SAEM M4 EXAM TEST QUESTIONS WITH ANSWERS GRADED A
True or False: gastric distension due to
excessive volume or rate of ventilation impairing
ventilatory function is a reason to intubate a
neonate - ANSWER -False Low body temperatures in newborns can lead to
severe physiologic consequences, which include
all EXCEPT:
management for nursemaid elbow injury - Answers:
ANSWER -apply pressure to the radial 1. metabolic acidosis
head while flexing and supinating elbow 2. increased oxygen consumption
3. hypoglycemia
4. apnea
5. hyperglycemia - ANSWER -3.
A 17 year old boy injured his right shoulder hypoglycemia
playing football. He tried to arm-tackle a player
when his right arm was pulled away from his
body and back (abducted and extended). He felt
a sudden pain in his shoulder. He presents to the In a newborn, bradycardia is most commonly an
emergency department holding his arm in slight indicator of: - ANSWER -hypoxemia
abduction and external rotation by his good arm.
He has severe pain with adduction or internal
rotation. What is the most common fracture
associated with this injury? - ANSWER - All the following are signs of hypoxemia in a
compression fracture of the posteriolateral newborn, EXCEPT:
aspect of the humeral head (Hill-Sachs
deformity) Answers:
1.cyanosis
2.lethargy
3.tachycardia
What are most common heart rhythms seen in 4.unresponsiveness
pediatric arrest? - ANSWER -bradycardia 5.bradycardia - ANSWER -3. tachycardia
or asystole
A newborn presents to the emergency
risk factors for neonatal resuscitation - department a few days after hospital discharge.
ANSWER -prematurity The infant has been noted to be drooling,
IUGR choking, and coughing, and the mother reports
multiple gestation seeing bubbles at the baby's mouth. Which is the
thick meconium most likely explanation?
Answers:
1.osteogenesis imperfecta
In the post-arrest setting, which of the following is 2.inborn error of metabolism
the drug of choice in treating hypotension in a 3.congenital diaphragmatic hernia
4.foreign body
child: - ANSWER -epi
,SAEM M4 EXAM TEST QUESTIONS WITH ANSWERS GRADED A
5.tracheoesophageal fistula - ANSWER -5. that she is has very large pupils and is sweating
tracheoesophageal fistula profusely. Her respiratory rate, blood pressure
and heart rate are elevated. Which of the
following is the most likely agent to have caused
her symptoms?
Which of the following pairs of maneuvers are
consistent with current recommendations for Answers:
emergency care for a choking 5-month-old 1.Jimson weed
infant? 2.Cocaine
3.Heroin
Answers: 4.Insulin - ANSWER -2. cocaine
1.back blow then blind finger sweep
2.back blow then chest thrust
3.chest thrust then Heimlich maneuver
4.Heimlich maneuver then blind finger sweep A mother brings in her 4 year old child who was
5.Heimlich maneuver then chest thrust - happily eating "blackberries" from weeds in the
ANSWER -2.back blow then chest thrust garden and is now acting strangely. She has
identified them as Belladonna from a quick
internet search. Which physical examination
finding might you also expect to find in this child?
All of these steps are involved in pediatric rapid
sequence intubation (RSI) EXCEPT: Answers:
1.Diaphoresis
Answers: 2.Flushed skin
1.If administering succinylcholine, pretreatment 3.Miosis
with atropine is always indicated in children 4.Urinary incontinence - ANSWER -2.
under age 10. flushed skin
2.Lidocaine pretreatment is usually provided to
children with head trauma.
3.When deciding which size endotracheal tube to
use, one may approximate by using the size of For which of the following cases is activated
the small finger or nares as a reference. charcoal therapy most appropriate?
4.Due to the fragility of the pediatric C-spine, a
cervical collar should always be placed prior to Answers:
intubation for children under age ten. 1.Acetaminophen overdose
5.Uncuffed endotracheal tubes are the preferred 2.Drain cleaner ingestion
devices used in children under 6-8 years of age. 3.Iron supplement overdose
- ANSWER -4.Due to the fragility of the 4.Lithium overdose - ANSWER -1.
pediatric C-spine, a cervical collar should always Acetaminophen overdose
be placed prior to intubation for children under
age ten.
A 45 year-old is brought in 8 hours after a large
overdose of his lithium. What is the best
A 23 year old woman is dropped off by her treatment method for this overdose?
boyfriend after an unknown overdose. You notice
, SAEM M4 EXAM TEST QUESTIONS WITH ANSWERS GRADED A
Answers: following statements is TRUE?
1.Activated charcoal
2.Gastric lavage Answers:
3.Hemodialysis 1.An acetaminophen level drawn at hour four
4.Whole bowel irrigation - ANSWER - dictates need for antidotal therapy.
3.Hemodialysis 2.Serial liver function tests are indicated in all
acetaminophen ingestions.
3.Renal sequelae are expected.
4.The intravenous formulation of N-acetylcysteine
A 42 year-old woman presents with an overdose is safer than oral N-acetylcysteine. -
of her Xanax (alprazolam) that her family ANSWER -1.An acetaminophen level drawn
indicates she has been taking for years to help at hour four dictates need for antidotal therapy.
with her anxiety. The bottle indicates that the
prescription was filled yesterday with 90 pills and
is now empty. The patient is minimally
responsive to painful stimuli and does not react A 2 year old child presents with an overdose of
when you suction secretions out of her posterior her mother's iron containing multivitamins. What
pharynx. What is your next management step? antidote should you consider for iron toxicity?
Answers: Answers:
1.Administration of flumazenil 1.Deferoxamine
2.Administration of narcan 2.Glucagon
3.Close observation 3.Methylene blue
4.Intubation for airway support - ANSWER - 4.Pyridoxine - ANSWER -1.Deferoxamine
4.Intubation for airway support
Severe lead toxicity can commonly result in
A 72 year-old presents with an intentional which of the following clinical symptoms
overdose of a bottle of aspirin about 3 hours prior
to presentation in the ED. Which of the following Answers:
arterial blood gas results would you expect to 1.Constipation
come from this patient? 2.Dermatitis
3.Memory loss
Answers: 4.Stocking glove peripheral neuropathy -
1.pH 7.14 pCO2 68 pO2 102 HCO3 23 ANSWER -3.Memory loss
2.pH 7.33 pCO2 48 pO2 58 HCO3 29
3.pH 7.45 pCO2 21 pO2 124 HCO3 14
4.pH 7.47 pCO2 31 pO2 96 HCO3 25 -
ANSWER -3.pH 7.45 pCO2 21 pO2 124 A 27 year old woman is brought into the
HCO3 14 emergency department by her roommate 30
minutes after ingesting a bottle of aspirin in a
suicide attempt. Which of the following acid-base
disorders is most likely to be present in this
A teenager presents one hour after ingesting a patient?
"handful" of acetaminophen tablets. Which of the
True or False: gastric distension due to
excessive volume or rate of ventilation impairing
ventilatory function is a reason to intubate a
neonate - ANSWER -False Low body temperatures in newborns can lead to
severe physiologic consequences, which include
all EXCEPT:
management for nursemaid elbow injury - Answers:
ANSWER -apply pressure to the radial 1. metabolic acidosis
head while flexing and supinating elbow 2. increased oxygen consumption
3. hypoglycemia
4. apnea
5. hyperglycemia - ANSWER -3.
A 17 year old boy injured his right shoulder hypoglycemia
playing football. He tried to arm-tackle a player
when his right arm was pulled away from his
body and back (abducted and extended). He felt
a sudden pain in his shoulder. He presents to the In a newborn, bradycardia is most commonly an
emergency department holding his arm in slight indicator of: - ANSWER -hypoxemia
abduction and external rotation by his good arm.
He has severe pain with adduction or internal
rotation. What is the most common fracture
associated with this injury? - ANSWER - All the following are signs of hypoxemia in a
compression fracture of the posteriolateral newborn, EXCEPT:
aspect of the humeral head (Hill-Sachs
deformity) Answers:
1.cyanosis
2.lethargy
3.tachycardia
What are most common heart rhythms seen in 4.unresponsiveness
pediatric arrest? - ANSWER -bradycardia 5.bradycardia - ANSWER -3. tachycardia
or asystole
A newborn presents to the emergency
risk factors for neonatal resuscitation - department a few days after hospital discharge.
ANSWER -prematurity The infant has been noted to be drooling,
IUGR choking, and coughing, and the mother reports
multiple gestation seeing bubbles at the baby's mouth. Which is the
thick meconium most likely explanation?
Answers:
1.osteogenesis imperfecta
In the post-arrest setting, which of the following is 2.inborn error of metabolism
the drug of choice in treating hypotension in a 3.congenital diaphragmatic hernia
4.foreign body
child: - ANSWER -epi
,SAEM M4 EXAM TEST QUESTIONS WITH ANSWERS GRADED A
5.tracheoesophageal fistula - ANSWER -5. that she is has very large pupils and is sweating
tracheoesophageal fistula profusely. Her respiratory rate, blood pressure
and heart rate are elevated. Which of the
following is the most likely agent to have caused
her symptoms?
Which of the following pairs of maneuvers are
consistent with current recommendations for Answers:
emergency care for a choking 5-month-old 1.Jimson weed
infant? 2.Cocaine
3.Heroin
Answers: 4.Insulin - ANSWER -2. cocaine
1.back blow then blind finger sweep
2.back blow then chest thrust
3.chest thrust then Heimlich maneuver
4.Heimlich maneuver then blind finger sweep A mother brings in her 4 year old child who was
5.Heimlich maneuver then chest thrust - happily eating "blackberries" from weeds in the
ANSWER -2.back blow then chest thrust garden and is now acting strangely. She has
identified them as Belladonna from a quick
internet search. Which physical examination
finding might you also expect to find in this child?
All of these steps are involved in pediatric rapid
sequence intubation (RSI) EXCEPT: Answers:
1.Diaphoresis
Answers: 2.Flushed skin
1.If administering succinylcholine, pretreatment 3.Miosis
with atropine is always indicated in children 4.Urinary incontinence - ANSWER -2.
under age 10. flushed skin
2.Lidocaine pretreatment is usually provided to
children with head trauma.
3.When deciding which size endotracheal tube to
use, one may approximate by using the size of For which of the following cases is activated
the small finger or nares as a reference. charcoal therapy most appropriate?
4.Due to the fragility of the pediatric C-spine, a
cervical collar should always be placed prior to Answers:
intubation for children under age ten. 1.Acetaminophen overdose
5.Uncuffed endotracheal tubes are the preferred 2.Drain cleaner ingestion
devices used in children under 6-8 years of age. 3.Iron supplement overdose
- ANSWER -4.Due to the fragility of the 4.Lithium overdose - ANSWER -1.
pediatric C-spine, a cervical collar should always Acetaminophen overdose
be placed prior to intubation for children under
age ten.
A 45 year-old is brought in 8 hours after a large
overdose of his lithium. What is the best
A 23 year old woman is dropped off by her treatment method for this overdose?
boyfriend after an unknown overdose. You notice
, SAEM M4 EXAM TEST QUESTIONS WITH ANSWERS GRADED A
Answers: following statements is TRUE?
1.Activated charcoal
2.Gastric lavage Answers:
3.Hemodialysis 1.An acetaminophen level drawn at hour four
4.Whole bowel irrigation - ANSWER - dictates need for antidotal therapy.
3.Hemodialysis 2.Serial liver function tests are indicated in all
acetaminophen ingestions.
3.Renal sequelae are expected.
4.The intravenous formulation of N-acetylcysteine
A 42 year-old woman presents with an overdose is safer than oral N-acetylcysteine. -
of her Xanax (alprazolam) that her family ANSWER -1.An acetaminophen level drawn
indicates she has been taking for years to help at hour four dictates need for antidotal therapy.
with her anxiety. The bottle indicates that the
prescription was filled yesterday with 90 pills and
is now empty. The patient is minimally
responsive to painful stimuli and does not react A 2 year old child presents with an overdose of
when you suction secretions out of her posterior her mother's iron containing multivitamins. What
pharynx. What is your next management step? antidote should you consider for iron toxicity?
Answers: Answers:
1.Administration of flumazenil 1.Deferoxamine
2.Administration of narcan 2.Glucagon
3.Close observation 3.Methylene blue
4.Intubation for airway support - ANSWER - 4.Pyridoxine - ANSWER -1.Deferoxamine
4.Intubation for airway support
Severe lead toxicity can commonly result in
A 72 year-old presents with an intentional which of the following clinical symptoms
overdose of a bottle of aspirin about 3 hours prior
to presentation in the ED. Which of the following Answers:
arterial blood gas results would you expect to 1.Constipation
come from this patient? 2.Dermatitis
3.Memory loss
Answers: 4.Stocking glove peripheral neuropathy -
1.pH 7.14 pCO2 68 pO2 102 HCO3 23 ANSWER -3.Memory loss
2.pH 7.33 pCO2 48 pO2 58 HCO3 29
3.pH 7.45 pCO2 21 pO2 124 HCO3 14
4.pH 7.47 pCO2 31 pO2 96 HCO3 25 -
ANSWER -3.pH 7.45 pCO2 21 pO2 124 A 27 year old woman is brought into the
HCO3 14 emergency department by her roommate 30
minutes after ingesting a bottle of aspirin in a
suicide attempt. Which of the following acid-base
disorders is most likely to be present in this
A teenager presents one hour after ingesting a patient?
"handful" of acetaminophen tablets. Which of the
