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SAEM Derm Exam with Questions and Answers A 58 year old construction worker who has no primary care doctor comes to the emergency department because of a non-pruritic rash above his ankles (see Figure). Physical examination reveals bilateral erythematous and swollen ankles that are mildly warm but non-tender to touch. His overlying skin of both legs show mild scaling and thickened skin. There is no puncture site or visible opening in the skin, although he has prominent varicose veins bilatera...

SAEM Emergency Medicine Exam with Questions and Solutions A thin 18 year old female complains of acute onset of sharp right-sided chest pain this morning. She has developed some mild shortness of breath during the morning and thought she should get it checked out. Her chest X-ray is shown in the Figure. The next course of action should be: [image] A. Chest tube placement B. Antibiotics C. Electrocardiogram D. Needle decompression ANSWER The answer is A. This patient has a large righ...

SAE Prep Exam with Questions and Answers Which of the following advanced directives describes the treatment a patient would want if he became terminally ill, but has not specifically appointed someone else to make the medical decisions? A. DNR B. Patient bill of rights C. Notarized living will D. Durable power of attorney for health care ANSWER C. Notarized living will A patient in end-stage liver failure develops ascites and SOB. Tissue edema would most likely be visible in the patien...

SAEM Emergency Medicine Exam with Questions and Answers The next step in treatment for a patient with ventricular fibrillation, which is refractory to multiple countershocks and epinephrine, is: A. calcium B. transcutaneous pacing C. adenosine D. lidocaine E. bicarbonate ANSWER The answer is D. Ventricular fibrillation is primarily treated with defibrillation. If three successive shocks and epinephrine have been given, the next line agent would be an antiarrhythmic, such as lidocaine...

SAEM Exam with Questions and Verified Answers A 50 year-old male presents with a chief complaint of chronic nasal itching and "a sore that won't go away" over the past few months. Of the following choices, which is the most appropriate management? [image nasty basal/scc looking thing] A. prescription of topical steroid cream and follow-up in 5-7 days B. provision of an antibiotic-soaked dressing and reassessment in the E.D. within 48 hours C. urgent or next-day outpatient foll...

SAEM Exam with Questions and Verified Solutions An 18 year old male is transported to the emergency department after being involved in a motor vehicle collision. On initial evaluation, he is found to be comatose, hypotensive, and is diagnosed clinically as having a tension pneumothorax on the left side. What is the correct statement regarding needle decompression or chest tube placement in this patient? A. Placement of the needle should be in the 3rd ICS, midaxillary line. B. An 18 French...

SAEM Exam with Latest Questions and Solutions "A 46 year old woman was wearing high heels and tripped stepping off a curb. She thinks she inverted her left ankle. She complains of pain on the lateral side of her foot. On exam she has tenderness and swelling with ecchymosis on the lateral aspect of her left foot. Her X-ray shows: [image] A. 5th metatarsal tuberosity fracture B. fifth phalanx fracture C. Jones fracture D. ligamentous injury only E. no fracture, just a sesamoid bon...

SAEM Exam with Questions and Solutions "A 36 year old male backpacking in the wilderness loses his way in a snowstorm. Temperatures are well below zero degrees and his clothing is inadequate. He is rescued 5 days later and presents to the ED. Rescue crew has already initiated passive rewarming and have removed patient's damp clothing. On arrival, vital signs show pulse of 100 and temperature of 35.5C. On physical exam, you note patient has several toes that are purple with hemorrhagic b...

SAEM Exam with Questions and Solutions "A 36 year old male backpacking in the wilderness loses his way in a snowstorm. Temperatures are well below zero degrees and his clothing is inadequate. He is rescued 5 days later and presents to the ED. Rescue crew has already initiated passive rewarming and have removed patient's damp clothing. On arrival, vital signs show pulse of 100 and temperature of 35.5C. On physical exam, you note patient has several toes that are purple with hemorrhagic b...

SAEM Exam with Questions and Answers "Regarding the diagnosis of acute appendicitis, all the following are true EXCEPT: A. Vital signs are usually abnormal, even early in the course of acute appendicitis. B. Rebound is usually elicited only after the appendix has ruptured or infarcted. C. Rovsing's sign is pain in the right lower quadrant upon palpation of the left lower quadrant. D. The obturator sign is pain upon flexion and internal rotation of the hip. E. The psoas sign is...