SAEM M4 Exam Actual Exam 2025/2026 | Complete
Questions and Correct Answers | Graded A+ | Verified
Answers | Just Released
Question 1
A 65-year-old male presents to the emergency department with sudden
onset of crushing chest pain radiating to his left arm. He is diaphoretic and
dyspneic. His ECG shows ST-segment elevation in leads II, III, and aVF. Which
of the following is the MOST appropriate initial management step?
A) Administer IV fluid bolus
B) Prepare for immediate cardiac catheterization or fibrinolysis
C) Order a stat CT pulmonary angiogram
D) Administer oral aspirin and clopidogrel and observe
E) Initiate broad-spectrum antibiotics
Correct Answer: B) Prepare for immediate cardiac catheterization or
fibrinolysis
Rationale: The ECG findings of ST-segment elevation in leads II, III,
and aVF are indicative of an inferior ST-elevation myocardial
infarction (STEMI). Reperfusion therapy, either through primary
percutaneous coronary intervention (PCI) or fibrinolysis, is the most
time-sensitive and critical intervention to restore blood flow to the
ischemic myocardium.
Question 2
A 25-year-old female presents with sudden onset of dyspnea and pleuritic
chest pain. She takes oral contraceptives. Her vital signs are T 98.6°F, HR
110 bpm, RR 24 bpm, BP 118/72 mmHg, SpO2 92% on room air. Her ECG
shows sinus tachycardia. Which diagnosis is high on the differential?
A) Pneumonia
B) Acute coronary syndrome
C) Pulmonary embolism
D) Spontaneous pneumothorax
E) Asthma exacerbation
,Correct Answer: C) Pulmonary embolism
Rationale: Sudden onset dyspnea and pleuritic chest pain, especially
in a young woman on oral contraceptives (a risk factor for
hypercoagulability), with tachycardia and hypoxia, are classic signs
of pulmonary embolism. Other options are less likely given the
acute presentation and risk factors.
Question 3
A 5-year-old child presents with a sudden onset of barking cough, inspiratory
stridor, and mild respiratory distress. The child has no fever. Which of the
following is the MOST likely diagnosis?
A) Epiglottitis
B) Bacterial tracheitis
C) Bronchiolitis
D) Croup (laryngotracheobronchitis)
E) Foreign body aspiration
Correct Answer: D) Croup (laryngotracheobronchitis)
Rationale: Croup, or laryngotracheobronchitis, is a viral infection
characterized by inflammation of the larynx, trachea, and bronchi,
typically presenting with a characteristic barking cough, inspiratory
stridor, and mild respiratory distress, often without high fever.
Question 4
A 70-year-old male with a history of hypertension and hyperlipidemia
presents with sudden onset of severe headache, worst of his life, associated
with neck stiffness and photophobia. His vital signs are stable. His
neurological exam is non-focal. Which diagnostic study is the MOST
appropriate initial step?
A) Lumbar puncture
B) CT angiogram of the head
C) Non-contrast CT scan of the head
D) MRI of the brain
,E) EEG
Correct Answer: C) Non-contrast CT scan of the head
Rationale: The classic presentation of "worst headache of life" with
meningeal signs (neck stiffness, photophobia) strongly suggests
subarachnoid hemorrhage (SAH). A non-contrast CT scan of the
head is the initial diagnostic study of choice due to its high
sensitivity for detecting SAH acutely.
Question 5
A 30-year-old male presents with right lower quadrant abdominal pain,
nausea, and vomiting for 12 hours. The pain started periumbilically and
migrated to the right lower quadrant. On physical exam, he has tenderness
at McBurney's point with rebound tenderness. His WBC count is 14,000/µL.
Which of the following is the MOST likely diagnosis?
A) Gastroenteritis
B) Renal colic
C) Appendicitis
D) Ectopic pregnancy
E) Cholecystitis
Correct Answer: C) Appendicitis
Rationale: The classic migratory abdominal pain (periumbilical to
RLQ), associated with nausea, vomiting, localized tenderness at
McBurney's point, rebound tenderness, and leukocytosis, is highly
suggestive of acute appendicitis.
Question 6
A 45-year-old female presents with acute onset of severe right upper
quadrant abdominal pain, radiating to her right shoulder, after eating a fatty
meal. She has nausea and vomiting. On physical exam, she has right upper
quadrant tenderness and a positive Murphy's sign. Which of the following is
the MOST likely diagnosis?
A) Gastritis
, B) Hepatitis
C) Pancreatitis
D) Cholecystitis
E) Perforated ulcer
Correct Answer: D) Cholecystitis
Rationale: Acute onset RUQ pain radiating to the shoulder,
exacerbated by fatty meals, with nausea, vomiting, localized
tenderness, and a positive Murphy's sign, is characteristic of acute
cholecystitis (inflammation of the gallbladder).
Question 7
A 28-year-old female presents with sudden onset of severe, unilateral lower
abdominal pain and vaginal spotting. Her last menstrual period was 8 weeks
ago. Her vital signs are stable. A urine pregnancy test is positive. Which
diagnosis is a critical consideration?
A) Ovarian cyst rupture
B) Pelvic inflammatory disease
C) Ectopic pregnancy
D) Appendicitis
E) Uterine fibroid degeneration
Correct Answer: C) Ectopic pregnancy
Rationale: Sudden, severe, unilateral lower abdominal pain in a
pregnant woman (even with spotting) is a classic presentation of
ectopic pregnancy, which is a life-threatening condition requiring
immediate evaluation.
Question 8
A 60-year-old male with a history of diabetes and hypertension presents with
sudden, painless loss of vision in his left eye, described as a "curtain coming
down." On fundoscopic exam, the retina appears pale with a cherry-red
macula. Which of the following is the MOST likely diagnosis?
A) Retinal detachment
Questions and Correct Answers | Graded A+ | Verified
Answers | Just Released
Question 1
A 65-year-old male presents to the emergency department with sudden
onset of crushing chest pain radiating to his left arm. He is diaphoretic and
dyspneic. His ECG shows ST-segment elevation in leads II, III, and aVF. Which
of the following is the MOST appropriate initial management step?
A) Administer IV fluid bolus
B) Prepare for immediate cardiac catheterization or fibrinolysis
C) Order a stat CT pulmonary angiogram
D) Administer oral aspirin and clopidogrel and observe
E) Initiate broad-spectrum antibiotics
Correct Answer: B) Prepare for immediate cardiac catheterization or
fibrinolysis
Rationale: The ECG findings of ST-segment elevation in leads II, III,
and aVF are indicative of an inferior ST-elevation myocardial
infarction (STEMI). Reperfusion therapy, either through primary
percutaneous coronary intervention (PCI) or fibrinolysis, is the most
time-sensitive and critical intervention to restore blood flow to the
ischemic myocardium.
Question 2
A 25-year-old female presents with sudden onset of dyspnea and pleuritic
chest pain. She takes oral contraceptives. Her vital signs are T 98.6°F, HR
110 bpm, RR 24 bpm, BP 118/72 mmHg, SpO2 92% on room air. Her ECG
shows sinus tachycardia. Which diagnosis is high on the differential?
A) Pneumonia
B) Acute coronary syndrome
C) Pulmonary embolism
D) Spontaneous pneumothorax
E) Asthma exacerbation
,Correct Answer: C) Pulmonary embolism
Rationale: Sudden onset dyspnea and pleuritic chest pain, especially
in a young woman on oral contraceptives (a risk factor for
hypercoagulability), with tachycardia and hypoxia, are classic signs
of pulmonary embolism. Other options are less likely given the
acute presentation and risk factors.
Question 3
A 5-year-old child presents with a sudden onset of barking cough, inspiratory
stridor, and mild respiratory distress. The child has no fever. Which of the
following is the MOST likely diagnosis?
A) Epiglottitis
B) Bacterial tracheitis
C) Bronchiolitis
D) Croup (laryngotracheobronchitis)
E) Foreign body aspiration
Correct Answer: D) Croup (laryngotracheobronchitis)
Rationale: Croup, or laryngotracheobronchitis, is a viral infection
characterized by inflammation of the larynx, trachea, and bronchi,
typically presenting with a characteristic barking cough, inspiratory
stridor, and mild respiratory distress, often without high fever.
Question 4
A 70-year-old male with a history of hypertension and hyperlipidemia
presents with sudden onset of severe headache, worst of his life, associated
with neck stiffness and photophobia. His vital signs are stable. His
neurological exam is non-focal. Which diagnostic study is the MOST
appropriate initial step?
A) Lumbar puncture
B) CT angiogram of the head
C) Non-contrast CT scan of the head
D) MRI of the brain
,E) EEG
Correct Answer: C) Non-contrast CT scan of the head
Rationale: The classic presentation of "worst headache of life" with
meningeal signs (neck stiffness, photophobia) strongly suggests
subarachnoid hemorrhage (SAH). A non-contrast CT scan of the
head is the initial diagnostic study of choice due to its high
sensitivity for detecting SAH acutely.
Question 5
A 30-year-old male presents with right lower quadrant abdominal pain,
nausea, and vomiting for 12 hours. The pain started periumbilically and
migrated to the right lower quadrant. On physical exam, he has tenderness
at McBurney's point with rebound tenderness. His WBC count is 14,000/µL.
Which of the following is the MOST likely diagnosis?
A) Gastroenteritis
B) Renal colic
C) Appendicitis
D) Ectopic pregnancy
E) Cholecystitis
Correct Answer: C) Appendicitis
Rationale: The classic migratory abdominal pain (periumbilical to
RLQ), associated with nausea, vomiting, localized tenderness at
McBurney's point, rebound tenderness, and leukocytosis, is highly
suggestive of acute appendicitis.
Question 6
A 45-year-old female presents with acute onset of severe right upper
quadrant abdominal pain, radiating to her right shoulder, after eating a fatty
meal. She has nausea and vomiting. On physical exam, she has right upper
quadrant tenderness and a positive Murphy's sign. Which of the following is
the MOST likely diagnosis?
A) Gastritis
, B) Hepatitis
C) Pancreatitis
D) Cholecystitis
E) Perforated ulcer
Correct Answer: D) Cholecystitis
Rationale: Acute onset RUQ pain radiating to the shoulder,
exacerbated by fatty meals, with nausea, vomiting, localized
tenderness, and a positive Murphy's sign, is characteristic of acute
cholecystitis (inflammation of the gallbladder).
Question 7
A 28-year-old female presents with sudden onset of severe, unilateral lower
abdominal pain and vaginal spotting. Her last menstrual period was 8 weeks
ago. Her vital signs are stable. A urine pregnancy test is positive. Which
diagnosis is a critical consideration?
A) Ovarian cyst rupture
B) Pelvic inflammatory disease
C) Ectopic pregnancy
D) Appendicitis
E) Uterine fibroid degeneration
Correct Answer: C) Ectopic pregnancy
Rationale: Sudden, severe, unilateral lower abdominal pain in a
pregnant woman (even with spotting) is a classic presentation of
ectopic pregnancy, which is a life-threatening condition requiring
immediate evaluation.
Question 8
A 60-year-old male with a history of diabetes and hypertension presents with
sudden, painless loss of vision in his left eye, described as a "curtain coming
down." On fundoscopic exam, the retina appears pale with a cherry-red
macula. Which of the following is the MOST likely diagnosis?
A) Retinal detachment
