SAEM M4 EXAM QUESTIONS AND
CORRECT ANSWERS
TrueA2orA2False:A2gastricA2distensionA2dueA2toA2excessiveA2volumeA2orA2rateA2ofA2ventilati
onA2impairingA2ventilatoryA2functionA2isA2aA2reasonA2toA2intubateA2aA2neonateA2-A2Ans--
False
managementA2forA2nursemaidA2elbowA2injuryA2-A2Ans--
applyA2pressureA2toA2theA2radialA2headA2whileA2flexingA2andA2supinatingA2elbow
AA217A2yearA2oldA2boyA2injuredA2hisA2rightA2shoulderA2playingA2football.A2HeA2triedA2toA2ar
m-
tackleA2aA2playerA2whenA2hisA2rightA2armA2wasA2pulledA2awayA2fromA2hisA2bodyA2andA2bac
kA2(abductedA2andA2extended).A2HeA2feltA2aA2suddenA2painA2inA2hisA2shoulder.A2HeA2prese
ntsA2toA2theA2emergencyA2departmentA2holdingA2hisA2armA2inA2slightA2abductionA2andA2ext
ernalA2rotationA2byA2hisA2goodA2arm.A2HeA2hasA2severeA2painA2withA2adductionA2orA2intern
alA2rotation.A2WhatA2isA2theA2mostA2commonA2fractureA2associatedA2withA2thisA2injury?A2-
A2Ans--
compressionA2fractureA2ofA2theA2posteriolateralA2aspectA2ofA2theA2humeralA2headA2(Hill-
SachsA2deformity)
WhatA2areA2mostA2commonA2heartA2rhythmsA2seenA2inA2pediatricA2arrest?A2-A2Ans--
bradycardiaA2orA2asystole
riskA2factorsA2forA2neonatalA2resuscitationA2-A2Ans--prematurity
IUGR
multipleA2gestation
thickA2meconium
InA2theA2post-
arrestA2setting,A2whichA2ofA2theA2followingA2isA2theA2drugA2ofA2choiceA2inA2treatingA2hypote
nsionA2inA2aA2child:A2-A2Ans--epi
LowA2bodyA2temperaturesA2inA2newbornsA2canA2leadA2toA2severeA2physiologicA2conseque
nces,A2whichA2includeA2allA2EXCEPT:
Answers:
1.A2metabolicA2acidosis
2.A2increasedA2oxygenA2consumption
3.A2hypoglycemia
4.A2apnea
5.A2hyperglycemiaA2-A2Ans--3.A2hypoglycemia
,InA2aA2newborn,A2bradycardiaA2isA2mostA2commonlyA2anA2indicatorA2of:A2-A2Ans--
hypoxemia
AllA2theA2followingA2areA2signsA2ofA2hypoxemiaA2inA2aA2newborn,A2EXCEPT:
Answers:
1.cyanosis
2.lethargy
3.tachycardia
4.unresponsiveness
5.bradycardiaA2-A2Ans--3.A2tachycardia
AA2newbornA2presentsA2toA2theA2emergencyA2departmentA2aA2fewA2daysA2afterA2hospitalA2
discharge.A2TheA2infantA2hasA2beenA2notedA2toA2beA2drooling,A2choking,A2andA2coughing,A
2andA2theA2motherA2reportsA2seeingA2bubblesA2atA2theA2baby'sA2mouth.A2WhichA2isA2theA2
mostA2likelyA2explanation?
Answers:
1.osteogenesisA2imperfecta
2.inbornA2errorA2ofA2metabolism
3.congenitalA2diaphragmaticA2hernia
4.foreignA2body
5.tracheoesophagealA2fistulaA2-A2Ans--5.A2tracheoesophagealA2fistula
WhichA2ofA2theA2followingA2pairsA2ofA2maneuversA2areA2consistentA2withA2currentA2recom
mendationsA2forA2emergencyA2careA2forA2aA2chokingA25-month-oldA2infant?
Answers:
1.backA2blowA2thenA2blindA2fingerA2sweep
2.backA2blowA2thenA2chestA2thrust
3.chestA2thrustA2thenA2HeimlichA2maneuver
4.HeimlichA2maneuverA2thenA2blindA2fingerA2sweep
5.HeimlichA2maneuverA2thenA2chestA2thrustA2-A2Ans--2.backA2blowA2thenA2chestA2thrust
AllA2ofA2theseA2stepsA2areA2involvedA2inA2pediatricA2rapidA2sequenceA2intubationA2(RSI)A2E
XCEPT:
Answers:
1.IfA2administeringA2succinylcholine,A2pretreatmentA2withA2atropineA2isA2alwaysA2indicated
A2inA2childrenA2underA2ageA210.
2.LidocaineA2pretreatmentA2isA2usuallyA2providedA2toA2childrenA2withA2headA2trauma.
3.WhenA2decidingA2whichA2sizeA2endotrachealA2tubeA2toA2use,A2oneA2mayA2approximateA2
byA2usingA2theA2sizeA2ofA2theA2smallA2fingerA2orA2naresA2asA2aA2reference.
4.DueA2toA2theA2fragilityA2ofA2theA2pediatricA2C-
spine,A2aA2cervicalA2collarA2shouldA2alwaysA2beA2placedA2priorA2toA2intubationA2forA2childre
nA2underA2ageA2ten.
,5.UncuffedA2endotrachealA2tubesA2areA2theA2preferredA2devicesA2usedA2inA2childrenA2und
erA26-8A2yearsA2ofA2age.A2-A2Ans--4.DueA2toA2theA2fragilityA2ofA2theA2pediatricA2C-
spine,A2aA2cervicalA2collarA2shouldA2alwaysA2beA2placedA2priorA2toA2intubationA2forA2childre
nA2underA2ageA2ten.
AA223A2yearA2oldA2womanA2isA2droppedA2offA2byA2herA2boyfriendA2afterA2anA2unknownA2ov
erdose.A2YouA2noticeA2thatA2sheA2isA2hasA2veryA2largeA2pupilsA2andA2isA2sweatingA2profus
ely.A2HerA2respiratoryA2rate,A2bloodA2pressureA2andA2heartA2rateA2areA2elevated.A2WhichA2
ofA2theA2followingA2isA2theA2mostA2likelyA2agentA2toA2haveA2causedA2herA2symptoms?
Answers:
1.JimsonA2weed
2.Cocaine
3.Heroin
4.InsulinA2-A2Ans--2.A2cocaine
AA2motherA2bringsA2inA2herA24A2yearA2oldA2childA2whoA2wasA2happilyA2eatingA2"blackberrie
s"A2fromA2weedsA2inA2theA2gardenA2andA2isA2nowA2actingA2strangely.A2SheA2hasA2identified
A2themA2asA2BelladonnaA2fromA2aA2quickA2internetA2search.A2WhichA2physicalA2examinatio
nA2findingA2mightA2youA2alsoA2expectA2toA2findA2inA2thisA2child?
Answers:
1.Diaphoresis
2.FlushedA2skin
3.Miosis
4.UrinaryA2incontinenceA2-A2Ans--2.A2flushedA2skin
ForA2whichA2ofA2theA2followingA2casesA2isA2activatedA2charcoalA2therapyA2mostA2appropria
te?
Answers:
1.AcetaminophenA2overdose
2.DrainA2cleanerA2ingestion
3.IronA2supplementA2overdose
4.LithiumA2overdoseA2-A2Ans--1.A2AcetaminophenA2overdose
AA245A2year-
oldA2isA2broughtA2inA28A2hoursA2afterA2aA2largeA2overdoseA2ofA2hisA2lithium.A2WhatA2isA2theA
2bestA2treatmentA2methodA2forA2thisA2overdose?
Answers:
1.ActivatedA2charcoal
2.GastricA2lavage
3.Hemodialysis
4.WholeA2bowelA2irrigationA2-A2Ans--3.Hemodialysis
, AA242A2year-
oldA2womanA2presentsA2withA2anA2overdoseA2ofA2herA2XanaxA2(alprazolam)A2thatA2herA2fa
milyA2indicatesA2sheA2hasA2beenA2takingA2forA2yearsA2toA2helpA2withA2herA2anxiety.A2TheA2
bottleA2indicatesA2thatA2theA2prescriptionA2wasA2filledA2yesterdayA2withA290A2pillsA2andA2isA
2nowA2empty.A2TheA2patientA2isA2minimallyA2responsiveA2toA2painfulA2stimuliA2andA2doesA2
notA2reactA2whenA2youA2suctionA2secretionsA2outA2ofA2herA2posteriorA2pharynx.A2WhatA2isA
2yourA2nextA2managementA2step?
Answers:
1.AdministrationA2ofA2flumazenil
2.AdministrationA2ofA2narcan
3.CloseA2observation
4.IntubationA2forA2airwayA2supportA2-A2Ans--4.IntubationA2forA2airwayA2support
AA272A2year-
oldA2presentsA2withA2anA2intentionalA2overdoseA2ofA2aA2bottleA2ofA2aspirinA2aboutA23A2hour
sA2priorA2toA2presentationA2inA2theA2ED.A2WhichA2ofA2theA2followingA2arterialA2bloodA2gasA2r
esultsA2wouldA2youA2expectA2toA2comeA2fromA2thisA2patient?
Answers:
1.pHA27.14A2pCO2A268A2pO2A2102A2HCO3A223
2.pHA27.33A2pCO2A248A2pO2A258A2HCO3A229
3.pHA27.45A2pCO2A221A2pO2A2124A2HCO3A214
4.pHA27.47A2pCO2A231A2pO2A296A2HCO3A225A2-A2Ans--
3.pHA27.45A2pCO2A221A2pO2A2124A2HCO3A214
AA2teenagerA2presentsA2oneA2hourA2afterA2ingestingA2aA2"handful"A2ofA2acetaminophenA2t
ablets.A2WhichA2ofA2theA2followingA2statementsA2isA2TRUE?
Answers:
1.AnA2acetaminophenA2levelA2drawnA2atA2hourA2fourA2dictatesA2needA2forA2antidotalA2thera
py.
2.SerialA2liverA2functionA2testsA2areA2indicatedA2inA2allA2acetaminophenA2ingestions.
3.RenalA2sequelaeA2areA2expected.
4.TheA2intravenousA2formulationA2ofA2N-acetylcysteineA2isA2saferA2thanA2oralA2N-
acetylcysteine.A2-A2Ans--
1.AnA2acetaminophenA2levelA2drawnA2atA2hourA2fourA2dictatesA2needA2forA2antidotalA2thera
py.
AA22A2yearA2oldA2childA2presentsA2withA2anA2overdoseA2ofA2herA2mother'sA2ironA2containing
A2multivitamins.A2WhatA2antidoteA2shouldA2youA2considerA2forA2ironA2toxicity?
Answers:
1.Deferoxamine
2.Glucagon
3.MethyleneA2blue
CORRECT ANSWERS
TrueA2orA2False:A2gastricA2distensionA2dueA2toA2excessiveA2volumeA2orA2rateA2ofA2ventilati
onA2impairingA2ventilatoryA2functionA2isA2aA2reasonA2toA2intubateA2aA2neonateA2-A2Ans--
False
managementA2forA2nursemaidA2elbowA2injuryA2-A2Ans--
applyA2pressureA2toA2theA2radialA2headA2whileA2flexingA2andA2supinatingA2elbow
AA217A2yearA2oldA2boyA2injuredA2hisA2rightA2shoulderA2playingA2football.A2HeA2triedA2toA2ar
m-
tackleA2aA2playerA2whenA2hisA2rightA2armA2wasA2pulledA2awayA2fromA2hisA2bodyA2andA2bac
kA2(abductedA2andA2extended).A2HeA2feltA2aA2suddenA2painA2inA2hisA2shoulder.A2HeA2prese
ntsA2toA2theA2emergencyA2departmentA2holdingA2hisA2armA2inA2slightA2abductionA2andA2ext
ernalA2rotationA2byA2hisA2goodA2arm.A2HeA2hasA2severeA2painA2withA2adductionA2orA2intern
alA2rotation.A2WhatA2isA2theA2mostA2commonA2fractureA2associatedA2withA2thisA2injury?A2-
A2Ans--
compressionA2fractureA2ofA2theA2posteriolateralA2aspectA2ofA2theA2humeralA2headA2(Hill-
SachsA2deformity)
WhatA2areA2mostA2commonA2heartA2rhythmsA2seenA2inA2pediatricA2arrest?A2-A2Ans--
bradycardiaA2orA2asystole
riskA2factorsA2forA2neonatalA2resuscitationA2-A2Ans--prematurity
IUGR
multipleA2gestation
thickA2meconium
InA2theA2post-
arrestA2setting,A2whichA2ofA2theA2followingA2isA2theA2drugA2ofA2choiceA2inA2treatingA2hypote
nsionA2inA2aA2child:A2-A2Ans--epi
LowA2bodyA2temperaturesA2inA2newbornsA2canA2leadA2toA2severeA2physiologicA2conseque
nces,A2whichA2includeA2allA2EXCEPT:
Answers:
1.A2metabolicA2acidosis
2.A2increasedA2oxygenA2consumption
3.A2hypoglycemia
4.A2apnea
5.A2hyperglycemiaA2-A2Ans--3.A2hypoglycemia
,InA2aA2newborn,A2bradycardiaA2isA2mostA2commonlyA2anA2indicatorA2of:A2-A2Ans--
hypoxemia
AllA2theA2followingA2areA2signsA2ofA2hypoxemiaA2inA2aA2newborn,A2EXCEPT:
Answers:
1.cyanosis
2.lethargy
3.tachycardia
4.unresponsiveness
5.bradycardiaA2-A2Ans--3.A2tachycardia
AA2newbornA2presentsA2toA2theA2emergencyA2departmentA2aA2fewA2daysA2afterA2hospitalA2
discharge.A2TheA2infantA2hasA2beenA2notedA2toA2beA2drooling,A2choking,A2andA2coughing,A
2andA2theA2motherA2reportsA2seeingA2bubblesA2atA2theA2baby'sA2mouth.A2WhichA2isA2theA2
mostA2likelyA2explanation?
Answers:
1.osteogenesisA2imperfecta
2.inbornA2errorA2ofA2metabolism
3.congenitalA2diaphragmaticA2hernia
4.foreignA2body
5.tracheoesophagealA2fistulaA2-A2Ans--5.A2tracheoesophagealA2fistula
WhichA2ofA2theA2followingA2pairsA2ofA2maneuversA2areA2consistentA2withA2currentA2recom
mendationsA2forA2emergencyA2careA2forA2aA2chokingA25-month-oldA2infant?
Answers:
1.backA2blowA2thenA2blindA2fingerA2sweep
2.backA2blowA2thenA2chestA2thrust
3.chestA2thrustA2thenA2HeimlichA2maneuver
4.HeimlichA2maneuverA2thenA2blindA2fingerA2sweep
5.HeimlichA2maneuverA2thenA2chestA2thrustA2-A2Ans--2.backA2blowA2thenA2chestA2thrust
AllA2ofA2theseA2stepsA2areA2involvedA2inA2pediatricA2rapidA2sequenceA2intubationA2(RSI)A2E
XCEPT:
Answers:
1.IfA2administeringA2succinylcholine,A2pretreatmentA2withA2atropineA2isA2alwaysA2indicated
A2inA2childrenA2underA2ageA210.
2.LidocaineA2pretreatmentA2isA2usuallyA2providedA2toA2childrenA2withA2headA2trauma.
3.WhenA2decidingA2whichA2sizeA2endotrachealA2tubeA2toA2use,A2oneA2mayA2approximateA2
byA2usingA2theA2sizeA2ofA2theA2smallA2fingerA2orA2naresA2asA2aA2reference.
4.DueA2toA2theA2fragilityA2ofA2theA2pediatricA2C-
spine,A2aA2cervicalA2collarA2shouldA2alwaysA2beA2placedA2priorA2toA2intubationA2forA2childre
nA2underA2ageA2ten.
,5.UncuffedA2endotrachealA2tubesA2areA2theA2preferredA2devicesA2usedA2inA2childrenA2und
erA26-8A2yearsA2ofA2age.A2-A2Ans--4.DueA2toA2theA2fragilityA2ofA2theA2pediatricA2C-
spine,A2aA2cervicalA2collarA2shouldA2alwaysA2beA2placedA2priorA2toA2intubationA2forA2childre
nA2underA2ageA2ten.
AA223A2yearA2oldA2womanA2isA2droppedA2offA2byA2herA2boyfriendA2afterA2anA2unknownA2ov
erdose.A2YouA2noticeA2thatA2sheA2isA2hasA2veryA2largeA2pupilsA2andA2isA2sweatingA2profus
ely.A2HerA2respiratoryA2rate,A2bloodA2pressureA2andA2heartA2rateA2areA2elevated.A2WhichA2
ofA2theA2followingA2isA2theA2mostA2likelyA2agentA2toA2haveA2causedA2herA2symptoms?
Answers:
1.JimsonA2weed
2.Cocaine
3.Heroin
4.InsulinA2-A2Ans--2.A2cocaine
AA2motherA2bringsA2inA2herA24A2yearA2oldA2childA2whoA2wasA2happilyA2eatingA2"blackberrie
s"A2fromA2weedsA2inA2theA2gardenA2andA2isA2nowA2actingA2strangely.A2SheA2hasA2identified
A2themA2asA2BelladonnaA2fromA2aA2quickA2internetA2search.A2WhichA2physicalA2examinatio
nA2findingA2mightA2youA2alsoA2expectA2toA2findA2inA2thisA2child?
Answers:
1.Diaphoresis
2.FlushedA2skin
3.Miosis
4.UrinaryA2incontinenceA2-A2Ans--2.A2flushedA2skin
ForA2whichA2ofA2theA2followingA2casesA2isA2activatedA2charcoalA2therapyA2mostA2appropria
te?
Answers:
1.AcetaminophenA2overdose
2.DrainA2cleanerA2ingestion
3.IronA2supplementA2overdose
4.LithiumA2overdoseA2-A2Ans--1.A2AcetaminophenA2overdose
AA245A2year-
oldA2isA2broughtA2inA28A2hoursA2afterA2aA2largeA2overdoseA2ofA2hisA2lithium.A2WhatA2isA2theA
2bestA2treatmentA2methodA2forA2thisA2overdose?
Answers:
1.ActivatedA2charcoal
2.GastricA2lavage
3.Hemodialysis
4.WholeA2bowelA2irrigationA2-A2Ans--3.Hemodialysis
, AA242A2year-
oldA2womanA2presentsA2withA2anA2overdoseA2ofA2herA2XanaxA2(alprazolam)A2thatA2herA2fa
milyA2indicatesA2sheA2hasA2beenA2takingA2forA2yearsA2toA2helpA2withA2herA2anxiety.A2TheA2
bottleA2indicatesA2thatA2theA2prescriptionA2wasA2filledA2yesterdayA2withA290A2pillsA2andA2isA
2nowA2empty.A2TheA2patientA2isA2minimallyA2responsiveA2toA2painfulA2stimuliA2andA2doesA2
notA2reactA2whenA2youA2suctionA2secretionsA2outA2ofA2herA2posteriorA2pharynx.A2WhatA2isA
2yourA2nextA2managementA2step?
Answers:
1.AdministrationA2ofA2flumazenil
2.AdministrationA2ofA2narcan
3.CloseA2observation
4.IntubationA2forA2airwayA2supportA2-A2Ans--4.IntubationA2forA2airwayA2support
AA272A2year-
oldA2presentsA2withA2anA2intentionalA2overdoseA2ofA2aA2bottleA2ofA2aspirinA2aboutA23A2hour
sA2priorA2toA2presentationA2inA2theA2ED.A2WhichA2ofA2theA2followingA2arterialA2bloodA2gasA2r
esultsA2wouldA2youA2expectA2toA2comeA2fromA2thisA2patient?
Answers:
1.pHA27.14A2pCO2A268A2pO2A2102A2HCO3A223
2.pHA27.33A2pCO2A248A2pO2A258A2HCO3A229
3.pHA27.45A2pCO2A221A2pO2A2124A2HCO3A214
4.pHA27.47A2pCO2A231A2pO2A296A2HCO3A225A2-A2Ans--
3.pHA27.45A2pCO2A221A2pO2A2124A2HCO3A214
AA2teenagerA2presentsA2oneA2hourA2afterA2ingestingA2aA2"handful"A2ofA2acetaminophenA2t
ablets.A2WhichA2ofA2theA2followingA2statementsA2isA2TRUE?
Answers:
1.AnA2acetaminophenA2levelA2drawnA2atA2hourA2fourA2dictatesA2needA2forA2antidotalA2thera
py.
2.SerialA2liverA2functionA2testsA2areA2indicatedA2inA2allA2acetaminophenA2ingestions.
3.RenalA2sequelaeA2areA2expected.
4.TheA2intravenousA2formulationA2ofA2N-acetylcysteineA2isA2saferA2thanA2oralA2N-
acetylcysteine.A2-A2Ans--
1.AnA2acetaminophenA2levelA2drawnA2atA2hourA2fourA2dictatesA2needA2forA2antidotalA2thera
py.
AA22A2yearA2oldA2childA2presentsA2withA2anA2overdoseA2ofA2herA2mother'sA2ironA2containing
A2multivitamins.A2WhatA2antidoteA2shouldA2youA2considerA2forA2ironA2toxicity?
Answers:
1.Deferoxamine
2.Glucagon
3.MethyleneA2blue
