SAEM M4 LATEST 2026 CORE EXAM SET QUESTIONS AND
ANSWERS GRADED A+
✔✔Regarding the role of malignancy in the diagnosis of pulmonary embolism (PE):
Answers:
1.Hematologic malignancies such as leukemia and have the highest incidence of
venous thromboembolism
2.25% of PE patients without identifiable risk factors are diagnosed with cancer within 2
years.
3.The risk of PE is decreased in patients on chemotherapy
4.Autopsy studies indicate that greater than 60% of patients who die of ovarian cancer
have PE. - ✔✔2.25% of PE patients without identifiable risk factors are diagnosed with
cancer within 2 years.
✔✔A 25 year old female presents with fever, productive cough, and shortness of breath.
Physical exam reveals T101, RR 24 and SpO2 of 94%. Her left tympanic membrane is
inflamed and there are TM bullae. The chest X-ray reveals a large right middle lobe
pneumonia. The organism most commonly associated with this type of presentation is:
Answers:
1.Legionella pneumoniae
2.Strep pneumoniae
3.H. influenzae
4.Mycoplasma pneumoniae
5.Moraxella catarrhalis - ✔✔4.Mycoplasma pneumoniae
✔✔A pneumonia caused by which of the following organisms is classically associated
with currant jelly sputum?
Answers:
1.Strep. pneumoniae
2.viral
3.H. influenzae
4.Mycoplasma
5.Klebsiella - ✔✔5.Klebsiella
✔✔A 72-year-old male presents with five hours of substernal chest pain and pressure
despite taking three sublingual nitroglycerin. You order an EKG. What findings on the
EKG would indicate that this patient is potentially a candidate for thrombolytic therapy?
Answers:
1.Atrial fibrillation with a rapid ventricular response
2.ST-segment depression of at least 2mm in any precordial lead
3.ST-segment elevation of at least 1 mm in two or more contiguous leads
,4.Ventricular tachycardia - ✔✔3.ST-segment elevation of at least 1 mm in two or more
contiguous leads
✔✔A 58-year-old male previously in good health presents with chest pain for two hours.
Vital signs are BP 126/78, HR 80 (sinus rhythm), RR 14, oxygen saturation 99%, T
36.8. His EKG shows ST segment elevation in leads II, III, aVF and V1. ST-segment
elevation is greater in lead III than in lead II. What additional diagnostic test is indicated
prior to giving nitroglycerin?
Answers:
1.CXR
2.d-dimer
3.Echocardiogram
4.EKG with right-sided leads - ✔✔4.EKG with right-sided leads
✔✔A patient with nontraumatic chest pain is administered nitroglycerin in the field and
has subsequent drop in blood pressure. An EKG reveals ST-segment elevation in lead
V4R. What is the diagnosis?
Answers:
1.anteroseptal MI
2.pericarditis
3.pulmonary embolism
4.unstable angina
5.right-ventricular MI - ✔✔5.right-ventricular MI
✔✔A 71-year-old male presents after a syncopal episode. He reports 12 hours of
recurrent substernal chest pressure. A report from the patient's primary care physician's
office states that an EKG performed four days ago was completely normal. Repeat EKG
in the ED reveals no ST-segment elevation, but you do note a right bundle-branch
block, and a left anterior fascicle block. Troponin I is elevated above normal at 1.6.
What intervention would be indicated to provide definitive management for the findings
seen on EKG in this patient?
Answers:
1.Continuous cardiac monitoring for 24-48 hours
2.Emergent revascularization with thrombolytics or percutaneous coronary intervention
(PCI)
3.Radiofrequency ablation
4.Urgent placement of a cardiac pacemaker - ✔✔4.Urgent placement of a cardiac
pacemaker
✔✔Which coronary vessel is usually the cause of the myocardial infarction in a patient
with ST elevation in V1, V2, and V3?
, Answers:
1.left anterior descending (LAD)
2.left circumflex artery
3.posterior descending branch of the right coronary artery
4.right coronary artery (RCA)
5.right ventricular branch of the right coronary artery - ✔✔1.left anterior descending
(LAD)
✔✔A 65-year-old female presents 2 weeks after an MI complaining of chest pain, fever,
and shortness of breath. She has a new friction rub on exam and a leukocytosis. She
most likely has:
Answers:
1.congestive heart failure
2.Dressler's syndrome
3.new myocardial infarction
4.pneumonia
5.pulmonary embolism - ✔✔2.Dressler's syndrome
✔✔A 25 year old man returns to the ED, 24 hours after being released from the hospital
with a new diagnosis of schizophrenia. He has recently started to take haloperidal for
his psychotic symptoms. In the ED he is noted to have involuntary contractions of the
muscles of the face, a protruding tongue, deviation of the head to one side, and
sustained upward deviation of the eyes. Vital signs are stable, and initial labs show no
electrolyte or hematological abnormalities. Of the following choices, the preferred
medication for this condition is:
Answers:
1.diphenhydramine
2.lorazepam
3.phenobarbital
4.metoprolol - ✔✔2.lorazepam
✔✔A 55 year-old male presents with new onset agitation and confusion. Which of the
following medical histories would suggest a psychiatric (non-organic) cause?
Answers:
1.History of diabetes mellitus only
2.History of alcohol abuse only
3.History of hypothyroidism only
4.History of chronic obstructive pulmonary disease only - ✔✔3.History of
hypothyroidism only
✔✔A 53 year-old known alcoholic presents with agitation, vomiting and altered mental
status. His fingerstick glucose is 148. His serum ethanol level is undetectable and his
ANSWERS GRADED A+
✔✔Regarding the role of malignancy in the diagnosis of pulmonary embolism (PE):
Answers:
1.Hematologic malignancies such as leukemia and have the highest incidence of
venous thromboembolism
2.25% of PE patients without identifiable risk factors are diagnosed with cancer within 2
years.
3.The risk of PE is decreased in patients on chemotherapy
4.Autopsy studies indicate that greater than 60% of patients who die of ovarian cancer
have PE. - ✔✔2.25% of PE patients without identifiable risk factors are diagnosed with
cancer within 2 years.
✔✔A 25 year old female presents with fever, productive cough, and shortness of breath.
Physical exam reveals T101, RR 24 and SpO2 of 94%. Her left tympanic membrane is
inflamed and there are TM bullae. The chest X-ray reveals a large right middle lobe
pneumonia. The organism most commonly associated with this type of presentation is:
Answers:
1.Legionella pneumoniae
2.Strep pneumoniae
3.H. influenzae
4.Mycoplasma pneumoniae
5.Moraxella catarrhalis - ✔✔4.Mycoplasma pneumoniae
✔✔A pneumonia caused by which of the following organisms is classically associated
with currant jelly sputum?
Answers:
1.Strep. pneumoniae
2.viral
3.H. influenzae
4.Mycoplasma
5.Klebsiella - ✔✔5.Klebsiella
✔✔A 72-year-old male presents with five hours of substernal chest pain and pressure
despite taking three sublingual nitroglycerin. You order an EKG. What findings on the
EKG would indicate that this patient is potentially a candidate for thrombolytic therapy?
Answers:
1.Atrial fibrillation with a rapid ventricular response
2.ST-segment depression of at least 2mm in any precordial lead
3.ST-segment elevation of at least 1 mm in two or more contiguous leads
,4.Ventricular tachycardia - ✔✔3.ST-segment elevation of at least 1 mm in two or more
contiguous leads
✔✔A 58-year-old male previously in good health presents with chest pain for two hours.
Vital signs are BP 126/78, HR 80 (sinus rhythm), RR 14, oxygen saturation 99%, T
36.8. His EKG shows ST segment elevation in leads II, III, aVF and V1. ST-segment
elevation is greater in lead III than in lead II. What additional diagnostic test is indicated
prior to giving nitroglycerin?
Answers:
1.CXR
2.d-dimer
3.Echocardiogram
4.EKG with right-sided leads - ✔✔4.EKG with right-sided leads
✔✔A patient with nontraumatic chest pain is administered nitroglycerin in the field and
has subsequent drop in blood pressure. An EKG reveals ST-segment elevation in lead
V4R. What is the diagnosis?
Answers:
1.anteroseptal MI
2.pericarditis
3.pulmonary embolism
4.unstable angina
5.right-ventricular MI - ✔✔5.right-ventricular MI
✔✔A 71-year-old male presents after a syncopal episode. He reports 12 hours of
recurrent substernal chest pressure. A report from the patient's primary care physician's
office states that an EKG performed four days ago was completely normal. Repeat EKG
in the ED reveals no ST-segment elevation, but you do note a right bundle-branch
block, and a left anterior fascicle block. Troponin I is elevated above normal at 1.6.
What intervention would be indicated to provide definitive management for the findings
seen on EKG in this patient?
Answers:
1.Continuous cardiac monitoring for 24-48 hours
2.Emergent revascularization with thrombolytics or percutaneous coronary intervention
(PCI)
3.Radiofrequency ablation
4.Urgent placement of a cardiac pacemaker - ✔✔4.Urgent placement of a cardiac
pacemaker
✔✔Which coronary vessel is usually the cause of the myocardial infarction in a patient
with ST elevation in V1, V2, and V3?
, Answers:
1.left anterior descending (LAD)
2.left circumflex artery
3.posterior descending branch of the right coronary artery
4.right coronary artery (RCA)
5.right ventricular branch of the right coronary artery - ✔✔1.left anterior descending
(LAD)
✔✔A 65-year-old female presents 2 weeks after an MI complaining of chest pain, fever,
and shortness of breath. She has a new friction rub on exam and a leukocytosis. She
most likely has:
Answers:
1.congestive heart failure
2.Dressler's syndrome
3.new myocardial infarction
4.pneumonia
5.pulmonary embolism - ✔✔2.Dressler's syndrome
✔✔A 25 year old man returns to the ED, 24 hours after being released from the hospital
with a new diagnosis of schizophrenia. He has recently started to take haloperidal for
his psychotic symptoms. In the ED he is noted to have involuntary contractions of the
muscles of the face, a protruding tongue, deviation of the head to one side, and
sustained upward deviation of the eyes. Vital signs are stable, and initial labs show no
electrolyte or hematological abnormalities. Of the following choices, the preferred
medication for this condition is:
Answers:
1.diphenhydramine
2.lorazepam
3.phenobarbital
4.metoprolol - ✔✔2.lorazepam
✔✔A 55 year-old male presents with new onset agitation and confusion. Which of the
following medical histories would suggest a psychiatric (non-organic) cause?
Answers:
1.History of diabetes mellitus only
2.History of alcohol abuse only
3.History of hypothyroidism only
4.History of chronic obstructive pulmonary disease only - ✔✔3.History of
hypothyroidism only
✔✔A 53 year-old known alcoholic presents with agitation, vomiting and altered mental
status. His fingerstick glucose is 148. His serum ethanol level is undetectable and his
