2examA2isA2normal.A2AA2non-
contrastA2CTA2scanA2ofA2herA2headA2isA2normal.A2OfA2theA2optionsA2below,A2whatA2isA2theA
2nextA2stepA2inA2herA2management?
A2A.A2PerformA2aA2lumbarA2punctureA2toA2ruleA2outA2theA2possibilityA2ofA2subarachnoidA2he
morrhage.
A2B.A2ObserveA2forA26A2hours,A2administerA2acetaminophenA2andA2normalA2saline,A2andA2
dischargeA2homeA2ifA2sheA2feelsA2better.
A2C.A2ConsultA2aA2neurologistA2forA2evaluationA2ofA2atypicalA2migraines.
A2D.A2ObserveA2forA26A2hoursA2andA2thenA2obtainA2aA2repeatA2CTA2scan;A2ifA2normal,A2disc
hargeA2home.
A2E.A2DischargeA2herA2homeA2withA2prochlorperazineA2andA2closeA2instructionsA2toA2return
A2ifA2herA2symptomsA2worsen."A2-
A2Ans--"A.A2PerformA2aA2lumbarA2punctureA2toA2ruleA2outA2theA2possibilityA2ofA2subarachno
idA2hemorrhage.

TheA2answerA2isA2A.A2SuddenA2onsetA2headacheA2withA2nausea,A2vomiting,A2photophobia
,A2orA2neckA2stiffnessA2shouldA2raiseA2theA2concernA2forA2spontaneousA2subarachnoidA2he
morrhage.A2SensitivityA2ofA2aA2non-
contrastA2CTA2scanA2variesA2withA2respectA2toA2manyA2factorsA2(e.g.A2timeA2sinceA2bleed)A
2butA2isA2generallyA2inA2theA2rangeA2ofA290%;A2therefore,A2ifA2theA2clinicalA2suspicionA2isA2h