SAEM Comprehensive Study Guide | Exam
Review | 2026/2027
With regard to specific causes of hypertension, which of the following is true?
A. Hypertensive encephalopathy is more likely than hypertensive stroke in
patients whose mental status changes are reversible
B. Hypertensive encephalopathy causes adverse outcomes over days or weeks,
rather than hours
C. Patients with stroke syndromes must have blood pressure normalized as
quickly as possible to reduce the risks of worsening neurological deficit
D. Laboratory analysis is rarely useful in cases of confirmed pediatric
hypertension
E. Laboratory analysis is rarely useful in cases of confirmed hypertension in
pregnant patients - correct answer-A. Hypertensive encephalopathy is more likely
than hypertensive stroke in patients whose mental status changes are reversible
Hypertensive encephalopathy is a true medical emergency, and can cause coma
and death over hours; however, encephalopathy due to hypertension is more
likely reversible than encephalopathy from other causes. Avoidance of
overzealous blood pressure lowering is particularly critical for patients with
strokes. Laboratory analysis can be important in cases of hypertension in pediatric
patients (for whom renal/renovascular or pheochromocytoma may be identified)
and in pregnant patients (for whom laboratory testing can help establish
diagnoses such as the HELLP syndrome).
,An 18 year old hockey player is hit in the mouth with a puck, fracturing a maxillary
canine tooth. He brings the severed piece of tooth with him. On physical exam,
the tooth is fractured halfway between the tip and the gumline. The root of the
tooth is still firmly intact. The exposed fracture site has a yellowish tinge without
blood. Of the following choices, which is the most appropriate management for
this patient?
A. No specific treatment required
B. Application of calcium hydroxide, placement of aluminum foil, and dental
follow-up
C. Placement of tooth fragment in saline gauze, outpatient dental follow-up
D. Immediate dental consult to avoid abscess formation
E. Replace fractured piece and place acrylic splint - correct answer-D. Immediate
dental consult to avoid abscess formation
Ellis II dental fracture involves enamel and dentin. The fracture site typically has a
yellowish tinge. Ellis III dental fractures are characterized by exposure of pinkish
pulp and often blood. These fractures require immediate dental consultation to
prevent abscess formation.
The most sensitive bedside test for nerve injury in a finger after trauma is:
A. light touch
B. O'Riain wrinkle test
C. pain
D. temperature sensation
E. two-point discrimination - correct answer-E. two-point discrimination
Light touch is a good screening test, but two-point discrimination is more
sensitive and should be used routinely in evaluating injuries to digits. The O'Riain
,wrinkle test involves placing the digit in warm water and looking for wrinkling of
the digital pulps. Presence of wrinkling indicates the nerve is intact.
Following a motor vehicle crash, a 25 year old man presents complaining of a
painful right eye. Visual acuity is 20/200 in the right eye and 20/25 in the left eye.
The right eye protrudes from the orbit and the patient has right eye pain with
extraocular movement. What is the most likely cause of his symptoms?
A. retrobulbar hematoma
B. chemosis
C. hyphema
D. orbital blow-out fracture
E. ruptured globe - correct answer-A. retrobulbar hematoma
The answer is A. Traumatic proptosis with impaired extraocular movements is
classic for retrobulbar hematoma. Sequelae include optic nerve ischemia and
secondary visual impairment. A ruptured globe presents with enophthalmos, not
proptosis, as vitreous humor leaks out of the eye. Neither hyphema nor chemosis
causes proptosis. Orbital blowout fractures can cause inferior rectus muscle
entrapment and secondary pain with impairment of extraocular movement. Yet,
they do not present with proptosis - unless complicated by retrobulbar pathology.
A 76 year old restrained driver is involved in a head-on collision at about 35 mph.
He arrives at the emergency department in a cervical collar and on a backboard.
His only complaint is neck pain, and he has mild posterior neck tenderness. A CT
scan of the neck shows no fracture and only degenerative arthritis. Upon re-
evaluation you note the patient has difficulty raising his arms against gravity and
there is decreased grip strength bilaterally. The remainder of his neurological
exam is normal. What is the most appropriate management for this patient?
A. Administration of IV steroids and ordering of cervical MRI
, B. Immediate neurosurgical decompression
C. Flexion and extention radiographs to rule out ligamentous injury
D. Discharge home with a hard cervical collar with neurosurgical follow-up
E. Reassurance and discharge with NSAIDs given the non-anatomical distribution
of weakness - correct answer-A. Administration of IV steroids and ordering of
cervical MRI
The answer is A. Central cord syndrome results from a hyperextension injury,
typically in elderly patients with significant degenerative joint disease. The
ligamentum flavum buckles into the cord, resulting in a contusion of the cord's
central portion.
A 46 year old construction worker falls 6 feet off a ladder onto a concrete surface
and has sudden and severe low back pain. The pain radiates down his right leg
and he develops numbness over the anterior shin and dorsum of the foot. On
physical exam he has decreased sensation to pinprick over the dorsum of the
right foot (medially) and some weakness in right foot dorsiflexion. At which level
is a protruding intervertebral disc most likely?
A. L1-L2
B. L2-L3
C. L3-L4
D. L4-L5
E. L5-S1 - correct answer-D. L4-L5
The answer is D. Sensation of the dorsal aspect of the foot and dorsiflexion of the
foot are functions of the L5 nerve root. Herniation of the L4-5 disc would result in
compression of L5.
Review | 2026/2027
With regard to specific causes of hypertension, which of the following is true?
A. Hypertensive encephalopathy is more likely than hypertensive stroke in
patients whose mental status changes are reversible
B. Hypertensive encephalopathy causes adverse outcomes over days or weeks,
rather than hours
C. Patients with stroke syndromes must have blood pressure normalized as
quickly as possible to reduce the risks of worsening neurological deficit
D. Laboratory analysis is rarely useful in cases of confirmed pediatric
hypertension
E. Laboratory analysis is rarely useful in cases of confirmed hypertension in
pregnant patients - correct answer-A. Hypertensive encephalopathy is more likely
than hypertensive stroke in patients whose mental status changes are reversible
Hypertensive encephalopathy is a true medical emergency, and can cause coma
and death over hours; however, encephalopathy due to hypertension is more
likely reversible than encephalopathy from other causes. Avoidance of
overzealous blood pressure lowering is particularly critical for patients with
strokes. Laboratory analysis can be important in cases of hypertension in pediatric
patients (for whom renal/renovascular or pheochromocytoma may be identified)
and in pregnant patients (for whom laboratory testing can help establish
diagnoses such as the HELLP syndrome).
,An 18 year old hockey player is hit in the mouth with a puck, fracturing a maxillary
canine tooth. He brings the severed piece of tooth with him. On physical exam,
the tooth is fractured halfway between the tip and the gumline. The root of the
tooth is still firmly intact. The exposed fracture site has a yellowish tinge without
blood. Of the following choices, which is the most appropriate management for
this patient?
A. No specific treatment required
B. Application of calcium hydroxide, placement of aluminum foil, and dental
follow-up
C. Placement of tooth fragment in saline gauze, outpatient dental follow-up
D. Immediate dental consult to avoid abscess formation
E. Replace fractured piece and place acrylic splint - correct answer-D. Immediate
dental consult to avoid abscess formation
Ellis II dental fracture involves enamel and dentin. The fracture site typically has a
yellowish tinge. Ellis III dental fractures are characterized by exposure of pinkish
pulp and often blood. These fractures require immediate dental consultation to
prevent abscess formation.
The most sensitive bedside test for nerve injury in a finger after trauma is:
A. light touch
B. O'Riain wrinkle test
C. pain
D. temperature sensation
E. two-point discrimination - correct answer-E. two-point discrimination
Light touch is a good screening test, but two-point discrimination is more
sensitive and should be used routinely in evaluating injuries to digits. The O'Riain
,wrinkle test involves placing the digit in warm water and looking for wrinkling of
the digital pulps. Presence of wrinkling indicates the nerve is intact.
Following a motor vehicle crash, a 25 year old man presents complaining of a
painful right eye. Visual acuity is 20/200 in the right eye and 20/25 in the left eye.
The right eye protrudes from the orbit and the patient has right eye pain with
extraocular movement. What is the most likely cause of his symptoms?
A. retrobulbar hematoma
B. chemosis
C. hyphema
D. orbital blow-out fracture
E. ruptured globe - correct answer-A. retrobulbar hematoma
The answer is A. Traumatic proptosis with impaired extraocular movements is
classic for retrobulbar hematoma. Sequelae include optic nerve ischemia and
secondary visual impairment. A ruptured globe presents with enophthalmos, not
proptosis, as vitreous humor leaks out of the eye. Neither hyphema nor chemosis
causes proptosis. Orbital blowout fractures can cause inferior rectus muscle
entrapment and secondary pain with impairment of extraocular movement. Yet,
they do not present with proptosis - unless complicated by retrobulbar pathology.
A 76 year old restrained driver is involved in a head-on collision at about 35 mph.
He arrives at the emergency department in a cervical collar and on a backboard.
His only complaint is neck pain, and he has mild posterior neck tenderness. A CT
scan of the neck shows no fracture and only degenerative arthritis. Upon re-
evaluation you note the patient has difficulty raising his arms against gravity and
there is decreased grip strength bilaterally. The remainder of his neurological
exam is normal. What is the most appropriate management for this patient?
A. Administration of IV steroids and ordering of cervical MRI
, B. Immediate neurosurgical decompression
C. Flexion and extention radiographs to rule out ligamentous injury
D. Discharge home with a hard cervical collar with neurosurgical follow-up
E. Reassurance and discharge with NSAIDs given the non-anatomical distribution
of weakness - correct answer-A. Administration of IV steroids and ordering of
cervical MRI
The answer is A. Central cord syndrome results from a hyperextension injury,
typically in elderly patients with significant degenerative joint disease. The
ligamentum flavum buckles into the cord, resulting in a contusion of the cord's
central portion.
A 46 year old construction worker falls 6 feet off a ladder onto a concrete surface
and has sudden and severe low back pain. The pain radiates down his right leg
and he develops numbness over the anterior shin and dorsum of the foot. On
physical exam he has decreased sensation to pinprick over the dorsum of the
right foot (medially) and some weakness in right foot dorsiflexion. At which level
is a protruding intervertebral disc most likely?
A. L1-L2
B. L2-L3
C. L3-L4
D. L4-L5
E. L5-S1 - correct answer-D. L4-L5
The answer is D. Sensation of the dorsal aspect of the foot and dorsiflexion of the
foot are functions of the L5 nerve root. Herniation of the L4-5 disc would result in
compression of L5.
