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SAEM EXAM 2025/2026| COMPREHENSIVE
QUESTIONS WITH VERIFIED ANSWERS
A 22 Year Old Man Is Punched In The Nose During A Fight. He Presents To The
Emergency Department With Obvious Nasal Bone Deformity. Pressure Controls
The Bleeding. Physical Exam Reveals No Maxillary Bone Or Orbital Rim
Tenderness, Intact Vision And Extraocular Movement. The Oropharynx And
Mandible Are Unremarkable. Nasal Inspection Reveals A Swollen, Ecchymotic,
Tender Nasal Septum. Which Of The Following Is The Most Appropriate Initial
Step?
A. Outpatient Follow-Up With An ENT Specialist To Surgically Correct A
Deviated Septum
B. Plastic Surgery Consult For Immediate Reduction Of Nasal Fracture
C. Facial Ct Scan To Rule Out More Serious Facial Fractures
D. Incision And Drainage Of The Septal Hematoma Followed By Nasal Packing
E. Needle Aspiration Of The Septal Hematoma - Correct-Answer-D. Incision
And Drainage Of The Septal Hematoma Followed By Nasal Packing
A 24 Year Old Woman Is Playing Racquetball And Sustains A Direct Blow From The
Ball To The Right Eye. She Presents To The Emergency Department Complaining Of
Eye Pain And Double Vision. On Exam, Her Right Eye Does Not Track Properly With
Upward Gaze. This Finding Suggests Which Of The Following Injuries?
A. Inferior Orbital Wall Fracture
B. Superior Orbital Rim Fracture
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C. Ethmoid Fracture
D. Zygomatic Arch Fracture
E. Inferior Orbital Rim Fracture - Correct-Answer-A. Inferior Orbital Wall Fracture
The Patient Most Likely Has An Orbital Floor Fracture With Entrapment.
A 32 Year Old Man Is Struck Several Times In The Head With A Baseball Bat. Upon
Emergency Medical Service Arrival, He Is Mildly Confused, Vomits Once, And
Complains Of A Severe Headache. The Emergency Medical Technicians Establish
Two Large-Bore IVS. Prior To Arrival At The Emergency Department, He Loses
Consciousness And Begins To Seize. He Is Actively Seizing When He Is Brought Into
The Trauma Bay. What Should Be The First Step In The Management Of This
Patient?
A. Administration Of Phenytoin 1000mg IV
B. Administration Of Mannitol 50 G IV
C. Rapid Sequence Intubation Using Paralytic Agent
D. Emergency Craniotomy
E. Administration Of 2 Liters Ns Bolus - Correct-Answer-C. Rapid
Sequence Intubation Using Paralytic Agent
The Airway Should Be Managed As The First Priority In This Patient. The Other
Maneuvers May Be Helpful But Are Secondary To Securing An Airway And
Providing Oxygenation/Ventilation. Airway Comes First!
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A 46 Year Old Man Is Brought In By Ems After A Motor Vehicle Collision In Which
He Was An Unrestrained Driver. Although He Has No Obvious Injury To His Head
Or Neck, He Complains Of Chest Pain And Appears Very Short Of Breath. His Vital
Signs Are: T
99.2 F, Bp 85/57, Hr 123, Rr 36, Spo2 95% On Non-Rebreather. The CXR
Demonstrates A
Tension Pneumothorax. Of The Following, Which Is The Most Appropriate Next
Step In This Man's Care?
A. Placement Of A Chest Tube Followed By A Chest Xray To Determine
Proper Placement
B. Transfusion Of 2 Units Of O-Negative Packed Red Blood Cells
C. Performance Of A Chest Ct Scan To Further Delineate The Pathology
D. Placement Of A Needle Decompression Device, Followed By Repeat CXR -
Correct- Answer-D. Placement Of A Needle Decompression Device, Followed By
Repeat CXR
This Patient Needs Emergent Chest Decompression And This Is Rapidly Done By
Needle Thoracostomy. A Chest Ct May Be Performed, But Only Once He Is
Stabilized. A Formal Chest Tube Will Be Placed, But Placement May Not Be Rapid
Enough And He May Decompensate In The Meantime. Transfusion Of Blood Does
Nothing To Correct The Physiology Of A Tension Pneumothorax
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
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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.
Which Is *Not* Part Of The Ottawa Ankle Rules?
A. Inability To Walk 4 Steps At The Time Of The Injury
B. Inability To Walk 4 Steps In The Emergency Department
C. Tenderness Over The Lateral Malleolus
D. Tenderness Over The Medial Malleolus
E. Tenderness Over The Talus - Correct-Answer-E. Tenderness Over The Talus
The Ottawa Ankle Rules Are A Validated (For Adults) Set Of Physical Exam Findings
To Determine If An Ankle X-Ray Is Needed After An Injury. If Any Of The First 4
Answers Is Present Or If There Is *Tenderness Over The Navicular Or Base Of The
5th Metatarsal*, An X-Ray Should Be Obtained. If The Correct Answer To All
Questions Is No, Then An X-Ray Is Not Needed.
Choose The Incorrect Statement Regarding Thoracentesis From The Anterior
Approach (Needle Decompression):
SAEM EXAM 2025/2026| COMPREHENSIVE
QUESTIONS WITH VERIFIED ANSWERS
A 22 Year Old Man Is Punched In The Nose During A Fight. He Presents To The
Emergency Department With Obvious Nasal Bone Deformity. Pressure Controls
The Bleeding. Physical Exam Reveals No Maxillary Bone Or Orbital Rim
Tenderness, Intact Vision And Extraocular Movement. The Oropharynx And
Mandible Are Unremarkable. Nasal Inspection Reveals A Swollen, Ecchymotic,
Tender Nasal Septum. Which Of The Following Is The Most Appropriate Initial
Step?
A. Outpatient Follow-Up With An ENT Specialist To Surgically Correct A
Deviated Septum
B. Plastic Surgery Consult For Immediate Reduction Of Nasal Fracture
C. Facial Ct Scan To Rule Out More Serious Facial Fractures
D. Incision And Drainage Of The Septal Hematoma Followed By Nasal Packing
E. Needle Aspiration Of The Septal Hematoma - Correct-Answer-D. Incision
And Drainage Of The Septal Hematoma Followed By Nasal Packing
A 24 Year Old Woman Is Playing Racquetball And Sustains A Direct Blow From The
Ball To The Right Eye. She Presents To The Emergency Department Complaining Of
Eye Pain And Double Vision. On Exam, Her Right Eye Does Not Track Properly With
Upward Gaze. This Finding Suggests Which Of The Following Injuries?
A. Inferior Orbital Wall Fracture
B. Superior Orbital Rim Fracture
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C. Ethmoid Fracture
D. Zygomatic Arch Fracture
E. Inferior Orbital Rim Fracture - Correct-Answer-A. Inferior Orbital Wall Fracture
The Patient Most Likely Has An Orbital Floor Fracture With Entrapment.
A 32 Year Old Man Is Struck Several Times In The Head With A Baseball Bat. Upon
Emergency Medical Service Arrival, He Is Mildly Confused, Vomits Once, And
Complains Of A Severe Headache. The Emergency Medical Technicians Establish
Two Large-Bore IVS. Prior To Arrival At The Emergency Department, He Loses
Consciousness And Begins To Seize. He Is Actively Seizing When He Is Brought Into
The Trauma Bay. What Should Be The First Step In The Management Of This
Patient?
A. Administration Of Phenytoin 1000mg IV
B. Administration Of Mannitol 50 G IV
C. Rapid Sequence Intubation Using Paralytic Agent
D. Emergency Craniotomy
E. Administration Of 2 Liters Ns Bolus - Correct-Answer-C. Rapid
Sequence Intubation Using Paralytic Agent
The Airway Should Be Managed As The First Priority In This Patient. The Other
Maneuvers May Be Helpful But Are Secondary To Securing An Airway And
Providing Oxygenation/Ventilation. Airway Comes First!
,3|Page
A 46 Year Old Man Is Brought In By Ems After A Motor Vehicle Collision In Which
He Was An Unrestrained Driver. Although He Has No Obvious Injury To His Head
Or Neck, He Complains Of Chest Pain And Appears Very Short Of Breath. His Vital
Signs Are: T
99.2 F, Bp 85/57, Hr 123, Rr 36, Spo2 95% On Non-Rebreather. The CXR
Demonstrates A
Tension Pneumothorax. Of The Following, Which Is The Most Appropriate Next
Step In This Man's Care?
A. Placement Of A Chest Tube Followed By A Chest Xray To Determine
Proper Placement
B. Transfusion Of 2 Units Of O-Negative Packed Red Blood Cells
C. Performance Of A Chest Ct Scan To Further Delineate The Pathology
D. Placement Of A Needle Decompression Device, Followed By Repeat CXR -
Correct- Answer-D. Placement Of A Needle Decompression Device, Followed By
Repeat CXR
This Patient Needs Emergent Chest Decompression And This Is Rapidly Done By
Needle Thoracostomy. A Chest Ct May Be Performed, But Only Once He Is
Stabilized. A Formal Chest Tube Will Be Placed, But Placement May Not Be Rapid
Enough And He May Decompensate In The Meantime. Transfusion Of Blood Does
Nothing To Correct The Physiology Of A Tension Pneumothorax
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
, 4|Page
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.
Which Is *Not* Part Of The Ottawa Ankle Rules?
A. Inability To Walk 4 Steps At The Time Of The Injury
B. Inability To Walk 4 Steps In The Emergency Department
C. Tenderness Over The Lateral Malleolus
D. Tenderness Over The Medial Malleolus
E. Tenderness Over The Talus - Correct-Answer-E. Tenderness Over The Talus
The Ottawa Ankle Rules Are A Validated (For Adults) Set Of Physical Exam Findings
To Determine If An Ankle X-Ray Is Needed After An Injury. If Any Of The First 4
Answers Is Present Or If There Is *Tenderness Over The Navicular Or Base Of The
5th Metatarsal*, An X-Ray Should Be Obtained. If The Correct Answer To All
Questions Is No, Then An X-Ray Is Not Needed.
Choose The Incorrect Statement Regarding Thoracentesis From The Anterior
Approach (Needle Decompression):
