SAEM Practice 2020
SAEM Practice Exam Questions and Answers
Question 1
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).
Page 1 of 95
, SAEM Practice 2020
Question 2
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.
Question 3
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.
Page 2 of 95
, SAEM Practice 2020
Question 4
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.
Page 3 of 95
, SAEM Practice 2020
Question 5
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.
Question 6
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.
Page 4 of 95
SAEM Practice Exam Questions and Answers
Question 1
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).
Page 1 of 95
, SAEM Practice 2020
Question 2
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.
Question 3
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.
Page 2 of 95
, SAEM Practice 2020
Question 4
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.
Page 3 of 95
, SAEM Practice 2020
Question 5
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.
Question 6
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.
Page 4 of 95
