SAEM EXAM ACTUAL QUESTIONS AND
CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS).
Question 1
"A 65 year old male with a past medical history of poorly controlled hypertension
presents with new onset unilateral arm and leg weakness. There is no disturbance of
consciousness and there is no evidence of cortical findings (such as aphasia, agnosia,
or hemianopsia). What is the most likely location of the vascular obstruction?
A. basilar artery
B. lacunar
C. middle cerebral artery
D. posterior cerebral artery
E. anterior cerebral artery"
Correct Answer
"B. lacunar
The answer is B. Lacunar infarcts occur at the small, terminal branches of the
vasculature and more commonly occur in African-Americans and patients with
diabetes and hypertension. This patient's presentation, evidenced by pure loss of
motor function without disturbances in other neurological modalities, is consistent
with an infarct in the internal capsule. Because terminal branches of the vasculature
supply the internal capsule, it is frequently affected in patients with diabetes and
hypertension. A vascular obstruction in the MCA would affect not only motor
functions, but also produce cortical findings such as aphasia or agnosia."
Page 1 of 322
,Question 2
A 54 year old male comes to the emergency department complaining of intermittent
pain, swelling and constant burning sensation involving his right leg. He tells you that
six months ago he injured his leg in a car accident and his x-rays were negative. The
symptoms have gradually worsened over the past few months. He is presenting to the
emergency department because he doesn't have a primary care doctor. On physical
examination you notice that his leg is edematous, erythematous, dry and warm. The
leg is also characterized by hair loss, allodynia and hyperesthesia. Of the following,
which is the most appropriate emergency department course?
A. Obtain a CT scan of his leg to rule out osteomyelitis
B. Perform a femoral nerve block to control his pain
C. Order a venogram to rule out a deep venous thrombosis
D. Arrange follow-up for presumed complex regional pain syndrome
Correct Answer
D.
You'd do an US if you thought DVT.
Complex regional pain syndrome type I (CRPS-I), replacing the term Reflex
Sympathetic Dystrophy (RSD), has been used to describe pain syndromes that
sometime follow fractures, orthopedic surgery, soft tissue injuries, and even
unrecognized insults to the limbs and appendages. The sympathetic nervous system
appears to play a role in the maintenance of the symptoms in some, but not all,
patients. It develops after an initiating noxious event, extends beyond the
distribution of a single peripheral nerve, and is usually disproportionate to the
inciting event. The site is most often the distal end of the affected extremity, with a
distal-to-proximal gradient. It is associated with edema, changes in blood flow to
the skin, abnormal sudomotor (sweat gland stimulation) activity in the region of the
pain, allodynia (pain resulting from non-noxious stimulation to the skin),
hyperpathia (pain persisting or increasing after mild or light pressure), or
hyperalgesia. The presence of a condition that otherwise would explain the degree
of pain and dysfunction excludes the diagnosis of CRPS-I. The definition of CRPS-II
is the same as for CRPS-I except that there is demonstrable peripheral nerve injury.
Page 2 of 322
,Question 3
During opiate withdrawal which of the following symptoms would you expect to find?
A. Urinary retention
B. Tachypnea
C. Pruritis
D. Constipatio
Correct Answer
B.
Withdrawal syndromes tend to have symptoms that are the reverse of intoxication
syndromes. In opiate withdrawal, individuals present with CNS excitation, diarrhea,
mydriasis, tachypnea and often abdominal cramping and vomiting. While
uncomfortable, opiate withdrawal is not life threatening and is managed
symptomatically
Question 4
Which of the following pairs of hypertension-associated disease and specific therapy
represent reasonable therapeutic approaches?
A. aortic dissection - nitroprusside/propranolol
B. angina - phentolamine
C. bilateral renal artery stenosis - captopril
D. pheochromocytoma - hydrochlorothiazide
E. pregnancy induced hypertension - furosemide
Correct Answer
A.
Page 3 of 322
, Question 5
A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3
hours prior to presentation in the ED. Which of the following arterial blood gas results
would you expect to come from this patient?
A. pH 7.47 pCO2 31 pO2 96 HCO3 25
B. pH 7.14 pCO2 68 pO2 102 HCO3 23
C. pH 7.33 pCO2 48 pO2 58 HCO3 29
D. pH 7.45 pCO2 21 pO2 124 HCO3 14
Correct Answer
D. pH 7.45 pCO2 21 pO2 124 HCO3 14
The answer is D. Acute salicylate overdose characteristically causes a metabolic
acidosis mixed with a respiratory alkalosis
Question 6
In treating hepatitis secondary to alcoholic liver disease, all of the following are true
EXCEPT:
A. Treatment is primarily supportive including fluids and electrolyte correction.
B. Glucose should be administered prior to thiamine to avoid precipitating acute
Wernicke's encephalopathy
C. Magnesium replacement should be initiated empirically except in the setting of
contraindications such as renal failure or hypermagnesemia.
D. Coexisting gastritis should be sought out and treated appropriately.
E. Nutritional status should be assessed with attention to possible protein restriction.
Correct Answer
B. Glucose should be administered prior to thiamine to avoid precipitating acute
Wernicke's encephalopathy
Alcoholics often have low thiamine levels due to poor nutrition, and low glucose
levels due to the suppression of gluconeogenesis by alcohol. However, thiamine
should always be replaced prior to glucose to avoid the potential complication
of precipitating Wernicke's encephalopathy. Magnesium levels may appear
normal on laboratory testing, but alcoholics typically have low magnesium stores
and should be given magnesium empirically unless contraindications for
magnesium exist.
Alcoholics should also be evaluated for gastritis and overall nutritional status and
should be referred appropriately.
Page 4 of 322
CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS).
Question 1
"A 65 year old male with a past medical history of poorly controlled hypertension
presents with new onset unilateral arm and leg weakness. There is no disturbance of
consciousness and there is no evidence of cortical findings (such as aphasia, agnosia,
or hemianopsia). What is the most likely location of the vascular obstruction?
A. basilar artery
B. lacunar
C. middle cerebral artery
D. posterior cerebral artery
E. anterior cerebral artery"
Correct Answer
"B. lacunar
The answer is B. Lacunar infarcts occur at the small, terminal branches of the
vasculature and more commonly occur in African-Americans and patients with
diabetes and hypertension. This patient's presentation, evidenced by pure loss of
motor function without disturbances in other neurological modalities, is consistent
with an infarct in the internal capsule. Because terminal branches of the vasculature
supply the internal capsule, it is frequently affected in patients with diabetes and
hypertension. A vascular obstruction in the MCA would affect not only motor
functions, but also produce cortical findings such as aphasia or agnosia."
Page 1 of 322
,Question 2
A 54 year old male comes to the emergency department complaining of intermittent
pain, swelling and constant burning sensation involving his right leg. He tells you that
six months ago he injured his leg in a car accident and his x-rays were negative. The
symptoms have gradually worsened over the past few months. He is presenting to the
emergency department because he doesn't have a primary care doctor. On physical
examination you notice that his leg is edematous, erythematous, dry and warm. The
leg is also characterized by hair loss, allodynia and hyperesthesia. Of the following,
which is the most appropriate emergency department course?
A. Obtain a CT scan of his leg to rule out osteomyelitis
B. Perform a femoral nerve block to control his pain
C. Order a venogram to rule out a deep venous thrombosis
D. Arrange follow-up for presumed complex regional pain syndrome
Correct Answer
D.
You'd do an US if you thought DVT.
Complex regional pain syndrome type I (CRPS-I), replacing the term Reflex
Sympathetic Dystrophy (RSD), has been used to describe pain syndromes that
sometime follow fractures, orthopedic surgery, soft tissue injuries, and even
unrecognized insults to the limbs and appendages. The sympathetic nervous system
appears to play a role in the maintenance of the symptoms in some, but not all,
patients. It develops after an initiating noxious event, extends beyond the
distribution of a single peripheral nerve, and is usually disproportionate to the
inciting event. The site is most often the distal end of the affected extremity, with a
distal-to-proximal gradient. It is associated with edema, changes in blood flow to
the skin, abnormal sudomotor (sweat gland stimulation) activity in the region of the
pain, allodynia (pain resulting from non-noxious stimulation to the skin),
hyperpathia (pain persisting or increasing after mild or light pressure), or
hyperalgesia. The presence of a condition that otherwise would explain the degree
of pain and dysfunction excludes the diagnosis of CRPS-I. The definition of CRPS-II
is the same as for CRPS-I except that there is demonstrable peripheral nerve injury.
Page 2 of 322
,Question 3
During opiate withdrawal which of the following symptoms would you expect to find?
A. Urinary retention
B. Tachypnea
C. Pruritis
D. Constipatio
Correct Answer
B.
Withdrawal syndromes tend to have symptoms that are the reverse of intoxication
syndromes. In opiate withdrawal, individuals present with CNS excitation, diarrhea,
mydriasis, tachypnea and often abdominal cramping and vomiting. While
uncomfortable, opiate withdrawal is not life threatening and is managed
symptomatically
Question 4
Which of the following pairs of hypertension-associated disease and specific therapy
represent reasonable therapeutic approaches?
A. aortic dissection - nitroprusside/propranolol
B. angina - phentolamine
C. bilateral renal artery stenosis - captopril
D. pheochromocytoma - hydrochlorothiazide
E. pregnancy induced hypertension - furosemide
Correct Answer
A.
Page 3 of 322
, Question 5
A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3
hours prior to presentation in the ED. Which of the following arterial blood gas results
would you expect to come from this patient?
A. pH 7.47 pCO2 31 pO2 96 HCO3 25
B. pH 7.14 pCO2 68 pO2 102 HCO3 23
C. pH 7.33 pCO2 48 pO2 58 HCO3 29
D. pH 7.45 pCO2 21 pO2 124 HCO3 14
Correct Answer
D. pH 7.45 pCO2 21 pO2 124 HCO3 14
The answer is D. Acute salicylate overdose characteristically causes a metabolic
acidosis mixed with a respiratory alkalosis
Question 6
In treating hepatitis secondary to alcoholic liver disease, all of the following are true
EXCEPT:
A. Treatment is primarily supportive including fluids and electrolyte correction.
B. Glucose should be administered prior to thiamine to avoid precipitating acute
Wernicke's encephalopathy
C. Magnesium replacement should be initiated empirically except in the setting of
contraindications such as renal failure or hypermagnesemia.
D. Coexisting gastritis should be sought out and treated appropriately.
E. Nutritional status should be assessed with attention to possible protein restriction.
Correct Answer
B. Glucose should be administered prior to thiamine to avoid precipitating acute
Wernicke's encephalopathy
Alcoholics often have low thiamine levels due to poor nutrition, and low glucose
levels due to the suppression of gluconeogenesis by alcohol. However, thiamine
should always be replaced prior to glucose to avoid the potential complication
of precipitating Wernicke's encephalopathy. Magnesium levels may appear
normal on laboratory testing, but alcoholics typically have low magnesium stores
and should be given magnesium empirically unless contraindications for
magnesium exist.
Alcoholics should also be evaluated for gastritis and overall nutritional status and
should be referred appropriately.
Page 4 of 322
